Tag Archives: Voice of Experience

Voice of Experience: A farewell and final reflection

By Gregory K. Moffatt October 24, 2023

A street in a rocky tunnel with an amazing sunset coming through at the end

Daniel Vulin/Shutterstock.com

My students and colleagues have teased me for years because of the many jobs I’ve held throughout my life. I was a paper boy, truck driver and locksmith. I’ve worked in the restaurant industry and even worked in coal mines while I was in college. I’ve been a painter, mechanic, writer, columnist, business consultant, teacher, clinician and supervisor. I also briefly served as a pastor, directed a television show and worked as a disk jockey, telephone operator and boat builder.

Gregory Moffatt sitting in the cockpit of a CRJ700

Moffatt in the cockpit of a CRJ700 during flight training. Photo courtesy of Gregory K. Moffatt.

As a counselor, I’ve worked as a criminal profiler and consultant to law enforcement on violent crimes. I’ve also served as clinical adviser to judges, actors, television and movie producers, and novelists. And of course, I’m a college professor and dean.

As you can imagine, since I was in the fifth grade, I’ve never had only one job.

Over all these years, my career has seen many doors open and close. I taught part-time at Georgia State University for a decade or so. I lectured regularly at the FBI National Academy for an equal number of years. I wrote a newspaper column for over 35 years, and I worked as a profiler for the Atlanta Cold Case squad for just over a decade. Bethany Bray, a former staff writer for Counseling Today, wrote an article about my work with the Atlanta Cold Case Squad back in 2016 titled “Adding a counselor’s voice to law enforcement work.”

Gregory Moffatt with three children in India

Moffatt with some children in India. Photo courtesy of Gregory K. Moffatt.

My work has also allowed me to travel the world. I’ve visited nearly 40 countries, landing on every continent except Antarctica. I was even invited by the president of Rwanda to train Rwandan counselors to manage the trauma of the 1994 genocide.

Each one of these experiences has now become a part of my past. I enjoyed most of these jobs, and not once have I had any regrets when each of those doors eventually closed.

I published my first article in Counseling Today in 2011. Since that time, I’ve written several feature articles, and for the last five years, I’ve written the Voice of Experience column. Through these articles, I’ve shared with you my clinical experiences — including my successes and failures — spanning the past four decades.

Gregory Moffatt and his friend Eddie at Machu Picchu

Moffatt and his lifelong friend, Eddie, at Machu Picchu. Photo courtesy of Gregory K. Moffatt.

I cannot begin to count the number of responses I’ve received from readers over the years. They have mostly been positive, but even the criticisms have been thoughtful. Interestingly, readers often start an email with, “I read your article…,” as if I had only written one.

I was surprised to learn recently that my Voice of Experience column started in 2018. Even though it is cliché, time goes by so quickly. I’ve enjoyed sharing my thoughts with you, but like all my other experiences, the time has come to close this door as well.

I continue to serve as dean of the College of Social and Behavioral Sciences at Point University, where I’ve worked since 1985, and I still see clients at my clinical practice and serve as a supervisor. I am also carrying on my role as editor of the Georgia Journal of Professional Counseling and as a member of the Georgia Composite Board of Professional Counselors, Social Workers, and Marriage and Family Therapists.

Gregory Moffatt, his mother and another man at the Great Smoky Mountains in Tennessee

Moffatt and his mother visiting the Great Smoky Mountains in Tennessee. Photo courtesy of Gregory K. Moffatt.

But as retirement approaches, I am enjoying my world becoming smaller as I transition from seven or eight jobs down to three or four.

I am a die-hard American Counseling Association supporter and long-time member. I have always attended the ACA conference when it didn’t conflict with my travel schedule, and I’ve never been disappointed with its quality. I also regularly read Counseling Today cover to cover. ACA has served me well all these years.

I’m deeply grateful to Counseling Today’s previous editor, Jonathan Rollins, and the current editor, Lindsey Phillips, for allowing me to contribute to my profession through my writing. Both editors have done a fantastic job at improving my work. I’m a meticulous writer, but with each submission, they have made improvements. We are so fortunate to have such competence at the helm of one of our primary publications.

With that, my friends, I bid you farewell and wish you the very best as a new generation steps up and an older generation, of which I am a part, steps away into the background. Best wishes to you always, and thank you for reading my work.

