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Professional Issues

How to land an internship you’re excited about in 48 hours or less

By Wesley Murph January 19, 2022

The accident happened on a sunny Saturday afternoon.

I was driving home from my internship site, where I had seen clients that morning, when I stopped at a red light. As I changed the radio station on my car’s stereo, I heard screeching tires and crunching metal.

Then, as if I were in a Steven Spielberg movie, a maroon-colored car launched over the back of my car. It landed on its side and skidded down the asphalt against oncoming traffic.

As I stared at the unfolding scene, something big plowed into the back of my car, pushing it into the car in front of me. Glass shards and taillight debris rained down inside of my car.

I glanced in the rearview mirror and saw green liquid spewing from the van that was now embedded in my car. I feared that my car would explode and that I would be burned inside. As quickly as I could, I opened the door on my car and stepped on to the slick pavement. I glanced around to make sure I wouldn’t be hit by an oncoming car and heard a woman screaming from behind the maroon car. I immediately dialed 911.

“There’s been a bad accident,” I said to the 911 operator. “I think people are hurt. Please send help quickly.”

Minutes later, several police cars arrived and began directing traffic. A firetruck and an ambulance arrived next. A first responder said the woman driving the maroon car was shaken up but was otherwise OK. Just to be safe, they were taking her to the hospital.

I sat down on the sidewalk, grateful that nobody was seriously hurt. But when I looked at my car, I knew it was totaled. I also knew I would have to find a new internship site because my site was 60 miles from my home and the majority of clients I saw were in-person.

A few days later, I emailed my internship coordinator at the graduate school I attended and told him what had happened. We met on a video call, and he said it might be three months before I was placed at a new site. “If that happens,” he said, “you may not graduate on time.”

My pulse quickened. I had been in graduate school for nearly two years, and I was six months away from graduating. I needed 150 additional direct client hours to walk with my peers, and there was no way I was going to wait three months to find a new internship site.

So, I put on my marketing hat with one goal in mind: to find a new internship site. I never imagined what would happen, but I am grateful to say that I received five internship offers in 48 hours.

I would like to share what I did so that others looking for an internship site can find one they are excited about. Or you might tweak my campaign to connect with potential supervisors and land a new job.

I can’t guarantee the results if you follow this campaign, of course. But I can say it will help you connect with counselors in your area. It will also strengthen your sense of confidence and freedom by giving you more control over your future.

Google search

The first thing you need to do is find clinical supervisors for whom you want to work.

I played around with keyword searches in Google until these searches brought me to a webpage containing nearly a hundred clinical supervisors in my area. The webpage had a picture of each supervisor, a paragraph about the supervisor, and the supervisor’s email address and phone number.

I carefully read each supervisor’s bio until I found 25 whom I wanted to contact. I then researched the various supervisors using Google to find out more about each person. I went to each supervisor’s website, if they had one, and read their “About Me” page. I wanted to make sure that I genuinely connected with each supervisor before reaching out to them in an email.

I recommend that you complete this step too. Research the clinical supervisors in your area until you have a list of folks you want to work for. Really get to know these people. What clinical theories do they practice? Have they published any studies? If so, what are the results of those studies? How did they get into counseling? Have they written any blog posts or been a guest on a podcast? If so, what did you learn from their post or podcast? Do a deep dive into these people so you can honestly say to yourself whether you would want to work with them or not.

Next, I encourage you to create an Excel or Google Sheets file to help you keep track of your campaign. I created a new Google Sheets file using these headings:

  • Full Name
  • Email
  • Phone
  • Specialty
  • When Contacted
  • Response
  • Result

I filled my Google Sheets file with the 25 clinical supervisors I liked and connected with the most. I then sent a sincere and personal email to each of these supervisors.

Cytonn Photography/Unsplash.com

Email marketing

Here is what I wrote in the email:

 

Subject Line: Clinical Supervision?

Hi (First Name of Supervisor),

 

My name is Wes.

I found your contact information online, and I connected with you because ________. I am reaching out with a question about clinical supervision.

I am completing my master’s degree in clinical mental health from Northwestern University. I am supposed to graduate in March 2022.

Last January, I started my clinical hours at an internship site in Salem, Oregon. I live in Portland, and in August I was involved in a car accident that totaled my car. I am unable to drive to Salem to complete my clinical hours and am looking for a new internship site closer to my home.

Do you know of a licensed mental health clinician in Portland who may be interested in letting me finish my clinical hours underneath their supervision?

If not, do you know someone I can contact who may know someone?

I appreciate you for taking time out of your schedule to read my email.

 

Very respectfully,

Wes

 

Notice how the first paragraph has a blank line. This is where you put the information you gathered from your research. The more specific you are, the better connection you are likely to make.

The third paragraph contains my story. It grabs my reader’s attention because it’s heart-wrenching. You may not have a story like mine. But that’s OK. You can tell your contact another powerful reason why you would like to work with them.

The results

I emailed 25 potential supervisors on a Thursday. I received 18 responses and scheduled video interviews with five of them. I interviewed with one supervisor that Thursday night, three on Friday and another one the following Monday. All five of these amazing supervisors graciously offered to take me on as their intern. Working for any of them would have been delightful, but I chose the one that aligned best with my goals.

I relayed this information to the placement team at my graduate school. A day later, the site at which I wanted to intern was approved.

I also responded to each supervisor who got back to me. I told them I was thankful that they took time out of their schedule to try to help me and that I hoped we would bump into each other at a professional conference in the future.

I made sure to sincerely thank the four sites that offered me an internship but which I politely declined. This is respectful and maintains the relationships I established with each of these generous supervisors.

I was amazed at the outpouring of support from the counseling community in my city. The counseling community in your area is likely just as supportive. All it takes is a sincere and genuine email to open a conversation with someone you admire and want to work for. Who knows what will happen? But this process gives you some control over your future instead of simply hoping that fate is on your side.

 

*****

Before he began a master’s degree program in mental health counseling, Wesley Murph owned two small businesses, including one that was featured on The Dog Whisperer with Cesar Millan. He currently helps couples communicate more effectively so that each person feels valued, heard and appreciated. He also works with men to resolve anger issues and relationship conflicts that are lowering their quality of life. You can find him at BuildingBetterMenPDX.com.

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

Culture-centered counseling

By Lindsey Phillips November 22, 2021

The 2020 census revealed a growing multiracial U.S. population, with the number of people who reported multiple races increasing from 2.9% in 2010 to 10.2% in 2020. Part of this increase stems from changes the U.S. Census Bureau made to the questions about race and ethnicity to more accurately capture the shifting demographics of the nation’s population. These changes included removing the word origin on the instructions for the Hispanic ethnicity question, because this term can mean different things to different people, and adding write-in response areas for the question about racial identity. 

The counseling profession could also benefit from rethinking the way it approaches diversity and multiculturalism. Most of its foundational theories and approaches, such as psychoanalysis, cognitive theory and cognitive behavior therapy, were developed by white men, leading many counselors to ask whether these approaches still meet the needs of an increasingly diverse and multiracial clientele.  

Answers to these questions are not easy or straightforward. Some counselors want to revise or adapt these foundational counseling theories to make them more inclusive, while others argue it’s time to make room for more culture-centered theories or even create new ones.

The thought of adapting traditional forms of counseling to make the process more appropriate for culturally diverse populations bothers Derald Wing Sue, a professor of psychology and education at Teachers College, Columbia University, because “it almost assumes that no societies or other groups ever had anything like counseling or psychotherapy,” he says. Instead, he argues the mental health field should broaden its understanding of Indigenous and non-Western help-giving networks.

Broadening the theoretical perspective 

“All theories of counseling and psychology represent worldviews, primarily ones from the developer of that theory,” says Sue, the author or co-author of several books and articles on multiculturalism, including Counseling the Culturally Diverse: Theory and Practice and Race Talk and the Conspiracy of Silence. Rational emotive behavior therapy, for example, stems from Albert Ellis’ view that problems reside in the cognitive realm. In turn, these theories “represent worldviews that define normality [and] abnormality, what is therapeutic [and] what isn’t therapeutic,” Sue says. “So, the first objective is for therapists and systems of counseling and psychotherapy to deconstruct their worldviews.” 

Sue also argues that theories of counseling and psychotherapy should encompass an understanding of the social-political dynamic that affects the counseling situation. Many clients come to counseling with a worldview that is intimately linked to their status as a member of a marginalized group and the social-political dynamics surrounding that status, he notes. 

