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Professional Issues

Voice of Experience: Revenue streams for counselors

By Gregory K. Moffatt July 28, 2020

Counselors-in-training often ask me how much money a counselor can expect to make in a year. In many fields — education, for example — that is a fairly simple question. But not so for counselors.

Counselors basically have to work for free until they complete their graduate work. Then, depending on where they land employment, they must work from the bottom up until they are fully licensed. As a general rule, I tell my students to plan on five years post-bachelor’s degree before they really start making a decent living and can focus on their preferred areas of practice. That is a long time and, even then, annual incomes vary tremendously. So, here are some considerations for counselors who are just starting out in the field.

The easiest path: By far the easiest path for therapists is to be hired by an established practice or hospital. Here counselors might make a little less than they would on their own, but they don’t have to bother messing with insurance companies (other than documentation), paying the light bill or scheduling. In private group practice or hospitals, you show up, put in your hours and go home. Working 20-30 hours a week is not uncommon in such circumstances, but your hours are set for you, and you may have zero flexibility.

Expect no-competition contracts in these practices. This means that you can’t leave the practice and take your clients with you. In some cases, you also won’t be able to open a private practice within a certain number of miles of the place you worked should you decide to leave.

Subleasing: A nuance on the “easy path” is joining an existing practice by subleasing office space. Here you may have to pay your own light bill and cover expenses, and you will do your own scheduling and billing. In this scenario, you might make more money per clinical hour, but with billing and paperwork, 20 hours per week is a very busy practice. One advantage of this option is that you will have the built-in benefit of the reputation and advertising of the existing practice (assuming that reputation is good, of course).

Opening your own practice: Starting your own practice provides maximum flexibility and freedom, but this path requires you to start from the ground up in creating your client base. Plus, you will be doing all of your own advertising, web building, billing and scheduling. This approach takes energy and commitment.

Teaching: Once you complete a master’s degree, you are qualified to teach at the undergraduate level. Many counselors teach college courses in-seat or online as an additional revenue stream and for variety in work experience. Online courses usually pay around $1,500 per course ,and traditional in-seat courses usually pay around $3,000 per course. This experience also provides you with potential referrals from students. Contact the department chair of a college or university where you might like to teach for more information. Have your vita and transcripts ready.

Consulting: Consulting with schools, businesses, churches, law enforcement, lawyers and other public agencies not only provides additional income but can also put your name out there with other agencies.

Working for free: Generally, I want to get paid for my work, but doing pro bono work as a consultant might put you in position to make more money later. I worked for one worldwide company for almost 10 years and never charged them a dime, but I made tens of thousands of dollars from referrals because of my affiliation with that company. I knew that was possible, which is why I agreed at the onset to provide free services for them.

CEs and presentations: As with teaching or consulting, providing continuing education workshops and presenting at professional meetings can help get your name out there to a wider audience. In this type of networking, it is critical that you polish your “act.” A poorly presented seminar can earn you more name recognition, but not in a good way. When I started teaching at the FBI Academy many years ago, the director at the time told me, “I opened the door for you, but you had to keep it open.” That’s important advice.

Specializations, licensing and certifications: In combination with maintaining your license(s) and involvement with local and national organizations such as the American Counseling Association, specializations can help you build your practice. Receiving training in marriage and family therapy, eye movement desensitization and reprocessing, play therapy, dialectical behavior therapy or other specializations can serve to set you apart from others in the field and bring in clients. Achieving specialty certifications can also give you the option of charging a higher per hour rate.

I can’t be exhaustive in discussing all revenue streams in a short column, but depending on where you live and which of these routes you pursue, a counselor in full-time practice can make a very healthy living. You just have to work for it.

 

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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.

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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’s evolution under COVID-19

By Bethany Bray May 20, 2020

Under a shelter-in-place order, are professional counselors considered essential workers?

What if a client’s insurance covers in-person therapy but doesn’t cover video or telephone sessions?

Are Skype, WhatsApp or Zoom compliant with health privacy laws?

My employer expects me to continue seeing clients in person, but I’m not comfortable with the health risk that entails. What can I do?

This spring, worried practitioners flooded the American Counseling Association’s on-staff ethics specialists with these and many, many other questions as the new coronavirus that causes COVID-19 gradually became a concern and then — very rapidly — upended the landscape of daily living across the United States. The past three-plus months have presented a steep learning curve for professional counselors, especially with the pandemic causing disruptions and difficulties with something at the heart of their work: connecting with people.

Many counselors in clinical settings responded to these new realities by ceasing in-person interactions and quickly getting up to speed to offer client sessions via telebehavioral health. Most school counselors and counselor educators found themselves negotiating unplanned extended breaks or even abrupt halts to their school years in early spring. Many of these professionals navigated a similar scramble to that of their clinical counseling colleagues, having to adopt and use new technologies so they could continue supporting and teaching students online.

In addition to those challenges, the economy took a dramatic downturn, causing many counselors to wrestle with financial worries and even job uncertainty. Despite the widely reported rise in mental health concerns connected to or exacerbated by the COVID-19 pandemic, some counselors are facing income loss because of a decrease in clients. That’s due in part to many clients experiencing financial struggles of their own, including loss of insurance.

Under the strain of adjusting to this new normal, counselors say they have experienced a flood of emotions, from stress, worry and fear to vulnerability and frustration. At the same time, professional counselors are finding silver linings, such as learning the heights of their own strength and flexibility.

“It’s exhausting,” acknowledges Andrea Morganstein, a licensed professional counselor (LPC) and owner of a solo private practice in West Chester, Pennsylvania. When interviewed in mid-April, she had shifted her entire client caseload to sessions via telebehavioral health. “It’s been a constant evolution,” she says.

Morganstein says she has been relying on the support of her professional peer consulting group, which has been meeting virtually more frequently throughout the spring. In addition, she says her new self-care routine of taking a walk every morning at 7 helps her to anchor her day and maintain a stable schedule, including observing regular mealtimes and bedtime.

“I’m not scared of the virus. I try to take the approach that if there’s nothing to worry about right now, there’s no productive reason to take on extra worry. [But] at times, I’m not feeling good about myself and getting down on myself about not being able to manage everything and get enough work done,” she says. “I’ve learned about how much I was taking for granted in terms of the day-to-day social contact that I had [before the pandemic] and that it’s so important that it’s worth putting in the extra energy that is needed now to maintain those relationships and feelings of connection.”

As this article was being written in April, there were still many questions about how COVID-19 might affect the counseling profession over the long run. Will counselors rush back to offer in-person sessions as soon as possible — and will clients rush back to schedule them — after becoming more comfortable with online therapy? Will some of the emergency measures that offered flexibility regarding regulation of telebehavioral health spur change for the future? Will a mental health pandemic follow the COVID-19 pandemic as some experts predict?

Only time will tell. In the meantime, professional counselors will continue to do what they do best: supporting their clients and students, regardless of setting or circumstance.

Navigating the learning curve

Morganstein had set up the office at her practice so that she and the client sat perpendicular to each other during sessions. The comfort of that arrangement went missing when Morganstein shifted to offering sessions exclusively via video and phone in mid-March.

In addition to learning and adjusting to the technical piece of telebehavioral health, including a new web camera that initially caused extreme frustration, the medium forced Morganstein  and her clients to be “eyeball to eyeball” for video sessions. Some of her clients who struggle with self-esteem also expressed discomfort at seeing themselves for the duration of their sessions in the little video box in the corner of the screen.

When sitting with clients in her office, Morganstein often uses her own body language and positioning to help clients feel more comfortable during moments of silence or when struggling with difficult emotions. That subtle strategy is harder to deploy with telebehavioral health sessions. Although, as time has gone on, Morganstein has adjusted to sit farther away from the camera to bring more emphasis to her upper-body language and less to her face, she says.

“The biggest thing for me has been the use of silence. I have been finding that sitting in silence in telehealth feels different — more anxious and less comfortable for me,” says Morganstein, a member of ACA. “In exploring that, I realized when there’s silence on a video or phone call in the social realm, it’s a cue to say goodbye; we’ve said all we need to. But in therapy, I will often use silence to give the client space to think or process [a question or topic] or think through a new idea that’s coming to them. You can see it in their body language, that they’re ‘getting it’ and seeing a concept. It’s much harder, in my experience anyway, to do that in telehealth.”

“I’m finding instead that in my own internal experience with telehealth, my brain is telling me that I should be doing something — I should be keeping this conversation going and doing something to fill this space. It shifts the role that I typically inhabit in counseling,” Morganstein continues. “At some point, I do think it would be helpful to put it on the table and say [to the client], ‘Gosh, this feels different. Here’s a time that I would [normally] sit here quietly and let you think. What is this feeling like for you?’”

Morganstein says she is trying to stay mindful that as different as this new normal feels for her, it feels just as different for her clients. As the weeks pass, she continues to look for ways to shift her approach and re-create the warmth and openness she strives for during in-person sessions.

She lives in a townhouse with her spouse and children, so she has set up a section of her bedroom to conduct video therapy sessions. She has staged a section of wall to mimic an office setting, complete with a plant, a lamp and a canvas print. “I refer to it as ‘my home office’ to my clients. But it’s my bedroom, and I can’t leave confidential files lying around. That’s the part I’m finding very stressful,” Morganstein says.

Morganstein says the shift to telebehavioral health has also caused her to adjust the methods she uses with clients. In person, she often writes on a whiteboard in her office during sessions to illustrate a topic. “I find that [now] I am encouraging my clients to do a little bit of [in-session] journaling themselves, when normally I wouldn’t have slowed down to have them do it,” Morganstein says. “I’m finding it to be powerful and will bring it more into my in-person work. … I’ve learned that I should have clients write things down more on their own, in their [own] words. At the end of the session, they’re more likely to internalize what we just talked about when their brain had to do the work to construct it and put it on paper.”

On the minus side of the ledger, Morganstein says the exposure component of the social skills work she does with clients with attention-deficit/hyperactivity disorder has “ground to a halt” because clients aren’t leaving their homes. She is also finding that in-depth counseling work such as processing trauma is being put on hold because clients need to focus on more immediate needs such as dealing with the stress of going to the grocery store or, for school-age clients, mourning the loss of school activities and graduation celebrations.

“Doing trauma work temporarily leaves clients more vulnerable,” Morganstein points out. “Now is not the time to leave people feeling more vulnerable or emotionally exhausted.”

