Tag Archives: Voice of Experience

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.

Voice of Experience: The hurting counselor (an update)

By Gregory K. Moffatt October 7, 2020

In 2018, I published a Member Insights article in Counseling Today titled “The hurting counselor.” I received more feedback on that article than anything else I’ve ever written, and it went on to become the most-viewed article posted to CT Online at any point in 2018. Nearly all the responses I received were comments about how counselors had (just like me) neglected self-care until crisis slapped them in the face and they realized they didn’t have the tools to deal with it.

In that article, I described a time when my marriage was failing and how, at the same time, my self-care had been sorely neglected. Even though my own story was a part of that article, my real point was to petition readers to take self-care seriously. Fortunately for me, at the end of the article, I gratefully noted that my marriage had been salvaged. Healing was slow and setbacks continued, but things improved.

Sadly, I’m here to tell you that a very painful tragedy has found me once again, and I’m devastated. I’ll leave the specifics of my painful situation unspoken because if I told you what it involves, then some readers might think to themselves, “That doesn’t apply to me.” The specifics of my situation are not why I am writing this follow-up article, any more than my original article was just about the sadness of my failing marriage. Let’s just say that I’m hurting as much as one can hurt and still survive.

But just like before, my purpose is to address the importance of self-care. I religiously practice what I told readers about in “The hurting counselor” two-plus years ago. My separation that I wrote about at the time had happened almost a decade prior, and it nearly crippled me. I couldn’t eat or sleep, and I scarcely could get through each day. My compromised self-care nearly did me in.

But since that time, I’ve been practicing everything I wrote about in “The hurting counselor,” and now that I’m yet again facing a very painful experience, I’m so glad I did. The follow-up is that self-care is not only helpful but crucial.

Don’t get me wrong. The tragedies of life are always hard: the loss of a child, the humiliation of arrest and jail, failed relationships, crippling physical illnesses, etc. The timing of my current situation, coming as it does in the midst of the coronavirus, the beginning of a very challenging school year at my university, and a generally hard time of life, makes it worse.

My days are difficult and my nights are even harder, but I’m managing reasonably well — unlike the time I wrote about previously — because I’ve practiced our ethic of self-care. The unavoidable pain of personal crisis won’t defeat me as it nearly did years ago. I have a therapist, I play, I eat right, and I rest as well as I can. All the keys to reasonable self-care.

As noted above, self-care is not an option. It is an ethical obligation. The excuse that “I don’t have time” to exercise, go to therapy, eat well or take a day off is not only untrue, it is irresponsible.

Unlike the situation I found myself in all those years ago, today I’m making better decisions because I’m in better condition and I have the strength to do it. I will weather this storm with clarity of thought and resilience of heart. Neither of those things is possible without regular self-care. Fortunately, I’ll also be in reasonable condition to continue working with my clients, my interns and my supervisees. They will never know that I’m in the midst of a crisis unless I tell them.

If we are not taking care of ourselves, we will make poor decisions in all sorts of areas. We will stay in toxic relationships and dead-end jobs or work too many hours. Our lack of clarity will make it hard to see the damage we are doing to ourselves. I know that in my prior life of poor self-care, I could not have weathered this current hurricane. Today I’m so strong, even though daily I’m feeling vulnerable and battered.

I often tell stories about my life, my clients and my practice in my column, but this particular article is as personal as it gets. I’m not just processing my current pains with you, however. Because of the outpouring of responses I received from my original article on self-care, I know that self-care is a problem and a challenge for many therapists. It is imperative that we tend to it so that we are adequately prepared when we are facing deep hurts — as we all inevitably will in one way or another.

My testimony here will hopefully convince you that there is a good reason to take care of yourself. And I want you to know that I not only practice what I preach to you, but that it works.

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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: The miracle of 28 days

By Gregory K. Moffatt September 17, 2020

When I began my life as a mental health worker well over 30 years ago, the words “managed care” weren’t even a blip on the radar. Almost everyone had personal insurance. People who had an HMO were mostly factory workers, and to have an HMO or a PPO was generally not regarded as a good thing. Otherwise, you could go to whatever doctor you wanted, there were no “referrals,” and both physicians and counselors had immense latitude in the first few weeks of treatment.

In those days, there was a joke in our profession that went something like this: “How long does it take to treat [fill in the blank with any issue]?”

The answer: “Twenty-eight days.”

The reason for 28 days is that insurance companies would reimburse for up to 28 days of treatment — even in-patient care — without question. After that, lots of other documentation was required. So, miraculously, in-patient care was often — you guessed it — 28 days.

Of course, no responsible therapist planned their treatments based on that 28-day ceiling, but we had tons of latitude on treatment plans. But the late 1980s brought us major changes in health care. Managed care (HMOs and PPOs) changed the way we did business. I was too new in the field to have an opinion at that time, but I remember the outrage among my supervisors and other veteran counselors.

In retrospect, the change in how insurance worked actually helped us (forced us?) to become better in how we provided services. For example, brief solution-focused therapy, which was something that didn’t exist when I was a graduate student, is a result of this change.

You may be asking yourself whether there is a point to this interesting trip down memory lane. Well, I think we may be seeing something just like I described above happening right now.

Americans are innovative. I am confident that the coronavirus pandemic has created a scenario that will permanently change much of our culture. In the 1980s, therapists didn’t have to think about being “brief” or efficient, but the rise of managed care forced our hands, and we got better because of it.

This virus has forced us into telemental health and other ways of offering services that, prior to March of this year, we didn’t have to think about unless we wanted to. I have encouraged all of my supervisees to pursue the telemental health credential in our state, and I have done so myself, both as a clinician and supervisor, but I suspect that lots of veteran therapists just didn’t want to mess with a new modality.

Imagine that. Once again, here is something that we were forced to do that we should have been doing already because it provides options and helps our clients. In my early years, I learned to be efficient — to do in one session what my teachers might have had the luxury of doing in five or 10 sessions. I did things efficiently because managed care forced me to do so. But shouldn’t we have been doing that anyway?

I’m not belittling my predecessors. My teachers and supervisors didn’t have to do something they weren’t accustomed to doing, so they only did it if they felt like it. Now I’m realizing that this current pandemic is changing the way we do business, and that change isn’t going away when the virus eventually fades away. I predict that some of our clients will never choose to go back to the way it was. And maybe they shouldn’t. Young therapists will probably look back on this time in history and say, “Why did my teachers need a virus to get them to routinely offer services that benefited their clients? Crazy!”

This will also affect me as a college professor. My students undoubtedly will be asking, “Why do I have to come to the classroom?” long after the pandemic is history.

My clients will be asking something similar: “Why do I have to drive all the way across Atlanta and deal with traffic every week when I can see you from the quiet of my home office (in my slippers and jammies) if I wish?”

So, in our very near future, I suspect that graduate programs will not offer telemental health as an optional certification. Instead, programs will be adjusted to provide telemental health as an expected option for clients who fit well with this modality.

If any of you reading this are holding your breath until things “get back to normal,” don’t hold your breath any longer. We have a new normal, and this will almost certainly, in some ways, be very good for us, good for the counseling profession and, most importantly, good for our clients.

 

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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.