“Therapists often don’t understand that in their work, they may be encouraging clients in a forced compliance to assimilate and acculturate [and] to do things the white, Western way,” he says. “A liberated form of helping is one that recognizes strongly the social-political element and is unafraid to include that as part of the counseling session and structure that is going on.” 

Although many theories of counseling and psychotherapy attempt to do this, they have done it in a way that is not well integrated in terms of the system of counseling, he adds.

In addition, Sue, co-founder of the Asian American Psychological Association, points out that counseling theories typically study only one aspect of the human condition: the behavioral self, the feeling self, the cognitive self, etc. But human beings contain more depth; they are also cultural, political and spiritual beings, which traditional counseling can often overlook.  

Culture-centered counseling theories such as liberation psychology, relational-cultural theory and critical race theory begin to address some of the gaps in more traditional counseling approaches. These theories have basic tenets that counselors can use as a foundation for how they interact with clients, says Regina Finan, an American Counseling Association member whose research interests include multiculturalism and social justice. 

One tenet of critical race theory, for example, is that race is a social construction with real-life implications, she notes. Critical race theory asks people “to stretch and expand themselves, and bracket all the things they think they know and understand as ‘right’ and ‘true’ [about race and racism] and make space for things that they can’t understand because they haven’t lived it,” Finan says. “But isn’t [making space for clients’ experiences] what we are trained as counselors to do? … We just don’t always talk about it in terms of race, sexual orientation, gender identity, religion and all these pieces.” 

Even if counselors have never experienced depression or anxiety themselves, they don’t doubt that their clients have, says Finan, an assistant professor of counselor education at the University of West Georgia, and they set about educating themselves on those issues. That is what equity-centered theories are asking counselors to do, she stresses.  

For example, a Black client might have panic attacks whenever they get pulled over by the police. A counselor could choose to use cognitive behavior therapy to help this client because it has been shown to be an effective treatment for panic attacks. But the counselor could also approach this situation using the lens of critical race theory, Finan says. This lens can help situate the client’s fear as rationale within the broader systemic context of police brutality and racial bias. Being culturally aware will help the counselor broach this issue with the client and remind them that the problem is a systemic one, not something that is “wrong” with them. 

Broaching the topic is important, Finan adds, because although the counselor may find that there is a specific fear associated with the client’s race, it is also possible that the client fears getting in trouble. Ultimately, the counselor has more information, and then they can work together and use appropriate techniques to help the client manage the panic attacks and explore the concerns underlying the attacks.

Unlike many traditional counseling theories, Black existentialism asks counselors to broaden their perspectives and sit with the knowledge that there are multiple truths and experiences, notes Linwood Vereen, an associate professor of counseling at Shippensburg University of Pennsylvania. In the article “Black existentialism: Extending the discourse on meaning and existence” (published in The Journal of Humanistic Counseling in 2017), Vereen, an ACA member, and his colleagues explain how Black existentialism aims “to merge both individualistic and collectivist representations and dimensions of the respective self, in such a manner that the real and constructed selves are intricately bound with the social circumstances human beings find themselves situated within.”  

This theoretical approach challenges counselors to find ways of applying this notion of individual existence to clients who live and operate within communities, he adds.

Doralis Coriano Ortiz, an ACA member and licensed clinical professional counselor in Illinois, acknowledges that theories that are more culturally centered can provoke uncomfortable feelings for some counseling professionals because these theories often challenge what they have been taught in the U.S. educational system. These theories often force counselors to confront the racist origins of counseling and psychology and the ways they have appropriated and repackaged Indigenous practices, she says. 

Taking a culture-centered approach 

Culture-centered theories acknowledge that people are affected not just by interpersonal relationships but also by larger systems, notes Finan, the Association for Multicultural Counseling and Development (AMCD) vice president of multiethnic, multiracial and transracial adoptee concerns. This view allows counselors to broaden the context for clients, helping them realize that the counseling relationship involves more than just the counselor and client; it’s about the counselor’s and client’s lived experiences, which are embedded in their families’ lived experiences, as well as privileges and marginalized experiences, she says. 

If a client is struggling with how racism or poverty is affecting them, Finan suggests that the principles of critical consciousness and liberation psychology can be used to engage the client in a conversation about how systemic and historical oppression can shape them. She may have clients complete a family genogram to unpack the role that racism plays in their life. Clients can go back as far as they are able in their family tree, thinking about the experiences that their family had with racism, how that shaped them then and how it continues to shape the client today. 

The goal of this exercise is to help clients clearly understand the systemic nature of racism and realize that these experiences are not their fault, says Finan, co-author of a book chapter on intersectionality in Introduction to 21st Century Counseling: A Multicultural & Social Justice Approach. (The book is co-edited by ACA President S. Kent Butler.) In addition, this strengths-based approach seeks to center the resilience and characteristics of individuals, which in turn can be used to reject deficit narratives created by oppressive systems, she adds.

Monica P. Band, a licensed professional counselor and clinical supervisor who owns the private practice Mindful Healing Counseling Services, with offices in Washington, D.C., and Manassas, Virginia, also highlights how systemic factors affect her clients’ mental health. For example, she has worked with several women of color who were struggling with impostor syndrome. Some counselors may be tempted to focus on changing the client’s thoughts and behaviors around being an “impostor” without first considering context, Band says, but then they are leaving out a large part of the problem. 

“While the experiences of impostor syndrome are not unique to BIPOC [Black, Indigenous and People of Color] folx, the experience takes on a different tone, and cultural influences must be considered,” Band explains. “Most spaces are not created for [this client]; in fact, they often actively exclude her and, historically, have been meant to exclude her via legislation or social norms. So, some of the discomfort that the client is experiencing is not about her ‘not being enough’ but an appropriate and natural reaction to systems which have defined her as ‘not enough,’ and the client has internalized harmful narratives like this.”

She advises counselors to be cautious and avoid pathologizing the client’s distress and instead be active in observing the client’s lived experiences. “When believed, narratives associated with impostor syndrome like ‘I am not good enough’ or ‘I shouldn’t/don’t deserve to be here’ continue to perpetuate the oppressive nature of impostor syndrome by attacking the client’s self-concept,” Band says. “It is our goal as culturally competent counselors to call out and normalize these narratives by providing a broader, historical understanding for our clients by decolonizing and deconstructing their intersecting cultural identities with them.”

First, Band would normalize the client’s complex feelings of shame and pressure to succeed around being an “impostor,” and she would remind the client that the feelings associated with being an impostor, counterintuitively, helped the client survive in oppressive spaces at one point in her or her ancestors’ lives. “When I say surviving oppressive spaces, what I mean is to adapt and assimilate,” she explains. “At some point in history, BIPOC folx learned that in order to survive physically and emotionally, sometimes it was necessary to make oneself smaller, to not be seen, to not take up space, to not be [themselves] — in other words, oppress [themselves] and adapt to the legislation that has excluded [them] from these spaces.”

When these individuals enter spaces where they don’t feel like they belong or that don’t have many people with similar cultural backgrounds or lived experiences, Band continues, they begin to ask themselves, “Is this a mistake? Should I be here? Why am I here? It doesn’t feel safe.”

When Band and the client step back and begin to deconstruct the perspective of belonging considering this context, the client can then grieve the lost opportunity that resulted from intergenerational trauma and inequitable systems. The client can also learn to intentionally respond to these systems rather than react out automatically, Band adds.

“Counselors must contextualize these harmful narratives [and] understand and focus on the history as a source of strength,” Band argues. “The client has autonomy in choosing these narratives as their own once they build conscious awareness. The client and [counselor] then can build upon the strength, energies and spirits of [the client’s] ancestors as motivation and reflection. The counselor is not just working with that individual client in front of them on that couch; they are working with the ancestors and traumas the client brings with them.”

Liberation psychology means redirecting pathology away from individuals and onto systems that create environments where it is not possible for someone to be healthy, says Sarah Sevedge, a licensed mental health counselor in private practice who also holds a doctorate in counseling psychology. LGBTQIA and BIPOC clients have come to see Sevedge because of anxiety, depression and trauma — issues that can stem, she says, from the fact that they live in rural, conservative areas that may be antagonistic toward their identities. Sevedge realizes that the larger societal and systemic issues affecting her clients’ mental health work against their ability to be fully healthy, but often her clients view their mental health issues as personal failures. 

