Tag Archives: Voice of Experience

Voice of Experience: Knowledge is a coping skill

By Gregory K. Moffatt May 26, 2020

In 1994, I built my house in a tiny little village in Georgia. Back then, a neighboring town not even 10 miles away counted as a long-distance telephone call. At the time, nearly all cell phone companies charged by the minute. My phone plan gave me 10 minutes a month for $60. There was no Skype, Zoom or videoconferencing, and the internet was still something that many people didn’t have in their homes. In fact, many people in 1994 didn’t have a computer in their homes.

In 2003, when I was in India, I paid over $80 for a 15-minute telephone call home. Today I could talk as long as I want for free. We could go back further in time, and some of you would remember hand-dug wells, outhouses, coal stoves and homes with no electricity. I can.

The point here is that we are so fortunate. We couldn’t have managed the coronavirus 20 years ago as easily as we are managing it today.

Things are not as bleak as they might seem in light of COVID-19. I think of this coronavirus event as “The Great Interruption.” I take it seriously, but at the same time, I don’t regard it as the end of the world.

Part of coping with stress is knowledge. Think of a traffic jam. It is frustrating if everyone is stopped on the highway and you don’t know why. But if you receive information that there is an accident ahead that will take 30 minutes to clear, that knowledge helps you manage your stress. You can now make plans, and you have a hint of control.

Here is what we know about the COVID-19 virus:

  • It is one of many similar viruses that we have faced before; we will face others in the future.
  • It is transmitted through the air and via contact. Isolation and physical distancing can help lower risk of contracting and spreading the virus.
  • The time the virus can survive exposed to air varies depending on the type of surface it is on: metal (5 days), plastic (2-3 days), cardboard (only 24 hours — yeah Amazon.com).
  • It is currently thought that 1 in 4 carriers may be asymptomatic. On average, people are contagious for 48 hours before symptoms appear, but that can extend up to 14 days.
  • The fatality rate for COVID-19 remains a source of debate, but in general, the rate is low (about 2%). Vulnerability and age are significant factors. Among young people, the death rate is practically zero. Those 60 and older account for the majority of deaths (by far) from COVID-19, with those who are 80-plus the majority among that group.

I use this knowledge in hopes of putting this virus into perspective. It is very contagious, but so is the flu.

Nonstop news coverage of every new case, every celebrity and every athlete who has it, as well as the “experts” telling us all the terrible things that might happen, has created an impression of plague. One ridiculous teaser line I heard said, “Coming up next, an interview with an actual survivor!” Like approximately 98% of the people who get it?

We’ll get through this. Here are some ways we can manage our stress and that of our clients as we work through this pandemic.

First, we need to be aware that any stressful event magnifies pre-existing conditions — addictions, relationship troubles, anxiety, etc.

Second, self-monitor. I hate change, and this situation has caused me to change almost everything. Repeatedly throughout the week, I have to self-monitor, recognize my rising stress or frustrations, and manage them.

Third, don’t stop your daily routines unless you have to. If you shop for groceries on Fridays, shop for groceries on Fridays.

If you are a parent, keep an open dialogue with your children that is age appropriate. Help them manage their fears and anxieties.

Identify specific stressors of this isolation. I’m an extreme introvert. Staying home hasn’t caused me any stress, but for extroverts, the lack of socialization can be very stressful. Seeing people wearing masks everywhere can also subconsciously cause fear and anxiety.

Eat right, sleep right, and get plenty of exercise. If you are a regular reader of my work, you will recognize this as Moffatt’s Mantra.

Find the positive in the situation. We have lots of time with family or time to learn a new skill. Plus, no traffic and much less driving! I normally divide my time between three offices. This virus has returned to me almost 10 extra hours a week that I normally would have been on the road.

Finally, take it a day at a time and shut off the TV. We’ve had enough gloomy news.

 

 

****

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: It often comes down to grief

By Gregory K. Moffatt April 20, 2020

Somewhere along the way in our education as counselors, all of us studied great theoreticians such as Erikson, Piaget and Maslow. Their theories provide us with a general understanding of human behavior, and with that information we can develop clinical interventions. In my undergraduate days, I didn’t fully appreciate theory as much as I should have, but the further I traveled into my career as a counselor, the more I realized the importance of theory and how to use it.

But it isn’t just theory that is interesting to me. The insight behind the development of these theories is equally significant. How did these men and women come up with their theories to begin with? Have you ever looked at an invention and thought, “Wow, why didn’t someone think of that sooner?”

It is these potential blind spots that I have always tried to identify throughout the decades of my career. What am I failing to see? What might someone come up with in the future that would leave us wondering, “How did we miss that?”

