Using an ecological perspective Also inside: n Transitioning successfully into retirement n Reflecting “as if” with diverse populations n Drawing clients out of avoidant behaviors n Counseling students after sexual assault CT0213_CT0213 11/29/12 4:30 PM Page 1 Counseling Today

Alleged unprofessional conduct and inappropriate treatment – lead to a malpractice suit.

The client, a 51-year-old woman uses her email correspondence with the counselor to mount a formidable legal case, suing for $500,000 in damages. Read the details of this case study and how coverage through HPSO responded to protect our insured counselor at www.hpso.com/ct2

This program is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company, and is offered through the Healthcare Providers Service Organization Purchasing Group. Coverages, rates and limits may differ or may not be available in all states. All products and services are subject to change without notice. This material is for illustrative purposes only and is not a contract. It is intended to provide a general overview of the products and services offered. Only the policy can provide the actual terms, coverages, amounts, conditions and exclusions. CNA is a registered trademark of CNA Financial Corporation. Copyright © 2013 CNA. All rights reserved. Healthcare Providers Service Organization is a registered trade name of Affinity Insurance Services, Inc.; (AR 244489); in CA, MN & OK, AIS Affinity Insurance Agency, Inc. (CA 0795465); in CA, Aon Affinity Insurance Services, Inc., (0G94493), Aon Direct Insurance Administrator and Berkely Insurance Agency and in NY and NH, AIS Affinity Insurance Agency. © 2013 Affinity Insurance Services, Inc. CT0213

Endorsed by: Counselor’s Professional Liability Insurance Learn the value of having your own ACA-endorsed plan by visiting www.hpso.com/ct2 Counseling Today Counseling TodayApril 2013 Cover Story

30 Building a more complete client picture By Lynne Shallcross An ecological perspective in counseling involves identifying how a client’s environment affects his or her well-being and development, and using interventions that move beyond exclusive focus on the individual. Features

40 Life without an alarm clock By Stacy Notaras Murphy On the surface, retirement looks like paradise, but unless counselors are prepared to redefine themselves and make new connections, even they can get tripped 30 up while making the transition. 48 Knowledge Share Reflecting ‘as if’ By Richard E. Watts This brief, encouragement-focused counseling process integrates Adlerian and constructive theory and practice perspectives and can be useful for work with diverse populations in a variety of settings. 54 Reader Viewpoint Emerging from the cave By Kim Johancen-Walt 40 It is human nature to withdraw for a time when wounded, but clients who engage in long-term avoidant behavior run the risk of amplifying their pain and creating larger problems. 58 Reader Viewpoint After an assault By Margaret Edwards & Charlotte Chapman Consider following these first-session do’s and don’ts when counseling college students who have experienced a sexual trauma. Extras 62 McDonald, Nodar earn recognition in ACA Foundation essay contest focused on the future of the profession 48

64 FY 2013 Election Results

April 2013 | Counseling Today | 3 CounselingCounseling TodayToday April 2013

Columns 10 Washington Update 11 The Two-Minute Advocate 12 Through a Glass Darkly 16 New Perspectives 18 Private Practice Strategies 20 Recent Book Releases 24 Risk Management for Counselors 26 The Digital Psyway Join the conversation online

29 Counselor Career Stories Here’s what your colleagues have been saying about articles they have read on Counseling Today’s website at ct.counseling.org. n “Q&A with Brandon Ballantyne: From aspiring tornado chaser to counseling teens” Need to Know “Creative approaches such as the ones you shared meet kids where they are. They are so powerful in helping young clients express feel- 5 From the President ings in ways words cannot touch. Once an image is created, they then see previously unknown parts of themselves tangibly reflected back for 7 Executive Director’s Message integration. I would also recommend movement as a mode of expres- sion as well. Thanks again for the great article.” n “Record number of military suicides begs questions about 8 Letters to the Editor the path forward” “Thank you for this exceptional article. I am a professional counsel- 46 CT Learning Test ing graduate student and also a member of the United States Army Reserve. After completing both active duty time and now as a reserv- 66 Division, Region & Branch News ist, I recognize the need for more mental health counseling in both the active duty side as well as the Reserve side. Soldiers are looking 68 Bulletin Board for answers and show so many signs/cries for help. Those trained to recognize and identify need to be more accessible and on the ‘home front’ ready to support and educate …” n “Bully pulpit” “I am so glad that the Counseling Today article was written. This is an issue that no matter how much exposure it receives, those in charge of the schools more often than not do not know how to appropriately respond. My hope [is that] in the future we can instill in youth the necessary levels of empathy that would reduce this situation.”

4 | ct.counseling.org | April 2013 From the President Counseling Today Counseling Today Staff Publisher Counseling Today Richard Yep Mentors matter! Associate Publisher Carol Neiman Editor-in-Chief Jonathan Rollins 800.347.6647 ext. 339 Bradley T. Erford [email protected] Associate Editor and Senior Writer e owe so much to those ideas about the way things were or should Lynne Shallcross who have supported, be, and I didn’t always see the big picture 800.347.6647 ext. 320 Winfluenced and nurtured or where I fit in. Today we joke that [email protected] our development as professionals and Skip learned everything he knows about Staff Writer people. After completing a master’s advising from me — mainly, what not Heather Rudow degree in school psychology and working to do. I still hope I didn’t scar him for 800.347.6647 ext. 307 in the public schools near Richmond, life. He was constantly super busy, but [email protected] Va., in a hybrid role of school counselor/ he always took the time to understand, Senior Graphic Designer psychologist, I decided to pursue my converse and care. Carlos J. Soto II doctoral degree in counselor education Skip and I have since become good 800.347.6647 ext. 377 at the University of Virginia (UVA). colleagues and friends. We served [email protected] I still remember the day I walked up together on the American Counseling the hallway for my initial advising Association Governing Council a few Contributing Writer appointment with a brand new faculty years ago, and I was honored to put Stacy Notaras Murphy member just out of his own doctoral forth the motion that he be appointed Advertising Representative program at Penn State University. UVA editor of ACA’s Journal of Counseling & Kathy Maguire and Penn State happened to be playing Development. I was thrilled, as were his 607.662.4451 each other that weekend in football, so I other mentees, when Skip was selected [email protected] wasn’t sure what to expect when I saw a to receive mentoring awards from both sign on this faculty member’s door that ACA and the Association for Counselor CT Column Editors read “Go Nittany Lions.” Openly rooting Education and Supervision. for the rival was a pretty bold move for I remember asking Skip a decade ago Washington Update an untenured assistant professor who had about his secret to great mentoring. Scott Barstow been at UVA only a few weeks. I took a He told me, “There is no secret. Good Counselor Career Stories deep breath, walked through the doorway mentoring begets good mentoring.” You Rebecca Daniel-Burke … and my life changed forever. see, Skip was mentored by counseling Danielle Irving Skip Niles is everything you could legend Edwin Herr, distinguished Private Practice Strategies hope for in a mentor. Nurturing, professor emeritus at Penn State Anthony Centore understanding and humorous, he is University and a former president of a dynamic teacher, prolific scholar, ACA. Ed once joked that that made him New Perspectives exceptional editor and dedicated servant my grandmentor! Donjanea Fletcher Williams of the counseling profession. I was his I first met Ed more than a decade ago The Digital Psyway very first doctoral advisee and the first when he insisted on holding the door for Marty Jencius doctoral graduate he was supposed to me at the ACA convention in Anaheim Learning Curve: Notes From a Novice “hood.” I don’t think he ever forgave me — even though I am nearly 30 years his Suze Hirsh for blowing off the hooding ceremony at junior. Recognizing each other’s names, Through a Glass Darkly the UVA Rotunda! we sat inside that door and talked for I wasn’t easy to mentor. Like many an hour. I could feel myself growing Shannon Hodges graduate students, I was working full professionally and personally in his Risk Management for Counselors time in the school system, taking classes, presence. I have learned most everything Anne Marie “Nancy” Wheeler seeing clients in private practice in the evenings and raising a family. I had my Continued on page 67

April 2013 | Counseling Today | 5 HotHot OffOff thethe PressPress FromFrom ACA!ACA!

Assessment in Counseling: A Guide to the Use Multicultural Issues in Counseling: New of Psychological Assessment Procedures, Approaches to Diversity, Fourth Edition Fifth Edition edited by Courtland C. Lee Danica G. Hays The latest edition of this widely adopted, seminal text provides direction for culturally competent Now more user-friendly than ever, while practice with diverse client groups in a variety of continuing the legacy of excellence that Albert Hood settings. Fully updated—with seven new chapters and Richard Johnson began, the latest version of this and inclusive of feedback from educators and bestseller updates students and practitioners on the practitioners—this book goes beyond counseling basic principles of assessment and the most widely theory and offers effective techniques for work with used tests relevant to counseling practice today. ethnic minority populations, women and men, older More than 100 assessment instruments examining adults, LGBQQT clients, people with disabilities, deaf children and their intelligence, academic aptitude and achievement, families, socioeconomically disadvantaged individuals, and military career and life planning, personal interests and personnel. values, personality, and interpersonal relationships are described. Includes practical tools such as chapter pretests, summaries, and 2013 | 352 pgs | Order #72916 | ISBN 978-1-55620-313-8 review questions; self-development and reflection activities; client case List Price: $69.95 | ACA Member Price: $49.95 examples; practitioner perspectives illustrating assessment in action; and handy tip sheets. Counseling Around the World: 2013 | 400 pgs | Order #78074 | ISBN 978-1-55620-318-3 An International Handbook List Price: $72.95 | ACA Member Price: $49.95 edited by Thomas H. Hohenshil, Norman E. Amundson, Eating Disorders and Obesity: A Counselor’s and Spencer G. Niles Counseling Around the World provides a global Guide to Prevention and Treatment exchange of information about counseling activities edited by Laura Hensley Choate and services; counselor training; and professional practices, beliefs, and values. Experts from 40 Both practical and comprehensive, this book countries discuss the opportunities for growth and provides a clear framework for the assessment, the challenges they face. After an introductory section treatment, and prevention of eating disorders and that examines global diversity themes and issues, key obesity. Focusing on best practices and offering countries in Africa, Asia, Europe, the Middle East, a range of current techniques, leaders in the field North America, Oceania, and South and Central America are discussed. examine these life-threatening disorders and propose Each chapter covers the history and current state of counseling in the treatment options for clients of all ages. This text, country, theories and techniques that work best with the population, written specifically for counselors, benefits from diversity issues specific to the region, and counselor education and the authors’ collective expertise and emphasizes practitioner-friendly, training. wellness-based approaches that counselors can use in their daily practice. 2013 | 450 pgs | Order #78077 | ISBN 978-1-55620-316-9 2013 | 512 pgs | Order #78076 | ISBN 978-1-55620-319-0 List Price: $59.95 | ACA Member Price: $44.95 List Price: $54.95 | ACA Member Price: $39.95

Order Online: counseling.org By Phone: 800-422-2648 x222 (M-F 8am – 6pm)

6 | ct.counseling.org | April 2013 Executive Director's Message Counseling Today American Counseling Association President Bradley T. Erford 800.347.6647 ext. 232 A time to celebrate [email protected] President-Elect Cirecie West-Olatunji 800.347.6647 [email protected] Richard Yep Executive Director Richard Yep pril is Counseling Awareness impressive, dedicated, committed and 800.347.6647 ext. 231 [email protected] Month and an opportunity caring group of colleagues who have been to celebrate all of the good practicing as counselors and counselor Counseling Today (ISSN 1078-8719) is the A monthly magazine of the American Counseling work that professional counselors do for educators. Your impact on society Association, 5999 Stevenson Ave., Alexandria, millions of children, adolescents, adults, through the next several decades will be VA 22304-3300; Telephone: 703.823.9800; families and couples each and every amazing, and I want to wish you the very Internet: ct.counseling.org. Opinions expressed day. I hope you will visit the American best of luck as you begin this next stage in in this magazine do not necessarily represent opinions of the editors or policies of the Counseling Association website if you your career. American Counseling Association. are looking for ideas and information If you are graduating, I am sure you about how you can help to promote what are thankful for those who were part Subscriptions are available for $150 for 12 issues. Email: [email protected] I think is one of the best professions in of this journey. Some of you depended Americas: 1-800 835 6770 the world. on friends. For others, it was the help Europe, Middle East & Africa: I know that many of you have your of parents, significant others, faculty +44 (0)1865 778315 Asia: +65 6511 8000 hands full with clients, students and other members, administrators, student support Single copies are available for $12.50 each projects. You deserve acknowledgment personnel, babysitters or employers. by calling ACA in-house fulfillment at for all you do, yet I know that isn’t These were the people who believed in 800.422.2648 ext. 222. always forthcoming. But please know you and helped you get through your Periodicals postage paid at Alexandria, Va., and that the staff and leaders of ACA are very graduate program — even when you may additional mailing offices. Postmaster: Send appreciative of all you do. Your good not have been so sure of things. Let’s address changes to ACA Member Services, 5999 Stevenson Ave., Alexandria, VA 22304. work is what motivates us to develop thank all of them for the contributions All rights reserved, 2013 by the American products, resources and information they made to your success. Counseling Association. that will be of use to you. In addition, Last but not least, I wanted to let you Editorial Policies our work advocating for the counseling know that Jacki Walker, who served Counseling Today reviews unsolicited articles profession with public policymakers ACA for nearly 20 years as our director written by ACA members for publication. Not is just one example of how we hope of membership services, retired recently. all articles will be accepted for publication. Send articles or request a copy of the writing to help you obtain the jobs for which The staff gathered for a fond farewell to guidelines by emailing [email protected]. your education and training make you a colleague who did her best each and Anti-Discrimination Policy uniquely qualified. every day. Jacki often went that extra There shall be no discrimination against any We also know how very valuable mile to help members who called in or individual on the basis of ethnic group, race, your time is, which is why we invested emailed us with a question, concern or religion, gender, sexual orientation, age and/or significant funds and time of our own dilemma. As the person overseeing our disability. to greatly improve the ACA website at call center, Jacki made sure that our Mission Statement counseling.org. You will find an improved representatives did their best to provide The mission of the American Counseling Association is to enhance the quality of life search function, an easier login process exemplary customer service. Jacki in society by promoting the development that provides access to members-only and her crew were at the front line of of professional counselors, advancing the information, and a site that is much communicating with members, and I am counseling profession and using the profession and practice of counseling to promote respect friendlier to use and richer in content. grateful for her service. for human dignity and diversity. These next few months are special As always, I look forward to your for many of our readers because the comments, questions and thoughts. Feel academic year comes to a close and free to contact me at 800.347.6647 ext. graduation becomes a reality. For those 231 or via email at [email protected]. of you preparing to walk the stage You can also follow me on Twitter: to receive your master’s or doctoral @RichYep. degree, congratulations! You join a very Be well. u

April 2013 | Counseling Today | 7 Letters

Thinking creatively vs. combat, abuse, and natural disaster; persons practicing art therapy with adverse physical health conditions As the president of the American Art such as cancer, traumatic brain injury and ticultural and artistic traditions, creativity Therapy Association (AATA), I thank you other health disability; and persons with development, and curative and wellness for recognizing that art therapy is a non- autism, dementia, depression and other factors related to artistic expression. threatening way to engage people, develop disorders. Art therapy helps people resolve The ACA Code of Ethics wisely reminds a basis to explore one’s potential and over- conflicts, improve interpersonal skills, man- all counselors to practice within their scope come trauma and crisis (“Knowledge Share: age problematic behaviors, reduce negative of competence. For example, Standard C.2.a. says in part: “Counselors practice Thinking creatively: Expressive arts for stress and achieve personal insight. Art ther- only within the boundaries of their compe- counseling youth in the schools,” February apy also provides an opportunity to enjoy tence, based on their education, training, 2013). But just as I would not recommend the life-affirming pleasures of art making. supervised experience, state and national that everyone can practice as a counselor Art therapists who hold the credentials professional credentials, and appropriate without the required education, I am hop- that attest to the preparation for this professional experience.” Standard C.2.b. ing that as you continue to promote art specialized health profession would be states, “Counselors practice in specialty therapy, you recommend that your audi- great partners to counselors and others areas new to them only after appropriate ence works with a credentialed art therapist in the mental health field whose goals are education, training and supervised experi- as a collaborative health care partner in to improve the lives of those who seek ence.” And Standard C.4.a. says, “Coun- enhancing the work of a counselor. their services. Credentialed art therapists selors claim or imply only professional Art therapy is a mental health profession who meet the high level of education and qualifications actually completed …” in which clients, facilitated by the art thera- experience required for the profession can I encourage the author and others to pist, use art media, the creative process and be located through Find-a-Therapist or the resulting artwork to explore their feel- refrain from using the term art therapy to AATA’s Art Therapist Locator. Credentials describe what they do because they are ings, reconcile emotional conflicts, foster and education of a practitioner can self-awareness, manage behavior and addic- misrepresenting themselves to the public. be verified through the Art Therapy Other terms such as therapeutic art or tions, develop social skills, improve reality Credentials Board. orientation, reduce anxiety and increase expressive art are more accurate portrayals self-esteem. A goal in art therapy is to im- Mercedes B. ter Maat, Ph.D., LPC, ATR-BC of what they provide and do not raise prove or restore a client’s functioning and President, American Art Therapy Association these ethical concerns. Counselors seeking his or her sense of personal well-being. art therapy training should contact Art therapy practice requires knowledge While I appreciate author Patricia Van colleges that offer postgraduate programs of visual art, the creative process, human Velsor’s enthusiasm for the use of expressive in art therapy. development and psychology. A master’s and creative modalities, to imply that Marie Wilson, Ph.D., ATR-BC, ATCS, degree is required for entry-level practice in simply participating in “an art therapy ACS, LPC art therapy from institutions of higher edu- workshop” trains a counselor to use art Professor, Department of Psychology and cation recognized by regional accreditation therapy methods competently is misleading Counseling bodies approved by the Department of Ed- to readers and a potential liability to the Coordinator of Art Therapy Programs ucation. Minimum educational, profession- vulnerable populations they serve. Caldwell College al and ethical standards for the profession The term art therapy is specific to an en- are established by AATA, a membership tire profession with a long history, national Patricia Van Velsor responds: This and advocacy organization that provides and state organizations, research, standards letter is to reiterate as well as clarify the standards of professional competence, and of accreditation and credentialing, and a intent of my article “Thinking creatively: develops and promotes knowledge in, and code of ethics. Providing art therapy ser- Expressive arts for counseling youth in the of, the field of art therapy. vices requires specialized training at the schools.” The primary goal was to encour- Art therapy is practiced in mental health, master’s level, then an additional 1,000- age school counselors to think creatively as rehabilitation, medical, educational, foren- 1,500 hours of supervised postgraduate they design comprehensive school counsel- sic, wellness, private practice and commu- clinical work to be eligible for the ATR (art ing programs. The growing diversity in nity settings with diverse client populations therapist registered); a second level involves the student populations in U.S. schools in individual, couples, family and group board certification by taking and passing demands this. School counselors serve therapy formats. Art therapy is an effective an exam. Graduate work in art therapy students who have different learning styles, treatment for people experiencing devel- involves rigorous training that integrates come from different racial and ethnic back- opmental, medical, educational and social many factors such as human development, grounds, vary in family income levels and or psychological impairment. Individuals psychological theory, psychopathology, art- speak various languages. Thus, it is impera- who benefit from art therapy include those based assessment, art therapy methods, 700 tive that school counselors offer innovative who have survived trauma resulting from hours of supervised clinical practice, mul- approaches in their school counseling prac-

8 | ct.counseling.org | April 2013 tice. Because expression through arts crosses not charging for no-shows is a “universal Regarding late cancellations and no- cultures and because arts have been an es- design” approach that works well for the show fees, insurance companies do not pay sential part of communication throughout disadvantaged as well as the advantaged. our full stated price. We all know this. So human history, the integration of expressive I understand the sentiment behind the what is the justification for charging that arts into school counseling makes perfect article — the increasingly popular and price to a client who cancels? Anything sense in promoting students’ academic, sensible belief that our service as counselors above what you would have received career and personal/social development. is valuable. However, I think it is unrealistic for an actual appointment strikes me as My suggestion to have school counselors for us to want 100 percent of our working opportunism. Or revenge. explore expressive arts themselves was to hours to be billable. I believe the idea that If your client wants to remain your cli- give them an appreciation of the value of we must maximize our revenue because ent, he or she will pay legitimate fees for missed appointments. If not, you probably expressing themselves in different ways we deserve it — pioneered by lawyers and — through movement, drama, visual art, have seen the last of that person anyway. emulated by doctors and other health writing and music. These experiences will Thinking from a client’s perspective, professionals — is significantly responsible hopefully motivate counselors to learn I wonder whether I would intentionally for the uncontrolled cost of health care. more about expressive arts and find ways choose a counselor who is constantly on the Instead of trying to monetize our every to offer expressive arts experiences to defensive or angry over a legitimate cancel- their students. Just as Claudia Cornett in minute, private practice counselors should lation. Or would I choose one who strives The Arts as Meaning Makers encourages have a broader view of how to run a sound to be fair, both to client and counselor? business. Do not obsess over getting classroom teachers to integrate expressive Susan H. Robinson, LPC paid for each hour you work; watch the arts throughout the curriculum, this article Newark, Ohio monthly bottom line instead. Use those was focused on inspiring school counselors [email protected] to find ways to do the same in their unexpected free times to do paperwork counseling programs. My sincere hope for and catch up on continuing education. students is that professionals working in the Enjoy your day. You will be more effective Grief and abortion aftercare schools — school counselors, mental health as a counselor and have a longer career. In the January 2013 issue of Counseling practitioners, art therapists, classroom For me, that counts a lot more. Today, Trudy Johnson writes about her teachers and art teachers — can collaborate We do not need to take a vow of poverty experience providing grief counseling for to enrich the learning experience for all as counselors, but we did knowingly women who have had abortions (“Reader students in our schools. pursue a career with limited potential for Viewpoint: Bringing abortion aftercare into the 21st century”). wealth — or perhaps that is the informed Although there may be women who consent we need at the beginning of our Arguing the need for need grief counseling after they have own training. unforgiving no-show policies had abortions — particularly those As a counselor with a private practice, Jordan Shin, M.S., LPC women who require abortions due to I am compelled to take exception to the Eugene, Ore. an abnormality of the fetus — I think case made in the February “Private Practice this article may be a bit misleading. We Strategies” column (“The most over-the- I’m confused after reading Anthony need to be careful not to imply that all top, unforgiving no-show policy that your Centore’s column, “The most over-the- abortions will lead to unresolved grief practice must use!”). top, unforgiving no-show policy that your when that is simply not the case. There I have decided not to ever charge for practice must use!” While I agree that it are women who have had abortions missed sessions. This decision stems from is clearly important to have enforceable who do not experience any adverse side the fact that I have been working largely policies regarding clients’ failures to honor effects — physical, mental or emotional with lower-income clients. People with low their appointments, I also feel that Mr. — whatsoever. Furthermore, if there income have little flexibility in their work Centore’s attitude is “over the top.” In are adverse side effects, it may be related schedules; often need to help family or private practice, not every slot will be more to the shame produced by the social friends urgently; often have chronic health stigma of having an abortion. Of course, filled. There will be legitimate last-minute conditions that flare up from time to time; the experience of grief after an abortion cancellations. To succeed in business, it is and often cannot afford to pay for gas, will be altered by factors such as social, important to adjust your prices accordingly. have cars that break down and/or are at the community and family/friend support. My own disclosure statement reads “24 whim of the public transportation system. Perhaps instead of focusing solely on Even if they have insurance, they often hours’ notice absent an emergency.” I tell the individual, we should also be working struggle to come up with the copay and my clients, “If the roads are treacherous toward social acceptance of all life choices cancel at the last minute — if, that is, they or you are sick, I don’t want you in because they are personal choices that are have any phone minutes left. my office.” Usually, I beat them to the not ours to make. There are a thousand To think that everyone ought to know cancellation punch in hazardous weather different lifestyles, and ours is just one. what his or her day is going to look like 24 conditions. If I feel up to working but Although I realize there are two sides to hours in advance is patently classist. To be have any reason to think I might be every argument, and I am glad to see the sure, people who are solidly middle class contagious, such as having a bad cold, I also have these problems, which means that leave it to the client’s discretion to cancel. Continued on page 70

