Tag Archives: Professional Issues

Professional Issues

Client suggestibility: A beginner’s guide for mental health professionals

By Jerrod Brown, Amanda Fenrich, Jeffrey Haun and Megan N. Carter August 12, 2019

In the context of mental health treatment, suggestibility refers to a client’s vulnerability to accepting information provided by a third party as true, regardless of its veracity. This can result in the client providing inaccurate guesses or statements in a verbal, nonverbal or narrative format. Influenced by a range of individual, psychosocial and contextual factors, the client may be convinced that events unfolded differently than they actually did or that events that never took place actually occurred.

Such behavior is often encountered when clients are uncertain about what happened or what is true, lack confidence in their own memories or ability to understand, or are unable to discriminate between what is real and what is not. As such, suggestibility can profoundly limit a client’s capacity to navigate the various stages of the mental health system.

Suggestibility is a complex and multifaceted phenomenon that mental health treatment specialists rarely take into consideration, largely because of the lack of research on it and the limited availability of training opportunities on the topic specifically tailored for these professionals. The research that has been conducted is largely circumscribed to the fields of criminal justice, forensics and the law, where it is well-established that clients who are more suggestible are more likely to provide unreliable eyewitness accounts, spurious alibis or even false confessions to crimes.

Across mental health treatment settings, suggestibility may result in inaccurate diagnoses and ineffective or problematic goal and treatment plans. Given the importance of this topic, we aim to briefly describe the phenomenon of suggestibility within the context of clinical interviewing, assessment and treatment planning. We will also suggest future directions that may assist mental health professionals in addressing this threat to effective clinical decision-making.

Minimizing suggestibility risk in clinical interviews

Certain forms of questioning can increase the likelihood of suggestibility. A suggestive question is one that implies a certain answer, regardless of the client’s actual perspective. Such questions intentionally or unintentionally seek to be persuasive, often by using wording that excludes other possible answers. For example, asking “Where did your father hit you?” instead of “What happened with your father when you got home?” is leading. It promotes a response that would affirm the interviewer’s hypothesis that a physical assault took place and largely excludes the possibility that no altercation occurred.

Questions framed in a negative manner also can have a suggestible impact and are confusing to the client. For example, asking “Didn’t you want to run away?” rather than “Did you want to run away?” is biased in that it may make the client feel guilty for not saying that he or she wanted to run away.

To avoid asking suggestive questions and to lessen the likelihood of receiving false responses from clients, consider using the following strategies:

1) Use open-ended questions while avoiding or minimizing the use of forced-choice and either-or questions.

2) Allow the client to speak in his or her own words, and avoid interrupting the client.

3) Do not assume that you know what the client is trying to say when he or she is unable to fully convey his or her ideas.

4) Accept “I don’t know” responses as potentially valid.

To further illustrate this point of decreasing suggestibility within the context of clinical interviewing, mental health professionals should try to avoid the following approaches when questioning clients:

  • Use of closed-ended questions
  • Giving an impression that implies the client is providing the wrong answer
  • Implying that a certain answer is needed or required
  • Leading questions
  • Misleading questions
  • Negatively worded statements
  • Persuading the client to change his or her response
  • Pressing the client for a response
  • Rapid-fire questioning
  • Repeated lines of questioning
  • Biased statements
  • Subtle prompts

How often questions are asked may also have a suggestive impact. Clients may perceive repeated questioning as a sign that they have not responded in a manner that the counselor deems “correct” or acceptable. Indeed, repetitive lines of questioning in which the client is asked about details of events that either did not happen or that the client does not remember well may result in the unintentional formation of false memories or confabulation (i.e., filling in memory gaps with fabricated memories or experiences).

Asking more general questions about an incident (e.g., “Tell me about what happened at the park”) and then later following up with related questions (e.g., “How often do you go to the park?”) has been found to be a useful method for verifying or clarifying information that might appear to be inconsistent or illogical. Regardless of the questioning style, however, it is advisable to allow clients as much time as they need to respond to questions and to verbally reinforce that they can take their time when answering questions.

In addition to questioning style, the counselor’s nonverbal behaviors, including facial affect, gestural affect and intonation, both before and during the interview, may increase the likelihood of suggestibility and threaten the validity of the information elicited. An example of facial affect could be smiling when a client is providing certain answers but not others. A gestural affect might include leaning forward when a client is providing certain answers but not others. Intonation as a means of nonverbal communication could be providing feedback using upward inflection when a client provides certain answers but downward inflection when he or she provides others. These nonverbal, and often unintended, means of communication are forms of both positive and negative feedback that can shape a person’s responses and increase the risk of suggestibility.