And that is what brings me to the topic of grief. You’ve probably heard that “depression is really suppressed anger” or something very similar. We know there are often different emotions underlying the ones that we actually see in our clients. I’m convinced that grief is one of those underlying emotions in many cases.

When Elisabeth Kübler-Ross wrote her seminal work On Death and Dying in 1969, she was looking at grief only in the context of personal loss due to death. But later in life, she expanded her view to include other experiences of grief. Infertility, job loss, loss of health, and the death of a pet are among a host of other losses that one might grieve.

I’ve begun to believe that some of the dysfunction we see clinically is actually grief. When I was a very young man, my uncle once said to me that he grew up to “become everything I always hated.” What a sad thing to say. I didn’t realize it then, but I realize now that he was expressing grief to me — the loss of his dreams. He had hoped for one thing but achieved something quite different.

Addictions, affairs, anger and depression — to name a few things — may really be the client’s attempt to manage grief. A client struggling with fidelity in his marriage finally achieved an epiphany in therapy with me when he realized that his unfaithful behaviors had almost nothing to do with sex. Through extramarital relationships, he was seeking a fantasy — the thing he always hoped his marriage would be. In a way, he was in the bargaining stage of Kübler-Ross’ theory. “If I could just redo some choices in life, I would find happiness in a relationship with someone …”

Instead of grieving the loss of what he thought his marriage should have been, he tried to bargain his way through it. These bargains were illusions and, consequently, none of his extramarital relationships satisfied him. Once he was able to grieve the loss of the marriage he had hoped for, he was able to adjust his expectations and achieve a healthier relationship with his wife.

This doesn’t mean that we must settle for unhappiness. On the contrary! With resolution of grief comes peace of mind. Borrowing from yet another theory, perhaps this is akin to Rogers’ idea of the ideal self and the perceived self. No one suggests we stop dreaming of a better self, but there will always be a gap between these two “selves.” It is in the resolution of that disparity where strength of ego develops. Grieving the loss of the ideal can lead to healthier behavior.

In a sense, Erikson said as much regarding the final stages of psychosocial development — generativity versus stagnation and integrity versus despair. These two stages are successful, at least in part, when one has achieved a sense of accomplishment.

If a person can look back on life and find satisfaction with its direction, it provides a sense of “I did good” and allows one to sleep well at night. There is no grieving. On the other hand, looking back and ruing decisions and the direction of one’s life leads one to feel stuck and hopeless. This is grief — the loss of one’s expectations.

I suppose what I’m trying to communicate is that if we can see how grief might be driving our clients’ dysfunctions, then what we should be treating is grief rather than just depression, addiction or other symptoms of grief. We cannot change loss. Facing it and finding ways to cope are the keys to resolution.

 

****

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.

****

Recently published: See Gregory K. Moffatt’s article in the April issue of Counseling Today: “The need for standardization in suicide risk assessment

 

****

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 dangers of cultural un-awareness

By Gregory K. Moffatt March 6, 2020

I know this is hard to believe, but the first class I ever had on cultural awareness was one that I taught. My graduate programs in the 1980s didn’t have a single class on the importance of understanding the diverse backgrounds of our clients. The best we did in those days was a short paragraph at the end of each textbook chapter tipping a hat to cultural awareness. My first exposure to the issue was with Derald Wing Sue and David Sue’s text Counseling the Culturally Diverse. This book, now in its eighth edition, is used in many graduate programs. I still use it today.

For more than 30 years now, I have taught this course on cultural awareness to both graduate and undergraduate students pursuing counseling degrees, and each time I realize the importance of this topic. Frankly, I’d rather see graduate programs drop a personality theory class or something else and add a second or third required course on diversity. In one semester, I can only introduce the topic. Competence is still far from the reach of these young clinicians.

It was during one semester teaching this course when one of my students related the following story. With her permission, I have shared it with every class since that time because she passionately and succinctly conveyed the importance of cultural awareness. Addressing an experience with one of her clients during an internship, she wrote to me the following:

Just yesterday I interviewed a man at the psychiatric hospital while keeping my eyebrow raised in suspicion that he wasn’t being truthful with me. This tall, obese, African American gentleman looked as though he had not bathed for days. The mucus stains and dandruff that covered his shirt immediately triggered thoughts in my mind. As he denied his drug use and other suspecting issues, I secretly assumed he was lying and trying to avoid consequences. Through his missing teeth, he smiled and told me he had never, ever drank alcohol. Flash-forward to the phone call I made to his sister where I learned that he had suffered severe head trauma in the 1960s. This gentleman had been the victim of a riot started over racial disputes and ended by police beating his head to a bloody mess. The man had, indeed, never drank alcohol and was only at the hospital for medication adjustment for his schizophrenia. I went back and apologized for not believing this sweet man. The only head shaking I did yesterday was at myself.