April 2013 | Counseling Today | 9 Washington Update - By Scott Barstow, Art Terrazas and Jessica Eagle

Sequester ushers in automatic spending cuts

he fiscal cliff (aka within the VA. The VA can take Elementary and Secondary Education “sequestration”) lives. As these actions on its own without Act, which would be the most appropriate TCounseling Today went to press, congressional authorization. Among the vehicle for establishing new education it appeared that $85 billion in spending recommendations: programs, will be reauthorized this year. would be cut from Fiscal Year 2013 n Expand the eligibility criteria for In this difficult fiscal environment, it federal spending on March 1, with $26 counselor positions to include mental is more important than ever for ACA billion of that amount coming from health counselors who hold at least a members to communicate to their health, education and food programs. master’s degree in counseling from a congressional leaders the value of investing Most Department of Education programs regionally accredited program, are licensed in education and mental health services will be cut by 8.2 percent, including at the highest level of licensure and have either through new legislation or existing an estimated $1.3 billion in reductions passed the National Clinical Mental Health programs such as the Elementary and to Title I spending and $1 billion in Counseling Examination Secondary School Counseling Program reductions to special education programs. n Include counselors in the paid Although some department cuts won’t kick traineeship program operated by the VA’s and the Safe Schools/Healthy Students in until July, programs such as Impact Aid Office of Academic Affiliations. The VA Initiative. What follows are some of the were to be cut immediately. Pell Grant has for years supported paid traineeships new education and school mental health funding and federal student loans are for both clinical social workers and bills we are supporting. exempt from cuts. psychologists but has refused to expand this n The Student Support Act (H.R. More generally, the sequestration will well-trod pathway to careers within the VA 320): This bill addresses head on our result in loss of funding for food safety to accommodate either LPCs or marriage nation’s large student-to-school counselor inspectors, air traffic controllers, nutrition and family therapists. ratio, requiring the secretary of education assistance, unemployment insurance, and n Appoint a liaison to work with the to provide matching grants of at least $1 congressional staff and operations. Given counseling community regarding hiring million to states for allocation to local the fluid nature of deficit reduction talks, more LPCs in the VA educational agencies so that additional we will post more information on these n Have VA Secretary Eric Shinseki issue school-based mental health and student important developments on our website at a public notice to the entire VA health care service providers may be hired. Sponsored counseling.org/publicpolicy. system reminding its directors that they are by Rep. Barbara Lee (D-Calif.). empowered to hire counselors and directing ACA submits testimony on n The Mental Health in Schools Act them not to shut out an entire profession VA recognition of counselors of 2013 (S. 195 and H.R. 628): These that can provide desperately needed help to On Feb. 13, at the invitation of the bills would provide competitive grants for the nation’s veterans House Committee on Veterans’ Affairs, programs developed through partnerships To read Erford’s full testimony, visit ACA President Bradley T. Erford veterans.house.gov/submission-for-the-record/ between education agencies and at least submitted testimony for a hearing focused the-american-counseling-association. one community-based entity. Sponsored by on Department of Veterans Affairs Rep. Grace Napolitano (D-Calif.) and Sen. (VA) policies and practices for meeting Education bills Al Franken (D-Minn.), respectively. veterans’ mental health needs, as well as introduced in Congress n The Mental Health First Aid opportunities for improvement. The 113th Congress kicked off with Training in Schools Act (H.R. 274 Erford testified that despite the need lawmakers introducing, and in some and S. 153): These bills would establish for more mental health clinicians in the cases reintroducing, bills that support training courses on the skills, resources VA’s workforce, counselors continue to be school-based and community mental and knowledge needed to assist individuals almost completely shut out of hiring for health professionals. Lawmakers’ interest in crisis. Sponsored by Rep. Ron these positions. He also noted that since in addressing the mental health needs Congress and the president authorized the of youth is significant, especially in the Barber (D-Ariz.) and Sen. Mark Begich hiring of licensed professional counselors aftermath of the school shootings in (D-Alaska), respectively. (LPCs) in 2006, the VA has done very little Newtown, Conn. The likelihood of Introduction of these bills provides an to ensure that LPCs are brought into the Congress passing and funding any of excellent opportunity to remind members VA health care system. these new bills is questionable, however, of Congress of the value of investing in Erford shared several policy considering that many programs already in school counseling services. For more recommendations with the committee place have seen their support stall. Many information, contact Jessica Eagle at to increase participation of counselors policy analysts are also skeptical that the [email protected]. u

10 | ct.counseling.org | April 2013 The Two-Minute Advocate - By Art Terrazas

How do I talk to my member of Congress?

he American Counseling passion about the counseling profession ACA is making a continuing Association held its first- and helping the people they serve; we education credit available for viewing Tever public policy webinar want counselors to channel that passion the webinar. To obtain the credit, simply on Feb. 26, titled “Communicating into effective action. That all begins by visit the public policy section of ACA’s With Congress: How to Be an Effective having ACA members build relationships website (counseling.org/publicpolicy) and Citizen-Advocate.” The webinar discussed with their elected officials. However, we follow the link for the webinar. After ways that ACA members can most know that communicating with elected viewing the webinar, you will be provided effectively communicate with federal officials can sometimes be difficult and with all the information you need to lawmakers and their respective staff uncomfortable. This webinar will help obtain the credit. members to advocate for the profession. you overcome that discomfort. Regardless of whether you apply for We recorded the webinar and have made Developed by the Congressional a CE credit, we hope you will take it available online at counseling.org/ Management Foundation, the webinar this opportunity to learn from the publicpolicy. reveals the methods and benefits of experts about how to maximize your ACA presented the webinar in building relationships with elected effectiveness in advocating for the partnership with the Congressional officials. The information provided is counseling profession and build upon the Management Foundation as part of based on research that includes surveys wonderful work that you do every day. our ongoing push to strengthen our of congressional staff, focus groups with If you have questions about the webinar, grass-roots advocacy work. We know members of Congress and congressional contact Guila Todd with ACA at gtodd@ that our members have a great deal of staff, and interviews with state legislators. counseling.org. u

April 2013 | Counseling Today | 11 Through a Glass Darkly - By Shannon Hodges

Safari of light

y heart pounded like a bass lugubrious “fingerprints” are everywhere. scheduled start, the air conditioning drum as a massive bull Run-down, crime-infested streets are abruptly went on holiday, leaving Melephant stood just 30 feet named in his “honor”; the country’s students, staff, Vice Chancellor from the truck, aggressively stomping the hyperinflated, worthless currency sports Akapelwa and presenters in 95 degree ground and flapping his huge ears as we his mug shot; crumbling schools bear heat — perfect for a Bikram yoga studio lingered in South Africa’s famed Kruger his moniker. Although the government- but scarcely ideal for our purposes. National Park. owned and operated Zimbabwean In the United States, the workshop Strolling across the baboon-lined media occasionally reports on world likely would have been canceled. Victoria Falls Bridge, we felt the crises, it spews nothing but praise for In truth, it’s doubtful that I would rumblings of Mosi-oa-Tunya (“the basic governmental initiatives at home, have remained under such oppressive smoke that thunders”). leading one to imagine that Mugabe conditions. But the Victoria Falls Fulfilling a childhood dream, I spent and his minions have achieved nirvana. University students — born and raised three amazing weeks traveling with my Despite experiencing almost 35 years in adversity — simply shrugged this wife through sub-Saharan Africa. With of this self-serving rule, Zimbabweans off as one more hardship to overcome. our tour group, we encountered smiling remain steadfast in their optimism Everyone, including Ms. Akapelwa, children, curious adults, grim military and resilience. “If we could just get stayed, participated and uttered nary a checkpoints, Jurassic-size insects, honest leaders who would invest in the syllable of complaint. flowering jacarandas, stout baobab trees, country, we could be successful,” one Our presentation, titled “Creating frightening crocodiles, stifling heat, soul- Zimbabwean opined in a moment of Personal Peace,” resulted in numerous crushing poverty and, everywhere we unusual — and perilous — candor. participants sharing their personal and went, exotic, dangerous beauty. career visions. In every case, that involved A teachable moment Each December, my wife and I improving their teaching, upgrading their Before our safari, we spent several migrate to remote, tropical areas. My schools, creating scholarships for students days with Gertrude Akapelwa, visionary inclination is to travel to the Southern in need and the like. Not one participant founder of Victoria Falls University. Hemisphere, that remote part of terra articulated a vision targeting personal Hailing from a small, remote village, firma that contains few countries and wealth, fame or glory. comparatively little population. We she defied astronomical odds by have visited New Zealand, Australia and matriculating to Harvard and later The light goes on — slowly Indonesia, but none of these magical working for the World Bank and other After our presentation concluded, Vice places awed me the way Africa did. The notable organizations. But her lifelong Chancellor Akapelwa held a “high tea” sojourn to southern Africa, where we dream was to found a university to reception in her office. Like a beaming were confronted with numerous cultural, educate African lawyers, teachers, parent, she proudly showed off plans for social, spiritual and political variations, engineers and other professionals. She new modern buildings and professionally was like earning a Ph.D. in cultural explained that only around 10 percent landscaped grounds. Of course, there’s anthropology. During stops, we mingled of Zambians attend university, and her the very real challenge of transforming in traditional markets, purchasing crafts motivation was to help open doors for those blueprints into bricks and mortar, and engaging in conversation with underprivileged, deserving students. but Ms. Akapelwa is a force of nature, so artisans and the inquisitive. Crowds Ms. Akapelwa had invited my spouse I have little doubt of her ability to realize of people, many hawking their wares, and me to make a presentation to 100 those lofty dreams. frequently swarmed about us, peppering students — a mix of young women Still, the severely impoverished us with questions. and men from Zambia, Zimbabwe and conditions in Zambia, Zimbabwe and Our guides advised us to exercise a Botswana studying for a professional Mozambique left me with the stark circumspect approach in certain areas. teaching certificate. They appeared realization that I had viewed Africa In Zimbabwe, for example, even the eager to soak up whatever we had to through Western eyes and a Western most benign criticism of government is a offer, as evidenced by what preceded mindset. Because higher education felony, and Robert Mugabe’s oppressive, the workshop. Minutes prior to the transformed my own life, I tend to equate

12 | ct.counseling.org | April 2013 college degrees with cultural and social Given that in most places in southern are closely engaged in business, industry, mobility. I still believe this is true, at least Africa unemployment runs at or above 50 education, tourism and communication for most. But given their social, cultural percent, literacy rates hover between 60 through Skype, email, the Internet and and economic realities, a university and 70 percent, and HIV/AIDS infection other avenues. The world is evolving, education is simply unrealistic for most rates are among the world’s highest, the and the counseling profession is running Africans. Ms. Akapelwa bluntly stated as counseling profession potentially could to catch up, particularly in developing much to me: “TIA” (“This is Africa”), she play a vital role. Realistically, however, countries and regions such as Africa. said, eyes sharp as a raptor’s. Nevertheless, most African governments are strapped But deliberate as it may be, the I have no doubt that everyone — in Africa for cash, inefficient or corrupt, and given counseling profession’s traditional, and elsewhere — can benefit from tertiary how much cultural indifference there is to developmental, vocational/career education. The debate revolves around the education, particularly when it comes to approach may hold the greatest potential focus of that postsecondary education. the education of girls, counseling will be in Africa. We must certainly continue to a slow grower there. But slow growth is In a somewhat controversial plan, establish mental health and addictions preferable to no growth. Vice Chancellor President Obama’s higher education counseling in Africa, particularly given Akapelwa agreed that counselors would agenda targets community colleges. Given the overwhelming social strains that be an especially good idea in Africa’s escalating college costs and the need for HIV/AIDS and other issues pose. But schools and universities. The stumbling a more technically trained populace, this because I believe education is the linchpin block is governmental priorities and makes practical sense and would also in societal progress, school counseling seem a good model for Africa. I do not funding, which is something we have also strikes me as being paramount (and I say mean to imply that African countries witnessed here at home. this as a mental health counselor). Our should divest from their universities. In No doubt, it is far easier to write African expedition cemented in my mind fact, they should do the opposite and articles, books, blogs, personal manifestos what research has already suggested — create more opportunities for promising and the like than it is to craft and namely, that a society’s health is directly yet financially strapped students (as implement policy. As taxing as writing proportionate to its educational system. Victoria Falls University has done). can be, my burden is far easier and School counseling is a needed yet vastly But an educational alternative to the simpler than that of, say, Richard Yep, university system is sorely needed for Bradley Erford, the American Counseling underutilized profession in Africa. Association Governing Council and the far greater numbers of Africans who Repairing our own house our counseling lobbyists. Furthermore, cannot hope to attend a university. A critic could easily point out that the innumerable demands are always once proud U.S. educational system is The counselor’s role in an competing for the profession’s attention. dilapidated and that our efforts should emerging nation’s development But all indications are that our world has Southern Africa transformed many of shrunk and is rapidly becoming more focus here on the home front. No doubt, my previously held beliefs regarding that interdependent. We can see evidence of our public schools are in crisis. Creative region of the world, which speaks to the this by looking at financial markets, the thinking and difficult changes will be importance of travel. Upon learning I am growing international workforce and the required to improve our capricious, a professor, Africans frequently inquired increasing popularity of international inequitable P-12 system. But even as about my field. Counselor education study. society engages in this reconstruction puzzled them, however, because the term A century ago, Rudyard Kipling could process, room remains for the counseling was foreign to most. When I explained smugly opine, “Oh, East is East and West profession to continue its expansion that counselors address health education, is West, and never the twain shall meet.” beyond Western borders. The social, addictions and career/vocational training, But a high-tech, increasingly mobile educational and career needs abroad are among other functions, most thought world has stamped “Paid” to that colonial legion, and the counseling profession is counseling a very good idea. apologist’s poetic fallacy. East and West suited to address many of these issues.

April 2013 | Counseling Today | 13 My travels abroad also reaffirm my belief that local and global needs are New! strongly connected, which makes transcending borders a necessity rather than a luxury. Modest as it may be, there Developing & Managing Your School is overseas interest in our profession. My own counseling program recently Guidance & Counseling Program began receiving a trickle of interest from Asia, the Middle East and Africa, and it Fifth Edition would be instructive to hear from other counselor education programs regarding Norman C. Gysbers and Patricia Henderson the international interest they have attracted. The future likely will reveal “…A rich resource for school counselors, joint international counseling programs school counseling program leaders, and similar to the one between the University counselor educators alike. I have relied of Maryland and the University of Malta. I would hope to see similar ventures in on previous editions to help me organize non-Western countries as well. my own campus program, lead a district program, and educate graduate students. Seeing the world’s beauty During my childhood, circumstances I highly recommend this book!” dictated that I would experience travel —Elias Zambrano, PhD only through the landscape of my The University of Texas at San Antonio mind. Because of education, pluck and, certainly, luck, the world has opened The fifth edition of this bestseller its borders to me in adulthood. Given expands and extends Gysbers and my meager upbringing, I never take the privilege of international travel Henderson’s acclaimed five-phase model for granted. Each time I go abroad, I of planning, designing, implementing, evaluating, and enhancing remember how blessed I am. Pre-K–12 guidance and counseling programs. This enduring, Landing in Johannesburg, we stepped influential textbook has been fully updated to reflect current theory onto the tarmac under a stunning azure and practice, including knowledge gained through various state and sky. Warmed by the rays of the Southern local adaptations of the model since publication of the last edition. Hemisphere, the lethargy of a long trip Exciting additions to this new edition are increased attention to suddenly melted away. I fell into step alongside an African American woman diversity and the range of issues that students present, counselor from the Midwest. Her eyes watery with accountability, and the roles and responsibilities of district- and joy, she exclaimed, “It’s my first time building-level guidance and counseling leaders in an increasingly in Africa. Coming over was a lifetime complex educational environment. An abundant array of examples, dream.” sample forms, job descriptions, evaluation surveys, flyers, letters, and “Mine too,” I replied. Instinctively, we procedures used by various states and school districts clearly illustrate reached out to each other, linked arms and walked forward in solidarity. u each step of program development. At the end of each chapter, a new feature called “Your Progress Check” functions as a tracking tool for growth at each stage of the change process. 2012 | 544 pgs Order #72915 ISBN 978-1-55620-312-1 List Price: $69.95 ACA Member Price: $49.95 Shannon Hodges is a licensed Please include $8.75 for shipping of the first book and mental health counselor and $1.00 for each additional book. associate professor of counseling at Niagara University. Contact him Order Online: counseling.org at [email protected]. By Phone: 800-422-2648 x222 Letters to the editor: (M-F 8am – 6pm) [email protected]

14 | ct.counseling.org | April 2013 You listen. You seek solutions. You make a difference. Rise to your calling. You’re “that friend” — the one everyone turns to when they have a problem. So why not fulfill your passion for helping others by earning your Master of Science in Counseling. Licensed mental health professionals teach all our classes in-person at 15 campus-based University of Phoenix locations. Our curriculum is rigorously aligned to national industry standards so you can prepare for state licensure. You’ll gain hands-on experience through an internship program and, with an average of 9 students per class, personal connections and perspectives to help you succeed.