“So many clients look at mental health issues as if something’s wrong with them — they’re anxious, they’re depressed,” Sevedge says. She reminds them not to be upset with their bodies for responding appropriately in unhealthy environments. “If you have high levels of anxiety in an oppressive context, then your body is functioning properly; you’re not the problem,” she explains. “But we don’t always look at it that way.” 

Sevedge also tries to create a brave space within the oppressive environment by not being neutral about the oppression and validating her clients’ experiences. She believes clinicians must be willing to step into a therapist-activist role in the community and actively engage in the larger social dialogue on diversity and multicultural issues. Counselors can do this, she says, by attending Pride and Black Lives Matter events, participating in discussion groups about these topics, and integrating inclusive symbols into their practice (e.g., Pride flags, anti-racist and religious-inclusive artwork). Counselors can also refer clients to peer groups and other social support networks that share similar struggles to help them form community. 

Coriano Ortiz, a bilingual psychotherapist at Live Oak, a psychotherapy group practice in Chicago, often works with first-generation college students of color who attend primarily white institutions. So, if a client tells her that they have anxiety and don’t think that many people like them at school or can relate to their experiences, she doesn’t encourage them to challenge this “irrational thought.” That would only gaslight their experience, she says. Instead, she explores possible systemic issues that could be causing the client to feel this way. She asks questions such as “When did you first feel like others didn’t like you?” and “How is the transition from home to college going? Are you making friends?” These questions quickly reveal the underlying issues at play and help clients realize that their beliefs are not irrational and can be an understandable reaction to white supremacy. 

Clinical work will not always specifically be about race, gender or culture, Finan adds. Sometimes a client’s presenting issue is just about depression or anxiety, but counselors should be open to listening for when culture does play a role, she asserts. 

Decentering whiteness 

Band, an ACA member who serves on ACA’s Anti-Racism Commission, and Coriano Ortiz are intentionally decentering whiteness in their practices by asking their white clients some of the same questions that are often asked of clients from BIPOC communities.

Counselors “don’t [typically] ask white people the same questions we ask people of color,” Band says. “Some of that’s for good reason because the trauma experienced historically is felt and experienced to a greater degree by BIPOC. Counselors want to be respectful of these differences in lived experiences by acknowledging and discussing race, ethnicity and various marginalized identities within the counseling session. However [this focus] often exclude[s] accountability for white people and their lived experiences. For example, by counselors not asking how white people feel about certain sociopolitical events, they are at risk of preserving white supremacy within the space. We can so readily talk with BIPOC folx on how it feels for them as a member of their community in relation to — insert a sociopolitical event — but asking white people the same is uncommon.” 

One of Band’s office locations is near the U.S. Capitol. So, in the aftermath of the Capitol insurrection on Jan. 6 — an event she believes illustrates a buildup and continuation of hate and violence toward marginalized communities — she asked all of her clients what it was like for them to see those events unfold. She got some culturally humbled responses from her white clients. One admitted they had not considered how, as a white person, this event could also affect them. 

“They didn’t think about it because white is the default,” Band stresses. “Right now, white is seen as a monolith; it’s created that way because that’s how white supremacy maintains power. … So, if you don’t ask white people what does that mean for them as white people, then we’re not going to begin to break through the identity development that needs to occur.” 

fizkes/Shutterstock.com

This simple question allowed Band’s white clients to become more self-aware and to pause and consider how they are also a part of the community, and it challenged them to reconsider their own privilege and accountability, she says.

“Most of the white clients I work with mean well, and they are deeply empathetic to BIPOC communities, which is why most of their focus is on how that makes others — i.e., BIPOC folx and their families — feel when they are shot, targeted and taken advantage of by the system,” Band says. “They do not focus on how they enable an inequitable system. But the truth is we all must look at our own role in these systems.”

Coriano Ortiz also makes a point to ask her white clients about their cultural background. They frequently respond by saying, “I’ve never thought about it” or “I didn’t realize I had a culture.” She often eases them into this discussion on cultural identity by asking what their holiday traditions look like. This question helps them consider the diversity within white culture, which may be rooted in German, English or Swedish cultures, for example. 

Counseling resources often focus on how to work with BIPOC communities but not on how to work with white people, notes Band, AMCD vice president of Asian American/Pacific Islander concerns. She hopes that as more BIPOC counselors enter the field, the focus will be not just on ways to treat these communities as “others” but also on ways to help BIPOC mental health professionals. This means there will need to be more trainings on how to work with white clients and supervisors and within predominantly white counseling programs, she points out. 

Allowing for other viewpoints

People often equate good mental health with having a positive self-concept or strong self-esteem, says Manuel Zamarripa, a licensed professional counselor supervisor in Texas. But this leaves out the collectivist piece of mental health. 

“The [counseling] field is built on a foundation of individualism,” he says. “There’s nothing wrong with individualism … [but] we need a balance in worldviews as well.” 

When counselors encounter clients who come from a different worldview, they tend to describe the other viewpoint as a deficient version of their own worldview, says Zamarripa, a dean of counseling at Austin Community College District. Instead, he stresses the importance of seeing these different pieces as two positive, healthy and beneficial ends of a continuum. 

For example, a counselor who values autonomy may believe that their client is struggling with self-worth because they don’t have healthy boundaries with their family. Although the client also values autonomy, they place a higher importance on community. If the counselor approaches this from an individualist viewpoint, they may think the client is being difficult, Zamarripa says. But if the counselor understands that both worldviews are positive and healthy, then they can help the client find a solution that honors the client’s values. 

Coriano Ortiz also considers clients’ cultural backgrounds and their intersecting identities before determining the best treatment approach. A common client she sees is a woman of color who assumes a caregiving role in her family because she is the eldest daughter. Approaching this client’s issue with an individualist mindset would only cause more harm, Coriano Ortiz notes, because the client’s goal is not to disconnect from her family. The client loves her family and wants to be with them even though some of their expectations can be a source of stress for her. So, the client needs an approach that values her collectivist culture while also helping her find a way to alleviate the stress and anxiety caused by a caregiving role that was imposed on her at a young age because of the parentification that often happens to girls of color, she says. 

Coriano Ortiz draws on the client’s cultural values by talking about the importance of community care. She asks the client, “If you are always taking care of others, are you allowed to take care of yourself as well?” Then, they discuss how the client can show her family that she also has needs and how being vulnerable and willing to access help from her family, friends and community will ultimately create a more balanced community care dynamic. The client comes in talking about community care, Coriano Ortiz says, but sometimes she needs help realizing that receiving care herself is a part of that.

Some of Coriano Ortiz’s clients also blend their spiritual practices, such as limpias (spiritual cleansing), espiritismo (spiritism), Santería (an Afro-Caribbean religion) and other practices common in Latin America, with therapy. If a client comes in talking about recently getting a limpia, she will ask, “What were you cleansing away during your limpia?” 

“Spiritual beliefs and cultural traditions for those seeking to reconnect with their ancestral wellness practices are important to process in therapy as a valid way of sustaining mental health,” says Coriano Ortiz, co-chair of Reclamation Collective, a nonprofit that helps people who are navigating religious trauma and adverse religious experiences.

Zamarripa, with Jessica Tlazoltiani Zamarripa, co-founded the Institute of Chicana/o Psychology in Austin, Texas, and developed Chicana/o/x affirmative therapy — an approach that assumes the centralizing of culture and that a positive perception of one’s cultural background will be facilitated in therapy. When working with Latinx clients, he incorporates the “pillars of brown wellness” — identity, family and spirituality — as a means of integrating cultural relevance into the therapeutic space. 

Zamarripa also uses the four elements of nature (earth, wind, fire and water) as a way for his clients to reconnect with Indigenous practices. When doing grounding techniques, he invites clients to leave the session and find an area outside where they can take off their shoes and stand in the grass for a few minutes. Then they can let what they were talking about in session flow from them into the earth. “It allows us to appreciate more the importance of nature, the importance of the elements,” he says. “It can teach some clients something new, and for those clients that are marginalized … who have heard this in their family but they don’t practice it, it can help them culturally reconnect.”