Moffatt and his wife in Sydney. Photo courtesy of Gregory K. Moffatt.

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.

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 danger of misinterpreting risk

By Gregory K. Moffatt September 28, 2023

Wooden cubes in the form of a speedometer showing the risk assessment. Hand holding pencil is pointing toward medium to high risk.

Fida Olga/Shutterstock.com

Last month I addressed the topic of dangerousness in mental health. I noted that most people with mental illness are not dangerous and that, among those who are, they are more likely to be a risk to themselves than to others. In this month’s column, I focus on who isn’t dangerous and how our fears and stigmas can sometimes cause us to mistakenly perceive someone with a mental health disorder as a threat.

Some years ago, an attorney in south Georgia called me and asked me to consider testifying in a murder case in which the attorney was counsel for the accused. The defendant had an IQ of just under 70 and he had allegedly killed his mother. The attorney wanted me to testify that the defendant’s IQ was responsible for his violent behavior.

I had to decline that request, of course. While it is true that intellectual challenges may limit one’s problem-solving skills, there isn’t any evidence that indicates intellectual limitations “cause” one to be violent.

Violence in psychiatric hospitals

In psychiatric hospitals, patients can be aggressive with each other and with staff members, but there are reasons for this other than the psychiatric disorders themselves. Although mood disorders, anxiety disorders and even personality disorders (with the exception of those I addressed last month) may be contributing factors in aggressive acts, rarely do they directly cause violent behavior

First of all, in hospitals, people with serious dysfunctions are concentrated together in a confined space. Therefore spats, disagreements and fighting are not unlikely in such environments.

Second, these patients may be withdrawing from substances, managing complicated relationship issues and managing financial burdens all in the context of their mental health issues. These added stressors on top of their diagnoses can increase the probability of aggression. It is not caused by the diagnosis itself.

Finally, some of the most aggressive individuals, as I addressed in last month’s column, can be found in hospitals, so it isn’t surprising that we see aggression in hospital settings.

Misleading data

Early research on violence and mental health was nearly all done within inpatient settings. John Monahan’s 1981 monograph was a classic example of this type of research. While it was an exceptional work, the research presented a skewed perspective on mental health in general. The findings of those early studies couldn’t reasonably be generalized to the population at large.

I aimed to address this gap in the literature by exploring violence risk assessment in the general population in my first academic article, which was published in 1991.

What we now know is that, excluding hospital practice, most of us in the mental health industry will never be assaulted by our clients, and most of our clients will never harm or attempt to harm anyone else. A widely cited study published in the American Psychological Association in 2008 indicates that 35% to 40% of psychologists are at “risk of being assaulted” by their patients. “At risk,” yes, but most of them aren’t.

In a 2011 study, the National Institutes of Health (NIH) noted that 14% of patients admitted to a psychiatric hospital had been aggressive toward other individuals in the month prior to admission. Yet again, those who are hospitalized represent a narrow segment of the overall population.

In another NIH study in 2019, researchers found that over half of the 470 clinicians in their study had been subjected to threats, verbal attacks or physical violence at some point in their career. While this is an astonishingly high percentage, we see again that “threats” are mixed in with the data of actual aggressive clients. The participants in the study reported confrontations by clients outside the office, harassing phone calls and other verbally aggressive behaviors that fell short of actual physical contact. Feeling threatened and actually being assaulted are not synonymous.

Recognizing real vs. perceived threat

I once consulted with a company that routinely hired housekeeping staff from an agency that worked with individuals on the autism spectrum as well as individuals with development disabilities. One adult male autistic worker had been working for the company for more than three years without incident even though he was on the severe end of the autism spectrum.

As we know, people with autism often don’t handle changes well. Any disruption in their routine can cause them to be agitated. In this particular incident, this worker had gone to the maintenance area as he had done hundreds of times before, but for some reason the closet where his equipment was kept was locked.

The worker became extremely agitated and was ranting in the hallway to himself, pacing back and forth. Another employee of the agency felt threatened by him, and he was eventually fired. It was a tragic end. The employee’s fear of the agitated worker is understandable, but he was no threat to the employee nor anyone else in the office.