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For more information about our on-time completion rates, the median loan debt incurred by students who complete a program and other important information, please visit our website at phoenix.edu/programs/gainful-employment.html The Master of Science in Clinical Mental Health Counseling (Arizona) and the Master of Science in Mental Health Counseling (Utah) programs are accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP; cacrep.org). In order to practice as a counselor in any state, you must be licensed with a state license designation (i.e., LPC, LCPC, CCMH, MFT, etc.). License requirements and title vary by state. It is your responsibility to ascertain and meet licensure requirements in any state in which you desire to practice. University of Phoenix is accredited by the Higher Learning Commission and is a member of the North Central Association (ncahlc.org). The University’s Central Administration is located at 1625 W. Fountainhead Pkwy., Tempe, AZ 85282. © 2013 University of Phoenix, Inc. All rights reserved. | SS-01888A

April 2013 | Counseling Today | 15

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Ad A - Red - Counseling - COATED New Perspectives - By Tiffany A. Stewart

Navigating the waters of academia

s the calendar turns to April, 1) Now is not the time to rest. If you all levels, not just at research institutions. counseling students and faculty thought being in a doctoral program was The expectation that you will be actively A members begin preparing demanding, consider it merely practice engaged in research is more common for the end of another academic year. to prepare you for life in academia. Gone today even if you are teaching at a For counselor educator Tiffany A. are the days of working an 8-to-5 job or university/college or community college. Stewart, this point marks four years in the resting after you turn in that big paper. There is simply no way around it. classroom and, in this “New Perspectives,” The job of an academic professional Given the importance of research to the she reflects on lessons learned during her literally never ends. Between preparing advancement of the academic profession, journey in academia. Stewart has been an for classes, teaching your required course it is logical for institutions to have this assistant professor at Midwestern State load, grading papers and tests, preparing expectation. However, pursuing research University since 2009, after obtaining her tests, attending meetings for various is easier said than done, especially doctorate from the University of Akron. committees you are on and actively when you are the newcomer in a group engaging in research, there is not much of established professionals who have u free time left over. Yes, the hard work already found their respective paths. By Once I defend my dissertation and secure of being a doctoral student is over, remaining involved in your professional my first job in academia, all of the hard but entering the world of academia is communities and organizations, you can work will have paid off, and I can finally something else altogether. It can take stay connected to other new professionals breathe. awhile to acclimate, but it becomes easier who share your interests and potentially This is what many doctoral students to adjust the longer you stay at it. conduct research with them. Working tell themselves just before graduation. 2) Do not spend your time alone can be lonely, frustrating and They rarely acknowledge that this is only agonizing. With each day being so busy, discouraging. the beginning of a long journey — one it is easy to get caught up agonizing over 4) Seek mentors. In addition to that should be carefully calculated from how to find your voice in this profession finding professionals who have interests the first year on the job as faculty. and how to find your stride with similar to your own, seek out mentors. Being a professor has its privileges, research. You might feel like there is no These individuals will be seasoned and one can grow complacent rather help available and that you do not have professionals who have already been quickly. For example, there is typically a enough time to fit everything in. But where you are and can thus offer great great deal of flexibility that comes with constantly pondering the “impossibility” advice and direction. Typically, these the job. There are no clocks to punch. of the task leads to more time wasted and individuals will not seek you out if you You make your own office hours, and less time used productively. Making a are not visible in their path, so finding holidays and breaks are plentiful. You list of things to do that includes possible a mentor may require assertiveness on are finally treated as a professional. You research topics with completion due your part. Do not focus solely on one start to think this may be the best job dates is a good way to work through this individual because you can learn and ever. However, after the first year passes, process. You may start out slow, but that gain valuable information from many you quickly realize the flexibility and is better than doing nothing. Just about different people. autonomy may be a double-edged sword. every successful professional in this field 5) Protect your time. During your At times, academia might feel like a one- would agree that research and writing first year on the job, you also might want man island with no one to help for miles are skills that take time and practice, to get involved in providing service to and miles around. practice, practice to develop. your community and university. These For those who will find themselves 3) Find people with similar research opportunities will begin trickling in in this position, I would like to share interests. Before choosing a career one by one. Soon, requests for your some tips I learned during my journey in academia, it is wise to know that service will be countless, and you may be that may help you better prepare for the research, writing and getting published tempted to take advantage of everything. world of academia. in peer-reviewed journals is important at Although service is a great thing and a

16 | ct.counseling.org | April 2013 significant part of your job duties, keep in mind that you can only do so much. It is OK to be selective when choosing the opportunities in which you want to get involved. This will also allow you to My life, my story make time for research. If you do not protect your time, no one else will. Nominate an exceptional student or new professional to be featured in “My life, 6) Do not take it personal. Finally, my story” by emailing [email protected]. in academia, rejection is a normal occurrence. Although I am not sure that handling rejection ever gets easy, it This month, doctoral student Dorothy “Dodie” Limberg is featured. She is helps to know ahead of time that it is the student representative to the ACA Governing Council. part of the process. The most important piece of information given to me while Age: 33 completing my dissertation was that it is a process and to trust it. I offer that same Home/current residence: advice. Rejection is part of the process Originally from Onalaska, Wis., and of developing as a professional because it offers you the opportunity to learn from currently living in Orlando, Fla. your mistakes and improve. Typically, when your work is rejected, you receive Education: Currently pursuing a feedback from other veteran professionals Ph.D. in counselor education from in the field. Use the feedback to your the University of Central Florida; advantage and strengthen your work. M.A. in counselor education-school Soon you will be the one providing the counseling from the University of feedback to new professionals who are Central Florida; B.S. in interpersonal where you once were. u communications (sociology minor) from the University of Wisconsin- La Crosse

Greatest professional accomplishments: Being able to live internationally and work as a school counselor. As a doctoral student, my greatest accomplishment is seeing students I work with be successful in their new careers as counselors. Additionally, I am grateful for the mentorship and support I received through my journey; it has been invaluable in my accomplishments. To submit a question to be answered in this column or to Biggest professional challenge: Deciding between pursuing a doctoral submit an article detailing the degree versus staying in school counseling. At the time, the decision was very experiences and challenges of being a graduate student or new difficult because I didn’t want to leave my students. However, it has turned counseling professional, email out to be a great one because I have been able to still work within schools, column editor Donjanea Fletcher conducting research and providing professional development through my Williams at acanewperspectives@ doctoral program, while developing my new identity as a counselor educator. yahoo.com.

Letters to the editor: Words of advice for students: Don’t lead with your title or degree. Lead with [email protected] your character, reputation, work ethic and contribution to the counseling field. Also, show gratitude for the opportunities you have in our field to positively impact others.

April 2013 | Counseling Today | 17 Private Practice Strategies - By Anthony Centore

Surviving an insurance company audit

n November, my company received “Actually … eight days,” my office that 10 percent of our records were deficient. a letter from a major third-party manager corrected. Apparently, the person So, they demanded 10 percent of their money Ipayer — an insurance company we delivering the mail had decided to give back. Over five years, that was over a billion will refer to as COMPANY. The letter read this particular envelope to a neighbor, so dollars!” as follows: by the time it reached our office, the clock I never knew what to make of these “[COMPANY is] conducting a review to was ticking. stories. Were insurance companies out verify services billed by you were rendered Thankfully, two of our senior medical to rob health care practices of their hard- and described appropriately on submitted billers already had started on the earned wages, or were some health care claims. In order to conduct this review, project. Better yet, being on the heels of practices keeping really shoddy records? COMPANY requires certain information Thanksgiving, we were able to convince the Both scenarios seemed plausible. All I knew from you. COMPANY requests that you auditor to give us a few additional days. We was that I was going to find out firsthand. provide us with complete documentation got the impression that the 10-day deadline Insurance audit = jury duty of services rendered, including but not was a bit arbitrary; COMPANY wanted When I visit health care practices (either limited to documentation evidencing us to take the audit seriously, but it didn’t as a consultant or for potential purchase), diagnosis and treatment.” want us missing Turkey Day because of it. I always ask the owners if they review their COMPANY requested the following list clinicians’ notes. The response is usually of items: Horror stories some derivative of “I don’t check clinicians’ n “Your daily office appointment Over the past four years, my practice has schedules, books and calendars for the moved from paper records to an electronic notes, but their contracts say they need to dates of service in which you treated the health records (EHR) program — and then keep accurate and complete records.” patients at your office site. another EHR program and then another I then ask, “Would you be comfortable n “Treatment plan or excerpts of the (see my June 2012 column, “Electronic if an insurance company audited your patient file that document diagnosis, dates health records in today’s private counseling practice’s records?” of services, type of therapy session and practice”). I knew we would need to And the owner will answer, “Ha! I’m not length of each therapy session. access four databases to get everything worried about that. We’ve been in business n “Initial psychological and/or medical COMPANY required. We were also for 10 years, and we’ve never been audited evaluation notes. surprised to see “appointment schedules, before.” n “Daily patient receipts. books and calendars” and “financial Being audited by an insurance company n “Financial records used to bill is like being called for jury duty. It is not insurance companies. statements sent to patients” on the list of a matter of if it will happen but when. n “Financial statements sent to patients. required items. We hadn’t known that we Health care providers need to be ready to “Please submit all documentation to me needed to keep these items. We did still 1) produce accurate and complete records within 10 business days from the receipt have them, but only by chance, not design. or 2) pay a lot of money back to the third- date of this letter.” As an aside, let me say that I am party payer. Attached to the letter was a roster of 20 paranoid about clinical notes. They are patients seen by one of the 10 clinicians a huge liability. I can get in trouble for Four tips for surviving an audit who work, or had worked, at our Boston losing them or for keeping them too long. Nobody wants to get audited, but with office. COMPANY requested anywhere I can get in trouble if they are too brief good preparation, the process doesn’t from one to seven months’ worth of treat- or if they contain too much information. need to be difficult. Here are four tips for ment notes (varying by patient) dating back They need to be organized, legible and surviving an insurance audit. through the previous four years. double locked. Clients and health care 1) Get organized. It is never too early to The samples requested were random providers request them, and courts begin organizing client files because even but comprehensive. If just one clinician subpoena for them years after treatment small practices produce a lot of records. was being sloppy with his or her notes, or ends. They take up office space. Bugs like Without good organization, locating if the practice was keeping poor records to hide in them. I loathe them. a specific case file can be tough. Some at any point between 2009 and 2012, As I read the audit letter, I was comforted practices organize files by provider, others COMPANY was going to find out. My by the knowledge that my clinicians keep by client type (child vs. adult or testing vs. first thought was, “Excuse me while I go good notes. Still, I harbored lingering therapy, for example). Others organize all get sick.” What I actually said was, “Really? worries, perhaps because I have heard files in alphabetical order and color-code We’re supposed to do this in 10 days?” horror stories. “The insurance company said them depending on the file’s age. After a

18 | ct.counseling.org | April 2013 couple years of inactivity, old files are put 3) Recruit your support team as owners are extremely reticent to buy more into storage (still in ABC order). quality assurance. It’s good to have checks filing cabinets. Get over it!) My practice It doesn’t matter what system you use and balances because no one is 100 percent uses EHR, and we still have a records room as long as you’re consistent. Ask yourself up to par with his or her notes 100 percent full of filing cabinets for releases, depression these questions: If a client from five years of the time. Have your admin or billing inventories, intake forms and more. ago requests her notes, how long will team review notes when filing insurance claims. They can check for the presence of No news is good news it take me to find them? If one of my treatment plans, completeness of SOAP Are you wondering about the outcome clinicians disappears tomorrow, will I be (subjective, objective, assessment, plan) of our audit? Well, it has been three able to step in as custodian and respond to or DAP (data, assessment, plan) content, months since we tendered copies of our requests for his or her files? accurate dates of service and so on. If a records. The auditor said we would hear 2) Conduct your own audit. If you note looks questionable, make sure that the from her if she needed anything else. have already received an audit letter, you’re claim isn’t filed until the note is reviewed. Asking around, we have heard that when reading this article too late. Consider 4) Support your clinicians. Clinicians there is a problem, insurance companies being audited “standard operating want to keep good notes. After all, most are quick to let a practice know. So far, procedure,” just like generating a receipt of the time it is their reputation on the we’ve heard nothing. It’s business as usual. for services rendered. To make sure you’re line. Help young clinicians understand We survived our first audit (knock on prepared, run some drills and check staff what constitutes a good client record. wood). Life is good. u records for thorough “documentation Equip experienced clinicians for success as evidencing diagnosis and treatment.” To well. For example, counselors need time to Anthony Centore is the founder complete good notes, and if your practice keep their certifications, some community of Thriveworks, a company that is using EHR, they need a reliable system mental health centers are required to helps counselors get on insurance that won’t crash when they are completing panels, find new clients and build perform a clinical review of every active their documentation. thriving practices. Contact him at client file every 90 days. Does this take When it comes to paper notes, clinicians [email protected]. time? Yes. Does this cost money? Yes. need the infrastructure to keep their files Does this prepare a practice in the event organized. Your practice should have more Letters to the editor: of an insurance audit (and perhaps even filing cabinet space than you think it needs [email protected] improve clinical care)? Definitely. because cabinets fill fast. (Some practice

April 2013 | Counseling Today | 19 Recent Book Releases

Newer titles of interest to the counseling community

Executive Function & Child Development Helping Beyond the 50-Minute Hour: By Marcie Yeager & Daniel Yeager, W.W. Norton & Co. Therapists Involved in Meaningful Social Action This book explains to parents and Edited by Jeffrey A. Kottler, Matt Englar-Carlson & professionals how executive function (EF) Jon Carlson, Routledge develops in kids, what EF difficulties This book is intended as an inspiration look like, and what creative and effective for practicing psychotherapists and interventions can meet their needs. counselors, as well as students, to become Rather than using traditional methods of actively involved in a meaningful effort. assessment that may overlook the The authors have searched far and wide to developmental needs of children with identify practitioners representing different immature EF and lead to ineffective disciplines, helping professions, geographic interventions, the authors have developed regions and social action projects, all of effective treatment practices that creatively whom have been involved in social justice draw on child development theory and play therapy. Their efforts for some time, whether in their dynamic interventions provide external support in a planned own communities or in far-flung regions and systematic manner, allowing children to compensate for of the world. Each has an amazing story to tell that reveals the difficulties and grow in their ability to intentionally regulate their challenges they’ve faced, the incredible satisfactions they’ve thoughts, emotions and behavior. experienced and what lessons they’ve learned along the way.

Healing War Trauma: A Handbook of Creative Approaches Deaf Mental Health Care Edited by Raymond Monsour Scurfield & Katherine Theresa Edited by Neil S. Glickman, Routledge Platoni, Routledge This volume presents a state-of-the-art account of the clinical This book details a broad range of exciting approaches for specialty of mental health care of deaf people, drawing upon healing from the trauma of war. The techniques described in some of the leading clinicians, teachers, administrators and each chapter are designed to complement and supplement researchers in this field from the United States and Great Britain. cognitive behavioral treatment protocols and, ultimately, to help Each chapter contains numerous clinical case studies and places a clinicians transcend the limits of those protocols. The innovative heavy emphasis on providing practical intervention strategies in approaches laid out in this handbook will inspire and inform an interesting, easy-to-read style. All mental health professionals both clinicians and veterans who do not respond productively to who work with deaf individuals will find this to be an invaluable office-based, regimented and symptom-focused treatments. resource for creating and maintaining culturally affirmative treatment. Group Techniques for Aging Adults, Second Edition By Kathie T. Erwin, Routledge The Rediscovery of the Wild Mental health professionals will appreciate Edited by Peter H. Kahn Jr. & Patricia H. Hasbach, The MIT Press these practical and detailed guidelines for We often enjoy the benefits of connecting design, implementation and monitoring of with nearby, domesticated nature, such as a elder group modalities that put theory into city park or backyard garden. But this book action. The group modalities are defined makes the provocative case for the necessity in the holistic contexts of mind, body, of connecting with wild nature — untamed, social and spiritual, including reminiscence, unmanaged, not encompassed, self-organizing, bibliotherapy, remotivation, humor and and unencumbered and unmediated by expressive arts. New material is presented in technological artifice. This work considers this edition on therapeutic writing, tai chi ways to engage with the wild, protect it and harp, sacred spaces and spiritual legacy. The goals, process, and recover it — for our psychological and equipment and outcomes offer a how-to guide for each modality. physical well-being and to flourish as a species.

20 | ct.counseling.org | April 2013 Crisis Intervention and Counseling by DBT Made Simple: A Step-By-Step Telephone and the Internet, Third Edition Guide to Dialectical Behavior Therapy By David Lester & James R. Rogers, Charles C. Thomas Publisher Ltd. By Sheri Van Dijk, New Harbinger This text offers specific techniques to deal with out-of-control Originally developed for the treatment of borderline situations, providing the highly important initial steps to protect personality disorder, dialectical behavior therapy (DBT) has the caller, the crisis worker and the community. The scope of rapidly become one of the most popular and effective treatments the book includes an overview of counseling by telephone, for all mental health conditions rooted in out-of-control how to effectively manage crises, how to be supportive verbally emotions. If you are a therapist new to DBT, this book will and nonverbally, how to accurately assess situations and how provide you with everything you need to use the model to treat to help create a sense of stability. This unique book serves as a people with problems involving emotion dysregulation. comprehensive tool for those setting up telephone and Internet counseling services and those in charge of centers already Healing Eating Disorders With Psychodrama and operating, especially in training and supervising those on the front Other Action Methods: Beyond the Silence and the Fury lines — the crisis interveners. By Karen Carnabucci & Linda Ciotola, Jessica Kingsley Publishers Psychodrama and other action methods The Tool Box: Tricks of the Trade for Raising Teenagers are especially helpful in the treatment of By Karren J. Garrity, CreateSpace the classic eating disorders as well as dieting This book offers tricks of the counseling struggles, body dissatisfaction and associated trade: hands-on, easy to understand, practical issues of fear, sadness, silence and shame. strategies used by many therapists to help This book provides clinicians with sound parents, mentors and teachers navigate their theoretical information, practical treatment relationships with teenagers. Today’s teens guidelines and a wealth of clinically tested live in a very complicated world, and that action structures and interventions. The makes parenting and teaching them more authors describe how they have introduced complicated too. Parents, caregivers and action methods to work with a diverse range teachers need simple ways of doing the day- of clients and suggest ways in which psychodrama practitioners, to-day difficult things.The Tool Box will coach experiential therapists and others may integrate these methods adults in building successful, strong and positive relationships with into their practice. the adolescents in their lives.

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April 2013 | Counseling Today | 21 Eating Disorders and Obesity: A Counselor’s Guide will have all the tools they need as they plan their personal path to Prevention and Treatment to college. Edited by Laura H. Choate, American Counseling Association Your College Planning Survival Guide: Smart Tips from Both practical and comprehensive, Students, Parents and Professionals Who Made It Through this long-needed book provides a clear By Christine Hand Gonzales, College Path Publications framework for working with clients The author, a professional college experiencing eating disorders and obesity. planning consultant, provides tactical tips Focusing on best practices and offering and proven techniques to make the most a range of current techniques, leaders in of the career search and college application the field examine these life-threatening process through an insightful and well- disorders and propose treatment options organized resource guide. More than 300 for clients of all ages with problems related tips are offered by those individuals who to eating, weight and body image. This have “been there, done that!” Students and text, written specifically for counselors, parents offered their insights by answering benefits from the authors’ collective expertise and emphasizes the question, “If you knew then what you practitioner-friendly developmental and wellness-based know now, what would you have done approaches that counselors can use in their daily practice. differently during your college planning process?” Mindfulness-Based Cognitive Therapy for Depression, Second Edition Motivational Interviewing in Groups By Zindel V. Segal, J. Mark G. Williams & John D. Teasdale, By Christopher C. Wagner & Karen S. Ingersoll, Guilford Press Guilford Press The authors demonstrate how the four processes of Step by step, the authors explain the “whys” and “how-tos” of motivational interviewing (MI) with individuals translate conducting mindfulness practices and cognitive interventions into group contexts. They explain both the challenges and the that have been shown to bolster recovery from depression unique benefits of MI groups, guiding practitioners to build the and prevent relapse. Clinicians are also guided to practice skills they need to lead psychoeducational, psychotherapeutic mindfulness themselves, which is an essential prerequisite and support groups successfully. Chapters by contributing to teaching others. More than 40 reproducible handouts are authors present innovative group applications targeting specific included. Book purchasers get access to a companion webpage problems: substance use disorders, dual diagnosis, chronic health featuring downloadable audio recordings of the guided conditions, weight management, adolescent risk behaviors, mindfulness practices. intimate partner violence and sexual offending.

College Bound: Proven Ways to Plan and Prepare for Getting Business Behaving Well: Social Responsibility, Into the College of Your Dreams From Learning to Doing By Christine Hand Gonzales, College Path Publications Edited by Ron Elsdon, Potomac Books This resource, also available as an This book provides a rationale and interactive eBook at , is a College-Path.com road map for organizations to incorporate comprehensive and useful guide for students socially responsible practices, building on and parents. It provides live links to more real-world examples from contributing than 1,200 verified college-related resources, authors and principles of social justice. including admissions, financial aid and Addressing strategic issues as well as practical scholarship resources, organized by topic implementation, this book is for anyone and where you are in the college planning who is actively engaged in the business process. The ultimate reference guide for the world, individuals working in the public and college application process, it is filled with nonprofit sectors, and students and faculty essential checklists and links that cover all the necessary bases. who study the relationship between business and social issues. My College Bound Plan By Christine Hand Gonzales, College Path Emotion Regulation in Children and Adolescents: Publications A Practitioner’s Guide This resource is designed to act as a By Michael A. Southam-Gerow, Guilford Press companion workbook to use in conjunction In a flexible modular format, this much-needed book presents with College Bound: Proven Ways to Plan and cutting-edge strategies for helping children and adolescents Prepare for Getting Into the College of Your understand and manage challenging emotional experiences. Each Dreams (see previous description) so readers of the eight treatment modules can be used on its own or in

22 | ct.counseling.org | April 2013 conjunction with other therapies, and includes user-friendly case Love With Intention examples, sample dialogues, and engaging activities and games. By Patricia L. Carter & David J. Carter, CreateSpace Publishing Emotion-informed assessment and case conceptualization are The key to creating an intimate, loving also addressed. relationship is intentional loving — a commitment to knowing, understanding Behavioral Addiction: Screening, Assessment and loving yourself and your partner on and Treatment a moment-by-moment basis. Drawing from more than 40 years of combined By An-Pyng Sun, Larry Ashley & Lesley Dickson, professional counseling experience, the Central Recovery Press authors guide readers through the process of Compulsive gambling, sexual compulsivity, applying the power of intention to the key eating disorders, problematic Internet use components of intimate love relationships: and more affect millions of Americans and Commitment, Mindfulness, Intimacy, Honesty, Integrity, their families. Behavioral addiction is every Self-Responsibility, Self-Empowerment, Passion and Purpose. bit as much a real, treatable brain disease as the manifestations of addiction with which Book descriptions are provided by the authors or their we are more familiar — addiction to alcohol publishers. Book announcements are for informational and other drugs. The science of addiction purposes only and do not indicate an endorsement by Counseling Today or the American Counseling Association. and its screening and treatment are examined Announcements featuring an image of the book’s cover in a collaborative effort by three expert indicate that the book was written or edited by a member researchers and educators. Written in scientific prose that can also of ACA. be understood by the layperson, this book is a must-read for those Send book announcements to [email protected]. working in the addiction field, as well as those interested in learning more about this devastating disease.

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April 2013 | Counseling Today | 23 Risk Management for Counselors - By Anne Marie “Nancy” Wheeler

New rule affects “covered” counselors’ duties under HIPAA

uestion: A colleague of the printed version to a client who that protected health information has mine told me the federal requests them. Also, when clients pay been compromised. The final breach Qgovernment passed a new rule for treatment by cash, they may instruct notification provision rule establishes affecting counselors’ duties their providers not to communicate four factors to consider in analyzing and under HIPAA (the Health Insurance treatment information to their health deciding whether to notify individuals: Portability and Accountability Act). Is plans. These are obviously points that 1) The nature and extent of protected this true? counselors should know to best protect health information, including types Answer: If you are considered a their clients’ rights. of identifiers and likelihood of re- “covered entity” under HIPAA, the One of the most important aspects identification (for example, credit card answer is yes. You should familiarize of the new rule affects counselors’ numbers, Social Security information and yourself with some important changes obligations under what is commonly sensitive clinical information likely would to HIPAA based on a final omnibus rule known as HITECH, the Health call for notice) that was published on Jan. 25, with an Information Technology for Economic 2) Who the unauthorized person was effective date of March 26. The final rule and Clinical Health Act (note that use who used or received protected health strengthens patients’ privacy protections of the term counselors here refers to those information and rights, while simultaneously who are considered covered entities 3) Whether the protected health bolstering the government’s enforcement under HIPAA). Even though this law information was actually acquired or ability. was passed in 2009 and added substantial viewed Many of the privacy and security “teeth” to HIPAA’s enforcement and 4) The extent to which the risk has requirements that apply to counselors penalties provisions, many counselors been mitigated and other health professionals who and other mental health professionals are For example, take the case of a are considered covered entities under still not aware of their obligations under counselor who is a HIPAA covered entity HIPAA have been extended to “business HITECH. If a covered-entity counselor and uses his computer to create and store associates” who receive protected health becomes aware of a potential breach electronic counseling records. His office information. These business associates of protected health information, that is broken into and his laptop is stolen. include contractors and subcontractors counselor would be legally required to He suspects the spouse of a client who such as billing services and document first perform a risk assessment and then is going through a bitter divorce because storage companies. However, temporary to mitigate breaches and report them to he saw the spouse hanging around the conduits such as FedEx or Internet affected clients, the federal government parking lot the evening of the office service providers may be exempt from and, in some cases, the media (for burglary. His laptop was not password the business associate requirements. examples of HITECH violations and protected and his clinical files were not Counselors who already had appropriate multimillion dollar penalties, see the sixth encrypted. In doing a risk assessment, the business associate contracts in place edition of The Counselor and the Law: counselor would likely realize that this prior to Jan. 25 may need to revise such A Guide to Legal and Ethical Practice by situation creates a presumption that a contracts, but there is a reasonable period Anne Marie “Nancy” Wheeler and Burt breach has occurred. The counselor then of time in which to make revisions. Bertram, published by the American would be obligated to take various steps Counselors should review the details in Counseling Association). listed in the rules to mitigate the breach the rule or consult their own attorneys for A breach is defined in the new rule and provide notice to affected clients and advice on updating these contracts. as the “improper acquisition, access, other entities. Under the final rule, patients and use or disclosure of protected health Contrast that situation with a clients may ask for copies of their information.” Furthermore, the rule scenario in which a counselor loses electronic health records in electronic clarifies that there is apresumption of a her smartphone in an airport. The form. For example, a counselor cannot breach under the above definition unless smartphone is protected with a strong make a unilateral decision to download a risk assessment by a provider or business passcode (with a combination of and print electronic records and send associate demonstrates a low probability letters, numbers and special characters).