Morganstein also believes some clients have taken her off of a pedestal after watching her operate outside of her typical office environment — and she is comfortable with that. Seeing her struggle with technology at times or hearing her dog bark occasionally during sessions has allowed more opportunities for her clients to see her in a new light. “It’s OK to be human with your clients,” she stresses.

Morganstein recalls one session — or rather, an attempted session — scheduled with a middle school-age client in the early weeks after switching to telebehavioral health. Morganstein had sent the client’s mother a link to connect on the video platform she uses. When it came time for the session, Morganstein couldn’t get either the microphone or camera on her computer to work. She knew she needed help from her husband — “my IT guy,” she jokes — but counseling ethics regarding confidentiality dictated that her husband should not see the client, who was visible on the video feed. The client’s mother offered suggestions, staying online with Morganstein as she tried to problem-solve, but after 25 minutes, Morganstein gave up and ended up rescheduling the session.

What could have been a frustrating or angering situation for both parties actually ended up improving Morganstein’s relationship with her young client’s mother. The client was relatively new to Morganstein’s practice, and before this incident, the mother had been a little nervous and somewhat guarded around Morganstein. After witnessing Morganstein in a vulnerable situation, the mother seemed to feel much more comfortable around her, even making the occasional joke, and their relationship has grown since that time, Morganstein reports.

Practicing what you preach

Licensed mental health counselor Stacey Brown closed her Fort Myers, Florida, group counseling practice and began offering client sessions via phone and video on March 13, well before many practitioners in her area were doing so. It was becoming clear to Brown how easily the COVID-19 virus could spread, and knowing the number of clients who came through her office in an average week, she followed her gut instincts that Friday and made an impromptu decision to cease in-person sessions. “It just felt like the right thing to do,” Brown recalls.

Since then, Brown has been able to keep a full schedule of client sessions while working from home. She has found that a majority of her clients prefer telephone sessions. To retain focus during sessions and maintain some privacy from family members or others with whom they live, Brown’s clients have talked to her while sitting in a parked car, taking a walk or even floating on a raft in a backyard pool.

“All of my clients’ [presenting] issues are still happening, so they need support — or need even more. When people are forced to be by themselves, they have to deal with themselves. A lot of our talk [in sessions] has been on how to deal with ourselves,” Brown says. “For me, when you’re with somebody [a client in session], you need to really be with somebody. You need to be 100 percent present. You can’t go into a session with preconceived notions. That really messes you up. You can’t go into a session and think, ‘Today we’re going to talk about her mother.’ … Over the phone, it’s the same — sitting and really listening and concentrating. I really feel like I can be right there with them, and it’s turning out OK.”

Client struggles with anxiety, trauma and grief have intensified since the outbreak of the new coronavirus, says Brown, a clinical supervisor and ACA member. In addition to using cognitive behavior therapy and other methods, Brown has found it helpful to emphasize calming techniques such as breath work and meditation with clients. She has also ramped up conversations and check-ins about how well clients are sleeping, engaging in self-care, staying hydrated and eating — some of the foundations of Maslow’s hierarchy of human needs.

Wellness practices can help counselors and clients alike process and digest emotions, just as the body digests food, Brown says. “Now is not the time to do just counseling or just therapy,” she says. “Ask your clients if they’re having neck and shoulder pain, or how are they sleeping and what are they eating. Everyone is ramped up right now, and we need to take care of our bodies. Talk about stretches and relieving tension and the difference between shallow breathing and deep breathing. Remember the mind-body connection.”

As the pandemic continues to affect counselors’ work, Brown emphasizes that practitioners — now more than ever — need to heed the guidance they give their own clients: Don’t forget the importance of self-care, and find ways to move away from rigid and one-dimensional thinking.

“If we’re upset because things aren’t the way they are supposed to be, we will only get madder and more closed off. See this change as an opportunity, a chance to be creative and flexible,” she says. “You have to nurture yourself and find balance. This includes turning off the news, if needed. Take the same advice you give your clients [to] be aware when your anxiety is rising.”

Likewise, counselors often encourage clients to be intentional about their life choices and the goals they set. The same guidance applies to practitioners themselves, especially during times of crisis, Brown asserts. Brown, who is certified to teach yoga and meditation, has found ways to diversify her work and supplement her income from counseling. In addition to offering meditation and yoga instruction, she paints and sells her artwork, writes, and supervises counselors-in-training.

From Brown’s perspective, the business side of counseling is a lot like a tennis match. When your opponent is about to serve you the ball in tennis, she explains, you don’t know where it will go, so you have to be agile and “springy” in order to run and meet the ball. So too with running a business: You have to think ahead and be both prepared and flexible when challenges arise.

“Counselors can’t just sit in their office and see people anymore; they need to diversify and have multiple income streams. We can’t just be awesome clinicians; we have to be awesome business people as well,” she says. “We have to practice what we preach — and this is the challenge, always. If you’re constantly in the box, then that’s where you’re going to stay. … If you’re always reactive, then you’re going to have some trouble with your business. If you’re intentional and manifest what you want, then you’ll be fine.”

Professionally, Brown says these past few months have presented her with lessons in creativity, patience, gratitude and self-trust. Even though she loves her office setting, she is thinking of continuing to offer telebehavioral health from home one day per week after the COVID-19 pandemic subsides.

“This has given me time for self-examination and time to reflect and confer with others on how they’re running their businesses,” Brown says. “Aside from the health fears, it has been a rejuvenating time for me because of the creativity element. When I was in the office, I was all zoomed in on day-to-day activities. Now I have been able to zoom out and see things from the big[ger] picture. It’s different somehow. … It’s helping me to refresh my perspective and stay curious on how to do this and how to grow my business to be sustainable to attain my ultimate goal: to help people.”

Emphasizing safety

Linda Diaz-Murphy has been doing play therapy with young clients via telebehavioral health ever since New Jersey enacted a shelter-in-place order in March. Parents and youngsters alike have easily adapted to the medium, she says. A parent or caregiver is always present during the session, and young clients use a combination of their own toys and play therapy items such as sand trays that Diaz-Murphy previously sent home with families.

Even when delivered via telebehavioral health, Diaz-Murphy says, the focus of play therapy remains the same: building clients’ sense of safety and developing their coping skills and strategies. This includes talking about and processing emotions as young clients draw or create scenes with figurines.

“We use whatever resources they have,” says Diaz-Murphy, an LPC and registered play therapist whose private practice in Leonia, New Jersey, is 15 minutes away from the George Washington Bridge leading into and out of New York City. “One child likes to cook [using a play kitchen] and feed everyone in his family. We used to do that in the office, and now we’re doing that in teletherapy. We’re continuing to do the same things in the home as we do in the office, which is really amazing. Nothing has really changed except the location.”

Diaz-Murphy has also been emphasizing safety with her adult clients in the form of extra outreach. As soon as she switched to telebehavioral health, Diaz-Murphy increased her communication with clients, checking in regularly (once or twice per week) via phone or text message. She has let her entire caseload know that she is available for extra sessions or even “just to talk,” although she limits client phone calls outside of sessions to 30 minutes.

“It’s more than I would usually do, but this is important,” Diaz-Murphy says. “Years ago we called it proximity control, but it is just being there for [clients], helping them feel safe and know that you’re there to help.” It also involves staying close with and being available for clients without being too intrusive, she explains.

One of Diaz-Murphy’s clients, an adult man who lives alone and is geographically separated from his family, had a relative die of COVID-19 in April. Initially, he was hesitant to use telebehavioral health, but Diaz-Murphy continued to stay in touch with him via text message. Eventually, he agreed to participate in a counseling session over the telephone. Now they are in contact roughly twice per week, and the client is reaching out to her instead of the other way around, which Diaz-Murphy views as a very positive development.

“What is important for me, especially during this coronavirus crisis, is to always be honest [with clients], share my limitations, discuss options, think of safety first, be patient, offer reassurance, speak in hopeful tones and use hopeful language, remain in the present and think of the future, make myself available, and remember [that] my presence is important,” Diaz-Murphy says.

Diaz-Murphy has completed extensive training in disaster mental health and is a crisis response counselor. She has drawn on that knowledge this spring, she says, adjusting her approach to meet her clients’ needs as anxieties swelled and so much was unknown. Part of her own coping strategy during the pandemic has been to continue learning. She recently completed a training on offering disaster mental health and crisis counseling over the phone, including best practices on strategies and language to use.

A little humor can also go a long way when anxiety is swelling, Diaz-Murphy says. During the toilet paper buying frenzy (and ensuing shortage) that accompanied the first several weeks of COVID-19 in the United States, she found a website that calculated how much toilet paper each household would need to make it through quarantine. She shared the site with a few clients to lighten the mood.

“It’s a source of humor, but [there’s] also a reality that people are afraid that others will take resources and there won’t be enough left. It’s the same with food. This [toilet paper calculator] puts things into perspective for people, and then it helps in other ways,” says Diaz-Murphy, a member of ACA.

Most of all, she has focused on making sure her clients have appropriate self-care and coping mechanisms in place to deal with the worry and uncertainty that have accompanied the pandemic.

In times of crisis, professional counselors must remember to trust themselves and fall back on their core counseling skills: empathy, communication and listening. “You want [clients] to be in control and feel empowered,” she says. “Behave the same way that you would in the office: Don’t panic, stay calm, and treat your clients with respect. Let them know that they can manage this, and give them the tools to manage.”

Finding connection on camera

Chris McClure still drives to her Manassas, Virginia, private practice to conduct telebehavioral health sessions, even though clients are no longer coming in. Sitting in the same chair and being in the same space where she used to conduct in-person counseling helps her to focus and “switch gears” from the personal to the professional, says McClure, an LPC and a member of ACA.

She also thinks it is important to retain that familiar setting for her clients. When Counseling Today interviewed her in April, McClure was working to set up her laptop so that clients would see her at the same angle and with the same backdrop as if they were sitting in the client chair in her office.

She admits that she is still struggling to strike the right balance while using telebehavioral health. Initially, she felt too detached and too “pulled away” from clients through video. Sometimes she feels that she has to “project my empathy larger than life” to get through to clients.

“Video doesn’t feel very intimate, and therapy is a very intimate interaction,” McClure says. “It can be kind of intrusive. I am coming into a client’s home, and some are uncomfortable with that.”