Counselors can also draw on narrative therapy and storytelling, which has been a part of Indigenous cultures for years, Coriano Ortiz notes. During her graduate school program, where she specialized in Latinx mental health, she learned about cuento therapy, an intervention that was implemented in Brooklyn, New York, with Puerto Rican children. This therapy integrates Puerto Rican stories or folktales into therapy for children. Cuentos are a big part of Puerto Rican culture, she says. They serve as a way for children to learn lessons, feel hopeful about healing if they’ve gone through adverse childhood experiences, draw from the knowledge of their ancestors, and stay connected to their culture for those who have migrated from Puerto Rico to other parts of the world. This therapy allows children to read stories that are culturally congruent to their own experiences, which helps them build rapport with the counselor and the adults who are part of their support system. Eventually, these clients create their own life story as a way of healing. 

Preparing counseling students 

Finan believes that counselor education and counselor trainings should help equip clinicians to use a culture-centered approach in their work and engage in difficult dialogues about diversity and social justice. However, from her perspective, many counseling programs aren’t doing enough. “We are asking people to engage in really challenging conversations without preparing them to do it,” she says.

To address this issue, she piloted a counselor training workshop using Sue’s Race Talk and the Conspiracy of Silence as a framework for discussing all types of isms and social justice work in counseling. The book provides practical advice on why and how to have difficult conversations about race.

Band suggests counselor education programs help students begin to think about their own identities and biases by having them create positionality statements, which require individuals to consider how differences in social position and power have shaped and continue to shape their identities and access. The exercise asks students to describe their early life experiences of feeling “different,” “othered” or privileged, including the thoughts and emotions they experienced at the time and how they make sense of themselves now. 

As stated in the Multicultural and Social Justice Counseling Competencies, privileged and oppressed identities are contextual and socially constructed, Band notes, so this exercise highlights how someone might hold privilege in one area but may be considered a minority and experience micro- or macroaggressions in another. A positionality statement does not simply ask students to list out their identities or privileges, she says. It asks them to recall others’ reactions to them during times when they felt “different,” “othered” or privileged and how they responded to those interactions. 

With this approach, Band stresses the importance of having students not just write their statements but also share them with the class because it makes the experience more transformative. “This exercise is often deeply emotional because it is detailed and there is a storytelling or narrative aspect to it,” she adds. “It has the potential to be very cathartic.”

Vereen, editor of The Journal of Humanistic Counseling and past president of the Association for Humanistic Counseling, still teaches traditional theory from names such as Sigmund Freud and Alfred Adler in his counseling classes. But he says he does this more as a way of helping students learn from the past and figure out where the theories do and do not apply today. 

For Vereen, theory serves as a learning tool to get counseling students to think about what they would do with a client, not what Adler or another theorist would do. And then he pushes them to consider the current relevancy of these theories by asking, “Now how do you step outside of this [theoretical] framework to then be a better helper to the student or client you’re working with? … [How] does what Adler’s saying [still] apply to the work that you’re doing? And in what way does it impact the relationship that you have with this student or client?” 

Vereen recently restructured one of his graduate exams to help students see the practical application of theory. Rather than giving them a multiple-choice exam on theoretical concepts, he had the students work in groups to discuss ways to apply certain theories to client cases. 

One group explored mental health implications for a pregnant teenager who had been emancipated. They looked up state statutes and thought about ways this young woman might get lost in the system. Then they considered the mental health impacts of carrying a pregnancy to term when it was not her choice, their role as her counselor, possible theoretical approaches they might use, and the ways these approaches did or did not address the client’s needs.

Sue says that his counseling psychology program does a good job of teaching counseling students the importance of social justice. At the same time, he acknowledges it does “a bad job of arming them with the strategies and techniques to bring about change and … of immunizing them against the resistance they are going to encounter.” Often, when counselors attempt to introduce a multicultural framework to an organization or agency, they are told that the strategies they want to use don’t align with the standards of practice or ethics codes that have been established there, he explains. 

Sue recounts how one of his former students finished the graduate program excited to be a school counselor. When he noticed that underrepresented students rarely came to his office at the school where he was hired, he decided to go to them instead. He went outside and played basketball with these students, which led to some great discussion about their mental health. But the head counselor said that his actions were unethical and violated school policy. This exchange left Sue’s former student feeling discouraged. 

“It does no good for any of us to become culturally competent when the very institutions that employ us punish us for it,” Sue says. 

In his latest book, Microintervention Strategies — What You Can Do to Disarm and Dismantle Individual and Systemic Racism and Bias, Sue provides strategies people can use to combat the micro- and macroaggressions that target marginalized groups. 

An evolving profession 

Vereen challenges his fellow counselors to ask themselves a question: “If we continue to operate in the ways that we always have, are we then moving toward being unethical as a profession because we are not advancing what we’ve done to more holistically support the people and communities that we purport to be providing good work for?” 

Sue says there is no one culturally appropriate way to maintain a good system of healing. Instead, to become culturally competent, he urges mental health professionals to work toward four main objectives:

  • Being aware of our own worldviews, values and assumptions about human behavior.
  • Understanding the worldviews of those who differ from ourselves.
  • Developing culturally appropriate intervention strategies and engaging in actions that positively affect the client’s environment.  
  • Recognizing the systemic factors at play that directly and indirectly affect the policies and practices governing the mental health professions. 

Culture-centered theories are “about how we view the world and how we conceptualize who we are in the world and [who] our clients and our students [are],” Finan says. “These are foundational ways of understanding what it means to be a 21st-century counselor. If we don’t … start using some of these theories to enhance our ability to connect with, understand and support clients and students, then we’re not growing with the profession. We’re not evolving.”

 

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Lindsey Phillips is the senior editor for Counseling Today. Contact her at lphillips@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.

Humility wins

By Ellie Rose September 15, 2021

Guess what? If you have ever been in or are currently in therapy yourself, Carl Rogers might not have been a good fit for you. Neither might have Bessel van der Kolk or Irvin Yalom.

The clout that some of these big names in therapy possess is generally well-earned. Who doesn’t appreciate the advances in thinking on things such as unconditional positive regard, trauma or transference that these experts have provided?

As counselor clinicians, we are fortunate to have a wealth of brilliant minds who have gone before us before we ever step foot in our first theories classroom. But it is OK that we are not them. Inside the walls of a therapy office, there is not a single human on this planet who is (or would have been) the best therapist for everyone.

One of the ways that I market myself as an associate-level clinician still working toward independent licensure is this: leaning into humility. Rather than feeling less than those who already have 20 years in the field, a doctorate-level education or an alphabet of special certifications, I focus on fully occupying my space in this little corner of the world where real and meaningful change can happen for my clients.

Humility is powerful. And accepting all that you are and all that you are not is far more of a strength than a deficit when it comes to attracting and retaining clients. Here are some tips to challenge your thinking on fully embracing what you bring to the therapy table:

1) Accept that you won’t be a good fit for everyone; you will be an excellent fit for some. My website FAQs include the question “Why should I pick you?” My answer leads off with “Maybe you shouldn’t …” before I expand on how important it is to find the right fit in therapy.

Do not be anxious about all the things you are not as a counselor; rather, stand tall in exactly what you are. Even if you are just an intern at the cheapest university in America and receive subpar supervision, you still bring an entire lifetime of experience to your clients. Your very person is a gift.

If you had an abusive childhood, bring it. If you face constant household moves from a military lifestyle, bring it. If you’re happily married or are in the middle of a high-conflict divorce, bring it. Are you a parent? An artist? Do you have attention-deficit disorder? Bring it. All the elements of your very person are tools. They are uniquely yours and uniquely perfect for certain clients.

2) Sell the confidence you have in the client, not yourself. During the first intake session, I am very open with clients that I am not necessarily everyone’s cup of tea. I give them permission to fire me. And I validate the challenge they currently face in going out on a limb with a new therapist. I let them know that I have myself had a string of therapists with whom I didn’t really connect before I finally found the right one.

I look them in the eye and say something like this: “If this doesn’t feel right here, or if you aren’t connecting with what’s happening in this room, by all means, let’s talk about it. I might not be the right person for you, but I trust that the right person is out there, and I will offer some names for you that might be a better fit for your needs.”

Clients have responded really well to this. Some tear up just at that moment of me recognizing how scary it is to start dissecting a lifetime of pain with a stranger. Others thank me for giving them permission to be direct. Candidly, there are very, very, very few clients who don’t come back. In being given the freedom to choose what is right for them, clients will typically stop wondering if you might just be a smarmy businessperson trying to make a buck off them.