24 | ct.counseling.org | April 2013 Additionally, the counselor has a system that allows her to deactivate the phone. She deactivates the phone promptly New! upon realizing that it is missing so that it cannot be used. As it turns out, she locates the device just 10 minutes later when she returns to the coffee shop where she had been previously. The owner says Family Violence: he found the phone and tried to activate Explanations and Evidence-Based Clinical Practice it to call her, but it already had been shut David M. Lawson off. This counselor’s risk assessment may produce a different result because the facts show that a breach was unlikely to “David Lawson has presented a clearly have occurred. written, well-organized, and fascinating Other details are set forth in the review of current treatments for victims final rule, including that genetic and perpetrators of family violence. information cannot be used for insurance This book will have universal appeal underwriting purposes. This factor may to students as well as to those already be important for mental health clients in practice. The author’s expertise is with genetically transmitted illnesses. noteworthy and this book makes a vital Additionally, counselors should be contribution to the field.” aware that “willful neglect” of their duties under HIPAA and HITECH will —Ola Barnett, PhD lead to compliance review by the U.S. Author, Family Violence Across the Lifespan Department of Health and Human Distinguished Professor Emerita Services. Serious monetary penalties may Pepperdine University be imposed. Counselors-in-training, educators, and clinicians will benefit u greatly from this in-depth and thought-provoking look at family The question addressed in this column violence, its effects, and treatment options. This book examines was developed from a de-identified composite of calls made to the Risk the major issues and current controversies in the field, provides Management Helpline sponsored by background information on each type of family violence, and ACA. This information is presented for offers strategies for combating domestic abuse. In an informative educational purposes only. For specific discussion designed to enhance counselors’ ability to assess and legal advice, please consult your own treat each type of family violence, Dr. Lawson covers both well local attorney. To access additional risk recognized forms of maltreatment, such as the abuse of women management Q&As, visit ACA’s website and children, and less understood issues, such as female-on-male at counseling.org and click on “Ethics.” u intimacy violence, parent and elder abuse, same-sex violence, and dating violence and stalking. Case studies throughout the text illustrate clinical applications in action, and recommended readings are provided for further study. 2013 | 360 pgs | Order #78075 | ISBN 978-1-55620-317-6 Anne Marie “Nancy” Wheeler, J.D., List Price: $54.95 | ACA Member Price: $39.95 a licensed attorney, is the risk management consultant for the ACA Ethics Department. Order Online: counseling.org

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April 2013 | Counseling Today | 25 The Digital Psyway - By Laura Gallo

Social media’s effects on children and adolescents

ost of us have a new outlook technology and are just as connected as they disclose on the Internet? Experts concerning how children and the adolescents with whom we work. report that the more children and Madolescents interact with one These digital adopters have found the teens understand the complexity of another today. Young people are immersed benefits to having information at their the Internet, the more positive their in a digital world. Consequently, they fingertips and staying in constant touch experiences will be and the less likely they have been dubbed “digital natives” with others. are to encounter problems. Nonetheless, because of the way they navigate their Even though a child or adolescent may children and adolescents have different social world. Many children and teens have hundreds of friends on Facebook, boundaries than adults and can reveal spend countless hours engaging in online typing messages into a phone or on a information about themselves that leaves or texting conversations, writing or computer screen is still a solitary activity. adults feeling uncomfortable. Parents may reading blogs, and posting status updates. Nevertheless, connecting with others not know how to set parental controls Counselors and counselor educators online is a large part of young people’s or privacy settings on their children’s are working with an increasing number lives today, and this reality will not be computers or on social networking of students and clients affected by leaving us anytime soon. It has become sites. Children and teens may not fully issues related to an “online” world. As a natural extension to how adolescents understand the appropriateness of professionals, we have a responsibility spend their time. what they are sharing with others on to our clients and students to help them Despite the risks, certain benefits can the Internet or through their phones. fully understand the online world they be found in interacting in a cyberworld. They also may not realize that the posts, are entering, as well as the impact this has For example, the endless creative pictures and comments they share online on their “real world” life. opportunities afforded through many can follow them for years to come. n Statistics on digital technology use of the social websites allow for dynamic n Protecting kids against app dangers (Pew Internet & American Life self-expression and can enhance identity (Pew Internet & American Life Project): pewinternet.org development. These sites also allow Project): tinyurl.com/awzrjpo Some of the most popular social children and teens to reach out to others n Parents, teens and online privacy (Pew with whom they may share common networking sites include Facebook, Internet & American Life Project): interests. This is especially important Myspace, Twitter, Pinterest, LinkedIn, tinyurl.com/d6vjfav Friendster and Bebo. Even YouTube when these connections have not been has social networking capabilities such made at school. n Netsmartz Internet Safety as sharing links with friends. Blogs Nevertheless, research does not show Presentations (National Center for are a popular form of keeping track evidence that the Internet is a great way to Missing & Exploited Children): of what friends, people of interest and create deep, long-lasting relationships with netsmartz.org/presentations organizations are reporting out. Most others at this age. Counselors may need n Tips from Working to Halt Online children today do not know what an to have conversations with children and Abuse: tinyurl.com/5puql encyclopedia is, yet they are very familiar teens about the differences between online n “Protecting Personal Privacy Online” with Wikipedia. Ask a child or teen how and offline relationships. The Internet (Common Sense Media): tinyurl. they do research for a school project, and creates a bit of an illusion for young com/7rurlzx the most popular answer is, “I Google it.” people. To them, it may appear that their Most adults today are labeled as “digital online world offers unconditional positive n “You’re Not as Private as You Think” immigrants,” meaning they did not grow regard and a sense of security, at least until (Common Sense Media): tinyurl.com/ up with the Internet and still remember something bad happens. azen7kv a time before cell phones. Some look n Our Digital Lives playlist (TED): n Protecting your privacy and avoiding back fondly on the days when “face time” tinyurl.com/bks99zs identity theft (USA.gov): tinyurl.com/ was more important than “screen time.” axcm9f9 The best we digital immigrants can do Privacy is to try to understand the new digital Digital privacy is an area of great Cyberbullying generation and attempt to guide them in concern for parents and counselors. We are hearing more and more about safe Internet practice. Of course, some Do children and adolescents really the cyberbullying that occurs with teens digital immigrants have fully embraced understand the ramifications of all and children. With cyberbullying, hurtful

26 | ct.counseling.org | April 2013 pictures, comments or rumors can be Prevention Council): tinyurl.com/ can be helpful not only to teen and child used to harass, threaten and humiliate n3tgpq clients but also to the parents attempting others. The hurtful messages, photos or n How to prevent and stop cyberbullying to monitor them. As counselors, we can videos are shown to countless others, (Kidspower): tinyurl.com/azushso also brush up on the legal ramifications furthering the humiliation and pain of of cyberbullying, sexting and electronic n “Stand Up to Cyberbullying” the victims. This type of bullying goes dating violence. Certain states have (Common Sense Media): tinyurl. beyond face-to-face interaction and passed legislation specifically addressing com/7kssuef follows students into their bedrooms some of these issues. When in doubt through their computers and phones. Our responsibility as counselors regarding any action that should be They cannot escape it because teens live What can counselors and counselor taken, always consult with an attorney in a digital world and spend countless educators do to help with the online who has expertise in technology law. hours connected to their devices. world in which our clients are often n Internet safety (National Crime These types of incidents push some immersed? First, we can try to understand Prevention Council): tinyurl.com/ kids to their breaking points, causing this world a little better. This does not ax8pgr5 mean we all have to create a Facebook intense emotional stress and pain, and n Enough Is Enough (Internet Safety even leading to suicide. But for many page or set up a Twitter account, 101): internetsafety101.org children and teens, giving up their digital but spending time on these sites to connections is not an option, even after understand how they work can be n Internet safety (KidsHealth): talking to an adult. useful. When a client comes to you tinyurl.com/dktdqn concerned because of something that n Bullying.org n Parent’s guide to Internet safety (FBI): has been shared on the Internet, it is tinyurl.com/3fenzjq n Cyberbullying.org helpful for the counselor to know how n Preteen rules for online safety n Cyberbullying Research Center: it has been shared or who actually sees (SafeKids.com): tinyurl.com/32lkpbv cyberbullying.us it. Having a good grasp of these issues allows counseling time to be used more n Safety tips (National Center for n Stopcyberbullying.org effectively. Counselors who understand Missing & Exploited Children): n Cyberbullying (National Crime how privacy settings work on these sites tinyurl.com/a6ssg3w

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April 2013 | Counseling Today | 27 n “Internet Safety: Rules of the Road New! for Kids” (Common Sense Media): tinyurl.com/a3ptexa

n Online safety tips (CyberPatrol): The Counselor and the Law: A Guide tinyurl.com/b9rqtto

to Legal and Ethical Practice There are benefits to us utilizing digital technology for ourselves as counselors Sixth Edition as well. For example, creating a Twitter Anne Marie “Nancy” Wheeler and Burt Bertram account (twitter.com) does not obligate you to actually “tweet” anything; you “The advice given in this clear, current, can simply find others whom you would and engaging book can promote sound like to follow. There are numerous practice, while minimizing the chances professional organizations that have of becoming involved in an ethical or created Twitter accounts, including the legal complaint. I highly recommend American School Counselor Association The Counselor and the Law as a (@ascatweets), the American Counseling valuable resource for both new and Association (@CounselingViews) and seasoned professionals.” Counseling Today (@ACA_CTOnline). —Gerald Corey, EdD, ABPP This can be a great way to stay current Professor Emeritus of Human on information related to your areas of Services and Counseling California State University, Fullerton interest. In this bestselling book the authors While writing this article, I discovered combine their far-reaching experience Schooltube (schooltube.com), safe, secure to inform counselors and other mental health professionals and free videos made by schools for about the legal and ethical dilemmas that can arise in practice. teachers and students. Blogs can also In addition to providing a broad overview of the law and ethics, provide readers with an abundance they discuss current information regarding federal and state of information related to a variety of laws, professionals’ legal and ethical responsibilities, and ways subjects. Staying connected to others to manage the risks inherent in the delivery of mental health through Listservs, email and texts also services. counts as utilizing digital technology. So This edition contains a new chapter on the use of social media maybe you are more of a digital adopter and other Internet-related issues, updates to HIPAA through than you thought. the HITECH Act and regulations, a new legal/ethical decision- u making model, and discussion of the specific legal risks for You can find these and other links on counselor educators, such as recent court cases involving students’ “The Digital Psyway” companion site at work with LGBT clients. The issues surrounding civil malpractice . Did we miss something? liability, licensure board complaints, confidentiality, duty to digitalpsyway.net warn, suicide and threats of harm to self, professional boundaries, Submit your suggestions to column editor records and documentation, and managing a counseling practice Marty Jencius at [email protected]. u are also addressed in detail. 2012 | 288 pgs Order #72919 | ISBN 978-1-55620-315-2-X List Price: $54.95 | ACA Member Price: $42.95 Laura Gallo is a professional school counselor at Linn-Mar High School Please include $8.75 for shipping of the first book and in Marion, Iowa, and a second- $1.00 for each additional book. year doctoral student in counselor education and supervision at the Order Online: counseling.org University of Iowa. Contact her at [email protected]. By Phone: 800-422-2648 x222 (M-F 8am – 6pm) Letters to the editor: [email protected]

28 | ct.counseling.org | April 2013 Counselor Career Stories - Interview by Rebecca Daniel-Burke

A long, hard road toward licensure Natosha Monroe

e met Natosha Monroe RDB: What did you do there? my life. Her husband is the pastor at the when she was about to NM: I worked as a subcontractor local church. It feels good to be at home Wdeploy to Afghanistan with researching and interviewing special agents. during this period. the Army Reserves. She has a master’s Then we would report back our findings to RDB: Do you have any leads on finding degree in counseling but has had a hard the training division. a position near your hometown? time getting her hours toward licensure, RDB: That sounds interesting. Did you NM: Yes, I got my foot in the door despite spending more than a decade as like it? at a group practice because my friend an Army behavioral health specialist with NM: I did. I think because of my military and colleague is employed there. We are assignments to Afghanistan, Guantanamo background, I was able to get closer to the discussing the possibility of me joining their Bay, Haiti and the Pentagon. She has been agents and break down communication group and helping to develop a veteran and completing her doctoral studies through barriers a little faster than others. In a way, military referral source for them. several changes of location. She also served military and the FBI are similar. RDB: That sounds like a perfect as a blogger for the American Counseling RDB: How long did that position last? opportunity for you. Association during her time in Afghanistan. NM: It lasted a year and then I was asked NM: I hope to start when I return from There have been twists and turns along to extend, but I decided against it. Africa in a few weeks. Natosha’s career path, but she stays the RDB: What was next for you? RDB: Why are you going to Africa? course. Here is her story. NM: Well, my grandmother was very NM: My Ph.D. program is an Rebecca Daniel-Burke: The last time ill, so I moved back to my hometown of international program that has partnerships we spoke with you, you had returned Blooming Grove, Texas, to help care for her with several countries. I am going with from your time with the Army Reserves and look into opportunities to accumulate colleagues to Ghana to explore the mental in Afghanistan. You were working at the hours toward licensure. health system there. Pentagon as a behavioral health specialist. RDB: Sometimes it feels like RDB: How interesting! So let’s pick up your story from that time circumstances conspire for a certain NM: Yes, we will be working … at the period. outcome. Were you also going to school at capital in Accra where we will be visiting Natosha Monroe: I became very this time? the psychiatric hospital and the orphanages. disheartened working as a federal employee. NM: Yes, I continued my Ph.D. studies RDB: It sounds like a fascinating trip. The work I was doing did not count toward at the Chicago School of Professional I look forward to hearing about it. I was licensure because licensed professional Psychology. I am focusing on trauma. wondering, are you still in the Reserves? counselors (LPCs) were not recognized by RDB: You worked at the traumatic brain NM: Yes, I connected with the group the military at the time. injury (TBI) clinic in Afghanistan, didn’t here, and they already had me speak with a RDB: None of those hours counted? you? veteran who was suicidal. NM: None. NM: Yes, that experience definitely RDB: You have a gift that allows you to RDB: Were the people at the top of the helped me focus my studies on trauma. quickly identify with soldiers and veterans. military hierarchy aware of that? RDB: Have you also found a place to NM: Thank you. NM: Interestingly enough, I spoke accumulate your hours? RDB: Will you be back from Africa with a general and told him my hours NM: Yes, I am working on that in time for the ACA Conference in didn’t count. He replied, “What do you now. I was able to spend time with my Cincinnati? mean? We have plenty of counselors in grandmother during the end of her life. NM: Yes, I wouldn’t miss it. u the military.” He, of course, assumed We talked about everything. Now I am we were all counselors — psychologist, ready to find the right place to work toward social workers, etc. He had no idea of this licensure. Rebecca Daniel-Burke is the division, which did not favor LPCs. RDB: I am so happy for you that you director of professional projects RDB: Thank goodness steps are finally had that time with your grandmother. You and career services at ACA. Contact being made toward changing that. But let’s will never be sorry you took that time. her at [email protected]. get back to you for a moment. Did you stay NM: Thank you. in that position? RDB: Has it been comforting to be at Letters to the editor: NM: No, I got offered a position with home in Texas during this grieving period? [email protected] a contractor to work at the FBI training NM: Yes, it has been comforting. I go division at Quantico. running with a girlfriend I have known all

April 2013 | Counseling Today | 29 Building a more complete client picture By Lynne Shallcross An ecological perspective in counseling involves identifying how a client’s environment affects his or her well-being and development, and using interventions that move beyond exclusive focus on the individual

magine picking up a stone on the side of proximity, ranging from his or her of a creek. Your task is to understand biologically determined characteristics to the Iits markings, characteristics and broader sociocultural context structuring shape solely through examination of the human interactions. … What happens to stone itself. an individual rarely occurs in a vacuum but Using that method would result in a rather is shaped by the confluence of events, comparatively limited view of the stone, propensities, relationships, memories and says Michelle Flaum Hall. “If, however, we other features of a life elaborated over time acknowledge the forces within [the stone’s] and across settings.” environment — the wind, water, weather, Hall, an ACA member who also runs a geographic characteristics and contact with private practice in Dayton, Ohio, recalls other stones — then we begin to build a one of her clients who was dealing with fuller picture of that stone’s development,” depression. Negative thought patterns she says. exacerbated the client’s depression, Hall The same idea applies to counseling work says, but she also had a long list of other with clients, says Hall, an assistant professor issues affecting her life and emotional state. in the Department of Counseling at Xavier The client lived in unsafe housing, was University in Cincinnati. “We must examine in an abusive relationship, had financial clients within the context of their lives concerns, felt disconnected from her because it is within this context that they church, had strained sibling relationships, grow, develop, suffer and change,” she says. felt disempowered at work because of “When we strive to understand and help discriminatory practices, felt isolated people, we cannot underestimate the impact geographically by living in a rural setting that their environment has had and will and felt disconnected culturally because continue to have on their well-being and she was a member of a minority group development. Most clinical and nonclinical and didn’t have any local connections with concerns do not rest solely within an others who shared her culture. “If I were a individual; therefore, interventions should cognitive behavioral therapist who focused not solely target the intrapersonal.” solely on helping her change how she thinks What Hall is describing is the ecological about her life circumstances, I may be perspective in counseling, which, much like focusing too narrowly,” Hall says. “However, the study of ecology in the physical world, if I also use the lens of the ecological takes into account the many systems that perspective, I can help her identify multiple influence and interact with individuals on a paths for growth and change, which could regular basis. all have some impact on her mental and In Ellen Cook’s book Understanding emotional well-being.” People in Context: The Ecological Perspective Alongside treatment for depression and in Counseling, published in 2012 by the low self-esteem, Hall worked with the American Counseling Association, she client to prioritize a list of the aspects of her writes that the term ecosystem “refers to the life she was unhappy about. “We targeted sum total of interactive influences operating seemingly insignificant things first, such as within an individual’s life in varying degrees painting her bedroom her favorite color,”

April 2013 | Counseling Today | 31 Hall says. “This was something she had never done before, but she mentioned New! several times that even her room depressed her. She discovered that some things really are in her control and that Understanding People in Context: she does have the power to change some aspects of her life.” The Ecological Perspective in The client’s progress snowballed, Hall says, leading to big changes that were Counseling accomplished one step at a time. The woman gradually built a solid support edited by Ellen P. Cook network for herself by joining a local book club and walking club and making “Dr. Cook and her colleagues friends. Hall credits that action for provide elegant applications of eventually giving the woman the strength ecological theory in practice settings. to leave her abusive relationship. She also Understanding the powerful role found an apartment closer to a nearby of human ecology is of critical city, visited local churches until she found importance in training the next one she liked and summoned the courage to speak to human resources to spark generation of counselors.” policy changes at her job. —Mary J. Heppner, PhD “These were but a few changes my University of Missouri–Columbia client made to help her transform her life,” Hall says. “She was healthier “After reading this book, counselors in mind, body and spirit and felt empowered to shape her life as she saw will have a better understanding of themselves and how to fit. In our last session together, she gave enhance their effectiveness with clients.” me an origami bird she had made using —Karen O’Brien, PhD paper that was her favorite color — for University of Maryland, College Park teaching her ‘how to use her wings,’ she said.” “A counselor oriented to the ecological This exceptional book emphasizes uniquely designed perspective is a creative counselor who interventions for individual counseling, group work, and recognizes that all aspects of a client’s community counseling that consider clients as individuals context can be placed on the table for within the contexts of families, cultural groups, workplaces, and assessment and intervention,” Hall says. communities. Part I describes the theoretical research base and Life’s interactions major tenets of the ecological perspective and its applications Susannah Coaston, a counselor and to counseling practice. In Part II, experts who have used the supervisor at a community mental health ecological perspective in their work discuss its usefulness in agency just outside Cincinnati, says the ecological perspective acknowledges various applications, including counseling diverse clients with that to best understand their clients, specific life challenges; assessment, diagnosis, and treatment counselors must also understand the planning; and in schools, substance abuse programs, faith-based relationships clients have with the people communities, and counselor training programs. 2012 | 335 pgs and contexts around them. “An individual acts on his or her Order #72918 | ISBN 978-1-55620-287-2 environment, and in a reciprocal manner, List Price: $54.95 | ACA Member Price: $39.95 the environment acts on the individual. It’s how the individual makes meaning Please include $8.75 for shipping of the first book of these interactions that can impact and $1.00 for each additional book. change,” says Coaston, an ACA member who contributed to Understanding Order Online: counseling.org People in Context and is also an adjunct instructor in the counseling program at By Phone: 800-422-2648 x222 Northern Kentucky University. “The (M-F 8am – 6pm) change that is sought in counseling involves improving the [client’s] fit in the environment with the right balance

