Tag Archives: Voice of Experience

Voice of Experience: Spokes of a wheel: A lesson in physics

By Gregory K. Moffatt March 29, 2021

I can’t count the number of calls and emails I’ve gotten over the past year, in addition to the many times I’ve been asked to speak (virtually, of course), on the same topic: How can we help people cope during the pandemic? In fact, I recently spoke on this topic to one group for the second time in the past year.

Who could have known this pandemic would go on for so long and how our lives would be disrupted? We are all fatigued. Not only do I have to help my clients manage their fatigue, but I am also focused on the needs of my clinicians and supervisees. No one is immune.

There is no single answer to the best way to cope. As is the case with almost any issue in mental health, we encourage our clients to eat right, sleep right and exercise. This is what I call Moffatt’s Mantra. The treatments for depression, anxiety, grief and a host of other common diagnoses must include these three common components.

But beyond that, coping is idiosyncratic. Things that bring me peace might bring you stress, and vice versa. For example, I just finished a five-day business trip to the Gulf Coast. I stayed in a luxury estate, had a private chef for suppers and ate catered meals otherwise. All of the refrigerators were stocked with just about anything you could imagine. I was paid very well, my workload was light, and I had plenty of time for sailing, deep-sea fishing and the beach.

But I don’t like the beach. I’d rather be in the mountains. I also find it very hard to relax when I’m working, even in luxury accommodations like the ones I experienced. I’m happiest sleeping in my own bed. I may be the only person who wouldn’t find this consulting trip relaxing, but I am intensely introverted. Social events leave me feeling drained, and I’m always “on” when I’m in environments like that.

As odd as I am, I’m not alone in my idiosyncrasies. Some of you reading this might list coping strategies that perhaps nobody else would find helpful. In other words, we shouldn’t assume what would be a healthy coping strategy or stress relief technique for our clients. Our clients need to teach us those facts.

So, here is the physics lesson. The individual spokes on a bicycle are quite weak. Even a child could easily bend one. A bike with only one spoke wouldn’t go very far. In fact, the weight of the bicycle alone would crush that single spoke. But when you put multiple spokes around the rim — with several dozen of them sharing the load — the bicycle sustains its own weight and that of the rider. And the pliability of those spokes — the ones a child could bend — helps the repair person true the rim so that it doesn’t wobble.

This brief foray into physics teaches us something about coping. If you were to ask the bicycle specialist which spoke was most important, they would laugh. All of the spokes are important, and they all have to work together. Our ability to cope with stress, frustrations, anger, relationship problems and grief — all magnified by the pandemic — is based on multiple strategies working together. The more the load is shared, the better.

Even though one strategy — exercise, let’s say — may usually work, it might not always work. Healthy coping involves many skills from which one can draw.

A minimum of three clear strategies, tailored to the individual, is a starting point. We might think of these strategies as legs of a stool. With at least three legs in place, a stool will remain standing, and the more legs on the stool — like the spokes of a bicycle — the harder it will be for something to break it.

So, my response to all those media questions about how we can help people cope during the pandemic is the same. Examine your own life. What tools, skills and strategies have you found helpful in the past? The longer your list, the more spokes you have to sustain you when you feel you are reaching the point of fatigue.

I exercise religiously — almost every day, rain or shine — because I know it helps me avoid fatigue and depression. I nurture relationships — especially my family relationships. I know they are important spokes in my wheel. I need solitude, quiet, predictability and routine. These are some of my spokes, and I might even add my own pillow and my own bed as two others. So, even though a lucrative consulting gig on the Gulf might sound good, I limit them because limiting that kind of work is a spoke for me too.

Know your own spokes and help your clients brainstorm their personal lists. We can’t do that for them. With overt tools to lean on, we will see our way through these very challenging days.

 

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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.

Voice of Experience: Managing requests for client information

By Gregory K. Moffatt February 23, 2021

In nearly four decades of practice, I’ve experienced a number of attempts by various individuals to gain access to my client records. Here are a few of them.

  • Two police officers showed up in my office asking for records regarding a former client. They told me that the person was of interest in a very serious crime and they were trying to close that case. Would I please give them my records for that client? When I told the officers that I would be happy to comply with any order from the court, they pressured me. “Really! You are going to make us get a subpoena?” Yep.
  • An attorney sent me a very official looking letter that I believe was deliberately drafted to look like a court order. It was full of legal jargon and demands for information regarding a former client. I could have simply thrown it in the trash, but instead I called the attorney’s office. I knew the attorney would be waiting on my call. Sure enough, when I told the receptionist who I was, she immediately patched me through to his office. He answered on the first ring.