This story is so powerful and moving that when I read it to my students, I sometimes have a hard time holding back tears. Imagine the dangers of cultural un-awareness. I know this is poor English, but I want to emphasize just not being aware. In contrast with the years of my graduate experience when cultural awareness was largely neglected, now most of us know that it matters. But I suspect we hear about it so often that we don’t really give much thought to its implications.

The graduate student I quote above was an intake intern at a major hospital. The least experienced person in the system was the first to have contact with the client. That alone is frightening, but it is not an uncommon situation. If this intern had not discovered her error, the gentleman easily (and errantly) could have been tracked as an addict. At the same time, his real issues would have been ignored. This victim of racial violence would have again been victimized by the systemic racism that had put him across from the intern in the first place.

And what is most frightening of all is that my student was as culturally sensitive as any of us at that stage of our education. She was simply doing what she had been trained to do by an educational system that can overlook important cultural clues.

Someone once said that “the most insidious form of racism is covert racism.” When racists rant on street corners or wear icons indicating their perspective, they are easy to spot and thus easy to avoid. Subtle biased thinking and, more importantly, systemic racial discrimination is much harder to combat because well-intentioned therapists, like my student, don’t even recognize it.

My students are often angry with the Sue and Sue text because the authors are very confrontational in their approach. I experienced the same anger the first time I read it. But I know why the authors approach it this way. Novelist Flannery O’Connor was once asked why she wrote such graphic novels, and she replied, “If you want to communicate with the blind, you must paint large, startling images, and in the world of the deaf, you have to shout.”

I have heard Derald Sue speak several times. He is a brilliant and gentle man, but he isn’t afraid to talk about hard topics. This quiet man isn’t afraid to shout or to paint large, startling images. Maybe this is what it takes for a deaf and blind society to get it.

 

****

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: Billing guilt

By Gregory K. Moffatt February 18, 2020

I am a very poor bookkeeper. I will admit that up front. I am capable, but I just don’t enjoy managing the finances of my clinical setting. Perhaps more importantly, for many years I felt guilty about charging my private practice clients.

Therefore, I was hesitant to mention overdue balances or to expect payment from my clients at the time of service. It just felt awkward. If clients didn’t pay their bills, I often would let their accounts slide into history and eventually ended up closing their files with an amount due in the ledger.

Then one day, many years into my practice, I got some new accounting software and decided to clean up my old books. For no reason other than curiosity, I went back through all my overdue accounts and was stunned. The total owed by overdue clients was in the thousands of dollars.

Granted, this was over a long period of time — more than 10 years — but those individual accounts that I let slide had added up. I could have bought a new car with that money. Fortunately, my private practice was not my primary source of income. Otherwise, I very likely would have been operating in the red.

It is uncomfortable asking for payment, but this seems to be true only for counselors. Can you think of any other service in which the vendor is hesitant about asking for payment? I can’t. Whether they are plumbers, mechanics, dentists, morticians or babysitters, people get paid for providing a service.

Nearly all of my new counselors, interns and supervisees express some hesitation about charging clients. One experienced counselor, in fact, asked me to look over her revamped informed consent. Her fees were clearly listed.

“You aren’t charging enough,” I told her.

“Really?” she said sheepishly. “I don’t want to be greedy.”

I asked her what her time, education and experience were worth. She had two degrees, was fully licensed both as a professional counselor and as a marriage and family therapist, and had several years of practice under her belt. Yet her fees were the same as when she was still in supervision.

I asked, “Are you providing a service that has value to your clients?” Of course, she said yes.

“Then there is nothing wrong with being paid what you are worth, at least within the market standards.”

She decided to raise her rate — and she deserved the higher fees. She also saw no change in her client base. In other words, none of her clients questioned paying a rate consistent with the standard in the field. As it should be.

One of my colleagues who has run a successful private practice for many years taught me something on this topic. She had a basket in her waiting area with a sign: “Check goes in the basket before you come back” (to the therapy room).

These days, her sign probably says something like, “Payment on my cash app must come through before therapy starts.” I don’t know. But the point is that she set an expectation for payment that was reasonable and clear, and people lived up to her expectations.

Even though my informed consent said payment was due at the time of service, I wasn’t clear about what my expectations for my clients were. My practice demonstrated vague expectations, so my clients back then lived down to them.

