Tag Archives: Professional Issues

Professional Issues

From the President: Building new partnerships

By Edil Torres Rivera September 1, 2023

In the past few years, our profession, like many others, has been affected by political polarization and social unrest. As we approach another politically charged election year, the American Counseling Association and other mental health organizations need to lead the way in terms of what our profession stands for. This requires us to remember and reflect on our professional roots.

As most of us know, our profession began with a social justice theme: We will not ask anyone to do something that we are unwilling to do ourselves. We have focused on diversity, equity and inclusion from the beginning — long before it was trendy or hip. Striving for inclusion, understanding differences and defining problems that arise from those differences are essential characteristics of being a practical helper or healer. Thus, our responsibility has always been to do the right thing at the right time without being asked.

Lately, politically motivated legislation seems to go directly against our professional and ethical standards, and many other organizations have made public statements reaffirming their support toward diversity, equity and inclusion. I also want to reaffirm to our members that ACA is committed to promoting professional development of counselors, advocating for the profession, and ensuring ethical, culturally inclusive practices that protect those who use counseling services.

I also want to remind ACA members to monitor what divides us versus what unifies us. We need to look beyond collaborations within our current organizational structure and focus on building mutually beneficial relationships with other organizations aligned with our mission in the broader mental health community. We can accomplish more together and have a more significant impact when we focus on how our priorities intersect with other mental health organizations.

During the Interamerican Congress of Psychology in Paraguay in June, I had the opportunity to talk with some other professional mental health organizations about arising issues both in the United States and globally that are entirely against our training and ethical standards. With that in mind and in agreement with our chief executive officer, I decided to reestablish conversations with the American Psychological Association and the Sociedad Interamericana de Psicología (Interamerican Society of Psychology). The intention is twofold: to better understand the lack of communication between our organizations and to investigate how the counseling profession can have a presence in Latin America. Our initial conversation was productive and informative and opened up opportunities for possible collaborations, including joint projects, in the future.

Finally, I want to update you on the Governing Council meeting happening this month. Our main priorities for this meeting include:

Embarking on a new strategic planning exercise with ACA staff that will create a better road map for our priorities and help us focus on what we want to accomplish in the next few years. (I’ll discuss this more in a future column.)
Discussing the next steps for ACA’s Anti-Racism Commission.
Exploring our options for the 2025 ACA Conference & Expo in Orlando, Florida. We know there is concern about hosting a meeting in Florida; this is a complex issue that requires careful consideration before making final decisions.

I welcome feedback about my conversations with other mental health associations and the Governing Council meeting. As I mentioned last month, whenever we are under the impression that we can dictate how others view themselves or us, we move toward the dangerous path of imposing on others. It is no longer helping or healing but taking away others’ ability to choose.

Reducing the occupational hazard of sexual boundary violations

By Michael Shelton August 10, 2023

A man's hand on a woman's knee. Her hand is pushing his hand away.

Kmpzzz/Shutterstock.com

Sexual boundary violations (SBVs) can be catastrophic for counselors. Some repercussions include loss of career; loss of licensure; loss of family, friends and professional colleagues; expulsion from professional organizations; financial penalties; and civil and criminal lawsuits. Despite knowing these consequences, too many mental health professionals still engage in romantic and sexual relationships with their clients. So why do smart, educated, knowledgeable and compassionate people make such damaging decisions?

Data indicate that SBVs are not infrequent isolated incidents. In a 2019 article published in the Journal of Counseling & Development, Tyler Wilkinson, Dannielle Smith and Ramona Wimberly found that 9% of ethical complaints to state licensing boards arose from sexual relationships. Also, the second edition of the Counselor Liability Claim Report published by CNA and HPSO in 2019 determined that engaging in a sexual relationship with a client or a client’s family members accounted for 36.4% of all closed claims between the years 2013 and 2017, with an average associated cost of $113,642. It’s not surprising then that Andrea Celenza, a psychologist and leading expert on the topic, estimates the incidence rate of SBVs is between 7% and 12%.

My decades of work with victims, transgressing professionals and college students in psychology programs led to an unwelcome realization: Catastrophic consequences will not prevent SBVs. Instead, reducing SBVs relies on four factors: recognizing myths about SBVs, assessing personal risk, realizing SBVs are a shared occupational hazard and recognizing that SBVs involve a process and are not sudden, unpredictable events.