“I’m calling regarding your ‘request’ for information from me,” I said. Not waiting for him to make a comment, I continued, “I’m sure you know I cannot even acknowledge who my clients are without a court order or the client’s permission. Do you have either of those?” Of course, he did not. The call was polite and short. I never heard from him again.

  • A parent called my office seeking “any records whatsoever” I had pertaining to my therapeutic relationship with his son, who was a minor at the time. Ordinarily, I would have been happy to chat with a parent. However, I knew that this father’s custodial rights had been terminated by the court (my client’s mother had provided those documents to me), so the man calling me had no legal right to his son’s records. I declined his request.

Without experience, it might be easy to be intimidated by police, angry parents or clever attorneys. But you cannot be arrested (as I was threatened on one occasion) for following counseling ethics and HIPAA requirements regarding client information. In fact, you will likely be in greater trouble if you concede to these “requests” and thus violate our code of ethics.

To make your life a little less stressful, let me suggest three simple statements/rules that will help you know when to divulge information and when to stay silent.

First, never forget this line: “Who my clients are or are not is confidential information.” The two officers I mentioned above began by saying, “We are here to talk about M— S—, one of your former clients. Do you remember her?”

They were playing me. If I had acknowledged that I remembered her (as, in fact, I did), they would already have been on their way to pressuring me for more information. I simply delivered the line above and then shut my mouth.

Second, remember to ask, “Do you have a court order?” No court order is verbal. Police officers, lawyers and others have tried to tell me they had a court order and wanted me to provide information. I always state that I’m happy to comply with any court order that I receive. Unless a court order is provided to me, that is nearly always the last I will hear about a request for information.

Even if a printed order is provided, it must be signed by a judge. The lawyer who tried to scam me knew he couldn’t forge or fake a judge’s signature without risking losing his license and perhaps going to jail. I always first flip to the last page of the order to see what judge signed it. No judge’s signature, no information.

Finally, ask, “Who has legal right to this information?” Without a court order, that legal right generally lies exclusively with the client, but in the case of minors, those who have legal guardianship can request records as well. That can get complicated, as I indicated in the scenario above. If I hadn’t anticipated the question of legal guardianship, I might have provided client records to a person who had no right to see them.

If you have no experience with court orders, always consult with your professional organization or a trusted and experienced colleague. If you have questions about a court order, you can call the court to confirm or clarify.

One final caveat: I am not an attorney. I know some jurisdictions may have systems in place that differ from what I’ve described, so check with legal counsel in your area before you need it. You will then be prepared.

 

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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.

Voice of Experience: Violations of trust

By Gregory K. Moffatt January 19, 2021

Trust is the foundation on which relationships of any kind are built. Think about how much we depend on trust in our everyday lives. We trust that our teachers are telling us the truth. We trust that a check from someone won’t bounce. Even the cash we exchange requires trust in the value of the currency in our hands. We trust that the products we buy will function properly and feel betrayed when they don’t.

And with every secret we share in confidence with another person — no matter how big or small the secret — we trust that it will be protected.

Trust comes easily for children in almost all relationships. Whether it’s with parents, siblings, teachers, coaches or sometimes even with counselors, children generally are quick to trust. “My teacher said …” “Coach told me …” “My dad told me …”

Sexual perpetrators take advantage of the ease with which children trust by “courting” — pushing boundaries a little at a time so their victims don’t ask too many questions. Con artists do the same thing to adults, preying on our natural human instinct to believe in one another. But once trust is violated, it will never come naturally again. A violation of trust compromises not only that relationship, but all relationships.

So, to protect ourselves, we must learn, by necessity, that not all people are equally worthy of trust.

In the field of ethnography, the term incorrigible propositions refers to beliefs that are so fundamental to our existence that we don’t even question them. The most serious violations of trust involve incorrigible propositions. When these beliefs are called into question, it shakes all of our beliefs. In a way, we say, “If I can’t trust in this, then what can I trust?”

For example, most people are familiar with statistics on divorce, but upon getting married, almost no one assumes that they will experience divorce themselves. They trust their spouses. But when the belief that they will always stay together is shattered — by infidelity, for example — their entire world is shaken. The incorrigible proposition that people are trustworthy comes into question. Distrust can generalize to all spouses, everyone of a given gender, or to people in general.