32 | ct.counseling.org | April 2013 of challenge and support. This fit is The first proposition is that all behavior Listen and learn individualized to the person.” is personal. In this sense, Cook says, a One of the most important aspects Cook, a professor of counseling at the person’s behavior is a function of that of the ecological perspective in University of Cincinnati, also co-edited person’s unique characteristics — both counseling is the ecological analysis, the 2004 book Ecological Counseling: An characteristics that are genetically based Coaston says. “I begin by building a Innovative Approach to Conceptualizing and those that have developed over strong therapeutic relationship so I can Person-Environment Interaction with time on the basis of the person’s past best understand [the client’s] situation,” Robert K. Conyne. She says the experiences. she says. “I try to be mindful of how the ecological perspective first took hold The second proposition is that all client makes meaning of the situation. within the helping professions four or behavior is contextual, meaning that it Here, I often use metaphor to help gain five decades ago. In 1977, psychologist is influenced by the circumstances of a understanding. Understanding that a Urie Bronfenbrenner “organized human person’s life, Cook says. This can include client feels as though they are in a hole life contexts as a series of concentric both physical circumstances, such as the in the ground, and every time they try to circles with the individual nestled at the geographical climate or the quality of a pull themselves up, more dirt falls from heart,” Cook writes in Understanding person’s housing, and the human context, the walls, can help me to feel how the People in Context. Those circles, moving such as a person’s relationships and client feels in [his or her] circumstance.” further out in terms of proximity to the connections with groups, Cook explains. In the chapter Cook and Coaston individual, were dubbed the microsystem, The third proposition is that all co-authored in Understanding People mesosystem, exosystem and macrosystem. behavior is interactional. That means in Context, they offer a wide variety of “In my experience, however,” Cook even the simplest behaviors are influenced “questions to consider in developing writes in her book, “counselors are by the characteristics of the individual an ecological analysis.” Among those typically more comfortable thinking interacting with the characteristics of questions: about the sites (e.g., home, school, that individual’s life context. “The world n How is the problem situated within neighborhood) involved in someone’s life around the client has an enormous the client’s ecology (who, what, when, than about abstract connections among impact on the person’s life,” Cook where)? And what does it mean to the systems that can be difficult to translate says. “Because we view behavior as client? into the particulars of a person’s life. interactional, counselors’ practice of n Where does the client live out his There are other ways to think ecologically focusing only on the client’s psyche leaves or her life physically and interpersonally about behavior while remaining faithful out much of the client’s reality that might (where is the client’s ecological niche)? to Bronfenbrenner’s insightful schema. be changed.” n What are the client’s important In our ecological perspective, then, we The fourth proposition contends that interactions with people? Groups? will refer to contexts differently than all behavior is concerned with meaning. Community or neighborhood? Larger Bronfenbrenner did while retaining “In other words, it’s how people perceive, systems? How do these interactions several of his key assumptions about the evaluate and predict events in their lives,” influence the client’s life? nature of contexts. These key assumptions Cook says. “People can perceive the same n What life roles and identities appear about contexts concern proximity, things quite differently. Some of these salient to the client? salience and embeddedness.” perceptions are genetically based — our n What central life meanings are salient Cook’s view of the ecological preference for certain flavors, for example to the client’s targeted concerns? perspective in counseling includes four — but most of the issues counselors and Coaston says these analysis questions propositions. The propositions aren’t new clients explore together are based on how are an excellent place for the general to counseling, she says, but combining the client has learned to perceive and counseling practitioner to start. “The them and viewing them all as equally evaluate stimuli, events, other people and questions posed can be used to better important is innovative. so on.” understand clients beyond [what] is

April 2013 | Counseling Today | 33 usually gained from most traditional what barriers to change does the client weight issues … We all have limits to intake or diagnostic paperwork. For see? How might the counselor and client what we can do because of who we are as example,” Coaston says, quoting from the see the life concerns under question very individuals and professionals. We need book, “‘What impact does time have on differently?” Cook asks. “Clients may give to build our own network of support in the client? How does he or she experience up efforts to change their lives because our professional lives — people we know time every day (e.g., is there too little the challenges seem insurmountable can help our clients when we cannot do or too much of it, is it going by too and their resources inadequate. If so. It’s worth our time to establish these quickly or too slowly)? Where does the counselors are able to suspend their own networks so that we can refer as needed.” person feel he or she is in the life cycle? perceptions and experiences in order to Entering the client’s cave How age appropriate does the person truly understand the client’s life from [the Hall, who co-authored a chapter with feel important life events or problems client’s] own perspective, the counselor her mentor, Geoffrey G. Yager, about are?’ [These questions are] unlikely to be will find it easier to identify resources and training counselors in Understanding easily answered by a clinician who does opportunities.” People in Context, says assessment from not work from an ecological perspective. Counselors who fail to take a client’s an ecological perspective demands that However, [they] can give insight into the environment and meaning making into counselors formulate client problems inner experience of a client in [his or her] account run the risk of blaming the accurately, in detail and within multiple daily life.” client, Coaston says. “It is easy to forget dimensions. “Articulating the problem At the agency where she works, that our clients’ framework for perceiving as ‘I am depressed’ or ‘I’m worried about Coaston is expected, for billing purposes, the world may be different from our my child’ is not enough,” Hall says. to develop goals for treatment during own. What may be straightforward, easy “The ecological perspective demands a the first session. “However, after this first or not a big deal for us can be anxiety detailed problem statement that answers session, I let the client’s story marinate provoking, shaming and not worth it for the questions who, what, when, where, in a way and begin making connections our clients. When we can understand the why and how often. We determine the based on my understanding,” she says. relationship between the client and [his challenges and supports at the ‘person’ “These connections are discussed in or her] context, we may find change is and ‘environment’ levels and the health of future sessions so I can make sure I’m needed in the client, the environment or, the interaction between the two. We strive seeing the concern in a similar manner to often, both. However, when we look at to understand the meaning the client the client.” our client without the environment, it is derives from his or her life. Diagnostically, After reaching a better understanding up to us [as counselors] to ‘fix’ the client we understand the importance of all axes, of each client and situation, Coaston to resolve the problem,” she says. and our conceptualization and targets may teach the client new skills or offer Much like counseling as a whole, Cook of intervention must include Axis IV — resources so the client can address says the ecological perspective stresses deficits and strengths.” elements of the situation on his or that clients are the experts of their own Hall believes it is imperative to model her own. But Coaston also stays on lives and encourages counselors to focus the ecological perspective for her students. the lookout for ways that the client’s on client strengths, such as a supportive When sharing examples from her own environment could possibly be changed. network of relationships or an ability to experiences with clients, Hall says she “In our agency, we work closely with make and carry out decisions. “In the uses the “language” of the ecological case management staff who can help ecological perspective, we encourage perspective so that students will learn counseling staff understand the home counselors to identify the resources and from day one to expand their views of environment and identify community challenges the client has today,” she says. clients beyond the intrapersonal. resources that could be helpful. I will also “What do they have to work with? What Even when prompted to use specific look at how the client creates meaning are the issues or roadblocks preventing tools, her students learn to view clients in [his or her] life and look to expand, them [from moving] ahead in life? If a within their complex, multidimensional adjust or keep the current meaning counselor cannot identify any strengths contexts. “For instance,” Hall says, “if making for the health and well-being of or resources, it may be useful to consider I give students a case to examine and the client.” whether the counselor has negative I provide a multiaxial diagnosis, I am Some counseling perspectives tend to preconceptions that might prevent the careful to spend as much time with Axis revolve around a belief that the potential counselor from truly helping the client. IV as I spend with Axis I. I prompt for change rests solely within the client, People do the best they can with what discussions about the relationship Coaston says. In contrast, the ecological they have and what confronts them in life between person and environmental perspective takes into account how clients as they perceive it now. How have they factors, and I make sure that we expand interact with their environment and been able to get this far?” our lens to include strengths or nutritive contends that change sometimes must Cook points out that not all counselors factors as well as deficits, both within the happen outside the client. have the skill or interest to help clients person and his or her environment.” The ecological perspective also with every environmental factor. Hall says counselor educators can use dissuades counselors from viewing clients “Counselors may be uncomfortable multidimensional role plays, case studies as “unmotivated” to change, a label that exploring a client’s sexual orientation, and case presentations that emphasize an Cook rejects as never being helpful. “Just religious questions, housing needs, ecological perspective, thereby inviting

34 | ct.counseling.org | April 2013 Helping others is your passion.

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April 2013 | Counseling Today | 35 students to understand the rich context of that aspect is a relationship, a career, a counseling theories. “The perspective clients’ lives and problems. “By providing peer group, a lifestyle or a geographic is not meant to replace any other ongoing supervision using an ecological location. For instance, a large Air Force counseling approaches, and we [as perspective, our practicum and internship base is located near Dayton, where proponents of the ecological perspective] students will build a strong foundation Hall practices. One of her clients was certainly don’t mean to imply that there’s for their work in the future,” Hall says. a military spouse who moved from anything wrong with other approaches,” Hall points to something she learned Southern California to Ohio in the fall, she says. “What we do recommend is that from Yager, a professor of counseling at never having been exposed to a cold- counselors learn to ask themselves what the University of Cincinnati, who likened climate winter before. The woman loved other aspects of the client’s life ecology counseling to cave exploration. “If we the outdoors and typically remained very they might be overlooking.” enter into our client’s cave along with active year-round, but she started feeling Hall agrees. “The ecological perspective them, then we both will have expertise paralyzed by the cold, dreary days of helps us conceptualize and intervene in various areas,” Hall says, recounting winter in her new home. with our clients more fully than many Yager’s lesson. “Because our client lives “This quickly impacted her mood, single theoretical orientations,” she here, he or she will have knowledge about as she was no longer physically active, says. “It … weaves together constructs much of the geography of this cave, but social or experiencing nature, which and processes to create a broad picture may miss important aspects of the terrain was her connection to her spiritual of the client’s life, from intrapersonal due to the patterns of movement and self,” Hall says. “Together, we worked processes, including meaning making, awareness that he or she has developed. to identify how she was interacting to interactions with people, multiple Some of these patterns can become self- with this environment, the meaning she environments, life events, history, culture limiting, to the point that our client had created about this experience and and society across time. While a single would like to leave the cave or change then how she could begin to change theory often targets a small part of the the cave but cannot due to these patterns this interaction. While it is true that dynamics contributing to the client’s of behavior, meaning making and we cannot change the weather, we can life concerns, the ecological perspective perceptions about self and environment. learn how to change our interaction provides the bigger picture. Therefore, The counselor enters this cave not as an with it and its interaction with us. The with a wider lens, we have a greater range expert of this particular cave but with ecological perspective provided the lens, of possible targets of intervention.” a fresh perspective and a set of tools to and cognitive behavior therapy [CBT] Cook and Coaston say the ecological help the client uncover aspects of himself and mindfulness helped by giving tools perspective can apply to almost any or herself, or of the environment, that to alter meaning making, appreciate the counseling setting and client. “However,” perhaps the client has never seen. We present moment and learn to tolerate the Coaston says, “clients who are able to need our client to show us around, and discomforts inherent in everyday life.” think abstractly, willing to make tough they need us to see with new eyes and to The ecological perspective can changes and motivated to look at their share our tools. An ecologically oriented complement almost any counseling circumstances with new eyes are most counselor — and cave explorer — would theory, Cook says. Coaston calls it the successful.” focus just as much on understanding that lens through which she perceives each cave as she would on understanding the client and situation. Once the counselor ‘The problem isn’t the problem’ client because, most likely, the changes, has a clearer picture of what the client is Schools are their own ecosystems — solutions and well-being will come from hoping to achieve, different counseling and that makes them a perfect place to the interaction between the two.” theories can be utilized, she adds. implement the ecological perspective Many times, Hall says, people seek Cook explains that the ecological in counseling, says George McMahon, counseling because they are experiencing perspective is metatheoretical — not an assistant professor and counseling a poor fit between themselves and some a theory itself but rather a series of program coordinator at George Mason aspect of their environment, whether principles that underline many other University in Fairfax, Va. He began

36 | ct.counseling.org | April 2013 Multiculturalism and the ecological perspective

Comprehending diversity from is ineffective because it negates the and contextual [view] of life events. an ecological perspective means interactions between a comprehensive Using the ecological approach, which understanding that a person’s cultural list of cultural factors, says Bashir, will help clinicians uncover particulars identity results from a combination of who conducted research on Pakistani about cultural identity, can bring about biological, psychological, physiological, Americans living in Springfield last an understanding of clients’ cultural physical and spiritual selves that interact year as part of her doctoral dissertation contexts, which will help to avoid any in life spaces such as family and work at the University of Cincinnati. For misdiagnosis.” settings, says Huma Bashir, who works example, she says, the experiences of Clinicians must remain cognizant of as a counselor at a nonprofit community a female Pakistani American residing the many factors that can interact to health center in Springfield, Ohio. in a small rural community would be create cultural identity and influence the “When evaluating cultural identity, different from those of a female Pakistani effectiveness of counseling services, Bashir the ecological approach considers all American living in a metropolitan urban says. “For example, a counselor will be levels of influence in a person’s life, community. more effective if she understands the age looking at them in context,” says Bashir, Mental health issues and cultural and developmental level of her client who co-authored a chapter on the topic factors must be viewed together, Bashir and how those factors intersect with her says, because cultural factors may affect for Ellen Cook’s book Understanding family, parents and friends.” People in Context: The Ecological the definition and acceptance of mental Bashir recalls working with one client Perspective in Counseling, published by health disorders. “Muslims determine who presented with physical symptoms the American Counseling Association. their mental health in the context of associated with malnutrition. “After “The multifaceted nature of the religious values,” explains Bashir, a investigation, [it ended up] the young ecological approach is essential to dissect member of ACA and the Association woman was reacting to an arranged cultural differences of individual clients, for Multicultural Counseling and marriage she felt she was being forced allowing a clinician to take a snapshot Development, a division of ACA. of contextual information. It is the “Cultural factors and religious views into, and she was unable to communicate multidimensional factors that could pose may influence the diagnosis and her upset and anger to her parents. a challenge for the treatment of mental treatment of mental illness among By being aware of and understanding health issues for any population, [but Muslims within mental health services. the relevance of culture, clinicians can they are] especially critical for ethnically Working with clients from a diverse provide more effective services.” diverse clients.” ethnic group cannot be put in a To contact Bashir, email hbashir@ Simply viewing diversity in terms pigeonhole, and utilizing the ecological rockinghorsecenter.org. of a person’s cultural background perspective would offer a fluid, flexible — Lynne Shallcross researching the idea in 2007 and has alone might have been viewed as the Take, for example, instances of school presented on it at various conferences problem, says McMahon, a member of bullying that target those perceived ever since. ACA and the American School Counselor to be sexual minorities or gender Schools themselves are divided into Association, a division of ACA. “[But] nonconformists. Using an ecological multiple systems, McMahon says, such from an ecological perspective, that’s perspective, the counselor would first as social groups within the student feedback that something within the start on an intrapersonal level, McMahon body, different grade levels, teachers system is out of balance,” he says. “Maybe says, working with the student on ways versus students, and so on. Schools are the kids aren’t coming to school on time to stay safe and self-advocate. Then the also a system nested within the larger because they don’t feel safe at school. counselor might look at how teachers community. The basic idea behind Or maybe within their community, intervene or the language that teachers implementing an ecological perspective they’re not seeing kids graduate, so they allow students to use in their classrooms, in a school counseling setting is to value going to school and graduating he says. Next the school counselor might acknowledge that any problem or issue differently. Or maybe many of these kids look at schoolwide policies, and if those must be considered, and often solved, are older siblings and they’re getting their policies don’t cover sexual minorities or within the context of the system, younger siblings ready, and that’s why gender nonconformists, the counselor McMahon says. they’re late. We tend to assume that the might begin advocating for change. For example, a principal might say problem lies within the students, and we Counselors are in the perfect position to a school counselor, “We’re having a address it from a motivation standpoint.” to apply this perspective, McMahon says, problem with low attendance among Considering contextual variables can because they are among select few school our ninth-graders. They’re not getting to lead counselors to seek solutions in personnel to have access to students, school on time.” Traditionally, attendance more than one place, McMahon says. teachers, administrators, coaches, parents

April 2013 | Counseling Today | 37 and community members. “Because collaboration is a vital component to this model, professional school counselors have a role as connectors, because they Counseling and Psychotherapy: are in contact with such a wide variety Theories and Interventions of stakeholders,” McMahon says. “They can be the hub of the collaborative wheel, Fifth Edition so to speak.” Additionally, he points out, school counselors have the skill set edited by David Capuzzi and to foster collaboration, including skills Douglas R. Gross centered on empathic listening, team “Counseling and Psychotherapy building and advocacy. features important theories and trends Although it is prudent to consider not covered in other foundational all the contextual factors as a school texts; the emphasis placed on social counselor, McMahon acknowledges that justice is especially noteworthy. can feel overwhelming. The good news, he says, is that just doing something — Overall, this book provides readers anything — can make a difference. “You with a substantive foundation for don’t want to let yourself be paralyzed by their work as professional counselors.” how big a job it is. Make a guess [toward —Carl J. Sheperis, PhD a solution], start somewhere and then Walden University evaluate along the way. Any change you make will ripple out.” This student-friendly and well designed introductory text Another piece of good news? School provides a thorough overview of 14 widely used theories. Experts counselors don’t need to change what examine each theory from the perspective of its historical they’ve been doing; they simply need to background, major constructs, goals, cross-cultural considerations, open their eyes more fully to what might and limitations. Traditional and brief interventions integrate be contributing to an issue, McMahon theory with specific counseling strategies, giving students says. “The problem isn’t the problem. It’s further insight into the counseling process and guidance in an indication something else is going on,” developing their personal counseling style. A consistent case he says. School counselors can utilize the study across chapters reinforces the differences between theories relationships they have built, both within and illustrates assessment of client concerns and treatment the school and the community, to address planning. Introductory chapters explore core dimensions and any issue, he adds. brief approaches to the helping relationship, and how to best The first step in bringing the ecological deliver counseling and advocacy services to diverse client groups. perspective to school counseling is to A complimentary test manual and PowerPoints for instructors’ use are intentionally see and use the connections, available by request on university letterhead. 2011 • 408 pgs McMahon says. “It’s really a paradigm shift, a shift in perception. But once you Order #72902 ISBN 978-1-55620-271-1 begin to see the interconnections, you List Price: $69.95 ACA Member Price: $49.95 can’t stop seeing them. At that point, the next step is just to act in accordance Please include $8.75 for shipping of the first book with what you see. When you realize and $1.00 for each additional book. that student scores are not just a result of a lack of study skills, [that] there may be several other factors — some outside American Counseling Association of the school — that are affecting those 800-422-2648 x222 scores, then think creatively about how to act in accordance to what you see. counseling.org Address the larger factors, collaborate with others who have access or expertise you need, and work across levels rather than just ‘fixing the child.’ At that point, you are working ecologically.” Taking an ecological perspective can also help to carry out the ASCA National Model, McMahon says. “The ASCA model promotes a vision of what to do

38 | ct.counseling.org | April 2013 and, to some extent, how,” he says. “The many ways to assist her family to change In cutting across a wide range ecological model supplies the ‘why’ and their lives permanently.” of current counseling theories and expands on the ‘how’ by showing how all Hall cautions beginning counselors not approaches, Cook says the ecological of the different roles and responsibilities to fall into the trap of believing that any perspective implores counselors not are connected and working toward single theoretical orientation will fully only to gain a fuller understanding of the same goal of helping to create and explain a client’s situation or provide an their clients’ worlds but also to work maintain a healthy, equitable, diverse and all-encompassing list of interventions. toward change within those worlds. “In balanced system that graduates students “I would encourage them to learn about a nutshell, the ecological perspective who are ready to actively and positively ecological counseling to help them offers a language and model for participate in the larger community.” widen their lens [because] I believe we understanding human behavior that Seeing life through the client’s eyes can do clients a disservice when we limit our view,” she says. “Allow yourself to encourages counselors to think creatively Though Hall makes a point of exposing consider a full range of intervention and to reach outside their own offices to her students to the ecological perspective, other professionals and services to build Coaston says that isn’t the norm among targets, even if at first the change seems collaborative programs for change,” counselor educators. Elements of the too miniscule or irrelevant. The client she says. “When we truly appreciate perspective may be touched on in some I spoke of [previously] began her path classes, she says, but as a whole, it to transforming her life by painting how clients’ lives are influenced by generally goes uncovered. her bedroom. To some, this could be sociocultural forces and limitations But that shouldn’t stop counselors considered irrelevant to the counseling outside their control, we can broaden from learning about and applying the process, but to an astute counselor, this our change efforts to work toward social ecological perspective, says Coaston, can represent forward movement that justice for all people.” should be nurtured in the hope that it who points to both of Cook’s books as u good starting points. Formal training leads to something bigger over time.” To contact the individuals interviewed in the perspective isn’t necessary, she Cook offers more-seasoned counselors for this article, email: says, but she adds that supervision reassurance that they haven’t been doing and consultation with someone who anything wrong up until this point. n Susannah Coaston at susannah. understands the perspective can help However, she says, applying a focus on [email protected] the ecological perspective may assist them ensure fidelity. n Ellen Cook at [email protected] Cook says most experienced counselors in noticing additional opportunities eventually end up applying the ecological where change could occur for clients. n Michelle Flaum Hall at hallm4@ perspective to some degree, even without Hall agrees. “Ecological counseling can xavier.edu inject new life into counselors’ work by training. “They realize that human n George McMahon at hmcmaho3@ reminding us to be creative, open-minded behavior can never be understood in a very gmu.edu simple, straightforward way,” she says. and respectful of the multiple systems at Cook suggests that counselors who are work in the lives of our clients.” u just starting their careers begin applying The ecological perspective offers To purchase a copy of Understanding the perspective by looking for what counselors the opportunity to see details People in Context: The Ecological the client has done right. At times, she of a client’s life they may have missed Perspective in Counseling ($39.95 for otherwise, Hall says. Generally speaking, says, counselors see clients who seem ACA members, $54.95 for nonmembers; she adds, counselors can miss important to have one problem on top of another, order #72918), visit counseling.org/ and in these instances, counselors may aspects of a client’s context, especially publications and click on “Bookstore” or be tempted to look for what the client when the counselor is either too similar call 800.347.6647 ext. 222. u is doing wrong. “Supervisors need to to or too different from the client. “If we remind counselors that clients do the best perceive a great likeness to our clients, we they can with what they have experienced run the risk of making assumptions about and how they perceive it,” she says. them because we’ve ‘filled in the blanks’ Cook reflects on one particular client with our own experiences, perspectives who fit that description. The client had and judgments,” she explains. “Likewise, Lynne Shallcross is the associate worked out a plan to support herself and if we perceive our clients as being vastly editor and senior writer for her children throughout the month by different from us, we can miss important Counseling Today. Contact her at using a mix of food assistance, financial aspects of their context because we don’t [email protected]. assistance, free church suppers, food know what we don’t know, so to speak. banks and donating her blood plasma By attempting to understand every client Letters to the editor: for money. “She knew exactly where to as fully as possible using an ecological [email protected] go and when in order to provide for her lens, I believe we decrease the likelihood children,” Cook says. “These strategies that our own contexts might impede us in of exploring, identifying and utilizing our quest to both realize and appreciate community supports could be used in our clients.”