Three damaging myths

There are three myths that, if left unconsidered, can hinder our work in preventing SBVs:

The “bad apple” hypothesis proposes transgressing clinicians are “bad apples” mistakenly allowed into our field; these clinicians are often considered to have sociopathic tendencies and be predatory and highly dangerous. The majority of violations, however, are not the result of predatory clinicians. In Sexual Boundary Violations: Therapeutic, Supervisory, and Academic Contexts, Celenza created a simplified typology consisting of a mere two categories of transgressors: psychopathic predatory transgressors, who engage in sexual activity with numerous clients over the course of their careers and demonstrate little remorse or guilt for their actions, and one-time offenders, a group Celenza describes as “more like you and me than generally accepted or than is comfortable to acknowledge.”
Some believe that SBVs are a result of inexperience in the field or age. This belief unfairly places blame on younger clinicians who are new to counseling. There is no evidence to support this claim; in fact, research shows that SBVs are more common among counselors who are midcareer.
There is an unshakable certainty that we are personally invulnerable to engaging in an SBV or even having a temptation to do so. We can look in the mirror and confidently say, “I would never do that.” However, this statement ignores empirical research that says that risk is not static and unchanging. Although I might be low risk for a boundary violation today, I may be more vulnerable to it next month or next year. Our level of risk is constantly in flux.

Risk factors

As counselors, we do not enter the field as blank slates but instead have personality traits, some of which protect against boundary violations and others that may increase the risk. Risk factors that may increase the potential for SBVs include:

Sensation seeking (i.e., people who seek novel and often intense experiences despite the risk)
Impulsivity
A propensity for sexual excitement and the inability to inhibit arousal
A preoccupation with sex
Being a man (The majority of SBVs are committed by men.)

Of course, these factors alone do not mean someone will experience an SBV or they are unfit to work as a counselor. After all, there are counselors who have histories of depression, anxiety and substance use and who use their personal experiences for client growth. It just means that some of us are hardwired for higher risk of poor sexual decision-making, particularly when dynamic risk factors arise.

We encounter dynamic risk factors every day in our practice. Some of the most noted for SBVs are:

Experiencing a life crisis. Life crises can lead to boundary violations at any level in a person’s career; these crises include relationship problems, serious illness (of oneself or a loved one) or loss through death.
Undergoing a life transition. Significant life transitions can occur both in and out of the workplace and sometimes simultaneously. These transitions can include workplace promotion, job loss or a sudden change in finances. In a 2003 study published in Professional Psychology: Research and Practice, Douglas Lamb, Salvatore Catanzaro and Annorah Moorman interviewed psychologists who had engaged in SBVs and found that dissatisfaction with their personal life (e.g., being depressed and alienated from family, recently divorced, having a parent who was dying) was a precipitating circumstance preceding these violations.
Working with a vulnerable client. Most victims of professional SBVs are women presenting with low self-esteem, histories of difficult relationships with men and histories of sexual trauma, including sexual abuse.
Avoiding the topic. In an article published in Sexual and Relationship Therapy in 2008, S. Michael Plaut said that universities and clinical training programs do not prepare students for the inevitable boundary issues they will encounter in their careers. This lack of training is often compounded by supervisory reluctance to address the topic of erotic attraction because they are also not prepared to address the topic or fear that bringing up the topic will be misinterpreted by a supervisee as a sexual overture. In addition, supervisees often do not disclose issues of sexual attraction in supervision because they fear supervisors will judge them or question their ability to counsel others or they will face disciplinary action.

Decades of studies also show that organizational factors (e.g., work culture, leadership style, peer interactions) can increase or decrease the likelihood employees will comply with workplace rules and regulations. These factors can tax an employee’s ability to cope, which can then lead to poor decision-making. For example, a stressful work environment could compromise an employee’s ability to make good decisions. Organizational factors can also decrease the chances employees will engage in help-seeking behaviors, which means they will be less likely to report sexual misconduct or concerns.