McClure also tries to use her facial expressions to connect more with clients. The human brain is hard-wired to recognize emotions in others’ faces, so clients can pick up subtle cues, she says. “If they can see us looking reasonably calm and conveying very soothing messages, then they are better able to handle their anxiety,” she says.

When clients express discomfort about using video for counseling sessions, such as remarking that their home is messy or apologizing for family members who wander into the screen, McClure acknowledges that adjusting to the new medium is hard. To further validate their feelings and set clients at ease, she sometimes remarks that it would be difficult for her to “let someone in” to her home and that she is grateful for their hospitality. Complimenting something that she sees on camera, such as a pet or a piece of art on the wall, can also help, she notes. With clients who still seem a little uncomfortable, McClure revisits the topic in future sessions to help them continue to adjust.

“For most clients, after a time, they forget that they’re not in the office and just focus on me. Others are more aware of the limitations of it,” McClure says. “I’m very much a perfectionist and very much a caretaker, and I want this to be as comfortable and smooth for clients as possible. I’m very much aware when things are missing. [But] I do think that it’s possible to get there with this technology.”

One particular challenge McClure has noted while using telebehavioral health is picking up on clients’ nonverbal cues — something she says comes as second nature to her in person. Recently, she was conducting a session with a client, and the image quality and delay of the video feed made it difficult for McClure to recognize that the client was on the verge of crying until tears were streaming down his face.

“I’m working overtime to listen for those subtle cues in their voice. After almost 30 years [as a counselor], a lot of that is second nature, autopilot, and [now] I have to bring that up to a more conscious level of listening,” she says. “When you’re together with a [client], you can notice the slightest twitch of an eyelid or small facial movements that can convey so much, especially when people are trying to hide their emotions.”

At the same time, McClure acknowledges that her clients are expressing more basic needs right now, such as managing anxiety and getting enough sleep, which aren’t as dependent on nonverbal cues, or at least not at such a deep level as other counseling topics might involve. “It would be exaggerating to say that people are regressing [in therapy], but there is some truth to that. Some of what I’m doing is crisis management,” McClure says.

So much has felt like a moving target as the COVID-19 pandemic continues to unfold and new information becomes available, McClure notes. She has been trying to find a balance between staying informed and limiting her exposure to the news.

“I see a lot of [clients] with anxiety, and I’m trained to help them with [distinguishing between] rational fears and irrational fears, and it’s been very unclear between those two. I have some people who are absolutely terrified and don’t want to leave their homes, and others who think we’re overreacting. It’s hard to feel like I, as a counselor, have an authoritative message when there’s so much mixed information out there. … I think the vast majority of Americans are feeling a considerable amount of anxiety. This [virus] is a substantial threat to our way of life, our well-being, both health and economic.”

McClure has completed a number of trainings on telebehavioral health over the course of her career, although she didn’t use it much until the COVID-19 pandemic hit. She plans to seek more continuing education to keep adjusting to the medium. Eventually, she’d like to transition to semiretirement and be able to counsel clients via telebehavioral health while traveling.

“I’m excited by the possibility that a lot more people are going to get comfortable and used to [telebehavioral health],” McClure says. “Part of the reason I’ve been interested in distance counseling is that there are a lot of underserved populations [that could benefit]. I specialize in working with transgender clients and clients with gender concerns, and there are not that many practitioners who are genuinely trained and qualified to work with these clients once you’re past major cities. There are huge parts of [my] state that are just not well served on certain issues. I really like the idea that a client could get really quality therapy, even if there’s not a therapist within 50 miles. … Hopefully some of the temporary things that have happened during this [pandemic] will stay in place and [result in] positive change.”

‘We’re stronger than we think’

Celine Monif has a private practice near the junction of two states, Iowa and Nebraska, that have not enacted shelter-in-place orders. That has created a sticky situation, Monif says, because she can only suggest telebehavioral health and encourage her clients to use it. The other option would be to voluntarily close her office, but Monif is unwilling to do that because it would disrupt or suspend treatment for clients who are unable to use telebehavioral health. For those who opt to continue with in-person sessions, she has been seeing clients at her Bellevue, Nebraska, office, spacing out sessions so that no two clients cross paths and risk infecting each other.

“It’s been a heavy mix of demand and resistance to go to telehealth, which would not happen in a shelter-in-place state,” Monif says. “Some [clients] are coming in because this is their safe space, and they don’t feel they would get the [needed] privacy or freedom to talk freely at home.”

Monif, an ACA member, holds two licenses. She is a licensed mental health practitioner in Nebraska and a licensed mental health counselor in Iowa. She estimates that roughly one-third of her caseload continues to come in for in-person sessions. Some of these clients simply aren’t comfortable with telebehavioral health technology. For others, it poses logistical challenges. For example, one of Monif’s teenage clients continues to come to the office for in-person sessions because she doesn’t have a cell phone of her own and her large family has only one computer to share between them.

To minimize the risk of infection, Monif has been sanitizing her office and waiting room after every client, taking her temperature each morning, washing her hands regularly, and opening the door for each client so they don’t have to touch the doorknob. She has also posted a sign on her office door asking that people who are sick or have a fever not enter.

Monif admits that she has experienced a roller coaster of emotions this spring. “Because it’s the Midwest and we’re not the epicenter of the virus, we still have a percentage of people who are not taking this as seriously as they probably need to. This can be frustrating,” she says. “But at same time, there’s compassion. I understand about their fears or hesitancy to give up the safe space of my office. I understand the anxiety and feel a lot of compassion for them. … My emotions fluctuate so quickly throughout the day.”

In the past, Monif typically accommodated one or two pro bono clients at any given time to help those who couldn’t afford counseling or had lost their insurance coverage. With the recent economic downturn in the wake of COVID-19, that number has increased, with Monif offering pro bono sessions for several clients who have lost jobs or been furloughed.

“It would be unethical for me to stop [treatment] and not try and help them,” she says. “My husband and I are both working and will be OK for the near future. We have that luxury, so I will continue [to offer pro bono services].”

A trained volunteer for Nebraska’s Critical Incident Stress Management program, a statewide team that offers mental health debriefing for first responders after major incidents, Monif is also offering free sessions for first responders who need counseling.

The counseling profession’s swift and unexpected pivot to telebehavioral health this spring has revealed a few challenges that will need to be addressed for the long term. For example, there have been mixed messages concerning which telebehavioral health platforms are compliant with health privacy laws. Professional counselors need clearer guidelines both from licensing boards and insurance companies, Monif says.

“[Practitioners] in my area often have clients across state lines, and there’s some confusion on what our license allows. It’s a new territory,” Monif says. “When everything comes out, we’re going to have a little bit to unravel. … It used to be that online therapists were a specialty, and now it will be more of the norm. There will be a huge influx of providers who provide online therapy.”

“If there’s a silver lining to this,” she continues, “I’m hoping this helps raise the awareness that this [telebehavioral health] is something we need. It’s an essential service. People need access, and right now it’s an imperfect system, and we need to work on it.”

The fallout from COVID-19 has ushered in an opportunity (even if unwanted) to learn and see things from a new perspective, Monif says. She has witnessed counselors in her area rise to the occasion and rearrange their entire practice to work online, all while caring for family and dealing with both the personal and professional stressors of the coronavirus pandemic.

“I have learned that if I have to adjust quickly, I can,” Monif says. “I went from having zero telehealth clients to [those clients being a major] part of my caseload in seven days. I learned that we’re all in the same boat and we don’t have the answers, but we’re learning as we go. This threw us all off-kilter, and we’re still day by day, [but] we’re all so adaptable, and that’s great to see. … We’re stronger than we think, [but] we also need to make sure we’re taking care of ourselves. Find a balance between managing your own emotions, taking care of family, and being responsible for clients and helping them. Find that balance, and you’ll be OK.”


Identifying potential in crisis

Although the COVID-19 pandemic has forced some unexpected changes to the way professional counselors are working, it has also brought immense potential for practitioners to flex their outreach and advocacy muscles, says David E. Jones, an LPC in the Cincinnati area.

Counselors are well suited to help with the many needs that have arisen alongside COVID-19, from the anxiety and isolation that can accompany shelter-in-place mandates to the distress and burnout felt among health care workers and first responders, says Jones, an ACA member and assistant professor in the Department of Counselor Education and Family Studies at Liberty University.

“There is a chance of having a mental health pandemic after all of this. What are we [counselors] doing? What can we do? What should we do to help our communities? What are we going to do six months from now, beyond just our individual clients?” asks Jones. “Part of this is getting outside our walls of one-on-one thinking and coming together as a profession and collaborating across professions to address at-risk populations and structural disparities. We need to be collaborating with public officials and sitting at those tables for long-term planning and thinking of the mental health aftermath.”

Jones urges counselors to take their role as advocates seriously and to think about how they can reach across disciplines to address mental health in their communities. This could include collaborating with local organizations, schools and even houses of worship, but it should involve thinking outside the four walls of the counseling office, he emphasizes.

“Show up at town hall meetings or sit down with local politicians. Offer to go to your local firehouse and talk about mental health first aid. Or send them a letter and offer to have coffee with them and offer your insights,” suggests Jones, who was a public health researcher, including time spent as an infectious disease epidemiologist, before switching careers to become a professional counselor. “It doesn’t have to be a huge elaborate thing, but it’s a drop of water in a pond, and if you have a lot of people putting a drop of water in, it’s going to ripple and make a difference.”

For example, there will be immense need for career and employment counseling in the coming months, with millions of Americans being unemployed or underemployed. Counselors could host community workshops focused on learning job search and interview skills, seeking job training or studying for the General Educational Development exam.

“Counselors have so many points of contact to make a difference, [including] schools, parents and other nonprofits. Who do you know that could make a difference? Go and speak at groups, provide psychoeducation [about mental health], and shine light on local resources. We need to get out of our silos and work across professions. There’s connection points that can be made, and sometimes you just have to think outside the box to make them.”

In the wake of the coronavirus crisis, there is great potential to expand the counseling profession’s reach and impact while meeting needs in counselors’ communities, Jones stresses.

“During a time like this, we get a chance to reflect on who we are. And that’s a good time to make us pause and look at things that are working, and things that aren’t working, and have a potential place to effect change,” Jones says. “You can focus on the distressing part of this, or you can introduce yourself to fellow counselors in town and ask if they need anything. It’s time to reflect and be more person-centered than we were before.”