Imagine going to a car dealership and, right off the bat, the salesperson indicates that they want you to get the most out of your car-buying experience. Then, they acknowledge that they might not have what’s right for you but will help you find the place that does. Wouldn’t that feel great and immediately earn your trust? When you meet with a professional who is willing to recommend that you take your business elsewhere if warranted, that can lead to a substantial leap in rapport building with that person. When you do this as a counselor, it demonstrates to the client that you are perfectly confident in what you do offer and aren’t desperate for their business. Note: Even if you are desperate for their business, the client won’t benefit at all by knowing that.

3) Consider risking your own time. I found the therapist I’m currently seeing after I had interviewed a few others and was feeling weary in the hunt. Someone recommended him to me, and he stood out to me initially for one reason: The first session was risk-free. No, I’m not talking about the industry standard “free 15-minute consultation”; I mean that he offered an entire session at his expense to see if it would be a good fit. The catch was that if clients wanted a second session, they would book it and then pay the fee for the first session as well as the second. If he was terrible, no loss to the client; they could walk away.

I was immediately struck by his boldness and figured he must feel confident about what he was offering, so I gave it a shot. It paid off. I scheduled a second session right away and gladly paid the cost of the first. That was nearly two years ago, and I still see him regularly to this day. It was a marketing technique that served as a really attractive selling point for me as a client. Some variation of this might work for you too.

4) Be comfortable saying, “I don’t know.” You don’t need to be an expert on everything to be a great counselor. You don’t even need to be an expert on anything specific to be a great counselor! While establishing a niche can be a smart career move and might be personally fulfilling to you, it’s also OK to be a general clinician who handles only things such as anxiety, depression and grief. Evidence has consistently shown that it is not the specialized skill that produces the highest rates of success; rather, it’s the therapeutic alliance … and this is something that exists far beyond textbooks and continuing education workshops.

If a client asks you a question that you don’t have the answer to, say so. Offer to find answers for them or with them. If a client wants a particular type of therapy that is not in your wheelhouse, say what you know and what you don’t, and let them know if you are (or aren’t) willing to learn about the type of therapy they are seeking. Most of all, if you are asked for a very specialized service such as eye movement desensitization and reprocessing or brainspotting and you aren’t trained in it, PLEASE don’t pretend that you are and go home to binge on YouTube videos in hopes of faking it. State clearly your scope of practice and stay within it — while constantly trying to improve on your own time.

acidmit/Shutterstock.com

As a consumer, I am deeply appreciative of those experts who admit the limitations of their knowledge and don’t pretend to have all the answers. This deepens my trust in them. My general physician does this, which is why I would endure scheduling inconveniences just to see him; his word is gold. When you are confident in what and who you are, there is no reason to feel threatened by what you don’t know.

I remember the first time I worked with someone who had a chronic medical condition. She was nervous upon intake and asked what kind of experience I had in this particular area. I told her plainly that I knew nothing more than a couple of paragraphs out of my textbook regarding her condition but that I was honored to give her space to process her own pain and deepen my learning alongside her. During the same intake, I tried to defer by offering to find her names of people with special training in that area if she preferred someone with more experience. She declined, saying that she had a good feeling about me, and we worked through several fulfilling months together. This type of scenario has repeated many times in my young career, but I add the following caveat: There are certain situations or disorders that I insist on referring out because it would be detrimental to the client not to have the right kind of training for their needs in those cases. This brings me to my final point.

5) Never stop learning. Mandated continuing education credits are just the bare minimum. Competent professional therapists immerse themselves in the worlds of counseling, psychology and the human condition. This doesn’t mean reading every new self-help book that gets cranked out, but it does mean being diligent about exposing yourself to books, media, people and experiences that will not only deepen your skill set as a clinician but also deepen your own authenticity. This is especially relevant when you are dealing with couples, families and other unique populations.

Our world has been changing fast. Mental health therapists don’t need to know it all or specialize in everything. That would be an impossible feat. But we do need to constantly be updating our own knowledge and beliefs and fully developing our personhood to humbly bring best practices into the presence of our clients.

 

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Ellie Rose is a licensed mental health counselor associate, national certified counselor and private practice business owner in Vancouver, Washington. She works with individuals, couples and families through a therapeutic lens that encourages her clients to lean into reality, find meaning, and develop skills in handling the onslaught of life’s challenges. She is also a mother, reader, writer and speaker who can be contacted at ellie@ellierosetherapy.com or found on Instagram: @ellie.rose.therapy.

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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 while Black

By Lindsey Phillips June 29, 2021

The counseling field is not immune to racism, systemic or otherwise. Before the Association for Multicultural Counseling and Development (AMCD) formed, nonwhite members of the American Counseling Association paid their dues but had limited representation on ACA’s board and senate. A group of counselors lobbied for AMCD (then the Association for Non-White Concerns) to become an official ACA division, but their initial requests were denied. It was a struggle to get ACA’s leaders at the time to recognize the need for and legitimacy of a division that would focus on nonwhite needs, but the hard work of advocates finally paid off when the AMCD division became a reality at ACA’s 1972 conference. (See more about AMCD’s history at multiculturalcounselingdevelopment.org/amcd-history.)

Ebony White, an assistant clinical professor and the program director of the master’s in addictions counseling program at Drexel University in Philadelphia, points out that the counseling profession — like other smaller systems in our society — has largely tried to dismiss the role that racism has played and continues to play in the profession and society as a whole. 

“The counseling profession has mimicked that model of sweeping it under the rug,” she asserts. “So, it’s important that there is first an acknowledgment about what has happened, and instead of … saying, ‘This is what we are going to do about [racism],’ counselors should ask, ‘How have we perpetuated racism in our profession?’ And they should look at what’s been published in the literature and incorporate what has worked [for others] into our profession and our organizations to make change.” 

To shed light on embedded racism and help others better understand it, six Black counselors shared their experiences of working in a predominantly white field and their hopes for the future of the profession. 

Acknowledging racism in the counseling field

Black counselors’ intersecting identities affect the way they understand the world around them as well as how others perceive them. “I live and experience situations as a Black woman every day more than I live as a counselor,” says Noréal Armstrong, a licensed clinical mental health counselor supervisor in North Carolina and a licensed professional counselor supervisor (LPC-S) in Texas. 

As a Black woman in the counseling field, Armstrong says she has encountered microaggressions and racism from colleagues. For example, when serving as the department chair of the counseling program at a liberal arts college, Armstrong informed her colleagues about a Council for Accreditation of Counseling & Related Educational Programs (CACREP) standard needed to support the success of the counseling program. But, she says, her white colleagues questioned her, debated options without her and asked to speak to a CACREP representative, who simply confirmed that Armstrong had the correct information. This encounter left her wondering: “Are they questioning me because they lack confidence in me, because I’m a woman or because I’m Black?” 

The uncertainty in this and similar situations is “what keeps me up at night,” Armstrong says. “That’s what has my stomach in knots. That’s what has me frustrated.” 

Armstrong, an ACA member and the vice president of the AMCD Women’s Concerns group, says she didn’t ask her white colleagues why they felt it necessary to bring in the CACREP liaison because she was tired of having to navigate their defensiveness and denial that race played a role in their actions, even if it may have been implicit. 

White, who was part of the panel for ACA’s webinar “Our Community Gathers: A Conversation With Counselors About Mental Health in 2020” and is president-elect of the ACA division Counselors for Social Justice (CSJ), says she has been “dismissed … ignored, oftentimes not heard and many, many, many times called the ‘angry Black woman.’” 

White, the immediate past chair of the North Atlantic Region of ACA, recalls a microaggression that occurred in her last meeting as chair-elect. During the video call, she was looking down and typing notes from the meeting. A white colleague unmuted to remark, “Ebony, you look so angry. What’s wrong?” White was stunned. She had been labeled as “angry” simply for taking notes.

“The reality is that for some people, your complexion is more important than your intellectual ability,” says Raphael Bosley, a licensed mental health counselor associate who works at Cross Connections Counseling and at Courageous Healing in Fort Wayne, Indiana. 

Bosley, an ACA member, acknowledges that this truth weighs on him. He says that he questions himself and what he knows more than other clinicians might. He also finds that he frequently has to elaborate on the rationale behind his professional assessments to colleagues and clients. Bosley admits that sometimes he is the one who doesn’t trust his own thoughts, which he believes is the result of living in a society that has conditioned him to trust his athletic ability more than his intellectual ability. 