The context of the interview can also affect the likelihood of suggestibility. For example, false reports are more likely if an interview is conducted in a stressful situation (e.g., having an appointment with a therapist immediately following a family conflict). Environmental factors (e.g., a small room without windows or air conditioning on a hot summer afternoon) can also be influential. Providing clients with frequent breaks and avoiding very long clinical interviews is encouraged, when possible. The time between the occurrence of an event and the interview that focuses on the event can also influence suggestibility because clients can become more confident in the accuracy of their false accounts over time. Context within the realm of a clinical interview can include any of the following either prior to and during the actual interviewing process:

  • Body language of the counselor
  • Duration of eye contact from the counselor
  • Environmental distractions (lighting, noise, temperature, etc.)
  • Length of the interview
  • Pace of the interview
  • Tone of the counselor’s voice

Mental health professionals should also take into consideration personality and social characteristics that can influence suggestibility. These may include tendencies toward confabulation, acquiescence, memory distrust, low confidence, desire to please, extreme shyness and social anxiety, avoidant-based coping strategies, fear of negative evaluation, lack of assertiveness, attachment disruptions, fantasy proneness, and psychosocial immaturity (e.g., irresponsibility and temperament). Professionals should also consider cognitive factors, including executive function and memory-related problems (e.g., short-term, long-term and working memory), intellectual limitations, diminished language abilities, and deficits in theory of mind (the ability to understand mental states in oneself and in others).

Preparing for and debriefing from the interview

Understandably, many of these characteristics initially present as invisible, meaning that clients who are highly suggestible may not overtly appear as impaired or vulnerable. Clinicians would benefit from screening for such traits in the initial interview with new clients to determine the prevalence of traits that are likely to contribute to suggestibility. Specific screening tools for suggestibility, such as the Gudjonsson Suggestibility Scale, can help clinicians in determining a person’s level of suggestibility. This will also assist clinicians in understanding how best to proceed as it relates to interviewing techniques and treatment planning to account for an individual’s level of suggestibility.

False or misleading information can have a negative impact on diagnostic accuracy and treatment outcomes. Accordingly, it is important that mental health professionals not only conduct interviews properly but also prepare for and debrief from them properly. Prior to beginning an interview, counselors are encouraged to review client records (psychological testing, mental health records, criminal justice records, etc.) that may reveal a behavioral pattern of suggestibility and provide a resource for corroborating a client’s statements. Cross-referencing this information with information obtained from collateral informants is also recommended when appropriate. The importance of awareness of one’s self throughout the interview is an important factor for reducing the risk of suggestibility. This includes monitoring one’s verbal and nonverbal communication that could provide feedback to the client regarding potentially desirable versus undesirable responses.

It’s worth noting that some special situations may require clinicians to be more aware of their questioning style and require adaptations and flexibility on the part of the clinician to minimize suggestibility. For instance, those working in correctional and jail settings should consider how suggestibility presents among incarcerated populations, to include those with mental health needs and low intellectual functioning. Substance use is another variable that can have adverse effects on the accuracy of the information obtained during a clinical interview. Furthermore, when interviewing children or adults with neurocognitive and neurodevelopmental disorders, extra precautions may be necessary to reduce the risk of suggestibility. Finally, it is important to note that individuals with exposure to negative life events (e.g., the death of a parent or sibling, exposure to physical violence) may be more susceptible to suggestibility.

Conclusion

Given the importance of collecting accurate information, it is essential that mental health professionals acquaint themselves with the phenomenon of suggestibility. Unfortunately, many mental health providers lack the necessary awareness and training related to the detection and screening of suggestibility among clients.

Mental health professionals should seek to establish routine procedures to better identify clients who are at an increased risk of susceptibility to suggestibility before proceeding with the interviewing process. Such a procedure could include a validated suggestibility screening tool and a checklist of variables that research has found to increase risk of suggestibility among certain mental health treatment populations. We encourage mental health professionals to be aware of the various personality, social and cognitive factors that may influence some clients to be suggestible.

Suggestibility can have a negative impact on the various components of mental health treatment, including intake, screening, assessment, psychological testing, treatment planning, medication compliance, perceived understanding of treatment concepts, and discharge planning. For this reason, we urge mental health professionals to gain an increased awareness and understanding of this complex and multifaceted phenomenon.

One suggested step for moving the field forward is for mental health professionals to engage in self-study and continuing education via in-person and online training courses that focus on the evidence-based assessment and management of suggestibility. It is also important for mental health professionals interested in understanding suggestibility and its implications to review key research findings on at least a quarterly basis and to consult with recognized subject matter experts. Clinical interviews should be conducted through developmentally sensitive and suggestibility-informed approaches that consider the client’s psychiatric, neurocognitive, social and trauma history. By taking such steps, the potential negative impact of suggestibility can be minimized, thus paving the way for positive outcomes.

 

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Jerrod Brown is an assistant professor, program director and lead developer for the master’s degree in human services with an emphasis in forensic behavioral health for Concordia University in St. Paul, Minnesota. He has also been employed with Pathways Counseling Center for the past 15 years and is the founder and CEO of the American Institute for the Advancement of Forensic Studies. Contact him at jerrod01234brown@live.com.

Amanda Fenrich obtained her master’s degree in human services with an emphasis in forensic mental health from Concordia University. She is currently completing her doctoral degree in the advanced studies of human behavior from Capella University and is employed as a psychology associate for the Washington State Department of Corrections Sex Offender Treatment and Assessment Program.