April 2013 | Counseling Today | 39 Life without an alarm clock By Stacy Notaras Murphy On the surface, retirement looks like paradise, but unless counselors are prepared to redefine themselves and make new connections, even they can get tripped up while making the transition

etirement often seems to be about she says. “We attended conferences. We trade-offs. You may have more participated in professional organizations R time to do the things you love in a variety of ways. We read counseling but less money to devote to those things. literature. We wrote articles together. We You may have more opportunities to talked about counseling, teaching and exercise and enjoy life, yet you have to scholarship. Counseling was more than a navigate new health care and insurance profession. It permeated nearly every aspect issues. You can travel more, but that might of our lives. As I thought about retirement, mean connecting less often with former I worried, ‘If I am not a counselor or colleagues and community friends. You counselor educator, who am I? How do I may finally get to focus on being a full-time introduce myself? grandparent or spouse, but your previous How do I remain career-focused identity must be left behind. credible? Will my life Counselors are trained to help clients have purpose? What navigate this changing landscape as they will I do with all of cross the “finish line” into what may be my time?’ I had to the most carefree and satisfying time of redefine myself.” their lives. The counseling room is a great Facing that place for clients to engage in goal setting string of tough and strategize for the optimal retirement questions, many experience. So, when counselors reach that retiring counselors golden age of retirement themselves, it’s safe opt to remain to assume they will slide right into the new connected to the paradigm with ease, right? helping community. Not so fast. Opportunities for “Counselors recognize retirement as a engagement range part of career development,” says Sandy from simply reading Magnuson, a retired school counselor and up on new treatment American Counseling Association member trends to opening Sandy Magnuson and husband Ken Norem in Greeley, Colo., “[but] I don’t think I limited private write a mental health column for a rural integrated that theoretical notion into my practices. In fact, newspaper as one way of staying connected to life. That was about other people.” Retiring keeping a toe in the the counseling profession. at the earlier end of the spectrum at age counseling waters 60, Magnuson faced the question that all may be the healthiest counselors are likely to confront: What choice of all. According to a widely cited happens after a career spent helping others? University of Maryland study published in Magnuson’s life had been built around 2009, those who keep working on a limited her connections to the counseling basis during retirement have better health community. “I met my husband at a outcomes, including fewer major diseases counselors conference. We ate, slept and and disabilities, than those who quit drank counseling and counselor education,” working altogether. Furthermore, the study

April 2013 | Counseling Today | 41 revealed that those who continue part- time work in their original field enjoy better mental health than those who retire and blaze an entirely new path. Before retiring from full-time work in 2003, Estela Pledge provided mental health and substance abuse counseling at a community mental health center in Macomb, Ill. Now, at 71, she may have the ideal work situation. Pledge has a small private practice and works part time at the Western Illinois University Health Center, where she provides clinical services as well as supervision to interns and graduate assistants. “Because I can limit the amount of private clients I see, and with the limited hours at the university, I have the best deal. Both of these jobs are relaxing in comparison with working at the mental health center. The students at the university are young, David Denino encourages counselors who are thinking about retirement to immediately start and the women I see in private practice strengthening their connections to other activities they enjoy. One of Denino’s favorite pastimes are motivated. So this has been great,” is restoring sleighs from the late 1800s and early 1900s. says Pledge, an ACA member who still more years to put his ultimate retirement of] disengaging from your work may lives in Macomb. plan in place. Instead, he had to make a be arduous. Think of what you will stay Pledge has had to learn to live with decision in the span of two months. connected to, then do it. Increase your less money and find outlets for her Before ultimately choosing to take the spare time, but she appreciates the connections to your enjoyable activities offer, Denino wondered what it would opportunities semiretirement affords her as soon you can. Think about a longer be like to step away from his professional to spend time with her grandson and transition, perhaps by leaving full-time identity and career-long connection to friends. “Some colleagues and I met, and work [for] part-time work.” the university community. “And how they wondered how I had transitioned so Regardless, he cautions that no amount would that transfer to carving out a new easily,” she says. “I told them that I did of planning will fully prepare counselors identity? I spent my career providing not retire totally since I went to work at for the changes that retirement will counseling and teaching college students the university. But I was smart enough and adults, and the time came to practice introduce. “Resilience is something to set boundaries with the university so I the transitions [I] had preached,” he says. all counselors preach, but it becomes was not burdened with work I no longer Today, the ACA member continues as something we now have to practice,” wanted to do. I also started my practice SCSU’s director emeritus of counseling he says. “Professional connections will prior to my formal retirement from the services and is a part-time faculty member disperse — people move on, and so will mental health system. I advised [my in the Department of Counseling and you. … You will feel alone at times, just colleagues] to have a plan that they could afford and enjoy.” School Psychology. like your clients and patients have. You Counselors looking toward retirement Denino says the most significant helped them through the process. Now should be certain to fully understand postretirement challenge he faced help yourself with resources you have their financial commitmentsbefore revolved around the dramatic change in gathered over the years.” making the transition, Pledge says. And his routine, which was suddenly void Adds Denino, “It will take time to after retiring, she adds, they need to be of daily structure and opportunities figure this out, and often the first year out intentional about finding ways to have for camaraderie with colleagues. “As may be the most difficult. Many career counselors, we absolutely incorporate fun and keep learning. “Get together development theories connect work with these types of plans in our work but often with other counselors who have retired, personality and identity, and we lose may be remiss in personal application of and read, read and read,” she advises. some of that [when we retire].” what life will be like after helping others Preparing for the retirement plunge care for themselves,” he says. Still, Denino emphasizes the positives David Denino came face-to-face with As such, Denino offers advice for other that accompany the transition, including retirement a little sooner than he had counselors to consider when it comes to fewer worries about clients, budgets, planned. In 2009, he was offered early planning for retirement. “Start now,” he billing and so on. He also highlights the retirement from Southern Connecticut says. “If possible, build a plan that is at joy of having more control over one’s State University (SCSU) in New Haven. least two or three years out. If you don’t schedule and finally making time for “all He had expected to have three to five have that time, the emotional [process those things” on the to-do list.

42 | ct.counseling.org | April 2013 April 2013 | Counseling Today | 43 Practical matters our personal emotions throughout the No matter what the retirement fantasy journey — excitement about pursuing looks like — from maintaining a small new opportunities mixed with leaving a caseload of favorite clients to sailing therapeutic relationship.” off into the sunset entirely — there are Having retired in 2010, Magnuson certain practical issues that all counselors admits she is still struggling to determine must consider, including the likelihood of what to do with the journals, books, files living on less money, possible relocation and counseling equipment she amassed and the risk of being isolated from throughout her career. “We diligently longtime supportive relationships. saved every issue of every publication Depending on a counselor’s work thinking that someone would be so situation, the retirement process also may happy to receive a complete set. That was require careful decision-making in terms before the digital era when hard copies of closing a practice and helping current are neither valued nor wanted,” she says. clients find new resources. To protect “It was painful to take boxes of journals clients from feeling abandoned, the ACA to the recycling bins, [so] we’re not done Code of Ethics requires that counselors with that part yet.” follow proper termination procedures There are also choices to make about and make appropriate arrangements which professional associations to for clients who will need to continue maintain. Magnuson acknowledges that treatment. Accurate informed consent letting go of some of her professional must be made for a retiring counselor credentials was particularly difficult. “I to transfer case files to a client’s new worked so hard to achieve them, yet I treatment provider, and retired counselors simply could not justify the expense of also must make adequate arrangements maintaining them,” she says. “Those for long-term client record accessibility. decisions did not come easily. I still Denino advises counselors thinking have both licenses — LPC [licensed about retirement to act deliberately professional counselor] and school and afford themselves plenty of time counseling. In fact, I just renewed my to work through the ethical and legal school counseling license for five years. Trudie Atkinson, shown here with her issues involved in terminating client Without insurance, I won’t practice, [but] niece, Wendy Dunn, relocated to Oregon relationships. “All practitioners should I just needed to keep those licenses for a and continued working full time for four give adequate notice of their retirement,” while longer.” years because she knew she wanted to retire near family. he says, noting that not all clients will After 40 years in the counseling field, need the same amount of time. “A key including time as a school counselor says. “I knew I wanted to work until feature is to make sure there is enough and in private practice, Trudie Atkinson age 65 for the sake of health insurance, time to find another provider. In my case, envisioned relocating as part of her and I didn’t know what employment I having worked in a university setting, retirement. Winding down a career would find. I couldn’t expect to build transfers become a bit easier [because] that included chapters in New Orleans a sustainable private practice quickly, introductions to new counselors are and Chicago, the ACA member knew and the economy in the Northwest at readily available.” (Note: As a member she wanted to retire near family in the time was dismal. I also wanted to be benefit, ACA members receive free, the Eugene, Ore., area where she was available to my mother in her declining confidential ethical consultations; contact raised. She found a job in that area years while continuing to work. 800.347.6647 ext. 314 or ethics@ working as a therapist and supervisor at “The good news was that I found an counseling.org.) a residential treatment center for young interesting job that used my training Of course, there are also emotional children. She worked there full time and skills, while introducing me to new issues involved in closing a counseling for four years, retiring once she was emphases in therapeutic work. I also practice. Once again, Denino advises able to obtain Medicare coverage at age found an opportunity to volunteer at counselors to give themselves as much 65. She now maintains a small private a counseling center similar to one with time as possible. “Certainly, we have practice, provides supervision to other which I was involved in New Orleans, to handle the undertaking of telling clinicians and volunteers at a community giving back to the community by clients we are leaving, and that can be counseling center, putting in three to four counseling, training and supervision. a difficult process for both the client hours of clinical work per week. Both my employment and the and counselor,” he says. “It takes “The primary challenges in relocating community center provided contact with time to work through that process, so were that I was leaving trusted colleagues many professional colleagues. I found planning is essential. It’s a mix of both and friends, and that I faced an onerous a way to continue working and to help transitions and closure, depending on the licensure process in Oregon. This latter with my mother’s care through supportive relationship. We definitely have to face took two years to complete,” Atkinson meetings with family members.”

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April 2013 | Counseling Today | 45 April 2013 READ Counseling Today, TAkE the CT Learning Test, EARN Continuing Education Credit

Earn 1 CE credit by reading the selected article in this issue. Read the article identified below and answer 3 of 4 questions correctly to earn1 CE credit. It’s that simple! By reading Counseling Today every month, you can earn up to 12 CE credits each year. And you’ll be well informed. Start reading now! Article: Building a more complete client picture Learning Objectives: Reading this article will help you: 1) Understand how an ecological perspective can help counselors identify ways in which the client’s environment affects his or her well-being and development. 2) Reflect on interventions such as ecological analysis that move beyond exclusive focus on the individual. Continuing Education Examination 1) An ecological perspective in counseling takes into account: 3) Which question would not be considered in an ecological analysis? a) Teleological explanations of human behavior a) Where does the client live out his or her life physically and b) Negative thoughts and maladaptive beliefs interpersonally? c) The many systems with which an individual interacts b) How is the problem situated within the client’s ecology (who, d) The client’s subjective frame of reference what, when, where)? c) What are the client’s important interactions with people, 2) The ecological perspective in counseling includes four propositions groups or larger systems? that claim all behavior is: d) How is the problem situated within the client’s childhood a) Personal, contextual, interactional and concerned with experiences? meaning b) Biological, contextual, interpersonal and concerned with 4) The ecological perspective can apply to almost any counseling setting meaning and client. However, clients who are able to think abstractly, willing c) Psychological, sociopolitical, interactional and meaningless to make tough changes and motivated to look at their circumstances d) Personal, cultural, interactional and irrational with new eyes are most successful. ______True ______False q I certify that I have completed this test without receiving any help. Signature ______Date

Rate the following: Profession: Strongly agree Agree No opinion Disagree Strongly disagree ______Alcoholism & Drug Abuse Counselor 5 4 3 2 1 ______Counselor ______I learned something I can apply in my current work ______Counselor Educator ______The information was well presented ______Psychologist ______Fulfillment of stated Learning Objectives was met ______Social Worker ______Student ______This offering met my expectations ______Other

Complete the test online at http://learning.counseling.org. You will be able to pay online and download your CE certificate immediately! Mail: Complete the test and mail (with payment made out to American Counseling Association) to: ACA Accounting Department/CT, American Counseling Association, 5999 Stevenson Ave., Alexandria, VA 22304. Your CE certificate will be emailed, unless noted otherwise, in 2–3 weeks. Questions? 800-347-6647, x306. Please print clearly Total amount enclosed or to be charged q $20.00 member q $30.00 nonmember q Name: ______Check/money order (payable to ACA in U.S. funds) q VISA q MasterCard q American Express q Discover ACA Member Number: ______Card #: ______Zip Code: ______CVC Code: ______Exp. Date: ______(AmEx, 4 digits above card number; VISA, MC, Dis., 3 digits by signature line) Phone: ______Cardholder’s Name: ______Email: ______Authorized Signature:______

46 | ct.counseling.org | April 2013 Magnuson also relocated before retiring want to repeat,” she says. “Some of my everything. Then I had to go through a fully and acknowledges the decision was former colleagues ‘retired’ long before they fairly challenging, even difficult, vetting challenging. “At age 50, I began thinking resigned. Others became irritable, bitter, process to decide what I would continue seriously about where I wanted to grow cranky and impatient. I did not want to doing and what I would not continue old and die,” she says. “My husband and stay in any position if I could not continue doing. Resigning in the world of paid I began spending more time with friends to perform at the standard I expected for employment is much easier than in the from my hometown. I applied for a myself, if I could not be productive or if I world of volunteering,” she cautions. faculty position in that area. The position could not be cheerful and happy.” Magnuson also decided to maintain her was offered to me, and I accepted it In retirement, Magnuson continues her ACA membership as a way of preserving even though I had a compelling sense writing, including co-authoring a mental her counselor identity. “I appreciate the that it was not going to be a good fit. I health column in a rural newspaper with fact that ACA encourages continued was right. I believe this contributed to her husband, Ken Norem. She also enjoys membership with reduced dues,” she says. my retiring earlier than I would have formal storytelling, participating on local “I believe our profession has a tradition of otherwise. And, yet, I can’t imagine not organizational boards, staying active in honoring and respecting those who have living close to my extended family and politics and involvement in her faith gone before us.” u hometown community. I shared my community. aunt’s final days with her. We attend The individuals interviewed for our friends’ grandchildren’s ballgames. I this article repeatedly recommended Contributing writer Stacy Notaras see my lifelong friend a couple times a that their fellow counselors find ways Murphy is a licensed professional month. We go to alumni banquets. We to volunteer their time — whether counselor and certified Imago celebrate milestones and grieve losses in counseling environments or other relationship therapist practicing in with people I’ve known all my life.” venues — upon retiring. At the same Washington, D.C. To contact her, Magnuson continues to contemplate time, Magnuson also cautions retirees to visit stacymurphyLPC.com. the financial aspects of this new phase of guard against overextending themselves. life. “Certainly we have had to adjust our “I had often heard [from retirees], ‘I Letters to the editor: lifestyle, and I’m painfully aware of the don’t know how I had time to work.’ [email protected] financial challenges we may encounter That’s been my experience as I essentially with longer term health care,” she says. redefined myself. At first I said yes to Because she retired at age 60, Magnuson also had to find private health insurance before qualifying for Medicare benefits. “I had no idea that Recovery from Grief Is Possible. would be a problem,” she says. “I was and still am incredibly healthy, [but] Learn How to Help. insurance companies viewed me as a high risk because of my age. I had no idea that the process would be so time consuming, costly — in terms of providing information and obtaining Certification Training 2013 additional medical tests — stressful and MAY JUNE extensive. I was also stunned by the cost 17–20 Denver, CO 7–10 Phoenix, AZ of my premiums.” 17–20 New Orleans, LA 7–10 Hartford, CT 17–20 Sherman Oaks, CA 21–24 St. Louis, MO The good life 21–24 Calgary, AB What does Magnuson most like about being retired? Hands down, not having JULY AUGUST to use an alarm clock. “That’s the best!” 12–15 Palm Springs, CA 9–12 Wilmington, DE she says. “I value the additional time for 12–15 Oklahoma City, OK 16–19 San Francisco, CA 26–29 Chicago, IL 23–26 Omaha, NE self-care. I immediately began a weight- 26–29 Atlanta, GA 23–26 Toronto, ON training program. I have walked since the 26–29 Sherman Oaks, CA early [1980s] and have enjoyed longer 26–29 Moncton, NB walks [in retirement] in new places. I 4-Day Training  30 Contact Hours  Maximum 15 Participants didn’t remember what it was like to feel Tuition $1995 (Early Registration Discount $200) rested.” On this point, Magnuson urges other For more information or to register counselors to consider the impact that reduced stamina can have on their Call 800-334-7606 ability to serve clients. “I had observed www.griefrecoverymethod.com a phenomenon that I absolutely did not

April 2013 | Counseling Today | 47 Reflecting ‘as if’ By Richard E. Watts This brief, encouragement-focused counseling process integrates Adlerian and constructive theory and practice perspectives and can be useful for work with diverse populations in a variety of settings

n integration of cognitive, points of resonance, it is noteworthy existential, psychodynamic that both Adlerian and constructive A and systemic perspectives, approaches to counseling strongly affirm Adlerian counseling theory is a holistic, the importance of the client-counselor phenomenological, socially oriented and relationship; are optimistic and present/ teleological (goal-directed) approach to future oriented; and focus primarily on understanding and working with people. clients’ strengths, resources and abilities Furthermore, Adlerian counseling theory rather than on their weaknesses, deficits and is a relational constructivist approach and disabilities. affirms that people must be understood Given this common ground, it is not contextually because it is in our surprising to find that interventions relationships that we understand ourselves, discussed in the constructive therapy others and the world around us. literature are either similar to or congruent Counseling theories tend to focus on with interventions used in Adlerian either the individual or the collective. counseling. Nor is it surprising to see Adlerian counseling is a healthy balance significant opportunities for technical between these two perspectives. Adlerian integration between the two. This article counseling theory affirms that knowledge presents a brief, encouragement-focused is socially embedded and relationally counseling process that integrates the distributed but also affirms that humans Adlerian acting “as if” technique with are creative, proactive, meaning-making procedures drawn from constructive individuals who have the ability to choose approaches to counseling. and be responsible for their choices. Because Adlerian counseling is a relational Expanding the acting ‘as if’ technique constructivist approach, it accounts for One specific area Adlerian and both the social-embedded nature of human constructive therapies share is that both see knowledge and the personal agency of value in using the “as if” quality of human creative and self-reflective individuals within experience in counseling and psychotherapy. relationships. Humans act as if the constructs by which Given that Adlerian counseling is a they engage in everyday activities are relational constructivist approach, it facts or absolute truths rather than social makes sense that it shares significant constructions that are contextually situated. common ground with various constructive Using this perspective, Alfred Adler perspectives on counseling, including developed the acting “as if” technique, cognitive constructivist and personal which encourages clients to begin acting as construct therapies, solution-focused brief if they were already the person they would therapy and narrative therapy. (For further like to be — for example, a “confident discussion of this significant common individual.” The process asks clients to ground, please see the suggested readings pretend and emphasizes that they are only on page 52). Beyond the many theoretical acting. The purpose of the procedure is