He also finds that incorrect assumptions about his intellect can be a natural barrier with some clients in the therapeutic space — a space that involves understanding the brain. “They’re not used to seeing a Black male face as the one providing the service when it comes to dealing with the mind and emotions. Why? Because Black men are angry. Black men have rage. Black men are not supposed to be able to teach me how to calm down and ground myself,” Bosley says.

The (in)ability to be one’s authentic self 

Diversity is not just about issues such as race, ethnicity, gender and religion; it is also about the way we communicate, notes Tyce Nadrich, an assistant professor of clinical mental health counseling at Molloy College. Black counselors often can’t communicate in a way that is natural or authentic to them around their white colleagues, students and clients, he says. Instead, they code-switch, adjusting their style of speech, appearance or behavior to appeal to a different audience, often as a means of receiving fair treatment.

“The amount of code-switching that I think [Black counselors] are required to do is egregious,” says Nadrich, a licensed mental health counselor and coordinator of clinical training at Balance Mental Health Counseling in Huntington, New York. “It’s exhausting because I know if I communicate … the way that is natural to me … I will not be heard because folks will pretend that they don’t understand me or they’ll just dismiss it as not worth listening to.” 

For example, Nadrich says that when he gets upset, he may not use three- or four-syllable words — despite having them in his vocabulary — because that’s not the way he talks when he has heightened emotions. He expresses his feelings in a more casual register.  

Bosley, who is also an associate minister at Greater Progressive Baptist Church in Fort Wayne, concedes that as a Black counselor working in a predominantly white field, he often feels the need to be polished in the way he communicates, even in situations that don’t require it. He feels like there is a spotlight on him 24/7 because of his race. 

For Armstrong, whose areas of interest include substance use, Black women in academia, multiculturalism, the deaf community and spirituality in counseling, code-switching involves adopting a professional discourse of privilege. When speaking with white colleagues, she often avoids personal or emotional language and relies on data and numbers to convey her message and ensure they are listening to her. 

White, whose research interests focus broadly on advocacy and social justice within the Black community, came to the realization that no matter how she spoke or presented herself, people would have preconceived notions about her. She says she has reached a point where she will no longer code-switch for white colleagues because she knows she can’t control how others perceive her. So, she is her authentic self with colleagues, which may include saying “ain’t,” dropping verbs or rolling her neck. 

The fatigue factor 

Too often the burden of raising issues related to racism and educating others falls on Black counselors. “It’s a constant and common fatigue,” White says. “Because advocacy is such a huge part of my identity, I’m not one of those people that really chooses my battles. I’m always chosen to battle, which is tiring and exhausting.”  

White recalls sitting in multiple meetings and being so upset by what was being said or not said about race and diversity that she spoke up because no one else would. “It’s angering that I have to be the one to address it,” she stresses. White is a licensed professional counselor who developed the Center for Mastering and Refining Children’s Unique Skills (M.A.R.C.U.S.), a nonprofit organization that provides tutoring, mentoring and mental health counseling to children and adolescents, especially in the Black community.

A few days after George Floyd was killed by police in Minneapolis in May 2020, Nadrich noticed many of his white colleagues remained silent. So, he decided to broach the issue himself because he knew that students and faculty were hurting. 

After addressing the issue, a few white colleagues told him, “I’ve been thinking about this for so long, but it’s just so hard, so emotional. I’ve been torn up about what to say.” Rather than sharing those words after the fact, Nadrich, an ACA member who specializes in racial ambiguity, diversity and social justice work, wishes his colleagues had stepped up and spoken out against racial violence and injustice before he felt compelled to. 

The burden to respond to the wider community shouldn’t have been placed on his shoulders, Nadrich stresses, especially considering that he isn’t in a leadership role and because he was already dealing with the trauma and grief of yet another horrific act of racial violence being committed against someone in the Black community. 

Bosley says he often deals with white guilt and the burden of being expected to answer or pose questions about race himself. He never knows which one of those tasks will be required of him on a given day. He finds that being a mental health professional only compounds this obligation to educate others. “You have that uninvited burden that [you] need to take advantage of this moment to educate because any silence is going to give permission for the fire to keep burning. Whether that’s right or wrong or whether I should take that on or not, it’s my reality,” he says.

White stresses the importance of self-reflection and awareness, especially for white counselors. Counselors must unpack their own privileged identities and examine what that means for how they operate in the world, she argues. 

“We often talk in terms of ‘what do white people need to do,’ so it becomes another version of us having to educate white people and tell white people what to do when they can literally just read and watch what’s been put out there,” she says, offering the Multicultural and Social Justice Counseling Competencies as one example. 

Having courageous conversations 

Right after George Floyd was murdered, white students and colleagues asked Armstrong, who serves as the new executive director for A Therapist Like Me, a nonprofit organization that connects marginalized clients with marginalized therapists, how she was feeling. She wasn’t sure how to describe her emotions or even how this latest instance of racial violence was affecting her. 

“For the longest, I wasn’t able to put a word to it because I kind of didn’t feel anything. And I don’t mean that in a cold, shut off, numb way,” she explains. “I mean it more so in that, unfortunately, I feel like I’ve become desensitized to it because racial violence and injustice are so ingrained now in our society. It’s another thing I carry with me as a Black person in America.”

Armstrong wondered if her white colleagues were also bothered by these horrific acts of murder and violence against the Black community. Did they have knots in their stomachs? Did they call their family members to check on them too? 

So, Armstrong asked them a straightforward question: How did they feel about George Floyd’s death? But her white colleagues dodged the question. Armstrong’s frustration over this exchange resulted in her presentation, “Please Stop Asking, Because I Am Not Okay: The Struggle for Black Counselors During a Racial Pandemic,” at the North Carolina Counseling Association’s 2021 conference. Her goal, she says, was to start a serious dialogue on issues faced by Black mental health professionals.  

When it comes to race and social justice, counselors “have to get out of their own way and allow conversations to happen,” says ACA President S. Kent Butler. “Just like what we are trained to do as counselors … we must take ourselves out of the equation and be there as a culturally competent counselor for our [clients] so that we do no harm and [do not] negatively impact the outcome of what’s happening within the therapeutic relationship. We’re trying to help clients move forward,” he says. “That same philosophy also needs to go into social justice work. Counselors need to take themselves out of the equation because sometimes they may represent or be a part of the problem. And if you are indeed a part of the problem, then it is imperative that you take measures to understand your role in it and figure out how you may in fact help elicit systemic change. That’s what self-awareness is all about.” 

Camellia Green, an LPC-S with a private practice in New Orleans, agrees that lack of self-awareness often prevents society and the counseling field from moving forward. “In the field of counseling, we’re taught you have to know yourself and be aware of all the potential areas of countertransference. … Clinicians [are encouraged] to go to counseling themselves … but many people don’t,” she says. 

But this mandate goes deeper than counselors just knowing themselves. It requires them to dig into their racial identity development, which isn’t something they get in a continuing education unit, and to question their worldview, which has been developed over their lifetime, says Green, an ACA member who specializes in working with people who have experienced trauma. 

Bosley advises white colleagues to give themselves permission to be a beginner at discussing race. “Be courageous enough … to talk about it,” he says. “Because the same lump that’s in your throat is in my throat when I gotta bring it up. But I recognize if I don’t bring it up, you’re not.”

“And have the commitment not just to talk about it but then to do something about it,” he adds. 

fizkes/Shutterstock.com

Agents of change 

Counselors are in a prime position to put these courageous conversations into action. “We’re supposed to be leading the charge because from a psychological and mental health perspective, we know what’s at the foundation of [racism] … and we’re the ones who can speak to it and say here’s how you change it,” Armstrong says. “But counselors are not doing that.” 

Incongruity between counselors’ words and actions is a big part of the problem, Bosley stresses. He finds counselors often say they are against discrimination, but they don’t publicly speak out against those who are discriminating, or they claim to be “an agent for the voiceless” until they have to speak for them. Then, they are silent. 

“Don’t just use your voice for me when I’m there,” Bosley says. “Use your voice when I’m not there and your friend … [or] colleague is saying something [harmful].”

ACA began its own crucial conversations when the Governing Council released an ACA anti-racism statement in June 2020. Later that year, ACA created an anti-racism task force, which was chaired by Butler, who was then the ACA president-elect. 