Jeffrey Haun is employed as a forensic psychologist for the Minnesota Department of Human Services, where he conducts a variety of forensic evaluations and offers consultation, supervision and training in forensic psychology. He is an adjunct assistant professor in the Department of Psychiatry at the University of Minnesota and an adjunct instructor at Concordia University. He is board certified in forensic psychology.

Megan N. Carter is board certified in forensic psychology and has received the designation of fellow from the Association for the Treatment of Sexual Abusers. She has worked as a forensic evaluator at the Special Commitment Center, Washington state’s sexually violent predator facility, since 2008. She also maintains a small private practice focusing on forensic evaluations and child welfare issues.

 

Letters to the editor:ct@counseling.org

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

The pretend professional

By Jamie McNally July 9, 2019

W hen I served in the military, we would call cadence as we marched. Those call-and-response songs helped to build camaraderie amid challenge and established a rhythm that brought comfort and familiarity.

Similarly, in my role as a clinic manager, clinic director and site supervisor, I have heard an exasperated expression of uncertainty repeated by dozens of supervisees and interns — “I feel like I don’t know what I’m doing.” Those nine words have become as familiar and comforting to me as a cadence. In fact, the expression has transformed in my mind from something despondent into an indication of growth because self-doubt is a seemingly necessary step in the taxing process of professional development.

Doubt as part of development

I feel like I don’t know what I’m doing. I have come to recognize those words as a sign that the person speaking them understands the gravity of our profession and desperately wants to be able to help the clients in front of them, even if in that moment the person has little to no faith in their ability to do so. Although I empathize with the discomfort of that phase of development and growth, I also celebrate counselors-in-training’s awareness of their internal struggles and their willingness to confront the hard truth that the work we do is as intensely complicated as the human beings we’re called to help. As a supervisor, I’ve learned to cherish the opportunity to meet developing counselors in this place of doubt and help them understand — and even embrace — the normalcy of their insecurity and its role in our profession.

I feel confident in saying that we, as mental health professionals, have all been there — that place where our professional identity intertwines with the hesitancy embodied by those nine words: I feel like I don’t know what I’m doing. We so easily get lost within that phrase and the enormity of its implications.

What if I chose the wrong career?

How could I possibly start over in a different field after spending so much time and money on this one?

What if I cause harm to this client because I say the wrong thing? What if they find me out and tell people how awful I am?

In good company

Self-doubt is part of the human condition and can plague professionals in any field. The term impostor syndrome, coined in the late 1970s, encapsulates the idea that regardless of our accomplishments or skill, we can feel fraudulent in our own skin and fear being exposed as such. This fear becomes exacerbated in the counseling profession, where confronting the complexities of the human condition is a daily (OK, an hourly) requirement. In the face of such complicated realities, it is only natural to be uncertain about how to move forward and then to conclude that the confusion one feels is a sign of inadequacy.

During my own five-year supervisory journey, in which time I have trained more than 100 counselors, I can recall encountering two individuals who didn’t admit to having these struggles. Two. That means that, at best, in my small nonempirical sample, roughly 2% of the early career counseling professionals I have supervised have not vocalized doubts indicative of impostor syndrome.

Perhaps those two students just didn’t feel comfortable telling me about their difficulties, or maybe they were too fearful to disclose this truth to anyone, let alone their supervisor. It’s also possible that they truly never had experienced insecurity as a professional, in which case they were the enviable two who genuinely made their way through the early phase of their professional development unscathed. That would make them the exception, of course, and not the rule.

Diversity and discrimination

I find it critically important to also highlight that other aspects of our identities can influence how we experience impostor syndrome. For example, if a person has faced discrimination throughout his or her life, this can have a dramatic impact on the intensity of impostor syndrome’s doubts.

As a white person who has benefited from systemic privilege in certain ways, I may have an entirely different perspective on my accomplishments and credentials than does a colleague who acquired those credentials in the presence of prejudices against them. I therefore recognize that each person’s doubts and identity are affected in very different ways on the basis of cultural differences. For that reason, we cannot assume that impostor syndrome will affect each person similarly, and it is wise to self-reflect on how our personal experiences might mitigate or exacerbate our struggles with impostor syndrome.

Overcoming self-doubt

“I feel like I don’t know what I’m doing.” With this whispering refrain of insecurity in mind, the question now becomes, “How do I unbury myself from the weight of this doubt and find self-confidence?”

To answer this question, it helps to start thinking like a counselor because, let’s be honest, often we have to therapize ourselves and practice what we are preaching to our clients. Remind yourself of the difference between thoughts and feelings, and acknowledge that “I feel like I don’t know what I’m doing” is not actually reflective of a feeling. This gentle challenge reminds us to check in with ourselves and acknowledge the emotion we are actually experiencing, which is almost always the same for everyone: fear. Sometimes intense and paralyzing fear.