Recognizing who is actually a threat and who is not is a critical part of our work in mental health. Individuals who are not a threat, but inaccurately deemed to be so, can lose their jobs, custody of their children and potentially their freedom, among other things. There are also dire consequences in cases where people are a threat but inaccurately deemed not to be so, including the potential loss of life.

My experience has shown me that most therapists are not well trained in distinguishing between the two. In a workshop some years ago where I presented a seminar on violence risk assessment and self-harm assessment, I asked the roomful of 100 or so clinicians how many of them worked with suicidal clients. Every hand went up. When I asked how many of them felt well trained in assessing risk, only two or three raised their hands. None of them had any significant training in their graduate programs on risk assessment.

That leaves the responsibility for learning risk assessment to the clinician. We must stay current on the research on risk assessment, and we must interpret the data cautiously.

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.

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: Disorders with the potential for dangerous outcomes

By Gregory K. Moffatt August 30, 2023

A person's feet in sneakers standing on a street before the word caution written in yellow chalk

Photo by Goh Rhy Yan on Unsplash

My first trip to a psychiatric hospital was in 1978. I was a first-year college student, and one of my classes toured a state-run hospital. Like my classmates, I’d seen plenty of movies about a scary “crazy” person who escaped from a hospital and terrorized the community. But I learned on that trip — and my career experience has shown it to be true — that most people in hospitals like that came in on their own accord for help.

Our guide, the director of the facility, noted that the fence around the gigantic property was not there to keep the patients in, but rather it was there to keep others out. In fact, many of the patients in that facility could have walked out the front door any time they wanted. But they didn’t want to. They wanted help.

This trip reaffirmed what I have found to be true in my work with clients throughout my career: Most people with a mental illness are not dangerous. In fact, they are often more of a danger to themselves than others. But there are a few mental illnesses that can have potentially dangerous outcomes for others.

Three disorders associated with an increased risk of violence

Research is weak regarding which mental illnesses are correlated with dangerous behaviors. I’ve researched this area for close to 40 years, and I can assure you there is no simple answer. But here are three disorders that have the potential for dangerous outcomes and always give me cause for concern.

Reactive attachment disorder. In terms of dangerousness, reactive attachment disorder is the king. This disorder, which affects children, is one of the scariest due to the developmental limitations in children in terms of coping skills and problem-solving.

I’ve seen these children cut, pinch, hit, and even kill infants and young children. I’ve seen cases in which children as young as five years old have threatened their guardians with knives. I’ve had clients under the age of seven sexually assault younger children, and I’ve seen older children with this disorder kill family pets as well as rape adult women. Children with this diagnosis need 24/7 supervision along with intensive treatment plans.

Antisocial personality disorder. Antisocial personality disorder is the adult cousin of reactive attachment disorder. Clients with this disorder can exhibit their dysfunction in several ways. One key characteristic is that people with this disorder manipulate people. They can do this in a variety of ways, some of which don’t include violence.

But clients who choose to manipulate others physically or sexually can be dangerous. They have little compunction regarding the injury they cause others. The desire to manipulate others and see pain can lead to horrifying behaviors. These patients will attack staff or fellow patients in hospital settings, and they can easily attack therapists in outpatient settings. Individuals with this disorder are often the characters many of us know of as serial killers and serial rapists. Much of what I’ve seen of these individuals over my career is not far flung from the movies.

(For more on this disorder, see my article “Counseling encounters with the puppet masters,” which was published in the February 2019 issue of Counseling Today.)

Delusional disorders. My wife and I visited a restaurant in downtown Atlanta recently. As we approached the restaurant, I saw a man pacing back and forth on the sidewalk in front of us near the front door. He was clearly homeless and suffering from delusions. We gave a wide berth to the guy as we entered, but from our table, I could still him through the window. It grieved me to watch this gentleman outside the restaurant suffering in front of me.

As with antisocial personality disorder, individuals with delusional disorders exhibit their symptoms in a variety of ways. Only some of their expressions are dangerous. The sensory hallucinations (auditory, tactile, visual, etc.) that these clients experience are absolutely real to them.

But unlike antisocial personality disorder, these individuals are not dangerous out of spite or cruelty. Instead, the delusions they experience and the chaotic worlds in which they live can cause them to feel threatened and, in response, act out. This is why I steered clear of the homeless man as I entered the restaurant.