I completely understand why we feel guilty about charging as professional counselors. After all, we are helpers, not mercenaries. But few things in life are free.

If a client balks at my fee, I’m happy to provide referrals. I’m also very generous with pro bono hours — as are most therapists. But I no longer feel any guilt about charging my clients or my supervisees. I’ve invested in my career, it costs me money to run my practice, and I’m good at what I do.

“How much is your marriage worth to you?” I asked one potential client who hesitated at starting marriage counseling. (Sometimes I asked, “How much does a divorce cost?” That usually put things in perspective.)

“I guess it is worth $150 an hour,” he said, referring to the fee his therapist was charging. And it was worth it for the therapist too. She used her expertise to help heal a damaged relationship just as a physician might use medication or surgery to help the body heal.

Regardless of whether you have a sliding scale or a fixed rate, accept third-party payments or are cash only, you are providing a service. You spent time, money and energy developing and maintaining your expertise. You deserve to be compensated.

 

****

 

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 boring (and risky) part of the job

By Gregory K. Moffatt December 23, 2019

I spent almost 10 years as a lecturer at the FBI National Academy in Quantico, Virginia. The very best of the best from every possible area of forensic science were clustered together in the behavioral science unit deep underground on sublevel two.

I learned a lot from my colleagues in those years, but the most memorable thing I heard while I was there was this: “Agents will get themselves in far more trouble with their pens than they will with their guns.”

Written documentation lasts forever, and poorly written documentation can cost you your job. Most agents never have to take their guns out of their holsters through most of their careers, but every one of them will write hundreds of pages of reports over the course of 25 or 30 years. That is a very long paper trail, and it provides plenty of opportunities to do it wrong.

The counseling profession is much the same. I like to believe that most of us will never get in trouble for egregious ethical violations — the equivalent of an unauthorized shooting in law enforcement. But all of us will, like my FBI friends, write hundreds of pages of reports over the course of our careers.

We will file insurance documentation, create case notes, develop treatment plans, and perhaps write excuse notes to employers, teachers, colleges and other important people in the lives of our clients. Some of us will provide written statements to the court, child protective services, and other government agencies.

Most of our documents will never be seen by anyone other than us, our staffs, and perhaps insurance company employees. But sometimes, others will see our written work.

Once when I was consulting with a business, the company employee assistance program representative had required an employee to seek a mental health evaluation to ensure the employee was not a risk to self or others at the worksite. The written report from the psychologist was more than two pages long and full of opinion and subjective commentary about the client. But the worst part was the first sentence: “I declare that the employee is sane.”

Sanity is a legal term, not a mental health term. If the case involving this employee had gone to court and the psychologist had been questioned on the stand, the first thing a lawyer would have done would be to drop the Diagnostic and Statistical Manual of Mental Disorders on the bench and ask the psychologist to flip to the page where “sane” shows up. It isn’t there. The psychologist would have, at the very least, looked incompetent.

Likewise, to declare someone “sane,” ethically one must have training and expertise in competency evaluations. Because this psychologist apparently didn’t know the meaning of the word, I suspect she did not possess the requisite training. A single word on a more than two-page letter could have created major troubles for this psychologist with the ethics committee of her licensing board.

It’s likely this psychologist had never written such a letter before and didn’t think to run it by a colleague before sending it. That was risky. An otherwise (what I can assume to be) stellar career could have been derailed by the pen.

With this in mind, I propose five simple rules for counseling professionals:

Rule 1: If you don’t have to write it down, don’t. The letter from the psychologist could easily have been limited to one sentence: “I do not find this client to be a risk to self or others.” That was the mandate and all that the company wanted to know.

Rule 2: Be objective. What do you see or hear that is clear, pertinent to the case, and that another therapist sitting in the room would also see? Avoid adjectives and modifiers. The psychologist wanted to help her client, but her personal feelings about the client were irrelevant in that situation. Another therapist in the room might have had different feelings.

Rule 3: Use professional and clinical language carefully. “Sane”?  Really? If you haven’t diagnosed depression, for example, don’t say that a client is “depressed.”

Rule 4: Assume someone else — a judge, a jury, a licensure board member, an attorney — might someday see what you have written. Don’t write anything that you would be ashamed or embarrassed for someone else to see.

Rule 5: If you don’t have one already, find a mentor who can help you polish the writing part of your career.

I was trained as a person-centered counselor and, consequently, kept very few case notes. Looking back, I’m embarrassed at what I produced in those days when I was beginning to learn the art of writings things like progress notes. Today things are much different, and I’m hopeful this word of caution will help you get there quicker than I did.

 

****