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Professional resources

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

Interstate compact plan provides hope for licensure portability

By Laurie Meyers April 8, 2020

In an increasingly mobile society, it is not unusual for professionals in many fields to relocate for career or personal reasons. For those in professions such as human resources, information technology, publications and numerous other fields, moving to another area usually requires only a new employer. In fact, many professionals need not even seek a new office because they can telecommute.

But for professional counselors, moving requires obtaining licensure again in their new state. Because individual state requirements for licensure vary widely — particularly in the number of graduate semester hours, required coursework, number of hours of post-master’s supervised counseling experience, and examination requirements — it can be difficult and time-consuming for counselors to transfer their licenses. Additionally, most states also require that counselors be licensed in the same state in which their clients reside, which limits practitioners’ ability to provide therapy via telebehavioral health. Being unable to counsel from a distance doesn’t just limit counselors’ potential practice avenues but also often forces clients who move to seek a new mental health practitioner.

The American Counseling Association has long considered lack of licensure portability to be one of the most critical issues facing the counseling profession. The Building Blocks to Portability Project was one of the major initiatives to come out of 20/20: A Vision for the Future of Counseling, a yearslong strategic planning effort co-sponsored by ACA and the American Association of State Counseling Boards that involved 31 major counseling organizations. In June 2016, the ACA Governing Council passed the ACA Licensure Portability Model, which said:

“A counselor who is licensed at the independent practice level in their home state and who has no disciplinary record shall be eligible for licensure at the independent practice level in any state or U.S. jurisdiction in which they are seeking residence. The state to which the licensed counselor is moving may require a jurisprudence examination based on the rules and procedures of that state.”

However, to allow for true portability, individual state licensing boards nationwide would have needed to adopt the ACA model. Based on input received from state licensing boards, ACA eventually decided that the most effective way to achieve portability was through the creation of an interstate compact.

The compact “won’t be ACA’s plan or any other group’s [plan],” says Lynn Linde, ACA’s chief knowledge and learning officer and staff point person for the interstate compact project. “What is being proposed is what we expect the licensing boards will agree to given their input. That’s why it’s the best option.”

How an interstate compact would work

What, exactly, is being proposed? According to Linde, states that join a compact would be agreeing to accept the credentials of professional counselors who are licensed in another state. Individual state licensing boards would be allowed to impose additional requirements such as a jurisprudence exam or an FBI background check, but the compact would not change professional counselors’ scope of practice, Linde explains. Individual counselors would be required to hold a valid license from the state of their legal residence. Counselors could then apply to the compact to be licensed to practice in other states that have agreed to participate in the compact.

Although the process sounds relatively simple, implementing the interstate compact for portability is a multiyear process. In January 2019, ACA signed a contract with the Council of State Governments’ (CSG) National Center for Interstate Compacts (NCIC) to conduct the work. NCIC has divided the project into three phases:

  • Phase I: Developing the compact. This involves creation of an advisory group, drawing up a draft compact and getting feedback on the draft from all of the groups involved.
  • Phase II: Implementing the compact. During this phase, an online compact resource kit will be developed, along with a legislative strategy, including a national legislative briefing.
  • Phase III: Establishing the commission that will oversee and coordinate the compact.

(For more detailed information on the interstate compact process, access a fact sheet at tinyurl.com/vlh3gk2 on ACA’s website.)

Where are we now?

In October 2019, the advisory group, composed of ACA members, representatives from state licensing boards, state legislators, and attorneys for state licensing boards, met in person. Follow-up phone meetings were held in November, December, January and February. During these calls, the advisory group members had an opportunity to further discuss how they wanted to handle specific elements of the compact and talk with representatives of other compacts, Linde says.

A drafting team, composed primarily of lawyers who serve on the advisory group, lawyers from NCIC, and several other professionals who have specific expertise in licensure requirements, has been created and was scheduled to meet in March, Linde says. The goal is to produce a draft compact by May or June of this year. The draft will go back to the advisory group for review and then enter the formal CSG compact stakeholder review — an eight-week process for gathering feedback from state licensing boards, state legislatures, and state and national membership organizations. The drafting team will review the feedback and make any needed changes. The updated draft will then be presented to the advisory group, which will either endorse it or make further changes.

Once the advisory group endorses the final version, the plan will be presented to the states and phase II, the legislative process of implementing the compact, will begin. (Visit tinyurl.com/unav9ta for more detailed information about the drafting and implementation process.)

Phase II is expected to run from September 2020 through March 2023. Phase III is projected to take place from April 2023 to September 2023.

 

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For more details on the compact project, see the ACA webinar “Interstate Compacts for Professional Counseling: The Pathway to Licensure Portability

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

Marathon vs. sprint: Building a sustainable career as a professional counselor

Compiled by Bethany Bray March 27, 2020

Professional clinical counselors who sustain their careers over decades have literally thousands of clients come through their doors. There’s no denying that the job is rewarding, but the daily grind of helping people overcome trauma, loss, addiction and other “heavy” challenges can wear on even the most resilient of practitioners.

This begs a question: How do counseling professionals maintain their energy and motivation across the years? What does it take to stay fresh and inspired day in, day out, rather than growing stagnant over time?

Lynda Diane Noffsinger, a licensed clinical mental health counselor supervisor in Winston-Salem, North Carolina, has found that her answer to this question is to stay curious. Noffsinger has been a professional counselor for close to three decades but says she is still learning every day. Just last year, she earned her credential as a certified eating disorder specialist.

Noffsinger has worked as a counselor in a variety of settings — at a mental health hospital, at a residential substance abuse program, at a college counseling center and in a private practice that she owned for 20 years. She says each role taught her not just new counseling skills and techniques but also more about herself.

For instance, when she worked briefly as a clinical counselor at a residential and outpatient eating disorders program, “I learned that I do not like an administrative role. I missed direct counseling, and I missed the community I called home,” says Noffsinger, a member of the American Counseling Association since 1999.

Most recently, in her role as a counselor at a practice that specializes in helping adults and adolescents with mood disorders, she immersed herself in a 30-hour online training program in dialectical behavior therapy. “From this work experience, I’ve learned I’m a clinician, and that’s what I do best. I have spread myself too thin at times, experienced burnout at times and, some days, I’ve ended the day bone-tired,” Noffsinger says. “However, since 1993, I wake up every workday and, as Viktor Frankl would say, I know what my purpose is and [that] my life has meaning. Twenty-seven years later, I still love the counseling profession.”

What does it take to stay fresh, inspired and energized over the long haul of a counseling career? Counseling Today recently collected insights about career longevity from American Counseling Association members of varied backgrounds and practice settings. Read their thoughts below.

What has kept you energized across the years of your career? How have you avoided stagnation? Add your voice to the conversation by leaving a comment at the bottom of this article.

 

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In my 33rd year of private practice, I am grateful for a profession where we can work as long as we choose and our clients often see working with an older counselor as a good thing.

Compared with the early years of my practice, my clients have become a more diverse group. Half my clients are under 40. They come from a variety of ethnicities, races, religions and sexual orientations. My days are both busy and varied — what one client brings to therapy looks very different from the previous client or the next one. Along with continuing to work on my professional skills, maintaining cultural competence and relevance helps keep my professional life from becoming too routine. My clients challenge me to see life from fresh perspectives.

For more than 15 years, I’ve been part of a small peer supervision group. The group has been an enormous gift. We support and challenge each other and provide different points of view. As someone in a solo private practice, relationships with peers have helped me avoid feeling isolated or stale.

In talking with newer counselors — and in reflecting on my own development — I’ve often thought that counselors prioritize caring for clients over self-care. That’s hazardous. I’ve learned not to be endlessly accommodating of clients’ need to reschedule if that would overload my schedule and leave me exhausted. And I’ve learned to become comfortable with the business side of my practice.

As a young counselor, I knew I wanted a practice where my clients and I would make decisions about our work without interference from insurance providers. Choosing not to sit on insurance panels meant that my practice grew more slowly. In the early days, I worked part time for nonprofit [organizations] to make ends meet. Having a vision of how I wanted to work has allowed me to build a practice where I can earn a comfortable living while also maintaining reduced-fee spaces for limited-income clients.

Someone told me early in my career that the world doesn’t need any more “burned out do-gooders.” I have taken that advice to heart, and I’m grateful to my younger self for the faith, patience and commitment needed to build a professional life that sustains me while allowing me to be useful to my clients.

— John Ballew, a licensed professional counselor (LPC) with a solo private practice in Atlanta

 

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What an honor it is to have been providing counseling services for over 35 years. I may be simply lucky, but I’d like to think that the fact that I have never experienced burnout and am still in love with my profession has more to do with an intentional emphasis on taking care of my own mental health.

There are a number of intentional activities that have sustained my balance, hope and energy for the profession over three-and-a-half decades. The most potent of these might be to stay in my own lane. Regardless of the job I do, I recognize that others will do it differently and not comparatively. I’ve both supervised and provided counseling for other professionals who find their energy zapped, their attitudes hostile and their work disrupted due to a comparative evaluation of colleagues as either better or worse in some area of the job.

An early mentor of mine encouraged me to realize that what another [counselor] does — except in cases of gatekeeping — is none of my worry and that others might rise if they feel support and care. This has led me to celebrate my peers’ work, to be open to learning from them, and to generally feel positive about heading into the workplace in each of the venues [in which] I’ve been honored to work. The closest I’ve come to burnout involved colleagues who were unjustly negative. It’s truly an art to turn that around.

This leads me to the second most powerful agent of enthusiasm building: learning. I am a lifelong learner. I deeply value finding new theory, technique, strategy and skill and, even more, a deeper understanding and wisdom regarding the human condition. I just reread, along with one of my Gonzaga classes, [Viktor Frankl’s] Man’s Search for Meaning to jump-start our trek of discovery this semester.

This is related to a third factor: I mix up my work and the populations I serve. I teach, provide community prevention services, crisis intervention, group work, couples and family work, and individual counseling with as diverse a set of individuals as I can in my community. It’s never dull, I am never bored, and I am constantly learning more about each person and about humanity at large. I’m constantly reminded to advocate where needed but to not turn my attention to embitterment.