An occupational hazard

Richard Honig and James Barron, in a 2013 article published in the Journal of the American Psychoanalytic Association, argued that SBVs are an “occupational hazard” for mental health professionals and discussed six reasons for this:

Clients often start therapy when other relationships in their lives are dissatisfying or dysfunctional. Mental health professionals enter a client’s life when the client is more susceptible to being attracted to someone who genuinely cares about them.
Mental health practitioners experience highs and lows in their own romantic lives.
Although unconditional positive regard is a crucial ingredient for treatment, paradoxically it also increases risk for attraction.
Therapy aims for ever-increasing levels of intimacy. Even cognitive therapy, an approach not traditionally thought of as entailing profound intimacy, requires clients to move past examining overt behaviors to exploring automatic thoughts and implicit core beliefs. Therapy is a progressively intimate experience.
Limited self-disclosure by practitioners causes some clients to idolize them; they do not see the deficits, flaws and unflattering aspects of a counselor’s personality that are readily apparent to their romantic partners, friends and children.
Treatment is conducted without witnesses. This leads not only to a lack of surveillance as to what is happening behind closed doors in sessions but also to emotional deprivation in existing relationships. Because of confidentiality laws, professionals are unable to share major portions of their lives with loved ones, and in turn, clients often share their most intimate thoughts and feelings with their therapist and withhold this information from others in their lives. This secrecy often prevents people from recognizing when a therapeutic relationship is devolving into boundary violations.

Boundary violations as a process

Research clearly informs us of the need to examine the process leading to a violation. SBVs do not simply happen but instead culminate in an insidious chain of internal and external occurrences. The following is a brief overview of the parts involved in this process:

A triggering event: The initial arousal often occurs after a triggering event such as physical or emotional attraction, interaction style or a shared connection.
Fantasy: Clinicians may experience both voluntary and involuntary sexual or romantic fantasies of a particular client; this can include masturbation to the fantasies.
The choice: After recognizing arousal and attraction to a client, mental health professionals either stop progression toward an SBV or engage in faulty and distorted self-talk that leads to a violation. Distorted thinking (e.g., “My client would never tell anyone about this; it will remain between us”) allows them to minimize their doubts and fear of the consequences and overlook that SBVs are unethical and harmful to clients.
Nonsexual boundary crossings: Nonsexual boundary crossings consistently precede a sexual relationship between a client and mental health professional. According to the literature, two of the most common boundary crossings that happen before an SBV are increased self-disclosure by the professional and social contact with a client outside therapy (e.g., texting, emailing and calling a client to discuss social and nonclinical matters; meeting for drinks or a meal; socializing together).
SBVs: At this phase, a singular sexual behavior occurs, or a romantic or sexual relationship begins.
Post-violation considerations: After the violation occurs, the clinician must deal with the ramifications of their actions. During this phase, counselors may not disclose the relationship to anyone, may act like nothing has changed or may use distorted thinking (often justification and rationalization) to manage the crisis. They also have to consider the long-term ramifications of their boundary violation, especially if it develops into a romantic relationship.

When counselors understand this underlying process that often leads to SBVs, they can take control of the situation and make better decisions moving forward. A counselor can map where they are in the process and implement a series of corrective measures to change course.

Conclusion

Although SBVs seem to be a common occurrence in mental health professions, clinicians can take steps to prevent these boundary violations from happening. The first crucial step is acknowledging that SBVs are truly an occupational hazard; they are not typically the result of predatory clinicians and poor hiring decisions. Instead, they are an inevitable and unavoidable risk arising when two human beings, each with their own fragilities, meet and discuss profound and often intimate matters in privacy. Thus, we must normalize sexual and romantic attraction in clinical practice; interacting with clients can lead to attraction just as easily as it can lead to anger or frustration or reactivate one of our own traumas. The attraction is not wrong, but acting on it is.

We must also recognize and continually evaluate our personal and idiosyncratic risk for acting on potential attraction. No clinician is risk free.

Finally, we can educate ourselves about the process that often leads to SBVs. This behavior is not an abrupt occurrence; it is the result of an interconnected chain of events. With proper supervision or consultation with a colleague, counselors can disclose their feelings of sexual or romantic attraction early in the process and learn to navigate through it rather than act on it. We are all at risk for SBVs, so let’s start talking about them in a well-informed and productive manner.