The task force proposed an ACA anti-racism action plan, which includes nine initiatives to help combat systemic racism and racial injustices. ACA also recently formed a commission to help counselors understand ways to move this narrative forward, promote research, provide counselors with anti-racism resources, and incorporate more action-based projects such as providing scholarships to help underrepresented counselors attend conferences, adds Butler, the interim chief equity, inclusion and diversity officer and a professor of counselor education at the University of Central Florida, as well as a fellow of the National Association of Diversity Offices in Higher Education. 

The need for more representation 

Another problem within the field is the need for more diverse counselors and therapists. According to the American Psychological Association, only 4% of psychologists are Black, compared with 84% who are white.

Nadrich was one of two Black men in his master’s counseling program. When the class started discussing race, the students would often turn to these two men and explicitly or implicitly ask them their thoughts, as if they were appointed spokespeople for the Black community. Although Nadrich’s doctoral program was more diverse, he was still the first Black man to graduate from the program. 

When Nadrich, along with Michael Hannon (an associate professor of counseling at Montclair University) and four other colleagues, researched the underrepresentation of Black men in counselor education, they faced an interesting dilemma: How could they incorporate the voices of the eight Black men they interviewed without exposing or “outing” their identities? With so few Black male counselor educators, they feared other professionals would easily be able to identify their participants by the way they spoke. (The resulting article, “Contributing Factors to Earning Tenure Among Black Male Counselor Educators,” was named Outstanding Counselor Education and Supervision Article for 2020 by the Association for Counselor Education and Supervision [ACES] Awards Committee.) 

The counseling profession needs to make itself more accessible not only to nonwhite clients but also to nonwhite counselors. “There is very little intentional mentorship when it comes to including and getting … Black people into the counseling profession,” says White, the recent recipient of ACA’s Dr. Judy Lewis Counselors for Social Justice Award. “There’s this ruse … [that] we have all these things available, but it’s not accessible if it’s not attractive.” 

By way of explaining, White recalls attending a division meeting of one of the ACA regions a few years ago where she was greeted by a room filled with white faces. She remembers thinking how unwelcoming the space could be for other Black professionals like herself. As the counselors started discussing business as usual, White felt compelled to ask why there was so little diversity in the room. Her question was met with silence for a full minute. Then, passing comments were made about how the group had tried to address diversity. “It gives you the message that they don’t care; it’s not really of importance or value,” White says.

Although the counseling profession still has work to do to attract diverse counselors and clients, White is hopeful because she has noticed a shift in Black people becoming more open to counseling. “We’ve done something right where now more people in the African American community are considering [entering the] counseling [profession], are getting counseling and are recognizing the value of mental health,” she notes.  

White is also excited by the increase of Black counselors entering leadership positions: ACA’s current president is a Black man; the presidents of CSJ and the Military and Government Counseling Association (MGCA) are Black women; and the presidents-elect of ACA, AMCD, ACES, CSJ, MGCA, the American Rehabilitation Counseling Association, the National Career Development Association, and the Society for Sexual, Affectional, Intersex and Gender Expansive Identities are Black women.

These individuals “are more than qualified, but also I know that our voting body is very white. And so that gives me hope that they were able to see promise,” White says. At the same time, she worries that this shift in representation at the leadership level could cause a backlash. She says she has already heard counselors asking, “How did this happen?” 

The ongoing journey toward cultural competence

Multicultural training is central to preparing counselors to understand the experiences of people who differ from them as well as to be aware of their own privilege and bias. But Butler asks, “How can we change the narrative on systemic racism when the profession has some counselor educators and counseling programs that do not value multiculturalism or change?” 

Nadrich says that the multicultural education offered in his master’s counseling program was insufficient, which was more of a reflection on the dynamics of the one multicultural course he took rather than on the institution, he adds. The instructor of the course didn’t know how to navigate conversations about race and culture. “It was a very Black/white course. We didn’t talk much about anything beyond issues faced by Black and white people. We barely spoke about other oppressed groups and never spoke about topics like intersectionality,” he says. 

Some counseling programs require students to take only one multicultural counseling course, and as Armstrong and Green point out, one course is not enough to prepare clinicians to be culturally competent. Armstrong believes there needs to be an emphasis on cultural self-awareness and community awareness from the onset and through the entirety of the counseling program because cultural competence occurs over time and through practice. 

Multicultural counseling involves more than an organization or department saying that they value it and tacking on an extra cultural assignment to the curriculum, notes Green, a doctoral candidate in the counselor education program at the University of New Orleans. She would like to see counseling programs incorporate multicultural awareness into all counseling courses, not just one.

Butler, whose research interests include African American men, spirituality and ethics in counseling, and diversity and social justice in counseling, agrees that multicultural training needs to be integrated into every aspect of counseling, including theories, techniques and research. His forthcoming textbook, Introduction to 21st Century Counseling: A Multicultural & Social Justice Approach, which he co-edited with Anna Flores Locke and Joel M. Filmore, embeds multicultural and social justice competencies throughout each chapter and serves as a guide to enhance teaching and help counselors better understand themselves, their clients and the world around them.

“Cultural competence is not an endpoint. It’s not a destination. It’s a journey,” White says. And part of the journey involves self-awareness, especially for white people. “Your whiteness shapes your … interactions. It shifts the room. It takes up oxygen,” she notes. 

And people’s own perspectives shape their awareness of others, she continues. “How you see me is not fact,” she says. “It’s your perception of who I am.” So, counselors must be “aware of what shapes those perceptions and then be able to constantly trigger [themselves] to be mindful of those things when interacting with colleagues, students, clients [and] communities,” she adds.

White argues that the profession needs to figure out a way to make diversity training a requirement throughout a counselor’s professional development. For example, she suggests requiring counselors to take a set number of continuing education credits on anti-Black racism.

Counselor educators should also consider if nonwhite counseling students have the same opportunities as their white counterparts when it comes to mentorship and financial assistance, Butler says. It may be helpful to engage in some self-reflection: Are you overlooking working with nonwhite students on a research project? Who receives graduate assistantships in your department? Do mainly white students receive the more desirable graduate assistantships? How do you think nonwhite counseling students perceive you as their instructor or feel about the ways they are treated within your courses? 

Early in Nadrich’s career as a counselor educator, he wrote in his academic profile that he was passionate about mentoring and supporting students of color. Another colleague approached him and asked if his statement would dissuade white students from working with him. Although Nadrich was an untenured new faculty member, he declined to change his profile because he wanted to uphold his own beliefs. He told the colleague it would be OK if some white students didn’t come to see him because of his statement. 

Nadrich points out that his colleague’s comment contained two incorrect assumptions. First, it assumed that white students didn’t already have a large number of staff, faculty and professionals who looked like them and shared similar experiences to go to for support and resources while students of color did. Second, it assumed that Nadrich stating his passion for working with students of color was harmful even though stating other professional preferences, such as a passion for behavioral neuroscience or socioeconomic disparities, would have been viewed as less threatening.

Bridging the gap 

Bosley says it breaks his heart when people still insist they are colorblind anytime the specter of racism is raised. They may think they are making him feel better by uttering such statements, but they are in fact saying that they don’t see race rather than addressing it directly. The message they are sending is that “they don’t even think enough of me to try to see me,” he says. 

Nadrich teaches his counseling students why it is harmful to always look to underrepresented groups to explain themselves, the injustices they face and what others should do to help. “You have to figure out what it means to be you and how you can start bridging the gap between your identities and the identities of the people you serve and work with,” he says. 

If Nadrich is working with an adolescent woman of color, for example, then he knows his identity as a person of color might help bridge the gap between them. But he also recognizes that his identity as a man could widen the gap depending on the client’s own history and experiences. “I have to be cognizant of that,” Nadrich says, “and say overtly to myself, ‘How am I going to make sure that I’m bridging across gender in this situation?’”

And in speaking to his white colleagues, Nadrich asks, “Are you willing to be affected by my lived experience? Are you willing for my lived experience to be relevant to yours or necessary to yours when it doesn’t have to be?” 

Nadrich is grateful for the colleagues who don’t avoid the issue and demonstrate a willingness to bridge this gap. “If you’re willing to be affected by it, now you hear me,” he says. “Now you know what’s going on with me and people like me.”

 

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Lindsey Phillips is the senior editor for Counseling Today. Contact her at lphillips@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.

Therapy services: Money talk

By Stephanie Cox June 22, 2021

Here’s a topic that professional counselors love to talk about and don’t feel awkward at all bringing up: Money!