  Elisabeth Bennett, a professor at Gonzaga University who has had a counseling practice treating couples, families and individuals in Spokane, Washington, for 35 years

 

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Sixty years ago, with new graduate degree in hand, I was hired as a school counselor. My counseling career had begun. Over the years, it has taken different shapes as jobs, settings, responsibilities and functions changed. Then, 21 years ago, I gave up tenure, license, income and position to retire. From the beginning to the official end of my active career, I have been energized, shaped, nurtured and sustained by an intense fascination with people.

My graduate education, combined with my fascination, shaped the way I interacted with people when I wore the hat of counselor or educator. Focusing on how people communicate and relate as casual friends continues to hold my attention. In both my professional and personal life, I have worked to be aware of that fuzzy line that separates intense conversation from therapeutic response, and I have worked hard to respect boundaries — both for myself and for the person or persons in the other half of the communication.

Early in my graduate education, I was given the maxim: “Counselor, know thyself.” It has been a guiding principle. Throughout my active career, regional and national conferences fed me with new ideas, refined techniques, and gave me rewarding interactions with professional colleagues and friends. I have always tried to have a group to whom I felt some accountability and who could assist me in that self-knowledge arena. In retirement, I have a regular group of friends to keep me grounded but without the professional expectation.

In retirement, I increased my volunteer activities in noncounseling situations that still required that I be a listening, caring individual. As example, for several years I facilitated a group of caregivers who met to share the pain and stress accompanying that role. I was facilitator, not group therapist. It worked for them and for me and was richly rewarding.

There came a day when I realized that my hearing loss and my inability to keep all the details of a conversation in my mind were affecting my facilitation skill. I knew myself. And I knew that my performance fell short of my expectations. Knowing myself means knowing what to do; it also means knowing when to quit.

I have had a good professional life. The fascination with people that moved me into my career remains high. It continues to sustain me in retirement. I hope it will continue to do so.

  Brooke B. Collison, an emeritus professor of counselor education at Oregon State University and a fellow and past president (1987-1988) of ACA

 

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When I started my counseling training in 1990, I knew I wanted to pair expressive arts therapies with counseling. That has helped me build a long-term career. We artists recognize creation as a metaphoric marathon versus a sprint. The first draft of an art project does not have the rich depth of the final product.

Artists recognize that the path of producing a work of art — like an actual marathon in comparison to a sprint — travels a variety of landscapes such that the path often doubles back on itself. You revisit various aspects of each work of art and massage each aspect until each art piece feels completed.

Others, of course, have spoken of the art of counseling. I add to their words as I invite the dance of creation, which is different than a marathon or a sprint because creation involves movement that is more varied than running. When we are schooled, we are advised to do our own therapy, and that is key.

As we do the energetic dance of relationship with our clients, those dances will stir the dances we have shut down. Stephen Porges’ polyvagal theory and Peter Levine’s understanding of trauma patterning help us recognize the burst of intense feeling that awakens moves that have been mired in shutdown.

When we lose interest in expanding our movement repertoire because we sense an intense awakening, we may push ourselves to work robotically and eventually burn out. When we risk the drama, we awaken a presence that brightens our time with our grandchildren [and] helps us appreciate the journeys of our adult kids and those of our lovers. Finding presence allows us to pause to snuggle with our cats and walk our dogs around the block.

  Dee Wagner, an LPC and board-certified dance therapist at The Link Counseling Center in Atlanta for 26 years

 

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What does it take to sustain a counselor over the long haul of a professional career?

For me, it has taken a lot of work on myself and paying attention to my needs outside of the counseling chair. If I have put my mask on first for oxygen, I am much more able to help others with theirs. When I haven’t done so, I struggle more, I stagnate more, and I find myself more frustrated. I also have truly come to believe that everything you ask a client to do, you better have done yourself. Whether that’s a sand tray therapy exercise, an expressive art technique, thought stopping, or getting to the gym, you have to do the work too.

What has kept you passionate?

There are two things that have really kept me passionate. First, every kid and family I have worked with and their willingness to show me their world and be vulnerable. This inspires me each day, and I try not to forget it. Second, supervising counselors-in-training, seeing them wade through this wonderful process, and being a part of their professional journey.

What are some lessons you’ve learned?

I think the biggest lesson I have learned so far is that I really feel like I know less and less each day. What I mean by that is I have learned to trust the process and pay attention to when I am trying too hard. When I first started practicing, I had no idea what this phrase “trust the process” meant. Now, I can feel it, see it, and have really come to appreciate it.

What does it take to stay fresh, day in, day out, and avoid stagnation?

Kids in the playroom always keep things exciting. Moreover, I try to remember that counseling is difficult for people, and I will never be doing them a service by merely making them feel good about themselves. Care is only shown in the tough stuff. Remembering that it is an honor and privilege to do this work always pulls me out of a jam in my own headspace.

  Quinn K. Smelser, an LPC, registered play therapist and doctoral candidate in counseling at George Washington University who has specialized in play therapy and trauma training. She is also a clinical instructor at Loyola University Maryland, where she teaches school counseling students and will soon offer play therapy courses.

 

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When you’re at the beginning of your career is probably when you have the most stamina. You’re excited, you’re pumped, and you have great ideas. You’ve spent years and years learning and deciding on what you’ll do, and you’ve been dreaming about the day when you’re finally there. You get the career, and the hardest part in the beginning is [that] you still have to learn some more. You must master the specifics about your colleagues, your location and your administration. More importantly, you have to learn what you’re capable of. The first few years is more learning, and you need the patience to dedicate the time to observe. Whenever a race is started, we all fight the instinct to jump out of the gate, but you need patience and persistence if your goal is long term.

As you’re learning the career and carefully collecting knowledge, it’s important to build up your reputation, also known as your street credibility or “street cred.” You build up your reputation by showing up, being reliable and completing tasks. Be careful not to overcommit because if you miss deadlines or turn in inferior work, that becomes your reputation. The learning years help you figure out what that perfect balance will be — how much you can handle, what you can complete quickly, and what requires more effort and dedication on your part.

Once you have a good reputation and you’ve figured out the key players, you build up your crew, your squad, your allies, etc. Finding this group will help you brainstorm when you’re stuck, vent when you’re fed up and considering quitting, and inspire you to keep going. How do you meet these amazing people? Professional organizations. Attending conferences, meeting like-minded professionals and joining committees is where you’ll find these treasures. Stay in touch, and make the effort to stay involved with each other in between conferences. Having good people in your inner circle is worth their weight in gold.

Lastly, create healthy boundaries. We are not only our careers. We are family members, we are artists, we enjoy hobbies, and we’re involved in our communities in different capacities. Make sure you are getting fulfilled in all areas of your life, and dedicate time to all the things that matter. Practice makes perfect, and you will find out the equations and quantities that work best for you.

  Margarita Martinez, an academic success counselor and curriculum chair for student development at Northern Virginia Community College who also serves as vice president for Latinx concerns for the Association for Multicultural Counseling and Development (AMCD), as secretary of the Virginia Counselors Association, and as co-chair of the strategic plan committee for the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling

 

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The person of the counselor is one of the most important elements in the counseling office. Participating in one’s own counseling, then, is crucially important. Creating a space to address one’s own past hurts and current relational self makes a counselor more able to see and to have compassion for themselves and for those sitting across from them.

When I participate in my own counseling, it helps me to remember what it is like to sit in the waiting room, in that awkward space of waiting, with ambivalence and yet longing to be seen. It helps me to remember the anxiety over what to say or how to answer a difficult question. But most importantly, tending to my own ongoing healing creates a generativity in me for this work. It produces more space within me to care for others in deep and authentic ways.

Also, we must continue to cultivate our own interests. This year I have been on a growth edge, learning how the feminine body holds stories in its fiber and its tissues. I have found a renewed sense of excitement as I learn. Learning can be fun, and it can also be restorative. Such learning, then, has a direct impact in the counseling room. When I am excited and growing, my work with others is much more fluid and energetic.

In addition to the above, gathering a good community of people around oneself bodes well for long-term health. Health is found in belonging. Counseling is often isolating, and it can be an easy place to hide. Such hiding and isolation are the stuff of guilt and shame and not of health and healing. Because of such potential workplace hazards, I have a consult group of friends and colleagues whom I respect. They are people who push deep into my life and into my work. They are people who challenge me and know my inner world. I would not be able to do the work I do without having these people — and others like them — in my life, caring for and loving on me, in my goodness but also in my messiness. Honesty with my consult group turns into honesty in my counseling office, all the while keeping me grounded in remembrance of how hard it is to be vulnerable.

  Laura Wade Shirley, a wife, mother of three, licensed mental health counselor (LMHC) and teacher in Washington state. She worked with children and families in community mental health for three years, prior to opening a private practice in 2003. Since 2006, she has also taught and supervised students at the Seattle School of Theology & Psychology in practicum and case conference classes.

 

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When I reflect on lessons learned to sustain my counseling career, two thoughts come to mind. The first is accepting who I am and who I am not. The second is the importance of a peer group whom I can be completely vulnerable with.

We often talk to our clients about being true to themselves. Previously, I was comparing myself to other counselors, which is not mentally healthy. I saw other counselors were receiving the most up-to-date training in their niche areas, and I wondered if I was doing enough. However, in checking in with myself, I was setting myself up for burnout. Comparing myself or going for training because I see others doing so, not because it is my area of specialization, is not what is going to sustain me for the long haul. However, I also know the importance of avoiding stagnation. It is then that I realized I need to attend my own training to keep my clinical skills sharp, while focusing on pursing additional training in my own area of focus. One cannot be an expert in everything. I had to be true to myself, just as we ask of our clients.

The second realization I had is how invaluable a group of peers is who will listen and not judge. In Irvin Yalom’s book Becoming Myself, he discusses a peer group he met with where they could talk about anything that might be impacting their practice while [still] respecting client privacy. This could range from personal problems to countertransference. While I am an advocate of counselors attending their own counseling as needed, I have also found my group of peers — whom I know I can have honest discussions with about myself, or them with me — to be the primary source of keeping me fresh and available, day in, day out, to my clients. Having peers who are available and nonjudgmental is fundamental.

Having a solid identity as a clinician and knowing who my people are, are major factors in not only sustaining my career but maintaining my inspiration and motivation.