Having acknowledged that we are fearful, I find it helpful to then assess one’s perspective — why the fear is present — and test it against reality. This step can be made easier by recalling that all emotions have a purpose. Anxiety’s job is to prepare us for daunting or intimidating situations. Next, I find that a little rudimentary reframing, self-grace and reassurance make the process smoother.

Here are six important reminders to help you reframe your fear and self-doubt and reassure you that what you’re feeling is normal, all in an effort to combat impostor syndrome.

1) You already have the skills to overcome insecurity. Chances are that you experienced doubt before even enrolling in graduate school, yet you found a way to push through and find yourself face-to-face with actual clients. I would assert that simply by arriving at this stage of accomplishment, you have demonstrated the skills needed to overcome whatever doubts you may feel about your abilities as a professional. When a person’s doubts prevent them from even attempting to pursue their ambitions and career goals in the first place, I call this prodromal impostor syndrome. You found a way to get from prodromal to professional, so try to recall what helped you then and use those same skills to help you overcome your current obstacles.

2) You are in the top nine. Did you know that only about 9% of Americans have a master’s degree? That number will vary slightly depending on your source for statistics, but even so, let that number sink in: the top 9%. When it comes to educational and professional achievement, you are an outlier in the most positive sense. That doesn’t happen by accident or luck; you did that. Trust your knowledge and skills. You know what you’re doing.

3) Our normal is someone else’s goal. We often forget that our version of normal is not where a large number of people — including many of our clients — find themselves. That’s because we have worked so hard and long on our own garbage and made it past many of the obstacles that used to prevent us from being relationally healthy. Through that journey alone, we’ve developed skills and understanding that many of our clients just don’t possess yet or are unable to see in themselves. Sometimes by simply showing up and modeling hope and health, we are doing more for our clients in one hour than they are getting anywhere else in their week.

Sure, we all still have our own “stuff,” but we have to remember that we have earned advanced degrees and chosen a profession that, at its very core, is about achieving better emotional and mental health. You have the tools that clients desperately need. Meet them where they are and reassure them that such development takes time. Through a bit of work, they’ll get there too.

4) We don’t always get to see the results. Just because we shared the same moments in the session room with our clients does not mean that we shared the same reality. Our perceptions are often very different from those of our clients, and that is to be expected, because we’re very different people with very different backgrounds.

Strict adherence to a session agenda or a particular intervention is not a requisite for healing or progress. I have come to learn that during those times when I didn’t adhere to my initial plan for our time together or when I didn’t feel that I was a therapeutic master, my clients often felt differently and had takeaways that I wouldn’t have imagined. Our perfectionism is not reflective of our clients’ process. Our self-denigration is not reflective of their growth.

Additionally, we often work with clients who are only at the beginning of a very long journey toward healing and growth. As professionals, it is tempting to set goals or have expectations for our clients that are overly ambitious. Overcoming our own self-doubts often requires removing the pressure we put on ourselves to work unrealistic objectives.

It can help to try to remember that sometimes we are merely planting the initial seeds in clients’ lives and that these seeds will bloom only after clients have left therapy. We may never be aware of clients’ later successes even when we played a pivotal part in making those successes accessible. Learning to accept that results are not always visible to us can dramatically strengthen our ability to trust ourselves and our interventions.

5) See yourself in context. Having a title, a certification or a professional license doesn’t mean that we should compare ourselves (or our perceived shortcomings) to someone who has been doing this work for 40 years. I often see new professionals striving to be just like the counselors they look up to — those with decades of experience — even though they are so fresh out of graduate school that their degrees haven’t even arrived in the mail.

Measuring yourself against someone who is at such a drastically different level of professional development than you inevitably makes you feel like a fraud. It is important to see yourself in the context of your level of experience while remembering that even on day one, you bring value to clients and to the mental health field itself. Take time to celebrate that now and then — and rejoice that you will only move forward and improve from where you are now.

6) Mastery in mental health is a lifelong process. Confidence often coincides with mastery, and yet, in this field, mastery will always be elusive. As counselors, we do not get the advantage of clear-cut problems, let alone clear-cut solutions. Human beings will always be complex, meaning that our jobs will always be difficult.

It’s healthy to continuously strive to improve and learn more about one’s field; that mindset prevents complacency and arrogance. We can be skilled and competent and will always be privileged to do this work, but mastery is always an ongoing process. Being the “best” (as it may look or feel to most of us) isn’t a destination. Rather, it is an ongoing journey of humility and self-improvement that ultimately yields better client care.

The authentic professional

These six reminders can alleviate some of the uncomfortable symptoms of impostor syndrome. They can also highlight the need for us to accept the reality that some of those symptoms may always be present.

No matter what your background or where you are in your professional development, try to enjoy the thrill and uncertainty of this field’s learning curve. It helps to remember too that you are not alone. Your cohort and fellow professionals have experienced — and perhaps still are experiencing — the very same struggles as you.

