Tag Archives: Voice of Experience

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.

Voice of Experience: Revenue streams for counselors

By Gregory K. Moffatt July 28, 2020

Counselors-in-training often ask me how much money a counselor can expect to make in a year. In many fields — education, for example — that is a fairly simple question. But not so for counselors.

Counselors basically have to work for free until they complete their graduate work. Then, depending on where they land employment, they must work from the bottom up until they are fully licensed. As a general rule, I tell my students to plan on five years post-bachelor’s degree before they really start making a decent living and can focus on their preferred areas of practice. That is a long time and, even then, annual incomes vary tremendously. So, here are some considerations for counselors who are just starting out in the field.

The easiest path: By far the easiest path for therapists is to be hired by an established practice or hospital. Here counselors might make a little less than they would on their own, but they don’t have to bother messing with insurance companies (other than documentation), paying the light bill or scheduling. In private group practice or hospitals, you show up, put in your hours and go home. Working 20-30 hours a week is not uncommon in such circumstances, but your hours are set for you, and you may have zero flexibility.

Expect no-competition contracts in these practices. This means that you can’t leave the practice and take your clients with you. In some cases, you also won’t be able to open a private practice within a certain number of miles of the place you worked should you decide to leave.

Subleasing: A nuance on the “easy path” is joining an existing practice by subleasing office space. Here you may have to pay your own light bill and cover expenses, and you will do your own scheduling and billing. In this scenario, you might make more money per clinical hour, but with billing and paperwork, 20 hours per week is a very busy practice. One advantage of this option is that you will have the built-in benefit of the reputation and advertising of the existing practice (assuming that reputation is good, of course).

Opening your own practice: Starting your own practice provides maximum flexibility and freedom, but this path requires you to start from the ground up in creating your client base. Plus, you will be doing all of your own advertising, web building, billing and scheduling. This approach takes energy and commitment.

Teaching: Once you complete a master’s degree, you are qualified to teach at the undergraduate level. Many counselors teach college courses in-seat or online as an additional revenue stream and for variety in work experience. Online courses usually pay around $1,500 per course ,and traditional in-seat courses usually pay around $3,000 per course. This experience also provides you with potential referrals from students. Contact the department chair of a college or university where you might like to teach for more information. Have your vita and transcripts ready.

Consulting: Consulting with schools, businesses, churches, law enforcement, lawyers and other public agencies not only provides additional income but can also put your name out there with other agencies.

Working for free: Generally, I want to get paid for my work, but doing pro bono work as a consultant might put you in position to make more money later. I worked for one worldwide company for almost 10 years and never charged them a dime, but I made tens of thousands of dollars from referrals because of my affiliation with that company. I knew that was possible, which is why I agreed at the onset to provide free services for them.

CEs and presentations: As with teaching or consulting, providing continuing education workshops and presenting at professional meetings can help get your name out there to a wider audience. In this type of networking, it is critical that you polish your “act.” A poorly presented seminar can earn you more name recognition, but not in a good way. When I started teaching at the FBI Academy many years ago, the director at the time told me, “I opened the door for you, but you had to keep it open.” That’s important advice.

Specializations, licensing and certifications: In combination with maintaining your license(s) and involvement with local and national organizations such as the American Counseling Association, specializations can help you build your practice. Receiving training in marriage and family therapy, eye movement desensitization and reprocessing, play therapy, dialectical behavior therapy or other specializations can serve to set you apart from others in the field and bring in clients. Achieving specialty certifications can also give you the option of charging a higher per hour rate.

I can’t be exhaustive in discussing all revenue streams in a short column, but depending on where you live and which of these routes you pursue, a counselor in full-time practice can make a very healthy living. You just have to work 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: 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.

 

 

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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: 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.

 

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

 

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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.