Michael Shelton is a recognized national expert on male sexual disorders, substance use and LGBT issues. He is the author of seven books, including Sexual Attraction in Therapy: Managing Feelings of Desire in Clinical Practice and Fundamentals of LGBT Substance Use Disorders: Multiple Identities, Multiple Challenges. He is a faculty member in the psychology program at Thomas Jefferson University. He is also a content expert on human sexuality with Psychology Today.

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.

5 takeaways from the 2023 Virtual Hill Day

By Samantha Cooper June 29, 2023

Empty vintage congress hall with seats and microphones

Denis Kuvaev/Shutterstock.com

The American Counseling Association hosted the 2023 Virtual Hill Day on June 14. This event highlighted ACA’s legislative agenda for the year and included a panel on how the legislative process works and another on how to prepare counselors to meet with congressional representatives. Here are five key takeaways from the event:

1) Help advocate for these seven mental health legislative issues.

In 2023, ACA is prioritizing the following seven areas: veterans’ mental health, students’ mental health, education professionals’ mental health, maternal mental health, career counseling, student loan assistance and equitable health care.

The goal is to make mental health care more accessible by incentivizing counselors to work in areas affected by the mental health provider shortage. For example, ACA supports the Mental Health Professionals Workforce Shortage Loan Repayment Act, which would reimburse one-sixth of a counselor’s student loans for every year they work in an underserved area, and the Equal Health Care for All Act, which would make equal access to health care a protected civil right and prohibit discrimination based on race, national origin, sexual orientation, gender identity, disability, age or religion.

For other important legislative issues related to mental health, visit ACA’s Government Affairs and Public Policy page.

2) Get to know your state legislature.

Know how your state legislature works. It may seem obvious, but each state works very differently. For example, some states meet every year and others every other year. In North Dakota, where Sen. Sean Cleary serves as a member of the state Senate, congressional sessions last for 80 days every other year. It’s important to know when your state legislation meets so you can determine when it’s the best time to introduce your cause to your representatives, Sen. Cleary told the audience.

3) Find allies.

Allies are invaluable for helping get legislation passed. “You do need people to be able to champion and push it [the bill] through the process,” Sen. Cleary said. “The importance of building those relationships [with allies] … when you’re advocating is tremendously beneficial.”

Washington State Rep. Mari Leavitt told counselors not to rely solely on state representatives to push legislation. Instead, she recommended they find and collaborate with “unusual allies” — other groups and organizations that support the legislation they’re pushing.

Mara Boggs, the state director for U.S. Sen. Joe Manchin of West Virginia, agreed that allies can come from places people may not typically expect. For example, she said that state staff can be helpful advocates. These people have often been on the staff the longest and therefore are some of the most influential team members, she explained. So getting to know them could increase the changes of the legislation being seen.

4) Respect people’s time.

People’s time is important, so make sure you are organized when you meet with members of Congress, said Lisa Pino, an attorney and a Health Innovators Fellow at the Aspen Institute. She told the audience to prepare three main points about the legislation and be ready to explain why members of Congress should support it. “Being clear and consistent really helps so the agencies can more easily translate to their leadership what you’re trying to communicate,” she explained.

5) Don’t expect any guarantees.

Congressional staff members cannot make promises or guarantee that a representative will see or pass a certain piece of legislation, noted Layla Brooks, the senior legislative assistant for U.S. Rep. Troy Carter of Louisiana. She recalled how one group got upset when the bill they supported didn’t pass because they thought that asking for her support meant the legislation would definitely be signed into law.

“We [staff members] are not supposed to make promises,” Brooks said. “Give us grace and time.”

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Watch a recording of 2023 Virtual Hill Day.

Learn how to engage your legislator with ACA’s Advocacy Action Toolkit.

Samantha Cooper is a staff writer for Counseling Today. Contact her at scooper@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.

Voice of Experience: Professional organizations

By Gregory K. Moffatt June 27, 2023

black-and-white image of a speaker giving a talk in front of a large audience

Matej Kastelic/Shutterstock.com

I’ve been a supervisor for over 30 years. During my last supervision session with prelicensed clinicians who are about to get their full license, I tell them: “After today, you will never have to speak to another professional in the field again.”