It is likely that you will periodically allow that worrying impostor to enter your therapy office, but the trick is not letting it take control of the room. That impostor does not dictate your professional development. In fact, you can learn to accept the normalcy of those nine words — “I feel like I don’t know what I’m doing” — as a comforting cadence and an expected step in your professional growth process. Self-grace and compassion are vital. Remind yourself of your strengths and celebrate victories, no matter how small (or big) they may be. You are a lot better than you think you are, and yet, not as good as you can be. And that’s OK.

 

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Jamie McNally is a licensed professional counselor, a limited licensed psychologist, a certified HIPAA compliance officer, and the owner and clinic director of Sycamore Counseling Services (sycamorecc.com). Contact her at jamie.mcnally@sycamorecc.com.

 

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

Respecting the faith of clients and counselors

By Laurel Shaler May 20, 2019

The Association for Spiritual, Ethical and Religious Values in Counseling (ASERVIC) describes itself as “an organization of counselors and human development professionals who believe spiritual, ethical, and religious values are essential to the overall development of the person and are committed to integrating these values into the counseling process.” Although ASERVIC is a division of the American Counseling Association, and all counselors likely would agree to the importance of ethics, not all counselors share the mission of ASERVIC in its entirety.

With some counselors and counselor educators, this is related to a lack of knowledge, in particular because few counseling programs — other than those whose own missions include the integration of faith — address spirituality and religion thoroughly. Still other counselors and counselor educators perceive a value conflict between counseling and religion or spirituality. Although other spiritual, ethical and religious values should be explored, this article pertains specifically to the Christian faith because I believe this is something that is often misunderstood and overlooked by many counselors and counselor educators.

Unfortunately, many individuals in the counseling field are not comfortable addressing issues of faith. Although the majority of Americans highly value faith, the same cannot be said of mental health professionals, according to researcher Pamela Paul. If counseling students are not being trained to assess and treat from a faith-based perspective, how can they best meet the needs of clients who are seeking this?

The lack of comfort and competency in this area is reflected across presentations, publications and even Listservs such as CESNET (the Counselor Education and Supervision Network). At best, this is because of a lack of knowledge, training or understanding. At worst, it is a brushoff of the Christian faith of clients — in particular, if those clients are conservative or evangelical. Sadly, it is not just clients’ faith that is sometimes disrespected. Often, the Christian faith of the counselor is not respected by fellow counselors either.

From a personal perspective, I have seen many professional counselors put in writing disparaging remarks about conservative and evangelical Christians — including their own clients. If these counselors are making those comments publicly, how can we ensure that they are treating their clients who hold these views with authenticity and respect? I have even read where counselors attempt to persuade clients to “explore” their biblical worldviews — with a clear agenda of trying to encourage clients to change their deeply held beliefs. Much like the serpent in the Garden of Eden asks Eve in Genesis 3:1, “Did God really say you must not eat from any tree in the garden?” there are counselors who ask their clients, “Does the Bible really say … <fill in the blank>?”

There may be a place for this — such as when a Christian counselor and a Christian client are working together, based on a common belief system, to explore the truth of God’s Word about who the client is at his or her core, for example — but there is no place to try and convince clients that they are wrong about their biblical convictions.

Simply put, the faith of the client and the faith of the counselor must be respected. It is entirely possible for clients and counselors who do not share a similar faith to work together effectively. The ACA Code of Ethics applies equally to the evangelical Christian who should not force his or her beliefs on to a client as it does to the nonevangelical (Christian or otherwise) who should not attempt to force his or her beliefs on to a client.

Instead of just lamenting over the way that this population of clients and counselors is often discounted, I would like to offer three practical tips for integrating and respecting faith. Truly, this is what is expected of all counselors as they work with clients and interact with colleagues.

1) Listen: As the saying goes, listen to hear rather than to respond. If your first instinct is to prepare a rebuttal, that is a clear indication that you need to take a step back. Understand first, respond second. This is true not only in the counseling room with our clients, but also in communication with our fellow counselors. We should be willing to hear from those who are not like us without making assumptions or jumping to conclusions.

It is not our job to change anyone else’s belief system or way of thinking. While we absolutely should ensure that students and fellow counselors are upholding ethical standards, we should also recognize that we are all different; that is not only “OK,” it is good. For example, on more than one occasion I have worked in non-faith-based settings. When a potential client would come in requesting to see a counselor who was Christian, the client was often referred to me. It wasn’t that the other counselors could not work with the client effectively. Rather, we were trying to listen to the client and meet his or her needs. Instead of going to a place of defensiveness, our team was able to see the benefit of placing clients with counselors who shared similar values with them when possible.

2) Think: Put yourself in the other person’s shoes. We often call this empathy. Ask yourself how you might feel if your deeply held beliefs were brushed off or challenged in a demeaning or disrespectful way. Think through how you would want to be treated, and then treat the other person that same way. Take some time to reflect on what you are hearing before you immediately respond.