Let’s get it out there and acknowledge that in the counseling profession, money isn’t fun to talk about. That’s because the nature of our business is a sensitive one. We’re not selling the public “goods,” we’re providing a service. And this service isn’t a run-of-the mill one like doing your taxes or grooming your dog. We’re working with you to heal some of the most painful parts of your life. We’re helping you cope with tragedies. In some cases, we’re trying to keep you alive. It’s because of the sensitivity of the work we do as professionals that we can often feel “bad” for charging you money for this service.

Among my therapist friends, we frequently talk about our fees and all that comes with it. We go into this profession to help people. Still, reality comes in and we have to balance our hearts with our checkbooks. We have to reconcile that in order to use our skills, we have to pay our bills.

Speaking of bills, as therapists, we sure do have a lot of them. Some standard ones: student loans from undergrad, grad school or both, the costly liability insurance required to operate, the licensing fees, the required continuing education courses, our HIPAA (Health Insurance Portability and Accountability Act) secure phone lines, email and practice management software, marketing and advertisement costs, office space rent, material for clients — things add up. This doesn’t begin to touch the normal living costs we all have to consider such as other bills, mortgage payments, health insurance and food.

Kaspars Grinvalds/Shutterstock.com

As counselors, we know that we need to make money to live, but that guilt when we have to raise our fees or charge a client after a particularly emotional session is real. Something I try to remind my therapist friends (and myself) of is that at the end of the day, we are a business. It feels gross to say that because what we do feels like more than that.

However, when I think of all the people who are doing such hard work and seeing such positive change in their lives, it helps to reassure me. To stay in this business and stay available to use my skills to help people who are changing their lives for the better, I have to keep my lights on and pay my bills. I love what I do and am glad that I can keep doing it. I worked hard for these skills so that you can work hard to get better.

Even so, this question can be and needs to be explored in deeper context: Why isn’t mental health therapy more affordable?

Why isn’t mental health therapy more affordable?

This is an important and complicated subject. To start, as stated above, therapy is a service just like any other. Therapists are doing a job, and to do that job, they need to be paid a fee. But why can that fee seem so high?

If you think about the structure of therapy and compare it with similar industry services — such as CPAs, attorneys and other professionals whom you pay for providing a service rather than a product — it begins to make sense. Instead of selling a product, we’re selling time and expertise.

We don’t question why attorneys charge so much for their time. We understand that they had to go to school to become the best at their craft. In turn, we pay for access to that knowledge. The same holds true for professional counselors and other therapists. We had to go through extensive training and schooling (and accumulate substantial debt) to master the skills to serve you in the office.

Even so, this argument can feel shaky when we apply it to therapy because there is an assumption that therapists should be more compassionate to the needs of the population. Good mental health should be a human right, so why not cut people a break and provide these services at discounted rates so that more people can benefit for longer? After all, this is mental health — shouldn’t everyone be given the tools for better living?

Without a doubt, mental health services should be accessible to everyone and finances being a barrier is a societal ill. What isn’t always understood is that therapists also fall victim to this conundrum. We do not benefit from society not valuing mental health services.

Believe me when I say we wish we could provide all of our clients with a reduced fee. What makes this impossible is that most therapists whose fees are the highest are in private practice. There is no product to sell to make their profit, so it is their time and service that become their only source of income. Without a salary and a steady paycheck from a corporation, they rely on their fees alone to cover the costs of running their business, as well as the leftover income to pay their bills and support their families. This puts them in a bind.

What can be done?

This bind is one that could be remedied if mental wellness and mental health were prioritized by our society. For example, if the government had programs that supported mental health professionals and supplemented our incomes, we could reduce our fees and more people could be seen without us requiring assistance to live. If programs were created to provide mental health allowances to individuals so that services didn’t have to be paid for out of pocket, that would be another great way to allow therapy for all. If insurance companies raised their rates and paid a livable reimbursement rate for therapists (more on that later), more of us would accept insurance and our clients could pay less.

I hate the way that mental health is devalued in our country. Those of us who are therapists got into this field because we want to help people, and we’re aware there are whole swaths that we can’t reach. If we did, we couldn’t be in business for long, and then no one would benefit. I am hopeful though that change is coming. The more vocal people become about wanting mental health rights, the more likely we are to see them given.

If you’re looking for a professional counselor or other therapist and finding that the finances are not working out, I encourage you to ask if the therapist is able to offer a sliding scale or reduced fee. Until then, I know it’s a bummer seeing that price tag. We don’t like it either.

Why many therapists don’t take insurance

It’s true that you can find therapists in private practice who take insurance, but it won’t always be the case. Previously, I touched on some of the reasons behind the fees that therapists charge. Now, I’m going to explain why we don’t always accept insurance as a way to cover those costs.

If a therapist wants to accept insurance, there is considerable time and cost associated with this form of payment. To begin with, therapists have to apply to insurance companies in order to take their insurance. This process is complicated and lengthy. It can take anywhere from four months to a year to get approved. An insurance group will approve a therapist only if it recognizes a need in that area for the therapist’s services that isn’t already filled by another provider. It is common to be denied because there are already enough providers in the therapist’s area.

If you are among the chosen, the process gets more complicated from there. You must sign a contract with the insurance group and agree to a fee schedule. While I can’t share the specific fees that insurance companies pay to therapists, it is almost always less than what a therapy session costs. In fact, it can be anywhere from one-third to one-half of what a therapist normally charges for their services.

Additionally, therapists are not actually paid when they render the service to the client. After having the session, therapists must complete a time-consuming process of medical billing to submit a claim to the insurance company requesting pay for the service provided. Depending on a number of factors, the insurance company can deny the claim. In that case, the therapist has then worked for free. If an insurance company does approve the claim, they pay the therapist weeks later.

Mental health therapy agencies and group practices that have specific medical billing and coding teams have the time to dedicate to this complicated process. Providers who work with these agencies are also usually paid a steady salary so that the delays in insurance payments are not felt as acutely. That’s why you are more likely to find providers that take insurance in these settings.

In contrast, private practice therapists usually forgo these challenges because the cost in time and money does not make for the most efficient business practice. Self-pay among private practice therapists is simply a lot easier. In addition, insurance companies require therapists to diagnose clients in the first session and submit that to the insurance company or else services will not be covered. Not all therapists (or clients) agree with this practice of requiring a diagnosis, so this is another barrier to accepting insurance.

No surprise, this is a broken system. There should be alternative affordable systems in place to make therapy accessible to all people who want it and feasible for all therapists to provide it. Some therapists try to lower the barrier of finances by doing pro bono work or offering reduced-fee sessions.

Reduced fees and pro bono work

Therapists are encouraged by their codes of ethics to provide a portion of their sessions at a lower cost or, if possible, to offer some services pro bono (free).

Because we have limits to how many services we can provide at a reduced fee or for free, there is usually a cap on the number of clients who can receive this benefit at a given time. This depends on the individual therapist’s finances and choices, but most therapists will have a line on their business page stating whether they are open to “sliding scale” fees. This means that therapists will work with clients to determine what they can afford.

Sometimes this sliding scale comes with stipulations such as a set number of sessions or a set frequency, but talk with your therapist about what they can do for you.

Pro bono services work in a similar fashion. Therapists can provide some services for free, either directly or in a more generalized setting such as providing services for a charity, school or church.

If a therapist does not currently have any open slots for reduced-fee work, don’t lose hope. Whenever those clients graduate or phase out, those spots may become available again, so be sure to keep asking your therapist to be put on a waitlist for such services.

If you are a therapist and don’t currently provide these services, I highly encourage you to reconsider. I offer several reduced-fee spots on my caseload and am glad that I do because, as stated previously, therapy should be accessible to everyone.

Money talk as therapists is not fun, but it is necessary. If finances are a barrier for you to receive services, I encourage you to be honest about that with a potential therapist. We truly do want to help, and most therapists will work with you to get you the help you need. Now that you’ve been given some insight into the financial workings of this field, I hope you will have the confidence to seek help if you’re a potential client and to provide help if you’re a practitioner.

 

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Related reading, for counselors:

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Stephanie Cox is a licensed mental health counselor in Florida specializing in therapy with children, families and adults with mild to severe mental health and relational issues. She holds a degree in psychology from the University of North Florida and a Master of Science degree in counseling psychology from Grand Canyon University. Contact her via:

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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.