In other cases, their delusions lead them to think they are helping when they are doing the opposite. For example, Russell Weston, a 42-year-old man with schizophrenia, killed two Capitol police officers in 1998. He believed he was saving the world from aliens and was trying to access the “ruby satellite” he believed to be housed in the U.S. Capitol.

Violence risk assessment tools

Assessing dangerousness is a complicated process and an inexact science, and this can cause some mental health professionals to worry about assessing and treating clients with these disorders. But there are clinical tools that can help clinicians better assess the risk of potential violence.

I developed the Violence Risk Assessment Checklist in the 1990s (available at gregmoffatt.com) and have used it for years in businesses. This hierarchical checklist, like a suicidal ideation checklist, helps counselors evaluate for increased or decreased risk of potential violence. It contains twenty-eight items. Of the top eight, the more items the counselor checks when assessing the client, the higher the risk of violence.

The National Institute for Occupational Safety and Health provides a list of violence risk assessment tools that have been developed specifically for determining a person’s potential for violence to themselves or others. This list includes the Dangerousness Assessment Tool, which is a quick assessment scale clinicians can use to determine if an individual who is displaying signs of potentially dangerous behavior is a risk to others.

Clinicians need to realize, however, that just like assessing for risk of suicide, these instruments are only guides for decision-making and intervention, not precision tools.

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Next month, I’ll address who isn’t dangerous and how I know.

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.

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 gift of friendship

By Gregory K. Moffatt July 31, 2023

Silhouette of two people walking and talking on a forest path

mantinov/Shutterstock.com

July has been a hard month. My oldest and closest friend, Eddie, passed away. You didn’t know him, and he wasn’t a mental health professional. Far from it. He was a historian. But you benefited from him indirectly because he served as my editor for most of my professional life.

I met Eddie when I was only 22 years old. He was one of the first people I met when I moved to Georgia from Tennessee with my new bride, ready to begin graduate school. At the time, he was the academic dean at Point University — the university where I currently serve as dean of the College of Social and Behavioral Sciences and have worked as a professor of psychology for close to 40 years. Even though he was 16 years older than me, we immediately became friends.

We shared a love of birds, hiking and the outdoors, but I also valued his impeccable grasp of grammar and his love of scholarly pursuits. One of the first gifts he ever bought for me was a paperback copy of William Strunk and E. B. White’s Elements of Style, a writing style manual. It might seem like an odd gift, but it taught me a lot and showed me how much I still needed to learn about communicating clearly and effectively.

Around this time, Eddie also became my personal editor. He proofread every paper I wrote for graduate school, and I would often ask him to look over important emails as well. He edited every article I wrote for a newspaper column I hosted for 35 years, and he proofread each chapter of the dozen or so books that I’ve written.

I’ve also published several articles in various periodicals, including Counseling Today. And you guessed it: He edited them all. Before my Counseling Today editor ever saw a draft, it ran through Eddie’s editorial eyes. And until this past year, he edited my Voice of Experience column as well.

He provided this service as a friend and colleague, and he never once asked me for a dime. I cannot tell you how much he taught me along the way.

The readers of my column have also benefited because Eddie improved my quality of writing — a skill I often use when I write, speak in public or provide students and colleagues with feedback. I can’t recall how many times I sent him a draft where I thought I had used my words carefully and clearly, but then Eddie would suggest more subtle yet powerful wording or note places that needed to be clarified for readers who were not as well-versed in the subject as me.

My friend supported me in other ways as well. In my 2018 Counseling Today article “The hurting counselor,” I described a dark period in my life and how I was unprepared to handle it because of poor self-care. I didn’t have a counselor at the time — a mistake I admit in the article. The closest thing I had was Eddie. He walked me through those dark days and helped me pull myself up from the ashes. He made meals for me, drove me places, listened to me — for hours. Even though he wasn’t a counselor, he could have been.

But he wasn’t just there for the tough times. We also celebrated our children’s births, weddings and holidays. Eddie was the kind of friend that we all need — someone with whom we can experience and enjoy life.

It’s easy for counselors to get caught up in their work. Early in my career, I spent nearly all my time working. Although I don’t regret that hard work, it was a perfect example of “life imbalance.”