April 2013 | Counseling Today | 49 to bypass potential resistance to change would you be acting differently? If I were motivation to courageously engage the by neutralizing some of the perceived watching a videotape of your life, what more difficult tasks on his or her list. In risk. Acting “as if” affords clients the would be different? the sessions that follow, the client and opportunity to enact alternative or n If a good friend saw you several counselor discuss the enactment of the months from now and you were more preferred outcomes and possibly restory “as if” behaviors selected for the previous oppressive aspects of their personal like the person you desire to be or your situation had significantly improved, week. Enacting new behaviors often helps metanarrative (or “style of life” in what would this person see you doing clients to perceive themselves, others and Adlerian parlance). differently? the world differently. I really like the acting “as if” technique n What might some initial indicators Clients can grow frustrated and but have found that some clients are be that would demonstrate you are discouraged as they attempt the more reticent to follow through on the headed in the right direction? difficult tasks on their “as if” behaviors enactment due to discomfort with In phase one, counselors write down list because progress no longer comes potential ambiguity and a desire for more clients’ responses to these or similar so easily or consistently. Clients structure. In addition, I am reticent to questions without judgment or critique. may be more patient and find the ask some clients — for example, those On the basis of what has been shared process less frustrating if counselors who tend to act impulsively — to go out in prior counseling sessions, counselors use encouragement to help clients and act “as if” because I have concerns can contribute ideas as well. Sometimes frame success in terms of effort and about their well-being and the well- clients may offer responses that are too incremental growth rather than final being of others who might be affected broad; in such cases, counselors will outcome. Helping clients understand by their choices. Thus, I developed the need to ask for more specificity (“What, “positive movement as success” is a key reflecting “as if” (RAI) counseling process specifically, will you be doing differently element of the Adlerian understanding of to address my concerns as well as the to make that happen?”). Once it appears encouragement. concerns of my clients. the initial reflective process has been Although encouragement is crucial The integrative RAI process expands completed, the counselor and client are throughout the counseling process, it is the Adlerian technique by having ready to move to phase two. counselors ask clients to take a reflective particularly important in phase three of RAI. Let me diverge for a moment and step back prior to stepping forward to act Phase two briefly clarify the Adlerian understanding “as if.” This process encourages clients to In the second phase of the RAI process, of encouragement. Encouragement reflect on how they would be different if the client and counselor co-construct is often misunderstood as merely they were acting as if they were who they a list of “as if” behaviors that indicate an Adlerian “technique.” Actually, desire to be. By using reflective questions, how the client will act in moving toward encouragement is a way of being with counselors can help clients construct his or her desired goals. As part of this others, and Adlerians view counseling perceptual alternatives and consider co-construction process, the client and alternative behaviors toward which they counselor discuss the viability of each as a process of encouragement. Alfred may begin moving. item on the list and eliminate items that Adler and subsequent Adlerians consider encouragement a crucial aspect of human RAI phases are not realistic. growth and development. Stressing the The RAI process has three phases. In Subsequent to developing the “as importance of encouragement, Adler phase one, the counselor uses reflective if” behaviors list, the counselor asks stated that throughout the counseling questions to access the creativity and the client to rank the items from least process, “we must not deviate from imagination of clients. In phase two, difficult to most difficult. After the client the path of encouragement.” Similarly, the client and counselor co-construct has ranked the behaviors, the counselor Rudolf Dreikurs affirmed that therapeutic an “as if” plan of action on the basis engages the client in a dialogue about success was largely dependent on of the client’s reflective thinking. In the difficulty level of the items and their the counselor’s “ability to provide the final phase, clients implement the position on the list. Once the ranking “as if” behaviors and then discuss that process and dialogue are completed, the encouragement,” while failure generally experience in session with the counselor. client is ready to begin the enactment occurred “due to the inability of the As with most action-oriented procedures, process. therapist to encourage.” Encouragement the use (and success) of the RAI process skills include: is predicated on the development and Phase three n Accepting clients unconditionally and maintenance of a solid client-counselor Phase three starts with the client without judgment selecting a few of the least difficult “as relationship. n Demonstrating concern for clients if” behaviors to enact for the coming through active listening, respect and week. Beginning with the least difficult Phase one empathy In the initial phase of RAI, counselors behaviors increases the potential for use reflective questions such as the client success because success is typically n Focusing on clients’ strengths, assets following: encouraging for clients and often and abilities, including identifying n If you were acting as if you were increases their perceived self-efficacy. past successes and communicating the person you would like to be, how Success typically increases the client’s confidence in the same

50 | ct.counseling.org | April 2013 View from Diamond Head volcanic tuff in Honolulu. Hike a trail to the summit and see this in person! n Helping clients to generate perceptual Using imaginary the session. To begin, counselors can ask alternatives for discouraging fictional reflecting teams in RAI clients to think of one or more persons beliefs and oppressive narratives When clients are immersed in difficult whom they respect and view as wise. situations, they sometimes have difficulty The client and therapist then create a n Helping clients distinguish between with the RAI process. They struggle list of team members. To amplify the what they do and who they are (deed to see beyond the problem and need imagery, the therapist may provide chairs vs. doer) help stepping away from or out of the for each team member, similar to the problem so that alternative perspectives use of an empty chair in Gestalt therapy. n Focusing on clients’ efforts and can emerge. The use of imaginary I often put name tags on the chairs for progress reflecting teams is one way to help clients identification purposes and to anchor the n Communicating affirmation and create dialogic space for reflection in the team member imagery. appreciation to clients RAI process. Once the team is created, the counselor When clients have difficulty responding may call on team members for assistance n Helping clients see the humor in life to reflective questions, counselors can by asking clients questions from experiences invite imaginary team members into constructive therapies. For example: n Suppose you are talking to this person in the future after you have made significant progress in overcoming the Suggested readings problem. What changes will he or she say are evident? What, specifically, will he or n Adlerian Therapy: Theory and Practice by Jon Carlson, Richard E. Watts & she say is different about you? Michael Maniacci, 2006 n What specific steps would he or n Counseling and Psychotherapy Theories in Context and Practice, second she identify that you took to make this significant change? edition, by John Sommers-Flanagan & Rita Sommers-Flanagan, 2012 n What suggestions might he or she n “Reflecting ‘As If’: An Integrative Process in Couples Counseling” by make for responding constructively to Richard E. Watts, The Family Journal: Counseling and Therapy for Couples the problem? and Families, January 2003 n What might he or she say you do when (the problem) attacks you? n “Adlerian Therapy as a Relational Constructivist Approach” by Richard E. n How would he or she describe Watts, The Family Journal: Counseling and Therapy for Couples and Families, times when the problem isn’t a problem April 2003 for you? n n “Using Children’s Drawings to Facilitate the Acting ‘As If’ Procedure” How would he or she explain your ability to accomplish this great success? by Richard E. Watts & Yvonne Garza, Journal of Individual Psychology, n How will he or she know when you Spring 2008 are starting to move in the direction you n “Expanding the Acting ‘As If’ Technique: An Adlerian/Constructive want to go as a person? Integration” by Richard E. Watts, Paul R. Peluso & Todd F. Lewis, After the team has been “heard,” the counselor can proceed to phase two of Journal of Individual Psychology, Winter 2005 the RAI process, helping the client to n “Adlerian Psychology and Psychotherapy: A Relational Constructivist develop a list of “as if” behaviors and rate Approach” by Richard E. Watts & Kati A. Phillips, in Studies in Meaning 2: them in terms of difficulty. If the client has difficulty ranking the behaviors, the Bridging the Personal and Social in Constructivist Psychology, 2004 therapist may again invite imaginary n “Adlerian ‘Encouragement’ and the Therapeutic Process of Solution- team members to help the client with this Focused Brief Therapy” by Richard E. Watts & Dale Pietrzak, Journal of process. In phase three, when the client and Counseling & Development, Fall 2000 counselor discuss the enactment of the n “Using Imaginary Team Members in Reflecting ‘As If’” by Richard E. “as if” behaviors selected for that week — Watts & Jerry Trusty, Journal of Constructivist Psychology, October 2003 and any resulting perceptual alternatives or enactment difficulties — imaginary n “Opening Space for Reflection: A Postmodern Consideration” by John team members can be invited in to D. West, Richard E. Watts, Heather C. Trepal, Kelly L. Wester & Todd F. discuss areas of improvement or areas for Lewis, The Family Journal: Counseling and Therapy for Couples and Families, growth. As the client attempts the more difficult tasks on his or her behaviors list, October 2001 imaginary team members can be invited to positively reflect on the client’s efforts

52 | ct.counseling.org | April 2013 and forward movement, as well as provide of its integrative Adlerian/constructive encouragement when progress is slower. foundation, RAI is congruent with the “Knowledge Share” articles are The types of questions previously offered cultural values of many minority racial based on sessions presented at as examples are easily adapted for use in and ethnic groups. American Counseling Association this phase of the process. In addition, RAI strongly resonates Conferences. with evidence-based perspectives in Conclusion Richard E. Watts is distinguished counseling. John and Rita Sommers- RAI is a brief, encouragement-focused professor of counseling and counseling process that integrates Flanagan recently reviewed the literature director of the Center for Adlerian and constructive theory and addressing RAI in the second edition of Research and Doctoral Studies practice perspectives. Because of the their book Counseling and Psychotherapy at Sam Houston State University Adlerian and constructive theoretical Theories in Context and Practice and in Huntsville, Texas. A licensed and practice underpinnings, I believe offered the following evaluation: professional counselor and RAI can be useful for work with diverse “The RAI procedure is simple and supervisor in Texas, Watts is a populations and in a variety of settings. straightforward. It’s also a good example fellow of the American Counseling With the increasing emphasis on of not only the theoretical compatibility Association, a diplomate in multiculturalism and social justice in the of Adlerian approaches, but also of their Adlerian psychology and president counseling profession, many counselors empirical base. Specifically, RAI employs of the North American Society for Adlerian Psychology (alfredadler. have been drawn to constructive/ several evidence-based techniques, org). Since 2005, he has presented postmodern approaches because of including (a) collaborative goal-setting; on reflecting “as if” throughout the their focus on the social embeddedness (b) collaborative brainstorming as a United States as well as in Canada, step in problem-solving; (c) a focus on of humans and, consequently, human Lithuania, Romania, Switzerland concrete and measurable behaviors; and knowledge. Adlerians and Adlerian and Turkey. Contact him at theory addressed social equality issues (d) concrete behavioral planning.” [email protected]. and emphasized the social embeddedness For more information about the theory of humans and human knowledge long and practice of RAI, please see the sidebar Letters to the editor: before multiculturalism became a focal on suggested readings or contact me [email protected] issue in the profession. Thus, because directly via email. u

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April 2013 | Counseling Today | 53 Reader Viewpoint - By Kim Johancen-Walt Emerging from the cave It is human nature to withdraw for a time when wounded, but clients who engage in long-term avoidant behavior run the risk of amplifying their pain and creating larger problems

hen I first met urt,K age 60, lick our wounds as we recoil from the sting he appeared small despite of trauma and the pain of loss. It may be Wpossessing a lengthy frame that human nature to withdraw when we are should have filled any space he occupied. wounded, yet it is also human nature to He spent the first few sessions of therapy evolve. I remind clients that we have to discussing the details of his son’s diagnosis return to life above ground at some point. with a rare and often untreatable disease. Like Kurt, many of my clients resist He talked about how the subsequent the natural flow of thought and emotion, barrage of doctor visits, hospitalizations afraid to see what may be bubbling below and constant state of uncertainty haunted the surface. But in their effort to remain his family, deeply affecting his son, his wife hidden, they may be at risk of turning and others close to Kurt. Yet Kurt tended toward avoidant behaviors such as substance to minimize the impact these events had on abuse, self-harm and even suicide. Although him. He described his growing addiction to these behaviors are an attempt to survive, alcohol and pain pills without compassion, in actuality they will oftentimes amplify stating that he felt weak and disgusted pain and can create additional problems. with himself. He sought counseling for Individuals are at risk of allowing this help to change his actions and also to gain type of maladjustment to take root as an understanding of what had led him they attempt to protect themselves from down the heavily weeded path of addictive the pain of current and further injury by behavior in the first place. anesthetizing the wound. In my efforts to help clients understand I communicate to my clients that we have their addiction patterns, I explain that to intentionally turn off the instinct to flee avoidant behavior is more about an attempt and, instead, properly tend to the wound, to preserve the self than an attempt to working out the poison and rejoining the destroy it. This understanding may be race. Once they are able to courageously difficult to process, but it is one of the explore their thoughts and the feelings central concepts in recovery. Counselors attached to them (perhaps in the presence must not only have a firm grasp on what of caring others), they can then focus on leads many clients down the road of truly changing their behavior versus trying addiction but must also be equipped to desperately to avoid the impact of a communicate these core concepts in a way painful experience. Through this process, that will help clients forge a clearer path. they can begin the task of waking after the I explain to my clients that in order to long winter. heal, we have to work directly with our Using language seasoned with metaphor pain, and for many of us, this process can helped me communicate to Kurt that his feel counterintuitive. When we are hurt, addictive behavior made sense in light of we want to retreat into the comfort of recent events in his life. Becoming aware of darkness. We are pulled into the cave to his humanness helped Kurt understand that

April 2013 | Counseling Today | 55 his grief was both valid and in need of pleasure she received from food was a shaped and sculpted through years of some attention. This knowledge allowed short-lived distraction, the pain creeping practice. These clients not only attempt him to uncover valuable information back in inevitably after she had emptied to make sense of the loss in their lives by about his urges to use substances, the pantry. We talked about how the blaming themselves but also may accept including an understanding that his emotional fullness she experienced from responsibility for the pain experienced urges revolved around a more primal binge eating was an illusion. In actuality, by those around them. They have come instinct — the instinct to run. Because these incidents of self-abuse served only to believe they are the reason that “bad” of his newfound awareness, Kurt was to feed her particularly severe form of things happen. Unfortunately, other able to cultivate self-compassion, thus self-criticism. During one memorable people in these clients’ lives — many also allowing him to stretch and grow instead session, she looked up at me with puffy, desperate to avoid pain — may actually of remaining stuck in avoidant behavior, red-rimmed eyes and asked, “How did I encourage these clients to shoulder the shrunken and defeated. end up here?” blame, shucking their own responsibility In our attempt to answer her important Gretchen and accountability. question, Gretchen and I embarked on Gretchen was a beautiful 28-year-old Buying into the myth that we are with thick brown hair that fell just below a journey down the various pathways inherently flawed can create torrential her shoulders and large blue eyes lined that had contributed to her pain and pain, as it did for Gretchen. Recognizing with dark lashes. She was referred to food addiction. This included the impact self-blame as an attempt to make sense me for depression that had manifested of growing up with a critical, alcoholic of what has happened encourages us to itself in different ways, including a mother who continued to deny any examine our role in various relationships, poor self-image and recurrent suicidal culpability — most likely because of her including the relationship we have with thoughts. During our sessions together, own avoidant behavior — for the hurt ourself. Although growing pains may be and in between long periods of sobbing, she had caused her child. Gretchen gained experienced along the way, I assure clients Gretchen would talk about how much insight into how she had eventually that this recognition can have a profound she hated herself for being overweight. ingested her mother’s criticism over the impact on healing, self-awareness and She discussed believing she was unlovable years and how she now beat herself up self-esteem, creating ample interpersonal because of her size and her lack of mercilessly with her own cruel self-talk. growth. It is important to look at our role willpower to lose the weight. She felt Furthermore, she learned how these in connection with the events occurring imprisoned not only in her body but also earlier experiences had left a powerful in our lives so that we can continue to in her feelings of shame, helplessness and mark, creating a diminished ability to evolve, but oftentimes we are not solely isolation. self-soothe and a craving for attachment responsible for our losses — and we are Just as finding the right metaphor with that could not be effectively satisfied. certainly not responsible for the losses of each client is an important part of the I explain to clients that when we are those around us. therapeutic process, it is also essential not growing, we are withered, an echo of Painful feelings such as shame, isolation that we talk with our clients about the ourselves. Our natural instinct is to learn and helplessness can keep us wounded various ways they can begin disrupting from what happens in our lives so that we and in the dark, unable to access their dysfunctional patterns. With many are ever better at survival. When we are our inner knowingness and limitless clients, core wounds are buried beneath hurt, we examine the pieces of the puzzle potential. When we are hurt, our view other struggles and must be tenderly that have been scattered, attempting to can become narrow. We may collapse in exposed. Otherwise, these clients may put them back together in a way that on ourselves and feel powerless to change continue their maladaptive behaviors helps us understand what has happened our situation. Gretchen’s deepening and become increasingly frantic. As I and increases our ability to sidestep insight about her difficult childhood got to know Gretchen, I remained aware further injury. Yet through our loss helped us combat the destructiveness of of this process of unearthing the true experience, the puzzle is forever changed her critical thoughts. Her situation began problems and brought these ideas into because we no longer have all the pieces. to make sense as we painted the picture our work. With this framework and this I explain that it is only by accepting the of her current struggle — a reflection of language, our therapy quickly deepened. impact of certain events that we can unresolved grief and loss. For example, when I talked to her about begin the process of rebuilding after I remind my clients that it is deeply a need to “sift through the layers,” we the explosion, putting the puzzle back rooted in our fiber to disappear into the discovered how her focus on body size together in a new way. It is a process that cave when we are hurting. We are pulled was actually a distraction from the true cannot be forced if the bones are to heal there to heal so that we can eventually origins of her painful emotions. “Careful correctly. It takes as long as it takes. rejoin the rest of the world. However, I excavation” revealed how these feelings I tell clients that it is tempting to assign also remind them that this hardwiring were the reverberations of events that had blame and responsibility in our efforts to can at times interfere with other natural happened long ago. understand why the walls came crashing states of healing. Instead of working out Gretchen discussed how brief moments down. Many of my clients, like Gretchen, the poison, we may fail to acknowledge of reprieve from the emotional pain point the finger at themselves. This the wound at all so that it begins to fester. she felt came in the form of nightly type of self-injury is rarely a one-time When our need to evolve is overshadowed binging. But she also described how the event but instead a process that has been by our need to escape, we are at risk of

56 | ct.counseling.org | April 2013 avoidant behavior and at risk of collapsing surveying the landscape and all of the under the heavy weight of painful feelings possibilities. We have to find a way. u such as shame and helplessness. Just as probing the wound can lead to ACA THANKS OUR fresh bleeding, revealing the impact of trauma with someone is a tender process. SPONSORS! Regardless of where we meet our clients Kim Johancen-Walt is a licensed on their journeys, we have to craft the professional counselor in right language for each one, whether that Durango, Colo., who contributed means creating a powerful metaphor or a chapter to The Adolescent AON helping them uncover core wounds. Our & Young Adult Self-Harming words and caring presence as counselors Treatment Manual by Matthew Bio-Medical Instruments, Inc. can help clients put a face on their pain, D. Selekman. She has conducted California University of PA while also steering them back to their several workshops both locally true path; the mirror’s powerful reflection and nationally on her work with Capella University becomes a powerful beacon for someone self-harming and suicidal clients. CounselingInternships.com who feels lost. And our words must also She has also worked in multiple communicate hope. educational settings, including HPSO Insurance The richness of life cannot be found Fort Lewis College. Contact her at in the deep recesses of the hillside. We [email protected]. Liberty Mutual have to find a way to emerge from the Loyola University, Maryland cave, perhaps with the thick skin that only scars can provide. Otherwise, we will Letters to the editor: University of Phoenix continue to suffer, deepening the wound [email protected] Walden University despite our best efforts to avoid the risk of additional harm. We need to encourage clients to step back out into the sunlight,

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April 2013 | Counseling Today | 57 Reader Viewpoint - By Margaret Edwards & Charlotte Chapman After an assault

58 | ct.counseling.org | April 2013 First-session do’s and don’ts when counseling college students who have experienced a sexual trauma

oday’s college students face more whether a student will follow through with than exams, adjustment issues getting help in a timely manner. If a client Tand a tough job market. They in this situation feels judged, is pressed also deal with a complex sexual and social too fast for details or is offered unsolicited landscape that is full of choices and pitfalls, advice, she or he may not return for the often without the safety net provided by second appointment. It is important to their families at home. slow down and to support these clients as A 2007 Campus Sexual Assault Study they try to make sense not only of what has conducted with a Department of Justice happened but also their resulting reactions. grant by Christopher Krebs and colleagues The approach of motivational found that 28.5 percent of undergraduate interviewing, as developed by William women surveyed had experienced an Miller and Stephen Rollnick, is especially attempted or completed sexual assault either helpful in establishing a safe, trusting before or since entering college. According psychological environment in which to to Emily Douglas and David Finkelhor work through a trauma. Motivational of the Crimes Against Children Research interviewing is based on autonomy, Center, between 9 and 32 percent of girls collaboration and evocation. For example, and 5 to 10 percent of boys come to school asking for permission before providing with a history of sexual abuse. information or advice and reflecting Although the statistics vary depending feelings rather than asking questions about on what is counted, it seems clear that what happened allows the counselor to join many students on college campuses have with the client without also joining her in experienced trauma and the associated the trauma. In addition, allowing the client negative psychological effects. Trauma to set the pace and goals of counseling is known, for example, to increase a helps her to re-establish a sense of agency person’s risk of abusing alcohol and other in her own healing, which is important substances, as well as increasing the risk in likewise re-establishing her sense of of further trauma. Thus, sexual trauma psychological safety. recovery and related problems are a very common issue for college counselors. Client scenario Effective intervention soon after a trauma Anna is a college junior just getting ready can prevent mental health and substance to take her final exams. She walked into the abuse problems, the interruption of counseling center today in tears and said she social development and the derailment of wanted to talk about a bad date she had two academic dreams. But how should a college weeks ago. Anna explains that she attended counselor engage the traumatized student? a date function with Chris, the roommate of The first session after an assault is her friend Josh. At first, she says, things went particularly challenging, and a lot rides on pretty normally — drinks, dinner, dancing that session because it often determines and barhopping afterward. Anna’s first

April 2013 | Counseling Today | 59 Types of safety

Safety is more than physical, and it remains an issue situation, recognize what your intuition tells you and act on for anyone who is experiencing a trauma reaction. The these feelings appropriately. following kinds of safety must be re-established for a person n Mental: You are able to access belief systems and to heal after an assault. patterns of thinking and awareness to accomplish what you n Physical: Your body is not in danger. If a threat want or need on a consistent basis. presents itself, you are appropriately reactive to any warning n Spiritual: You can identify and trust in your beliefs signals to ensure that your body is protected. You either about a higher power and your connection to the universe, remove yourself from the situation or defend yourself (flight and you can use those beliefs to lead you to healthy or fight). decisions. n Emotional: You can identify your feelings in a — Margaret Edwards & Charlotte Chapman

indication that she might be in trouble n Relax your body posture, and breathe of how trauma affects the brain, Waking was Chris’ insistence on pushing more to help the client breathe. the Tiger: Healing Trauma: The Innate drinks on her. The second occurred when n Listen, and ask as few questions as Capacity to Transform Overwhelming Chris took her home after the function possible, making them as open-ended as Experiences. and followed her in, even after she said possible. no. Chris repeatedly suggested they have n Affirm the client’s desire to be in Don’t: sex and ignored Anna’s response. control of her reaction, her right to make n Call the incident rape or assault Since the date function, Anna says, a choice about how she responds or unless the client does. Do not otherwise she has been unable to sleep without reports, and her desire to be autonomous. label her experience because she may be the lights on, and she can’t remember This is especially important if she is experiencing ambivalence about what to what she just read, no matter how many unused to asking for help. call it herself. If you label, she may feel times she reads it. She says she is afraid n Use the client’s language as closely as you are judging or pushing her too fast. this will wreck her semester and end up possible, especially in terms of how she n Refer to the perpetrator in language costing her admission to medical school. refers to the incident (even if she refers to stronger than the client uses, especially Anna also says she is terrified she will run it as “bad sex” and you think it was rape). if the perpetrator is someone she knows. into Chris; she finds herself looking out n Summarize frequently. If you do use stronger language, the n for him constantly. She is afraid people Ask about safety issues (see sidebar client may feel an impulse to defend the above for more details). will take sides against her or judge her if perpetrator. n If the client needs help managing she reports the incident. Anna says she n Be overly expressive in terms of her anxiety as she is telling the story, ask blames herself because she was unable to sympathy. Many clients need to see for permission to teach her to ground stop Chris and because she was drinking whether it is safe to tell you their story. If herself through a breath or by focusing on before the incident happened. your reaction to what they are saying is a physical sensation (such as two fingers Listening to Anna’s story as a counselor, stronger than their reaction, clients can touching). it would be easy to fall into the trap become flooded or feel a need to hold of asking her too many questions, n If the client asks about why she is having certain symptoms or expresses back in order not to upset you. labeling what happened, jumping to a n Ask for more details than the client diagnosis or even reflecting back in such a concern that she is “feeling crazy,” ask for permission to explain the wants to provide (including how much a way that causes Anna to feel judged. she had to drink, what she was wearing or Understandably, it can feel especially physiological and psychological responses to trauma. Avoid jargon. For example, whether she kept any evidence). Beyond urgent as a counselor to give the client what is necessary to assess for the client’s advice about reporting this kind of the counselor can explain that many people have reactions to a loss of physical current physical safety (such as whether incident or seeking immediate medical the perpetrator lives nearby or has access help. Doing so, however, increases the or psychological safety that last for a to the client’s contact information), you risk of making the client feel judged, while beyond the incident. Symptoms do not need the full story to start the unheard and more anxious, which can that some people experience include counseling work. result in the client refusing to continue jumpiness, difficulty sleeping (or sleeping too much), changes in appetite, difficulty n Insist that the client report the with counseling. focusing or paying attention in class, incident right away. If there is a reporting First-session do’s and don’ts a feeling of numbness or, alternatively, procedure at your school or an advocate Do: feeling tearful. If the client wants to who helps students through the reporting n Build rapport through eye contact know more, she might find it helpful to process, you can ask if the client would that meets the client’s, mirroring her own. read Peter Levine’s excellent explanation like information about those resources.