Of course, that isn’t a recommendation but a fact. The point is that counselors can easily become isolated within the walls of their practice. Therefore, their professional interactions have to be intentional.

Roadblocks to professional interactions

As counselors, we often have 15 to 20 clients or more per week. On top of that, we often work unusual hours. Late afternoons, evenings and weekend appointments make it less likely we will see other professionals who have more standard working hours.

One of my closest professional friends has her own private practice and sees clients up to 40 hours per week. I couldn’t carry that heavy of a caseload, but even if I did, having that many clients doesn’t leave much time for collegial interactions.

Another one of my colleagues works in a private practice where she leases office space. There are more than a dozen other clinicians in that office building, and she doesn’t know anyone’s name. Everyone comes in, they go to their respective offices and they close the door.

Even continuing education doesn’t require face-to-face interaction with peers anymore. Before the COVID-19 pandemic, my home state of Georgia had restrictions regarding online continuing education, with no distinction between synchronous and asynchronous hours. A clinician could use only 12 hours of online learning for license renewal, with the remaining 23 hours required to be in person.

Now in Georgia it is possible to earn all 35 continuing education hours online as long as 25 of those hours are synchronous (including ethics). Although online learning has made our lives easier, this is yet another way we disconnect from professional interaction with colleagues. Synchronous workshops may not require the participant to engage, making it easy to hide in the background.

For those who are fully online in their practice, working from home makes it challenging to interact with other professionals in the field as well.

Benefits of professional organizations

Professional organizations create an environment where one can acquire professional interaction on a more personal level. Conferences, workshops and lunch-and-learns create a platform for professional development. I go to at least one professional conference every year.

I’m a hopeless introvert and my social needs are practically zero, but I value the relationships I’ve built over the years through my involvement in professional organizations. These connections have provided a fertile resource for referral options and updates in the law, ethics and board rule changes. They are also a resource for deliberating ethical dilemmas.

Most professional organizations have specialized districts/divisions that are tailored to the needs of various geographical regions or specialized areas of practice.

Finally, membership fees practically pay for themselves through discounts on conference registrations, free publications/journals and access to the resources mentioned above.

Advice on joining organizations

When I first began my career in mental health, I was a member of eight different professional organizations. I paid those membership dues every year, but eventually I realized that most of them were not serving my professional needs. I gained nothing from their publications, didn’t attend their conferences, and rarely found anything useful for my practice in their newsletters and announcements.

Today I’m a member of half that many, yet all of them serve me. I’ve been to all their conferences at one time or another and know people within those organizations that I can contact if I have ethical questions. I am partial to state organizations, or state chapters of national organizations, because they are more attuned to the specific laws and governing bodies in one’s state.

Counselors should also be careful about joining groups to become “certified.” Some organizations have impressive-sounding titles that, in reality, are meaningless. The American Organization of Certified Psychotherapist sounds great, but I just made it up. These fluff groups have no criteria for membership other than paying fees, but they act as if joining makes the clinician more competent or part of an exclusive club. Having one of these organizations on your resume or curriculum vita might do you more harm than good.

I require my supervisees to be a member of at least one professional organization while under my supervision, and they must demonstrate to me how that organization serves their needs. This is a part of one’s professional growth that needs to continue long after formal supervision has ended.

Don’t be an isolated clinician. Get involved in a regional, state or national professional organization.

Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. 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.

Behind the Book: Doing Counseling: Developing Your Clinical Skills and Style

By Samantha Cooper June 17, 2023

Jude and Julius Austin seek to demystify the counseling process in their new book Doing Counseling: Developing Your Clinical Skills and Style. This book aims to help counselors, especially graduate students and new professionals, learn to put counselor training into practice.

Counseling Today spoke with the authors to learn more about their motivation behind writing the book and the practical advice it offers counselors. Jude Austin is a licensed professional counselor and an assistant professor and clinical coordinator in the professional counseling program at the University of Mary Hardin-Baylor. Julius Austin is a licensed professional counselor and a clinical therapist and coordinator for the Office of Substance Abuse and Recovery at Tulane University.