Interact critically with what you are hearing. It is unlikely that someone will change their mind because someone has belittled or criticized them, but they may be willing to flex a bit in their thinking if given some time to process. For example, CESNET often becomes abuzz with emails flying back and forth rapidly. What if we took some more time (as some do) to really think through what is being stated before we respond? We talk about the value of silence in counseling. Perhaps it would be helpful if we put that into practice and spent more time thinking and less time speaking.

3) Ask: After taking the time to listen and to think, there is also a time and a place to ask questions. As every counselor learns in a basic counseling skills course, this can be done in a respectful manner. As we all know, open-ended questions typically produce richer responses that contain more depth and meaning. We should make sure that we are not attempting to lead the other person to what we perceive to be the “correct” answer.

Ask to learn rather than to teach. What do you want to know about the faith of the client? Don’t be afraid to ask about the client’s belief system, how they came to that belief system, how they are living out their belief system, and how they want to (or do not want to) integrate their belief system into their counseling sessions.

This does not mean that the counselor has to share the client’s belief system (although they very well may, and there is strength in that too). It does mean that as counselors, we should be able to respect our clients and meet their needs to the best of our abilities.

Evangelical Christian clients — as well as those who simply identify as traditional or conservative — deserve to be heard and treated with dignity and respect, even when the counselor does not agree with their points of views. I also identify as a Christian who is evangelical and conservative, but there are certainly times when I do not agree with all of these clients.

Years ago, I was working with an individual whose relative was dating someone of a different race. Because of my client’s deeply held beliefs, the client became distressed about this. When seeing the young couple together, my client became distraught, went home and attempted suicide.

Was there more going on with this client? Yes. Yet the reality was that this was the straw that broke the proverbial camel’s back. I consulted with a colleague about this case. In the process, I expressed my shock and disdain over someone reacting this way to a relative dating someone of a different race. I did not understand the client’s gross overreaction.

My fellow counselor reminded me of what I have shared in this article — that although I may not always understand my clients’ views, I should strive to empathize with them and that this situation had meaning for my client beyond what I could comprehend. My colleague was neither conservative nor Christian, but she was respectful of all clients — and of me.

Although I viewed my client’s beliefs as a distortion of the Bible, the client and I both identified as conservative evangelical Christians. Yet we have to be able to accept our clients where they are and take them where they desire to go — not based on our own agendas but on theirs. (There are limitations to this, of course, such as in the case of suicidal ideations.) I had to work hard to empathize with my client’s pain while also helping him work on his desired outcome of changing his thoughts and feelings about the situation as he grappled and struggled to accept what he could not change. With proper supervision, I was able to do this and supported this client during his time in counseling.

Likewise, we should be respectful of our fellow counselors. When we make disparaging remarks about people who are not like us — when I make disparaging remarks about people who are not like me — we are inevitably disparaging some of our colleagues. It is one thing for us to challenge one another, hold each other accountable, and even heartily debate. It is another thing entirely to expect that any group of people should change their entire belief system or else not be included in the field.

Conservative or evangelical Christians are not a rogue group or a small group. We constitute a substantial number in the field who share varying views and beliefs. We cannot all be lumped together. Neither can our clients. With so many clients seeking Christian counseling, perhaps the field should recognize the value of having counselor education programs that teach the ethical integration of Christian faith into counseling (while also recognizing that not all graduates from these programs will hang their shingles as Christian counselors). In fact, it may be time for more training programs to address spiritual assessments, religiously accommodated psychotherapy, and the impact of spirituality and religion on both the client and the counselor.

If you do not understand this perspective, I encourage you to get to know us for yourself. Listen. Think. Ask. Most importantly, get to know your clients. And respect them — and us — for who we are rather than for who you want us to be.

 

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There are many excellent resources for the integration of the Christian faith into counseling settings. These books, journal articles and videos provide the research behind and the details about the practice of being an ethical and effective Christian counselor. They make it clear that this type of treatment is not one-size-fits-all, and it can (and should) be provided at the highest competency level. If one wishes to be a Christian counselor, or if one desires to further understand the Christian faith of a client, the education is available and accessible through the works of individuals such as Tim Clinton, David Entwistle, Fernando Garzon, Ron Hawkins, Harold Koenig, Anita Knight Kuhnley, Mark McMinn, Jim Sells, Lisa Sosin, Siang-Yan Tan, John Thomas and many others.

 

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Laurel Shaler is a national certified counselor and licensed social worker. She is an associate professor and the director of the Master of Arts in professional counseling program at Liberty University. Contact her at doctorlaurelshaler@gmail.com.

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

Counseling Connoisseur: The Gift of Community for Counselors — An Interview with Thelma Duffey

By Cheryl Fisher April 30, 2019

“Pull up a chair. Take a taste. Come join us. Life is so endlessly delicious ― Ruth Reichl

 

I sit down to write my last client note of the day and click away about the client’s presenting concerns. Smiling at the great progress she has made, I conclude with final comments and an action plan and then click save and submit where my therapy notes will be forever stored in a HIPAA-compliant digital safe. I slurp down my last sip of coffee–cold from the morning. Just a few more things to do then I can head home. I put away my files and lock the file cabinet. I pack up my bag and turn off the lights. I am the last to leave the office so I turn off the Keurig and store the teas and sweeteners. I look around at the empty suite. It is 8:30 p.m. I wonder if my colleagues were in today? I have seen clients back–to-back today with little time to socialize. I lock up the suite and head home.