  Deanna Johnston, an LPC who owns a private practice in College Station, Texas

 

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When I think about [career] sustainability, I think about feeling appreciated and respected by my immediate supervisor and included by my colleagues with whom I have a trusting and supportive environment. And, of course, I need to feel compensated for my work and feel that I am valued by the institution in terms of my pay. With those things in place, I’ve always felt that I can tackle the tasks at hand and be creative. That being said, I have enjoyed collaborating with colleagues, early career professionals and students at all levels — undergraduate, master’s and doctoral.

This is how I would define workplace sustainability and job satisfaction. These are my most critical factors in remaining in a career for the long haul. This has been especially true for people of color and members of other marginalized groups. Research findings have suggested that we are far too often not supported by our peers nor by our supervisors and, as a result, we become targets of workplace bullying and implicit bias. This has led to the exodus of many talented counselors [and] counselor educators who are pushed out of promising careers.

What keeps me passionate about the work are, by far, my mentoring experiences. In every position that I’ve held, I have tried to pass on my knowledge about leadership, research, teaching and relationship-building. It has been a tremendous pleasure to see my former students acquire jobs and begin mentoring others. I feel content knowing that there is another generation of counselor educators and practitioners who have embraced the ideals that I have shared and wish to pass on these ways of being to others. I am thrilled to see how they have owned and advanced my research and teaching philosophy. And I am constantly challenged by new ideas and beliefs that they hold.

My most important lesson learned is that I am only a cog in a wheel. I have contributed to the profession to the best of my ability, but my ultimate goal is to be replaced by more energetic and passionate early career scholars and practitioners. I love to stay, but I’ll love to go even more. Generativity is a good thing.

  Cirecie A. West-Olatunji, a professor of counseling and director of the Center for Traumatic Stress Research at Xavier University of Louisiana. She is also editor of the Journal of Multicultural Counseling and Development and a past president of both ACA (2013-2014) and AMCD.

 

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There are many things that I have worked on in order to prevent burning out. One of the main factors in preventing burnout has been maintaining strong boundaries when it comes to my family. It is necessary for me to put my family first and not allow my work to overshadow them. The first thing I did after establishing my LLC [limited liability company counseling practice] was to purchase a separate phone so that I could shut it off when necessary. I do not take on more clients or supervisees than my schedule can handle, and I have learned to say “no.” This can be challenging when, as counselors, we just want to be there for everyone.

What has kept me passionate? Clients. Listening to, processing and being a part of clients’ stories gives me life. There have been times in my career when I was not seeing clients due to school or pregnancy. When I stepped back into the counseling space, I was renewed and reminded of what I love about being a counselor. I have also found that working with students and young professionals has been rejuvenating. I can recall being in their shoes. Assisting them on their journey to become a counselor is immensely rewarding.

A valuable lesson that I have learned is to live each moment of your process rather than completing things simply to check boxes. I did that, to a degree, early on in my training and career. I have since learned the importance of growing with each experience and not for a moment thinking that I have it all figured out. Continuing to learn from my peers, my clients and my mentors is a process I will never outgrow.

Education and learning have always been central in my life. Staying interested in what is new or on the horizon helps me to avoid stagnation as a clinician and supervisor. I can always try something new — or even something old in a new way. Working with populations that I love and feeling that I am helping others in some small way allow me to continue without feeling my work is mundane.

Clients and supervisees will never cease to amaze me with their stories, their strength and their resilience. I feel honored to be able to be a small part of their story.

  Christina McGrath Fair, an LMHC at GentleWave Counseling, Consultation and Clinical Supervision in Stuart, Florida

 

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The challenge to remain fresh depends greatly on my ability to effectively manage my time. Revelations surrounding my career — sex therapy — are an everyday occurrence, with issues ranging from sex education [and] advocacy [to] societal influences and legislation. My task is to discern how much time and energy are placed on the given subject. One day, a legislative bill threatens the rights of sexual minorities; the next day, multicultural interventions for the trans community are explored.

Human sexuality is so fluid, any staleness on my part would deem me an ineffective counselor. I often choose topics [to explore] that I am unfamiliar with or that are highly controversial. The opportunities to stay fresh on things relevant to sexuality are ubiquitous. It is just a matter of allocating the appropriate time to the appropriate issue.

I truly believe that I embarked on my counseling career decades ago, although I have been seeing clients for [only] two years. A long-term counseling career is synonymous with a long-term parenting career or long-term partner career. Counseling, similar to parenting and partnering, is innately what I do and have done for years. The particulars — CEUs, licensure, certifications, etc. — are the extenuating factors, but I have been educating, advocating, learning and counseling for years.

For me, building a long-term counseling career comes as natural as breathing. The less organic aspect is establishing a business based on my counseling career. Fortunately, my awesome support system and deep respect for entrepreneurship allow me to feel optimistic and excited about building a business around my career as a sex therapist.

Sustaining my motivation or passion for sex therapy is relatively easy. I don’t have to plan for it or think about it. When I awake in the morning, I’m reminded of the importance of intimacy and communication with my partner. As I interact with my daughters every morning, I’m reminded of the importance of sex-positive messages that occur throughout their formative years, particularly as they develop their sexual identities. When I talk or listen to people about their insecurities or their level of dissonance, I’m reminded of how misinformation, society, trauma and self-perceptions can adversely alter the trajectory of a beautiful soul.

There is no plan or preemptive thought of how to stay motivated. Life is gracious enough to constantly remind me that people deserve to exist without the harsh barriers that impede sexual wellness.

  Cheryl D. Walker, a sex therapist and associate professional counselor in private practice in Atlanta

 

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The climb to a successful career as a licensed mental health counselor has been both challenging and satisfying.

As a middle-aged woman returning to higher education, this was my first challenge as I struggled just with that decision. Did I really want to dive in, and would I be ready for the rigor of learning? Would I do well with the time and expense commitment? Would my children and husband be supportive … and was it truly OK to be self-full? I knew it was now or never as the clock ticked on.

I know now it was the right timing and decision. I know appreciating the classroom learning, possibly for the first time in my life, was a huge benefit because I could fully direct my focus without the distractions of starting and caring for a young family.

No sugarcoating here: Working in agencies was truly brutal from a systems perspective. I took some solid lumps by inadvertently stepping on management toes. The challenge of working with clients, while most important, became second to fulfilling the job requirement of productivity. I remain very grateful to have survived the mill-type atmosphere of clients in and out. I gained such amazing clinical experience and somehow managed to be regarded as a good counselor professionally. I would encourage people going through this portion of the climb to connect with counselors, co-workers and physicians with whom they feel commonality because they will be your future collaborators and colleagues in private practice or agency [work].

What sustained me was keeping my focus on my professional goal to be a licensed counselor and eventually to own my private practice. I look back and realize I was strong even when I felt inadequate or resource-less. I’ve learned these feelings are transient and never fixed, so I trust the journey.

Seeking your professional “peeps” in regular monthly meetings that you commit to in your schedule is golden and leads to the gifts of shared respect, as well as referral pools for your — and their — clients.

I’ve learned to value what I still need to learn, [including] aspects of private practice not covered in my education or practical work and the business end of owning a business. [I recommend that counselors] hire out what you don’t know or aren’t great at until you learn it yourself. Also, keep up with learning new theories because the freshness of exploring interesting trainings [will] always complement what you know so well already. My practice is eclectic because I enjoy variety, and it has been truly exciting.

The best advice I can give now that I’ve been self-employed for a while is to allow yourself regular self-care with vacations or staycations filled with calm, fun and levity. The balance is needed, not at all a luxury.

  Lena Kieliszak, an LMHC in private practice in Rochester, New York

 

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We all sing the songs we need to hear. By trade, I am a counselor educator and a counselor whose practice is made up largely of clients who are serving in helping, healing or ministry positions. Really, in many ways, my clients are people just like me.

So, what’s your song? Kindness? Self-compassion? Tending to empty thought patterns? Engaging in better self-care? It is our humanity that frees and guides us in our work with others. It is our humanity that breeds care and compassion, the hallmarks of neural/psychological/interpersonal integration, per Dan Siegel. Because I am human, I have needs and wants, not all of which get met. I know what it means to suffer. I know what it means to experience pain and to wish for ways to relieve it or deny it. I know what it’s like to find myself returning to unhelpful patterns of thinking and acting, time and time again. Because I am human, I have a song to sing.

I hope it can be said that I am far more human than I was when I first started this work 20 years ago. If we are all on a journey of becoming who we already are, then engaging with the work of others has offered me tender moments of being mirrored in my own humanity. The reality is that I need connection just as much as my clients do. Our profession has nomenclature — countertransference, getting triggered or activated, projection, collusion, etc. — that can tend to pathologize the humanness of the encounters we may experience with those who sit across from us. But part of the rich delight in doing this work — and part of what has allowed me to log 20 years at it and to be ready for another 20 more — is that I get to hear myself say things that I need to hear as much as my clients [need to hear them]. The frame of counseling and the counseling relationship holds not just my clients, but me too.

For me, what’s most sustaining is what inevitably comes when I am full and receptive: [being] open to hearing, in whatever form and from whatever voice possible, the song I need to hear. My humanity, my work and my longevity in the field all depend on it.

  Doug Shirley, an LMHC with a private practice in the Seattle area and assistant professor of counseling at the Seattle School of Theology & Psychology

 

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Early in my career as a professional counselor, I began to see that stepping into the world of [my] clients on a regular basis with my full attention and whole heart could leave me depleted and carrying concern for these clients long after the sessions were over. In response, I took care of myself by journaling, drawing and painting to allow space for my mind to simply be and to process my experiences. I began to set boundaries to remind myself when I could just be “Adele,” take care of my own needs, and engage in living life to the fullest.

There were times I took a break from the counseling field and worked in other similar people-oriented fields, but I missed that deep personal meaning from the counseling experience. So, I sought variety in the positions or environments in which I could engage in this role rather than stepping out of it completely. Through time, I also found a wider range of ways to express myself and release tension, stress or worry, such as running, taking drawing classes and enjoying acupuncture or massage.

Later, I invigorated my therapeutic approach by becoming trained in using sand tray therapy to bring clients’ experiences to life in ways they could not simply tell me. Seeing the power of clients exploring their experiences in the sand and seeing their issues in a new way was so exciting. Most recently, I became certified in yoga to apply the powerful healing effects of mindfulness, meditation and release of tension. Invigorating my counseling practice by attending more specialized workshops allowed me to draw upon new methods and delivery of a range of treatment strategies that are impactful, effective and, at times, even fun.