Marriage and family therapists see this kind of shaken trust almost every day. The abused children who come through my office have had their trust violated as well, and I have to work hard to prove myself worthy of their trust. This is often a monumental task. Their childlike gullibility is long gone by the time they come through my office doorway.

I have written before in this column that confidentiality is the foundation on which most of our ethics are built as counselors. This is so important because it relies on a client’s trust that we won’t betray secrets.

Sometimes, however, trust must be betrayed. We must act, for example, if clients are a threat to themselves or to others. Mandated reporters have no choice but to violate confidentiality when they suspect abuse or neglect. Even the sharing of therapeutic information with parents or guardians can potentially compromise our clients’ trust in us. These violations of trust cannot always be avoided.

But perhaps most damaging is when counselors — those of us entrusted with the scariest and most embarrassing secrets carried by clients — violate that trust in an unethical manner.

Unethical violations of trust can come in many forms. Unfortunately, carelessly using a client’s name while talking to a colleague or failing to adequately disguise a client’s identity in consultation with a supervisor are not uncommon occurrences.

Most serious is the violation of trust that takes place when a therapist engages in blatant boundary violations with a client. Inappropriate touching, inappropriate social relationships and other egregious boundary violations with clients always destroy trust in the long run.

Those of you who have been in the counseling profession very long have likely seen your share of clients who have had bad experiences with previous therapists. Therefore, you have almost certainly experienced the painstaking job of trying to prove that you are trustworthy (and that the profession as a whole is worthy of trust) to someone whose personal experience has taught them otherwise.

Even more painful to me is the knowledge of all of the clients who will never risk going to a counselor again. These clients will not seek help because of a violation of the trust-based relationship that is at the heart of our profession. Whether these violations were careless or intentional, the effects are the same. These are the people we have lost.

An ethical “oopsie” that violates trust might never be known to anyone else. But then again, it might. Even the slightest breach might damage a client’s trust to the point that they will never seek counseling again. And that, my dear colleagues, is unforgivable.

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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.

Voice of Experience: Intake: Avoid wasting paper — and clients’ time

By Gregory K. Moffatt December 14, 2020

If I were a teacher at any level other than the collegiate level, I would want to be a kindergarten or pre-K teacher like my wife. Over the years, I have spent hours in her classroom reading to children and helping her with the joys of managing her young students.

I especially love watching children being exposed to a formal educational experience for the first time at the beginning of a school year. That pre-K year is the foundation on which the rest of the child’s academic life will be built. If that experience is positive, the child is much more likely to enjoy the learning process in future years.

Internship for graduate students is sort of the adult equivalent of kindergarten in the counseling field. These students are mature adults, of course, but new clinicians are walking into the clinical world for the first time. In their faces I can see the same excitement, nervousness and fear that my wife sees in her students at the beginning of every fall. I love it.

As a supervisor, I’m in a unique position with my interns because I take on only one intern each year and, since I direct our counseling program, I can run it any way I want to. That gives me plenty of latitude and daily one-on-one personal mentorship time with interns, plus the freedom to expose them to the field however I see fit.

I enjoy supervision of postgrads, but what I absolutely love is watching new counselors actually begin to practice what they have previously only heard about in the classroom. Witnessing their development from those first weeks in sessions with clients to graduation months later is always a pleasure.

During our year together, we examine every aspect of the counseling process in detail — intake, assessment, rapport building, treatment planning, record-keeping, ethics, risk management, the law, termination, just to name a few. But one of the many things I do — and I doubt most other interns experience this — is help my interns develop their own intake forms and processes. I have never talked to any clinician who, during internship, didn’t simply have intake processes provided for them. Their job was to then simply follow orders.

Once clinicians move into regular practice, they either adopt some version of the forms they have always been told to use or they use forms provided to them by the hospital or clinic where they are working. This means that most clinicians never have to really think about the intake process. They just do what they have been told and simply assume this is the best way to do it.

Most counselors consider quality-of-life issues when suggesting that clients change behaviors, pursue medical treatment options or engage in other interventions. But I doubt most clinicians ever give a second thought to the intake process as a quality-of-life question because they have never been forced to do so.

Isn’t it irritating when you go to a doctor for the first time, fill out pages and pages of forms (many of which ask repeatedly for the same information) and then, when you see the physician in the examining room, you hear, “So, what brings you here today?”