I have found that while private practice affords many wonderful professional and personal benefits, it can be a very isolating experience. I see 20 to 25 clients a week, and I rarely schedule enough break time to visit with the other clinicians who practice in the suite. We each have our own schedule and do not rely on each other for our practices. Therefore, with the exception of my quarterly peer supervision breakfasts, weeks can go by without actually interacting with another therapist. This, I admit is not a good standard of practice, which becomes incredibly apparent when I leap toward my annual conferences with fervor. Conferences provide me with not only clinical, academic and business development, but professional community.

Professional community

As counselors we are held to a code of ethics that does not allow us to discuss the circumstances of our work day with others. Many years ago I was doing work with a prominent actress. While I would have never disclosed the circumstances of her therapy, I longed to tell my husband about meeting with her. Or the ex-girlfriend of a well-known musician. We work with celebrities, politicians and pillars of the community, in addition to marginalized individuals. The pain and suffering we hold for our clients is (at times) palpable. However, with the exception of supervision (and our personal journals which require de-identification), we don’t have a forum to process our work.

Community is essential. It is a place where others understand the magnitude of the work that we do and the weight it carries in our daily lives. It energizes, inspires and fortifies — allowing us to return to our work rejuvenated and renewed. Where do you find professional community? Do you participate in local counseling-affiliated organizations or make use of the extensive national opportunities that include the National Board of Certified Counselors (NBCC) and the American Counseling Association (ACA)?

Over the many years of my practice, I have affiliated with both local and national groups. However, I longed to find a forum that appreciates my research in nature therapy and my clinical interest in superhero narratives. I wanted to dialogue with others around the role of expressive arts and energy psychology in clinical practice. I wanted to collaborate with creative and innovative practitioners. I found my community in the Association for Creativity in Counseling (ACC), a division of the American Counseling Association (ACA).

I presented at ACC’s 2018 annual conference in beautiful Clearwater, Florida, where I was joined by dozens of others who genuinely uphold a creative lens to clinical practice. In addition to my nature-informed workshop and superhero presentation, topics included movement, art, expressive and animal-assisted therapies. Additionally, energy psychology was explored as a clinical modality. As I attached my Wonder Woman headpiece and armbands in preparation for my presentation I walked down the hallway of the conference and passed Snow White preparing for her session, I knew I had found my people.

 

Q+A

Thelma Duffey, ACA’s 64th president

Thelma Duffey, former ACA president and the founder of both the ACC and its accompanying Journal for Creativity in Counseling, participated in my nature therapy discussion and afterward allowed me to interview her about the conception and vision of ACC.

Cheryl:   What inspired you to found ACC?

Thelma: There were several factors that inspired my interest in creativity, and my hope to establish a division within ACA focusing on creativity in counseling. For one, I learned early on that as connected as we can be with our clients, and in spite of our sharing a trusting relationship, there are times in counseling when talk just isn’t enough. Most of us can identify with feeling stuck in a situation, thought, or feeling, and our clients are no different.  The good news is that people carry all sorts of resources within them, and there are all sorts of resources around us, which can serve as creative, innovative supports. When we tap into our clients’ creativity, and into our own, and share that creativity within a growth-fostering therapeutic relationship, we can create opportunities for change. This was particularly evident when I chaired a series of creativity conferences in the 1990-2000s in central Texas. The energy around them was incredible. These conferences became a place where practitioners, students, and counselor educators would come year after year with so much enthusiasm and shared energy.  It was that response, and my own experiences with clients, that generated the passion to establish ACC as a “home” for counselors with this interest.

 

Cheryl:  Over the past 14 years, what changes have you observed in ACC?

Thelma: One of the more exciting things I’ve seen over time is ACC’s growth into an international community of counselors who share a like-minded passion; counselors who are out there doing great things and making a difference. I’ve seen ACC evolve from a grass-roots effort into a well-established organization represented by members living across the country and throughout the world. That is amazing! I just returned from Clearwater, Florida where the ACC conference was held, and it was terrific being there with such great colleagues sharing such incredible ideas and interests.

 

Cheryl: What are your hopes/vision for ACC?

Thelma: My hope for ACC is that it will continue to thrive and that the membership will feel the comfort of “home” that we hoped it would. My vision for ACC is that as people connect with one another, they will discover new ways to support clients and communities, using creativity, connection, and the kind of compassion that can inspire change and promote healing.

 

Cheryl: What would you like counselors to know about ACC?

Thelma: ACC is a home base for students and counselors interested in exploring creative, diverse and relational counseling approaches. It was founded on the principles of relational-cultural theory and focuses on the interdependence of relationship and creativity. Creativity in Counseling as a new counseling approach has been included in a theories textbook, and it is exciting to see the many ways in which our creative thought processes, interventions, research, and resourcefulness can promote change. I feel so fortunate to be part of ACC!