Compassion fatigue from the demands of this role can take its toll on counselors. During my doctoral studies on this topic, I uncovered that counselors continually engage in empathy but may not find ways to close the deep concern needed to draw upon empathy. This was a real “aha!” moment for me. No supervisor had ever quite framed it for me this way. So, I developed ways to extend client empathy with purpose but then to step back out of it with clear intention.

Focusing on growing, being curious, and engaging in self-care has helped me to stay buoyant while navigating these powerful and deeply fulfilling experiences over the past 25 years.

  Adele Logan O’Keefe, an LPC and owner/director of Sage Counseling & Wellness in Lexington, Virginia

 

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I have managed my own private practice since 2006, and maintaining meaning and engagement has been a purposeful and intentional goal. I enjoy the marketing aspect of being a business owner, and I have made it a priority to stay current with technology and move into areas that do not come naturally to me, such as blogging and social media.

Thanks to Twitter, I follow meaningful cultural shifts worldwide. I listen to radio stations and podcasts with differing political views, as well as trending corporate leadership. Our mental health care reach is limitless, with DIY videos on YouTube, numerous virtual specialty groups on Facebook, and compelling personal disclosure at the hands of terrific authors with diverse backgrounds. I enjoy reading the Stoics as well as firsthand accounts of military culture from Navy SEALs [and of] high-achieving athletes — true psychological warriors reminding me to be the best version of myself.

It is healthy and appropriate to recognize my own areas of expertise and competence (therapists can be ambitious and confident too). As I learn my strengths and feel confident in that footing, I am more comfortable admitting to areas that need more growth and insight.

I so appreciate colleagues who have become friends. We chat often, consult, meet for walks and coffee. This is integral to my well-being and mental health. Private practice is a lonely proposition, and no one should go it alone.

I recently organized an open house for my office building. It was a true hodgepodge of small business owners with the primary goal to provide public awareness. The secondary gain was cross-referred business and a budding community.

An annual live continuing education training is always beneficial, and preferably not in my own backyard. Most recently, I drove an hour away, checked into a hotel and ordered room service (an act of self-care). The next day brought new friends and colleagues.

I encourage fresh ideas and the continued advancement of our field, such as Silicon Valley’s tech money currently being invested in psychedelic research.

My daily unwind is a meditative, 1,000-piece puzzle in the evenings. If my family feels like chatting, they can find me there. A completed puzzle gives me a sense of accomplishment. Every piece found its niche and is perfect in the end.

  Christina Neumeyer, a licensed marriage and family therapist in Carlsbad, California

 

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My identity as a professional counselor has grown in importance to me over the years as I’ve come to witness and experience the extraordinary need for our work and the positive impact we can make for individuals, families and communities. Witnessing growth, change and increased well-being with clients has been a sustaining factor in my ability to stay fresh, passionate and engaged during my career. Also, the ability to shift my focus from being a school-based counselor to becoming a health educator/coach while using my skill set and strong commitment to wellness has fed my ability to sustain. Becoming more involved in cross-cultural trainings as a trainee and then facilitator has been integral these past few years to actively address injustices and inequitable situations that clients suffer from. I feel strongly compelled to do this work as our world becomes more challenging to live within for so many people.

Keeping myself well so that I may do this work includes intentionally eating healthfully, physically moving my body in ways I joyfully anticipate regularly, drinking lots of water, getting adequate sleep and rest, receiving supportive supervision and personal counseling, and pursuing my pleasures as often as possible (time with family and friends, reading, traveling, and playing with my kitten, Daisy).

I never want to leave the profession because it is a part of me. I think I will always want to do this work in some capacity for at least a bit of time as I age.

Knowing what I know now, I could give this advice to myself at the beginning of my career: “Relax! You’ve got this. You are well-suited to share love and support with those you encounter. Take care of yourself as well as you encourage others to do for themselves.”

  Julie Bloomfield, an LPC and health educator and coach at Henry Ford Allegiance Health in Jackson, Michigan

 

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

Bouncing back from ‘failure’ as a counselor

By Lindsey Phillips March 3, 2020

Jude Austin, an assistant professor and clinical coordinator in the professional counseling program at the University of Mary Hardin-Baylor in Texas, started his counseling practicum like many clinicians do — with the lofty goal of saving lives and empowering clients. So, when he saw a client who was in an abusive relationship, he tried to do just that, reassuring her that she was a strong, independent woman who could stand up to her husband. The client took his advice. She went home and told her husband that she didn’t have to take his abuse. He responded by hitting her.

The client returned to her next counseling session with a black eye, and Austin was stunned. After recovering, he handled the crisis by informing the client he would have to report the abuse even if she couldn’t do it herself. In that moment, he realized the power he had over clients’ lives and that his words and savior mentality could get someone killed if he wasn’t careful. After the incident, Austin sought his own therapy to better understand his identity and role as a counselor.

Counselors aren’t immune from making mistakes, so they often have to deal with “failure” in their line of work. However, Jennie Vila, a licensed professional counselor (LPC) in Edison, New Jersey, would consider Austin’s interaction with his client to be a learning experience, not a failure. In fact, she doesn’t believe in failure. If a counselor learns something after making a mistake, then it was a success after all, she asserts.

“You can still be hurt by some of these struggles, but you can use that to move forward,” says Vila, an American Counseling Association member who likes to speak about the importance of mindset. “You don’t have to stay in [the pain] if you’re willing to learn from it.”

Fortunately, counselors can also learn from the mistakes of others. Here are a few lessons that fellow counselors and ACA members say they have learned the hard way.

Lesson 1: Set realistic expectations

Jude Austin, an LPC and a licensed marriage and family therapist associate in private practice in Temple, Texas, and his twin brother, Julius Austin, a clinical therapist and coordinator of the Office of Substance Abuse and Recovery at Tulane University, agree that a common mistake many counselors make early in their careers is trying to be an “ideal” counselor rather than being themselves.

Julius, an LPC in Louisiana, admits that he personally experienced this. From the day he started his counseling program, he began forming an idealized version of the future “Dr. Austin” — a professional counselor who never made mistakes, instantly identified a client’s emotions, and knew exactly what to say in session. “As a beginning clinician, one of my biggest issues was getting over the fact that [this ideal] Dr. Austin didn’t exist,” he says.

When Vila, a certified integrative wellness and life coach and owner of the business Growth Mindset, was working at a hospital, she also held assumptions about what she should be doing in session. She had one client who during active episodes of mania would barge into Vila’s office and ask for help paying her bills. Vila would call the credit card, rental and utility companies while the client waited with her in the office. When the client didn’t have the patience to wait on hold any longer, she would abruptly stand up and try to leave the room. Vila would remind her that they would just have to start the waiting process all over again if they hung up now and called back at some later point.

Vila, who is now the assistant executive director of the New Jersey Counseling Association, had imagined counseling to be more than assisting a client with paying his or her bills. Feeling frustrated and discouraged, she eventually said to her supervisor, “What am I doing for this client? We are just calling and paying her bills in session. I’m not helping her.”

But the supervisor corrected Vila: “No, you are modeling what it means to have social skills in the world. That is what she needs right now. She doesn’t need to go into deeper issues.”

This experience helped Vila realize that “not every session or client you work with [requires] deep psychotherapy. Sometimes, it is life skills or soft skills. That’s its own kind of therapy.”

Lesson 2: Embrace that therapy is an active process

Counselors frequently wrestle with a sense of failure when they feel like they have messed up or could have done better. But sometimes, clients will tell a counselor directly that the counselor has failed them.

Sam Gladding, a professor of counseling at Wake Forest University and an LPC in North Carolina, recalls a time when he was too Rogerian and reflective with a client. At the end of the session, the client told him, “You haven’t done a good job. I expected you to be more active in working with me.”

Those words stung, but they also taught Gladding a valuable lesson — that counseling isn’t only about listening to the client or offering minimal encouragers such as “Uh-huh,” “I hear you” and “Tell me more.” Instead, counseling is an active process. Now he makes sure to ask clients more engaging questions such as “What would you like to do?” “What do you think would be a good response to this?” and “What are some choices you have in this matter?”

Also, instead of starting sessions by asking what clients want to talk about, Gladding asks, “What do you want to work on?” This phrasing sets a tone and expectation that counseling involves work and action.

At the end of the day, “it’s our interaction [with the client] that is going to make or break the session,” says Gladding, a past president of ACA. “We can’t control everything, so [we] control what we can, and we have to let the other happen as it will.”

Lesson 3: Be mindful of what you bring into the therapeutic relationship

Counseling is a professional relationship, and because of that, counselors’ personal lives can affect sessions. When Julius Austin was working as a clinician at a university during the final year of his doctoral program, his dissertation chair called him to say that his committee had requested some final revisions. This meant he would no longer graduate that spring. He was devastated and embarrassed. His family had already bought tickets and were excited to see him and his twin brother, Jude, graduate together. As soon as Julius hung up the phone, he received another call informing him that his next client had arrived.

In retrospect, Austin says he should have explained the situation to the client and rescheduled the session so he could have taken time to process the news he had just received. Instead, the client came in and started talking about her decision to drop out of school and travel the world to gain real-life experience.

Austin recalls opening his mouth and unleashing his frustration on the client by saying, “You know, traveling doesn’t work like that.” He proceeded to paint a grim picture of traveling — one filled with misplaced luggage, missed connections and lost photos.

The client was quiet for a few seconds before responding, “I’m sorry that you haven’t had a good experience traveling, but I don’t think that is the case for everyone. I think I’m going to leave now.”

Austin, co-author with his brother Jude of the recently published ACA book Surviving and Thriving in Your Counseling Program, says that he had a great relationship with the client up until that moment. But after that encounter, he never saw her again. He instantly regretted what he had said, but counselors don’t always get a second chance to fix their mistakes in session.

Austin still laments that his personal struggles made him lose a client that day, but the lesson he learned from the experience has positively influenced his handling of subsequent therapeutic relationships. He says he has grown more aware of how he feels in the moment and is more intentional about what he says to clients in session.

Similarly, Suzan Thompson, an LPC in private practice in Virginia Beach, Virginia, acknowledges allowing her own feelings to affect her relationship with a supervisee. In their final session together, the supervisee said, “I’ll contact you for supervision in the future.” Previous supervisees had made similar claims without following through, so Thompson was skeptical. Without explaining that fact, she replied, “I doubt you will.”