But life must be about more than work. Friends, like Eddie, are hard to come by, and as I matured — both personally and professionally — I realized that. So I started investing more in my relationships. Eddie and I traveled many miles together and had many adventures, hiked many trails and camped in many campgrounds. We had so many inside jokes that we began referring to them by number (e.g., “Funny story #12”). No other words were needed.

Anyone who has experienced grief knows there is a hole in my heart — a chasm that feels impossible to close. But I’m thankful I learned to appreciate my friend.

Friendship is a gift, so we must make time to find and foster it. And in the end, we discover that supportive friendships are what make us become better people, parents and therapists.

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.

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: Professional organizations

By Gregory K. Moffatt June 27, 2023

black-and-white image of a speaker giving a talk in front of a large audience

Matej Kastelic/Shutterstock.com

I’ve been a supervisor for over 30 years. During my last supervision session with prelicensed clinicians who are about to get their full license, I tell them: “After today, you will never have to speak to another professional in the field again.”

Of course, that isn’t a recommendation but a fact. The point is that counselors can easily become isolated within the walls of their practice. Therefore, their professional interactions have to be intentional.

Roadblocks to professional interactions

As counselors, we often have 15 to 20 clients or more per week. On top of that, we often work unusual hours. Late afternoons, evenings and weekend appointments make it less likely we will see other professionals who have more standard working hours.

One of my closest professional friends has her own private practice and sees clients up to 40 hours per week. I couldn’t carry that heavy of a caseload, but even if I did, having that many clients doesn’t leave much time for collegial interactions.

Another one of my colleagues works in a private practice where she leases office space. There are more than a dozen other clinicians in that office building, and she doesn’t know anyone’s name. Everyone comes in, they go to their respective offices and they close the door.

Even continuing education doesn’t require face-to-face interaction with peers anymore. Before the COVID-19 pandemic, my home state of Georgia had restrictions regarding online continuing education, with no distinction between synchronous and asynchronous hours. A clinician could use only 12 hours of online learning for license renewal, with the remaining 23 hours required to be in person.

Now in Georgia it is possible to earn all 35 continuing education hours online as long as 25 of those hours are synchronous (including ethics). Although online learning has made our lives easier, this is yet another way we disconnect from professional interaction with colleagues. Synchronous workshops may not require the participant to engage, making it easy to hide in the background.

For those who are fully online in their practice, working from home makes it challenging to interact with other professionals in the field as well.

Benefits of professional organizations

Professional organizations create an environment where one can acquire professional interaction on a more personal level. Conferences, workshops and lunch-and-learns create a platform for professional development. I go to at least one professional conference every year.

I’m a hopeless introvert and my social needs are practically zero, but I value the relationships I’ve built over the years through my involvement in professional organizations. These connections have provided a fertile resource for referral options and updates in the law, ethics and board rule changes. They are also a resource for deliberating ethical dilemmas.

Most professional organizations have specialized districts/divisions that are tailored to the needs of various geographical regions or specialized areas of practice.

Finally, membership fees practically pay for themselves through discounts on conference registrations, free publications/journals and access to the resources mentioned above.

Advice on joining organizations

When I first began my career in mental health, I was a member of eight different professional organizations. I paid those membership dues every year, but eventually I realized that most of them were not serving my professional needs. I gained nothing from their publications, didn’t attend their conferences, and rarely found anything useful for my practice in their newsletters and announcements.

Today I’m a member of half that many, yet all of them serve me. I’ve been to all their conferences at one time or another and know people within those organizations that I can contact if I have ethical questions. I am partial to state organizations, or state chapters of national organizations, because they are more attuned to the specific laws and governing bodies in one’s state.

Counselors should also be careful about joining groups to become “certified.” Some organizations have impressive-sounding titles that, in reality, are meaningless. The American Organization of Certified Psychotherapist sounds great, but I just made it up. These fluff groups have no criteria for membership other than paying fees, but they act as if joining makes the clinician more competent or part of an exclusive club. Having one of these organizations on your resume or curriculum vita might do you more harm than good.

I require my supervisees to be a member of at least one professional organization while under my supervision, and they must demonstrate to me how that organization serves their needs. This is a part of one’s professional growth that needs to continue long after formal supervision has ended.

Don’t be an isolated clinician. Get involved in a regional, state or national professional organization.

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.

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.