 

 

Finding a community

I plan on attending and speaking at this year’s Association in Creativity’s annual conference, which will take place September 6-7 in Clearwater, Florida. I am ecstatic to have found a forum of like-minded clinicians who I can both share with and learn from in a professional forum.

The American Counseling Association has 18 divisions, four national regions, and 56 chartered branches in the United States, Europe and Latin America. Take the time to seek out a community that will ignite you and your clinical practice. It will not only inspire you– it will also benefit your clients.

 

Colleagues having fun at ACA’s 2019 Conference & Expo in New Orleans (Photo by by Paul Sakuma Photography).

 

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Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is director and assistant professor for Alliant International University California School of Professional Psychology’s online MA in Clinical Counseling.  Her research interests include examining sexuality and spirituality in young women with advanced breast cancer; nature-informed therapy; and geek therapy. She may be contacted at cyfisherphd@gmail.com.

 

 

 

 

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

@TechCounselor: Retaking ownership of your time

By Adria S. Dunbar April 15, 2019

For those of us who are counselors or counselor educators, it may feel like we are constantly juggling and, dare I say, multitasking during our days. As wellness experts, we know this is not healthy or productive. Even so, with so many possible distractions and so many things competing for our time and attention, sometimes we find ourselves being pulled (reluctantly) toward these counterproductive habits.

I’ve invested a significant amount of time over the past few months investigating my own use of time. In fact, for the first time in my life, I committed to pursuing a New Year’s resolution for 2019. I want to be more intentional with how I choose to spend the time I have each week. I don’t know about you, but I want to have greater ownership over my calendar rather than allowing my calendar to have ownership over me. I suspect that other counselors might also be struggling to find an ideal balance. So, here it is — a brief summary of some of the tools that are helping me increase my awareness around time.

 

1) I highly recommend a podcast called Hurry Slowly hosted by Jocelyn K. Glei. Listening regularly has been a great way for me to explore my own productivity habits related to time management, creativity, efficiency and balance. Glei describes the podcast in the following way: “Hurry Slowly explores how we make smarter decisions, feel more comfortable taking risks, and manage our attention more intelligently when we learn to take our time.” Counselor practitioners may particularly enjoy episodes by Jason Fried (“Whose schedule are you on?”), Cal Newport (“Using technology with intention”), Alex Pang (“Prioritizing rest and reflection”) and Fanny Auger (“Conversation isn’t about talking”). One of my personal favorites is Glei’s “Creativity vs. efficiency”.

2) I’ve also been using an online tool called Toggl. I have the app on my phone and downloaded on my MacBook. Toggl allows me (and reminds me) to track my time when I am working. For example, I had no idea how much time I was spending responding to email. Seeing the patterns allows me to make more intentional decisions about how to prioritize and block my time so that the time I am spending on tasks aligns with my work mission.

3) Laura Vanderkam is one of the leading experts on time tracking. She is the author of several books, including 168 Hours: You Have More Time Than You Think and Off the Clock: Feel Less Busy While Getting More Done. She also has a Free Time Makeover Guide (a pdf is available on her website), which is an eight-step framework to help you reconsider how you spend your time.

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In addition to these resources, or perhaps as a result of using them, I have also set some new norms for how I want to conduct the business of living my life. This has required quite a bit of self-reflection on my part, and technology has certainly impacted these results. Here is a list of a few of my new norms:

1) Plan for the next week on Fridays using (wait for it …) ANALOG tools. Typically, I was trying to make weekly plans on Sundays. There were several reasons this was not working for me, but two stand out. First, planning on Sunday meant that my work week was creeping into my weekend time. Second, it is much easier for me to plan for the following week when I’m still in work mode rather than weekend mode. I’ve been using a Clever Fox Planner to reach this goal. I still use Google Calendar for appointments, but my planner helps me prioritize and budget my time, while helping me stick to my focus for the week.

2) Once my schedule is set for the week, I try very hard not to make changes. I realized I was adapting too much to other people’s requests for meetings, phone calls, appointments, etc. I was rescheduling based on other people’s requests A LOT. Now that my schedule is set, I can better prioritize my time and feel an increased sense of control over my calendar, which allows me to spend my time in ways that align with my goals.

3) I’m still working on an earlier bedtime and wake-up time. This actually may be a lifelong growth edge for me. However, I have implemented a Screen Time curfew of 9 p.m. My iPhone settings have helped me stay committed to this practice.

I’d love to hear some of the strategies counselors are using to manage their own time, or feedback on any of the tools that you are trying to practice in your own life.

 

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Adria S. Dunbar is an assistant professor in the Department of Educational Leadership, Policy and Human Development at North Carolina State University in Raleigh. She has more than 15 years of experience with both efficient and inefficient technology in school settings, private practice and counselor education. Contact her at adria.dunbar@ncsu.edu.

@TechCounselor’s Instagram is @techcounselor.

 

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