Thompson, the author of an ACA member blog on failure (“Toolkit for Transformation: Allow Yourself to Fail”), instantly regretted her response. She tried to process her mistake through supervision, journaling and emotional freedom techniques (EFT) tapping. The misstep still lingers in her mind, but she hasn’t made a similar mistake again. In fact, recently, when another supervisee said she would like to continue supervision, Thompson laughed and replied, “I would love to have you come back.”

Sometimes a simple regionalism or phrase can lead to a misstep. Because Jude Austin is from southern Louisiana, he says he often uses “man” in his greetings (for example, “Hey, man” or “How’s it going, man?”). Once, a new client who was in gender transition was waiting in the office. Austin walked out and casually said, “Hi, man. Ready to come back?”

Instantly, the client’s face changed. Austin didn’t yet realize what he had done, but he decided to address the tension the second they started their session: “It feels awkward right now. Did I do something to make you feel uncomfortable?”

After discovering his mistake — and that the client preferred they/their pronouns — Austin apologized and explained that “man” was a common phrase where he came from. Even so, he promised not to use the phrase again.

Lesson 4: Be forgiving of your mistakes

Jude Austin had just finished eight hours at a supervision site when he met with a client. It was a beautiful fall day, and the windows in the room were open. The client spoke in a low, soft voice, and before Austin knew it, he had nodded off for a few seconds. When he woke up, the client was crying and saying, “You’re right.”

The client hadn’t noticed that Austin had gone to sleep, so he asked what had most affected her during the past few seconds of the session. The client said, “You sat there listening so quietly.”

Austin was mortified. Even though he hadn’t been caught dozing, he knew he had failed the client because his job was to be present — and he hadn’t been. He sought supervision and realized that he wasn’t taking proper care of himself, including getting enough sleep.

Gladding, who is president of the International Association of Marriage and Family Counselors, also fell asleep once during a session with a client, but his client noticed and was not happy. Gladding apologized and tried to turn the focus back to the client by asking how people in the client’s own life might not be listening to him. (Gladding wrote about this experience in his book Becoming a Counselor: The Light, the Bright and the Serious, published by the American Counseling Association Foundation.)

Those experiences taught Austin and Gladding the importance not only of self-care but also of self-compassion.

Counselors have to be “forgiving of [their] mistakes, forgiving of [their] own thoughts and forgiving of [themselves],” Julius Austin adds.

From Vila’s perspective, self-compassion is the biggest component in whether someone views an event as a success or a failure. Counselors are great at reminding clients to practice self-compassion, but counselors need to apply that same courtesy to themselves, she says. Of course, that is often easier said than done. Vila finds it helpful to externalize her problems or frustrations, asking herself, “If I had a client who came to me with this problem, what would I tell them?”

Lesson 5: Don’t be afraid to be vulnerable

It’s common for beginning counselors to feel like impostors whose mistakes will mark them as unfit for the profession. For this reason, Gladding and Julius Austin both say that counselor educators and supervisors should be vulnerable and share their own missteps.

“As educators, it’s important to share times where we felt uncomfortable, where we failed, where we had a setback or where things didn’t really go that well for us in session,” Austin says. “Being that vulnerable with students can really help [them] understand that it is possible to fail and still create meaningful, powerful relationships with clients.”

Austin also strives for vulnerability with clients by using the inside-out technique, which means sharing whatever he is feeling on the inside with the client. So, if he makes a mistake in session, such as missing a feeling word or not being as attentive as he should be, he directly addresses that as soon as he realizes it. For example, he may say, “I’m feeling like I missed something in your experience, and I feel like we should retrace our steps.”

Jude Austin agrees that the inside-out technique is an effective way for counselors to handle missteps. For instance, he sometimes finds that couple sessions can quickly escalate into an arguing match and leave him feeling overwhelmed. When that happens, he verbalizes his own needs out loud: “I need you to stop talking for a few seconds. I feel lost, and I need 30 seconds to collect myself. And if I feel lost, I can’t imagine how lost you must feel.” This technique can give counselors the break they need to find a productive way to move forward.

“It takes a lot of courage to be vulnerable,” Vila says. Like lots of other counselors, she has had sessions where she later wished she had said or done something differently. When this happens, she is open with clients and says, “I’ve been thinking about what I said in the last session. It’s been bothering me. Has it been bothering you?”

Vila will also be upfront with clients if she is having an off day. For example, if her dog isn’t feeling well or if she is recovering from a head cold, she will apologize in advance if she isn’t 100 percent in session.

Lesson 6: Approach sessions with curiosity

One of the biggest mistakes clinicians can make related to multiculturalism is not approaching differences or even sameness with curiosity, Julius Austin says. He acknowledges that it would be easy for him to assume that an African American male client who is also a former student-athlete would share the exact same experiences as him, but the reality is that everyone’s experiences are unique, regardless of whether two people share certain similarities. “It’s really important to approach each person, each identity, with curiosity and childlike unknowingness and humility,” he says. “To understand somebody’s experience is giving yourself permission as a clinician to learn and be wrong.”

Jude Austin says he wishes he asked two simple questions more often to avoid potential awkward moments or miscommunications in session: “What’s your experience with me right now when you sit down and look at me?” and “Think about who you are as a person — your background, sexual orientation, race/ethnicity, etc. What’s something you want me to know about you so that I can build a better relationship with you?”

Lesson 7: Adopt positive habits

It’s easy for counselors to beat themselves up mentally for making mistakes, but they can adopt healthy habits to counter these missteps. Gladding often uses thought-stopping techniques such as focusing on the negative thought for a few minutes and then saying “Stop” quietly in his mind. Sometimes he will change the scenery (e.g., go outside) or exercise (e.g., go swimming) to help clear his mind. Gladding jokes that he should have gone for a walk with his client the day he fell asleep in session.

Ultimately, failure is about how a person internalizes an event, Thompson notes. If the person considers themselves (rather than the activity or technique) to be a failure, then they have to address their negative self-talk, she says. To help her monitor and manage her negative self-talk, Thompson started a morning routine in which she texts a friend about something she is grateful for — such as a beautiful day or the fact that her dog didn’t bark and wake her up that morning.

Vila also focuses on the positives by keeping a “one good thing about today” message board (a practice she adopted from a psychiatric hospital where she once worked). This involves writing down one positive thing that has happened to her that day. Sometimes it’s as simple as “a client thanked me” or “there wasn’t any traffic on my way to work,” and other times it’s something more notable, such as “I got a promotion.”

Vila says it may be difficult at first for counselors to find something positive to say about a bad day. In fact, she admits that on certain days, the only good thing may be that the day is over. “But as you start to look for more positives, you’re eventually going to have a hard time picking one thing to put on the board. You’re retraining [and] rewiring your brain to look more for the positive and to filter out and not focus on the negative as much,” she explains.

If counselors find things are not going well in session, Gladding advises them to take a few minutes to collect themselves before proceeding. They could excuse themselves from the session and quickly talk to a supervisor or colleague, or they could simply take a deep breath and look at their notes to gain fresh perspective and identify new insights, he says.

Lesson 8: Take risks

Counselors may avoid taking risks out of a fear of making mistakes or failing, and often for good reason. In 2001, Thompson, who offers training in supervision as well as complementary and integrative therapies to professional counselors, left a good job to start her own private practice. Shortly after taking this career risk, she went through a separation and divorce. She admits that during this time, she could have felt like a failure (and in some ways she did), but she decided to focus on how she could use the experience to learn and grow. So, while slowly building up her practice, she devoted an hour a day to learning a new counseling technique — EFT tapping — which is now the main counseling approach that she uses in her practice.

A few years later, Thompson suffered another loss when a miscommunication caused her to lose a close friend. But again, she ultimately turned the situation into an opportunity. While using counseling tools to cope with her loss, she realized she had collected and learned a stockpile of such tools throughout her career. She decided to write them all down. Within a few days, she had compiled a list of 75-80 tools and descriptions. The list eventually evolved into a deck of cards, dubbed the Toolkit for Transformation, that provides other counselors with practical tools and strategies for helping clients and themselves when they experience setbacks.

Missteps in session can also become information that assists counselors in better understanding how to help their clients. Thompson once forgot she had reduced a fee for one of her clients, so she accidentally overcharged the client for a month. The client caught the error and mentioned it awkwardly in her next session with Thompson. The client’s worried face instantly changed to relief when Thompson apologized and said she would deduct the overpaid amount from that session. This information prompted Thompson to ask about money in the client’s life, and she discovered that the client had money issues that had not been brought up before in session.

“Our biggest struggles are also our greatest opportunities for learning and growth. Those biggest struggles — especially when they’re bringing us to our knees — also bring our life lessons,” Thompson says. “We really don’t learn when we are in our comfort zone.”

Lesson 9: Become friends with failure

Making mistakes over the course of a counseling career is — in one word — inevitable. “You fail almost every five minutes as a therapist in session. There’s always some small failure,” Jude Austin says.

Counselors will not always say the right thing or be “perfect” in every session. As Gladding notes, perfection is not a human quality, so counselors will most assuredly make mistakes. The important part, he says, is that they learn from these mistakes. In fact, Gladding points out that self-doubt can be a strength in counseling because it helps counselors reflect more deeply on their role and be more attuned with clients who are vulnerable and having a difficult time.

Austin’s misstep with the client in an abusive relationship stuck with him and ultimately forced him to contemplate his identity and purpose as a counselor. “One way to handle failure is to figure out what you’re doing,” he says. The experience taught him that he wasn’t there to “save” clients but rather to help guide them through difficult situations and give them tools to help them help themselves.

The experience (and other missteps that have followed since) also taught him that he can’t avoid failure. “Failure is a part of our experience,” he says. “You have to build a relationship with failure. Make it your best friend [as a supervisor once told him]. Get to know what it feels like. Get to know how it affects your family and relationships … because the more awareness you have of your failures and who you are when you fail and how you react when you fail, the more freedom it gives you” to be more genuine with your clients about those failures.

Like any relationship, therapy will feature its fair share of missteps and miscommunications, and that can leave counselors feeling like failures. But, remember, you are not alone in this feeling. By adopting a growth mindset, you can learn from your mistakes and continue growing as a counselor.

So, go ahead and fail. You never know what you’ll learn from it.

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

Letters to the editor: ct@counseling.org

 

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