Do you not find yourself wondering, “Well, I just spent 30 minutes writing that down for you. If you’re beginning by asking me why I’m here, why did I have to spend all that time filling out paperwork?”

During our first few weeks of supervision, I help interns think through this process. THE question is this: What is essential for you to know when you see a client for the first time? Some things are inescapable — HIPAA forms and informed consent, for example. But beyond that, what is critical? If it isn’t essential, then maybe it shouldn’t be a part of your intake paperwork.

My short-version intake form is only one page. In my practice, I need to know the child’s name, contact information, legal guardian and presenting issue. This is oversimplified but, generally, that is all that is critical for me. I have a longer form that I use if I know the case may go to court or if it involves an evaluation for a school or foster care system, but many of my clients don’t fall under those two situations. Anything that matters beyond the information captured on my short form will eventually come up in therapy.

So, I’m suggesting that you examine your paperwork. If we are going to ask a client to do something — complete homework, see a physician, change life habits or, yes, even fill out pieces of paper — we need to have a good reason 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.

Voice of Experience: Caution for second-language speakers

By Gregory K. Moffatt November 12, 2020

In the summer of 2010, I was teaching a seminar in Tacna, a small desert town in Peru. Even though I am a Spanish speaker, it is more efficient for me to teach with a translator, and I have done so many times in my classes in countries all over the world, including Central and South America. I had been to this particular venue more than once, and my translators had always been English speakers who were fluent in Spanish. I’d never had any significant difficulties with their translations. On this occasion, however, I had a novice translator who was also indigenous to Tacna.

He was very nice, but also very frustrating. Several times during lectures, I had to provide words for him in Spanish or had to clarify his translations. I was frustrated with him, but I attributed his long pauses and confused word choices to his not yet having learned the art of translating, which is, indeed, an art. On the plane heading for home, however, I had an epiphany.

Staring out of the airplane window, I rehearsed several specific instances in my lectures where my translator had trouble. As I thought through those situations, I realized he had been looking for a translation that best conveyed my thoughts into the culture he knew so well. As any speaker of a second language knows, literal translations can often be problematic. My native Peruvian translator knew of subtle nuances of which I could not possibly have been aware. That was the main reason for his pauses and delays in translation. His lack of experience as a translator was a secondary factor.

On the other hand, my American translators in past years had known what I meant, and they had chosen words to communicate to my audience that I heard with my American ears. Therefore, it sounded fine to me. The words matched my expectations. But on my long plane ride home, I realized my prior translators could easily have been making mistakes that I didn’t — or couldn’t — recognize. What I had perceived as correct translations were potentially errant. Ironically, I had been more comfortable with translators who were actually more likely to translate incorrectly than with the one who was most likely to do it accurately.

After working for several years in Central and South America, limping along in my very weak Spanish, I decided to go back to school. I wanted to be able to teach and to do counseling with Spanish-speaking clients in their language. So, I enrolled in a local community college and took two years of Spanish.

My fluency improved to the point that I was able many times to counsel with my Mexican, Peruvian, Argentinean or Chilean clients in their native language. I have spoken on television and in public forums in Spanish and have lectured in Spanish. I know what I’m doing.

But, if given the choice, I will almost always use a translator these days for anything other than casual conversations in Spanish. My fluency can be my enemy. Native Spanish speakers often overestimate my understanding and, if I’m not careful, I’ll do the same thing. They speak faster and assume much. I might hear a term or phrase and misunderstand it (just like we might do in English) but never even know I did it. Remember the days when “bad” meant “good”? Language changes regularly.

Even more critically, as counselors we know that every word, every inflection and every subtle nuance of language can help us better understand our clients. There is no way, even after living my summers in Chile for nearly 15 years, that I can master those nuances even in that one context — let alone generalize it to 20 or 30 different Spanish-speaking countries. Casual conversation? No problem. Counseling, though, requires great precision.

There are ethical and logistical problems with using a translator in counseling. Confidentiality is, of course, one of many. But I’d rather have a translator who is a native speaker and well-versed in the ethics of counseling than to try to go it alone and perhaps miss something critical.

If you serve populations that speak languages other than English, finding a local translator and training that translator for the counseling room is critical.

One last caution: Spanish doesn’t sound the same way in various countries. Whether you are in Spain, Argentina, Puerto Rico, Mexico, Columbia, Peru or Chile, each region has varied cadence and nuances. The same is true with many other languages. So, don’t just call for the “Spanish” speaker.

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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.