Jude Austin

Julius Austin

“We wanted to write this book because it’s the one we wish we had growing up as counselors,” the authors said during the interview. “This is a book that says, ‘Hey, it’s OK to be you, we just need to figure out what is it about you that is therapeutic.’”

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How does Doing Counseling help students put counseling theory into practice?

It does this through dialogue. The book is a conversation that acts like a bridge. We are not wizened tenured professors or big-time therapists telling readers how to be a successful and effective counselor. The book is a conversation about how to apply theory in practical ways. We work and talk through how theoretical aspects such as vulnerability in session, awareness, genuineness, annoyance, countertransference, differentiation and transparency apply to our work with clients. Admittedly, half the time, we are just trying to make each other snort milk out our noses from laughing when reading the chapters. The other half, we are using stories from our clinical experiences and lessons taught to us by our grandpa and parents to break down thick theoretical concepts and ground counseling theory into application.

You said a big motivation behind your book is to push back against “the invisible culture of whiteness.” What is this invisible culture and how does it hurt counselors?

When thinking about what a counselor looks like, most people don’t imagine them wearing Jordans or having J Dilla playing in the background of a session. The more we matriculated through graduate school and especially our doctoral program, the more it felt like there was a quiet but dominant and unquestioned norm against which our racial and ethnic identities were judged in session.

Sometimes when counselors, educators and supervisors say “be authentic,” it can feel like what they really mean is, “Make your ‘authentic self’ more like our way of being authentic.”

What are some practical tips for counselors that you discuss in the book?

Our book includes lots of practical advice for counselors to use in session. Some of our favorites are:

Create a structure so clients feel like you’re leading them the entire way.
Wear something that makes you feel good.
Find comfortable chairs for yourself and the client.
Be technically eclectic and theoretically pure.
Don’t feel like you have to “vibe” with every client. It’s OK if you don’t.

Vulnerability and authenticity are important aspects to counseling, so we always stress the following advice:

Vulnerability begets vulnerability.
It’s best to sacrifice the therapeutic relationship for the sake of authenticity rather than maintain one for the sake of duty.

What does multicultural and antiracist counseling look like in session?

There is no way for counselors to know everything about every culture, but we can be humbly curious about our client’s cultural background. Multicultural and anti-racist counseling looks a lot like effective counseling with the added, intentional focus on cultural and racial themes. These counselors ask uncomfortable questions about society and its impact on the therapeutic environment.

What can supervisees as well as supervisors learn from your book about creating a healthy supervisory relationship?

One big misconception that supervisees have is not taking responsibility for supervision. They often see their supervisor as an educator and supervision as a place for them to learn. But supervisees also need to play an active role in this supervisory process.

In our book, we talk about the ways to take advantage of supervision. For example, after session, supervisees can make note of things they want to discuss in supervision later (leaving out client details, of course). They can include questions and concerns that came up during sessions. It can also be helpful if new professionals and students share what they need or want out of supervision, rather than leaving that up to the supervisor to decide.

How does “doing counseling” virtually differ from in person? What advice do you have for new professionals who are starting their careers in a space where virtual or hybrid sessions are more common?

Well, there are the obvious differences such as ethical concerns, confidentiality and technical issues. But there is not much difference with the actual process and skill of counseling. Some classic ideas of good counseling remain consistent: genuineness, unconditional positive regard, empathy and immediacy.

We have noticed, however, that virtual counseling requires us to be more intentional and curious. In person, some of the client’s experience can be deduced through body language. Remote sessions, especially phone sessions, require us to ask more questions or take chances on reflecting what we are sensing in session.

We have also noticed that sometimes clients are more readily vulnerable during virtual sessions. Virtually, we are in their space, which can add to the deepening of the therapeutic process.

What advice do you have for counseling students and new professionals?

First, we wish we would have known how important and impactful it is to have a good therapeutic process. It creates a sort of built-in trust within the process and the counselor.

Second, we encourage students and new professionals to consider the kind of life they want to have instead of what they want to do for a living. This allows them to focus on how to use their degree and licensure to make that life possible.

Finally, this work is hard — rewarding, but hard. It is essential for us to get real about self-care. Create a self-care plan that works for your life and be willing to flex it as needed.

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Order Doing Counseling: Developing Your Clinical Skills and Style from the ACA Store.

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.