60 | ct.counseling.org | April 2013 Focus on safety There are three key areas of safety ways to cope with their responses As experts such as Judith Herman questions to ask a client: n Offer practical help, as they ask for and Lisa M. Najavits have observed, n What makes you feel physically it, so they can re-establish their ability to unwanted sexual contact of any kind safe when you are alone? What are some sense and respond effectively to danger, results in loss of one’s core sense of things you can do to feel physically safe in manage their emotions and regain their safety. Many authors, including Babette your room? feeling of control over their lives Rothschild and Peter Levine, have n Who helps you feel safe? Why do The first and most important step, described how reactions to this loss they feel safe? What do they need to however, is to help clients establish vary depending on a person’s prior know about you and about what has a feeling of safety in the counseling u experiences, sense of autonomy, culture happened to help you feel safe? relationship. and neurobiological factors. Even very n How can you establish some decisive, assertive people can freeze and/ boundaries so that [the perpetrator’s Margaret Edwards, a licensed or be unable to defend themselves when name] cannot make contact with you professional counselor, is a trauma faced with an unexpected sexual assault, without your permission? counselor at the University of regardless of whether they know the Conclusion Virginia Women’s Center. Contact perpetrator. As a result, many blame As counselors, we sometimes struggle her at [email protected]. themselves, numb themselves to avoid with the reality that we cannot change Charlotte Chapman, an LPC and feelings and, thus, lose some of their what has happened to our clients. national certified counselor, is ability to sense danger. Similarly, we cannot protect them from director of counseling services at One of the core purposes of counseling the unfolding series of reactions that are the University of Virginia Women’s a college student who has been raped common to people who have experienced Center. She is also a member of is to re-establish that student’s sense of trauma. They do the work, not us. the Motivational Interviewing safety and control. Even in the initial As our clients make their way through Network of Trainers. Contact her at session, it can be helpful to ask the a cycle of reactions — among them anger, [email protected]. student to identify elements of a safety guilt, shame and grief — we can: plan that includes practical physical and n Listen as they make sense of their Letters to the editor: psychological elements as a first step story [email protected] toward this treatment goal. n Reflect compassionately as they learn

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April 2013 | Counseling Today | 61 McDonald, Nodar earn recognition in ACA Foundation essay contest focused on the future of the profession

hristen Peeper McDonald figured out” and that it is time to move identifies. The research on racial identity and Martha Nodar, graduate on to other issues of diversity. However, and perceptions appears to assume that Cstudents in counselor education, it is this student’s opinion that diversity one’s outward appearances match social were recognized as winners of the fall 2012 is not a linear concept or set of concepts constructions of race. This constitutes a essay contest sponsored by the American that we move through, climbing the major gap in the literature and in the way Counseling Association Foundation. ladder of competence as we master race/ we conceptualize race and ethnicity as The ACA Foundation continues to ethnicity, classism, LGTBQ issues and professional counselors. support and celebrate all counseling so forth. Rather, I believe that diversity, As counselors working from the Wellness graduate students and new professionals. especially in the wake of an increasingly perspective, what do we think happens As part of this celebration, the ACA diverse America, is a concept that should to people that we mislabel? I can say Foundation encouraged all counseling be revisited time and time again, a concept from my own experience that I have truly graduate students and new professionals that we are never able to master, but one had to fight not to let go of my identity to write a brief essay concerning their in which we continually increase our as Biracial, even though many parts of thoughts on what the future of the knowledge and empathy toward each client that identity are readily available — for profession will encompass. we encounter. In this way, the examination example, my multiple names. I have an For submitting the top-rated essays, of the conceptualization of race, identity, English name and a traditional Cherokee McDonald, a doctoral student at Georgia and labeling are especially salient issues in name. When people categorize me as State University, and Nodar, who is reference to Biracial/Multiracial individuals White, I make a very conscious decision to pursuing a master’s degree at Mercer within the counseling profession. politely correct them, though this option University, Atlanta Campus, were awarded On a societal level, I wonder where the is not as easy as just letting them label me one-year ACA memberships. need to label, categorize, and box human as White. What harm could it do? By not Note: The following essays were edited beings based on appearance comes from. advocating for myself and showing that only for spelling and minor style issues. As professional counselors, I would argue “Biracial” doesn’t look one way, I hold onto The views expressed are those of the essay that we should resist societal norms in my identity and my belongingness to both authors. this way, and in the name of Wellness, the White and Native American parts of w empowerment, and good old-fashioned me. It is inevitable that our population Christen Peeper McDonald earned rapport building, allow our clients to label will continue to grow more and more recognition for her essay on how and identify themselves. When we put it diverse, but if professional counselors fail professional counseling will be affected in terms of Biracial and Multiracial, how to revisit our current assumptions about by an increasingly diverse population. could one even begin to describe what a race, we will not be able to competently It is no small fact that America continues Biracial or Multiracial person looks like? and empathically serve this increasingly to grow more diverse every day (Shih By definition, there are an endless number diverse population. Though more research & Sanchez, 2009). One need only look of racial combinations that could make up is needed in the area of racial mislabeling, around to find that the racial backdrop of a Biracial/Multiracial person. Yet, even my one suggestion I have for professional America is a colorful mix of people who fellow counseling students and professors counselors is to forgo all assumptions no longer fit into tidy racial categories. have been surprised and sometimes related to clients and allow them to use With this growing population of Biracial/ resistant to me self-identifying as Biracial labels as they see fit. Some clients, like Multiracial individuals comes an increased because I don’t fit into their Biracial myself, find empowerment in being given need for understanding the unique schema. This idea of a Biracial/Multiracial the opportunity to self-label, but other experiences of these individuals. As a person looking a certain way is also clients may find labels too restrictive. Biracial person who often gets mislabeled reflected in the existing literature. Though Labels have the power to help or hurt, and as monoracial, specifically White, I can’t a Biracial Identity Development Model has when we take our own assumptions out of help thinking that though race has had been created by Poston (1990) to account the equation and encourage our clients to a major impact on our country, I get the for the unique issues Biracial individuals use labeling as they see fit, this is a step in distinct impression from some of my face, the model fails to take into account the direction of Wellness that will allow us own counseling colleagues that we as a the effects of being classified as a race by to celebrate the growing diverse population profession have the concept of race “all Others that is different than how one self- rather than box it in.

62 | ct.counseling.org | April 2013 w which is deeper than self-awareness Martha Nodar received honors for her because it not only calls for being aware essay identifying an issue she believes of our history, but also an awareness The WHO will have the greatest impact on of our self-deceptions. Echoing Jung, tomorrow’s professional counselor. Gaylin (2001) argues that “it is essential wants you A commitment to genuine self- to know oneself” (p. 303). When we are awareness will be the issue that will driven mostly by our subjectivity, we are he World Health have the greatest impact on tomorrow’s “reacting with sympathy” to our clients’ Organization (WHO) professional counselor because self- distress by identifying with the issues TDepartment of Mental awareness is a challenging and rare they are bringing to the counseling room. Health and Substance Abuse dynamic for both clients and counselors. Under the realm of subjectivity, we have a invites members of the American True self-awareness is not common despite tendency to rescue the clients from their Counseling Association to register the many “talks” we have on the subject. feelings because they may be triggering our for the new Global Clinical Practice Gaylin (2001) argues that “what passes sore spots. Our sore spots may be holding Network. The goal of the network for self-awareness is often mere fantasy similar feelings as our clients. When we is to help inform the development and delusions” (p. 292). As a graduate are driven mostly by objectivity, we are of the classification of Mental student, I frequently witness a tendency “responding in empathy” to our clients’ and Behavioral Disorders for the around me to highlight “the positive” and distress. Thus, we encourage our clients next version of the International a resistance toward including other layers to stay with the feeling. We are able to Classification of Diseases (ICD-11). Participants may be asked to of the self, such as our common human go deeper when our sore spots are not provide information and feedback, imperfections. Gaylin (2001) suggests activated by our clients’ distress. We cannot review materials or participate in the tendency toward “self-deception is take our clients where we have never been. field studies as the WHO develops universal … and its power should never be I would argue that meeting the clients the new classification system for the underestimated” (p. 292). Self-awareness where they are takes nothing less than our ICD-11, set for publication in 2015. is not a destination, but rather a genuine full awareness about our own issues. According to the WHO, “The commitment to an ongoing process that Bowen suggests we need to become information you provide will exists on a continuum and depends on aware of how our body may react to inform our decisions about the whether we lean toward objectivity or our clients’ narratives when we are in content and structure of the new subjectivity. the counseling room. How do we feel classification system, as well as how Subjectivity falls under the umbrella of when we listen to our clients’ issues and that information will be presented self-serving biases and affects our cognitive concerns? Are we empathically listening to different users. The surveys that ability to accurately process information to discern meaning, or are we distracted we send to you will be based on your about ourselves and others (Myers, 2000). by how our internal dialogue may have own professional interests and areas Objectivity is an attempt to observe been triggered by our own sore spots? of expertise. Once registered … you things as they are, not as we want them Are we automatically reacting, or are will receive survey requests no more to be. Both subjectivity and objectivity we consciously responding? While the than once a month, and each survey are at opposite ends of the spectrum. counselor’s self-awareness is the road map will take approximately 20 minutes Bowen emphasizes: “Observe yourself; to identifying, assessing, and responding to complete.” examine yourself” (Kerr & Bowen, 1988, to the client’s meaning, objectivity is the “This is very important work that p. 131). Bowen proposes that objectivity compass. Together, self-awareness and will ensure any new classification is required for counselors to identify the objectivity encompass the most important is clinically useful,” says Rebecca real issues that may prompt clients to seek gear impacting how a counselor navigates Daniel-Burke, the director of counseling, which may be hidden from the through the counseling session today and professional projects and career clients’ awareness (Kerr & Bowen, 1988). tomorrow. services at ACA. “A very small When counseling under the umbrella of group of ‘licensed counselors’ — their words — were involved in subjectivity for the most part, counselors References: the ICD-10 revision process. Now may help clients with their presenting Gaylin, W. (2001). How psychotherapy that they want 2,500 [mental symptoms, while the real distress that really works. New York, NY: Contemporary health professionals to participate], brought them to counseling may remain Books. hopefully we will have more under the surface. I submit that the extent Jung, C. (1957). Memories, dreams, ‘licensed counselors’ representing to which we may engage in subjectivity reflections. Winston, R. (trans.) (1961). our profession.” in the therapeutic session, the more likely New York, NY: Vintage Books. The first studies are expected we will divert from beneficence because Kerr, M., & Bowen, J. (1988). Family to begin within the next few subjectivity may fog our perceptive ability evaluation. New York, NY: W.W. Norton months. To register, visit http:// to prevent harm. This is the reason I argue & Co. kuclas.qualtrics.com/SE/?SID=SV_ that engaging in genuine self-awareness is Myers, D. (2000). Exploring social exm6vdPhl8S3hUF. pivotal for the counselor of tomorrow. psychology (2nd ed.). Boston, MA: McGraw Jung (1957) champions self-knowledge, Hill. u

April 2013 | Counseling Today | 63 FY 2013 Election Results

American Counseling Association for Association for Counselor Association Creativity in Counseling Education and Supervision

President-elect President-elect President-elect Robert L. Smith Thelma Duffey Marty Jencius

Governing Council Governing Council Governing Council Student Representative Representative Representative Anna Flores Locke Shane Haberstroh Gerard Lawson

Trustee Position 1 Secretary Association for Assessment Ioana Boie Jennifer Jordan and Research in Counseling Trustee Position 2 President-elect Jason H. Rydzewski Association for Shawn L. Spurgeon Humanistic Counseling

Treasurer American College President-elect Jacqueline Swank Counseling Association Brandé Flamez Member-at-Large for Membership President-elect Elizabeth A. Prosek Tamara Knapp-Grosz Association for Lesbian, Gay, Bisexual and Transgender Governing Council Issues in Counseling Association for Adult Representative Perry C. Francis Development and Aging President-elect Jane E. Rheineck Treasurer President-elect Sylvia E. Shortt Robert A. Dobmeier Secretary Jeffrey D. Gowing Member-at-Large Governing Council Joseph E. Bednorz Representative Board Trustee 1 Catherine B. Roland Joel Marc Filmore

Treasurer Association for Counselors Graduate Student Trustee Meghan R. Lehembre and Educators in Government Sarah Meng

President-elect Association for Child Lynna Meadows Morton Association for Multicultural and Adolescent Counseling Counseling and Development Governing Council President-elect Representative President-elect Gail K. Roaten Sharon Guild Seesholtz Carlos P. Hipolito-Delgado

Secretary Director North Atlantic Evette Horton Judith Mathewson Regional Representative Trustee Position 1 Miles T. Sakaguchi Tiphanie Gonzalez Phyllis Post Angie Waliski Southern Regional Trustee Position 2 Treasurer Representative Yumiko Ogawa Linda Parker Krystle Dorsey

64 | ct.counseling.org | April 2013 Student Representative Association for Specialists International Association Anna Flores Locke in Group Work of Addictions and Offender Counselors Vice President-Asian American President-elect Concerns President-elect Mei Tang Jonathan J. Orr Larry Ashley

American Rehabilitation Secretary Secretary Counseling Association Chinwé Uwah Williams Jane Warren

President-elect Counselors for Social Justice National Employment David Staten Counseling Association President-elect Secretary President-elect Quiteya D. Walker Fred Bemak Seneka Rachel Arrington Treasurer Council on Development Trustee and Collaboration Jane Goodman Carolyn Greer Henry McCarthy Linda Jameison Counselor Representative Association for Spiritual, Mary Whitfield-Williams Midwest Region Ethical and Religious Values in Counseling Community Representative Governing Council Representative Eric L. Rhodes President-elect Christopher P. Roseman W. Bryce Hagedorn Student Representative North Atlantic Region Board of Directors Angelica Tello Christopher Christmas Governing Council Ryan D. Foster Representative Elizabeth O’Brien Terry Thurston Mitchell

Share Your Knowledge. Strengthen Your Profession. CALL FOR PRESENTATION PROPOSALS ACA 2014 Conference & Expo • March 27–30, 2014 Pre-conference Learning Institutes • March 26–27

ACA is seeking proposals for: Pre-Conference Learning Institutes: March 26–27, 2014 Education Sessions: March 28–30, 2014

April 1, 2013: Online proposal site opens June 5, 2013: Proposal Submission Deadline (5:00 p.m. ET) August 7, 2013: Acceptance/rejection notices emailed October 30, 2013: Scheduling notices emailed December 15, 2013: Education Session Presenters Registration Deadline

Please visit counseling.org/conference for additional information. Note: The primary presenter must be an ACA member.

April 2013 | Counseling Today | 65 Division, Region & Branch News

NCDA celebrates 100th anniversary under “About NCDA,” a few paragraphs Association for Humanistic Counseling Submitted by Deneen Pennington give a brief overview of the history of our and the counseling profession, for his [email protected] organization. A list of NVGA/NCDA open, warm and caring way, and for This year marks the 100th anniversary past presidents is included — see how leadership through his examples of of the National Career Development many names you recognize! volunteerism, service and career. Association. Originally named the Watch for more ways to acknowledge n Past President’s Award: Michelle National Vocational Guidance Association our centennial. Perepiczka for her energy, hard work and (NVGA), the first president was Frank organizational skills. She has welcomed Leavitt. “It was through humble ACCA announces research many into the AHC fold and leadership. beginnings where career development was grant opportunities n Past Editor’s Award: Colette born and began to thrive,” says NCDA Submitted by Taffey Cunnien Dollarhide for maintaining and President Rich Feller. [email protected] increasing high standards of humanistic Here is a start regarding how we can all The American College Counseling scholarship, while treating each author- celebrate together: Association announces two research submitter with the utmost respect and n The annual Global Career award opportunities for 2013. Grants are support. Development Conference, to be held awarded to research in the field of college n Humanistic Clinician Award: Brandé July 8-10 in Boston: The conference mental health at both the graduate and Flamez for promoting social change in will highlight a series of memorable doctoral levels of study. supporting schools, orphanages and other anniversary events in addition to the n $5,000: This funded research support systems in Tanzania. comprehensive professional development is designed to recognize and honor n Distinguished Journal Reviewer: institutes, special tours, keynote and individuals who are seeking to complete a Gloria Aquino Sosa for thought- featured speakers, and rich learning comprehensive research study, providing experiences. provoking reviews, proving that one can a cash award of up to $5,000. The be friendly, professional — humanistic, n The Career Development Quarterly purpose of this financial support is to even — in manuscript reviews. (CDQ) 2013 special series: The journal fund research efforts supporting research n Humanistic Educator/Supervisor is publishing a special series of articles in related to college counseling practices. Award: We honor two educator/ the next four issues highlighting historical n $1,000: This funded research supervisors. Sue Bratton was nominated developments connected to career is designed to recognize and honor counseling and NCDA. Members access individuals who are seeking to complete a by former and current students for the CDQ online, under MyNCDA on comprehensive research study, providing always making time for students, her the website. a cash award of up to $1,000. These tenacious belief in their capacity and n Historical articles published in investigations include counseling at that of all persons, and her personal Career Convergence: Beginning with the community, vocational and technical connection and commitment to students. Feb. 1 issue, the NCDA web magazine institutions, as well as colleges and Christopher Schmidt was nominated by will include documents from the years universities. The purpose of this grant peers and his chair, on behalf of student surrounding the 1913 debut of NVGA. is to support research that increases accolades, as a counselor educator who Articles covering current trends will understanding of professional counseling consistently demonstrates a humanistic also include a reference to the historical as it relates to college student populations philosophy and a model of what service perspective of the topic. and the professionals who serve those should look like. n Career Developments Magazine populations. n Humanistic Impact Award: Tricia looks to the future: “Celebrating Career Applications can be found on the McClam for her long and going-strong Development in the Next 100 Years” is ACCA website at collegecounseling.org. career in human services and counseling, the theme of the first issue of volume 29. Deadline for applications is June 3. and whose scholarship and service is Many advances will be made to our field Contact MJ Raleigh with any questions positively changing the lives of children, in the future, and NCDA members can at [email protected]. rely on the magazine to aid in the process youth, families and students. of honoring and valuing the work we do. n Humanistic Advocacy and Social Also, each issue in 2013 will include a list AHC honors award winners Justice: Bob Kronick for bringing wide- of significant dates in the history of career Submitted by Jeff L. Cochran ranging supportive services into full- development. [email protected] service community schools for some of n NCDA website (ncda.org) includes n Humanistic Leadership Award: our most troubled children and inspiring the NCDA mission and history: Listed John Parkman for dedication to the students to service and advocacy.

66 | ct.counseling.org | April 2013 n Humanistic Dissertation Award: Janee’ Avent, University of North Carolina-Greensboro, for her outstanding From the President dissertation with significant humanistic continued from page 5 content: “What Then Shall We Say to These Things? An Investigation of I know about mentoring by observing great mentors in action — and there are African American Pastors’ Response hundreds of exceptional mentors in ACA. to Mental Health Needs in the Black And that leads me to the real reason for this month’s column. What mark will Church and Their Influence on African you leave on the next generation of professional counselors? How will you help American Help-Seeking Behaviors and to grow and nurture the future of our profession? Answer: Become a mentor and Coping Strategies.” make a true and lasting difference, one mentee at a time. Mentoring students and n The Joe and Lucille Hollis new professionals takes little time and almost always is as rewarding for the mentor Publications Award: Nancy Cochran, as it is for the mentee. But how, you ask, do you go about finding a mentee? This is William Nordling and Jeff Cochran your lucky day — and an even luckier day for your future mentees! for Child Centered Play Therapy: A To directly address the mentoring needs of ACA’s student and new professional Practical Guide to Developing Therapeutic members, the ACA Graduate Student Committee has updated, redesigned Relationships with Children (2010, and expanded the previous year’s pilot mentoring program, and applications Wiley). are currently being accepted, both for mentors and mentees. In fact, the ACA mentoring program has already made more than 40 matches. The program is designed to provide an opportunity for counseling graduate TCCA and TCA join forces for students, or newer counseling professionals who have graduated within the past conference on college counseling year or so, to pair with more-seasoned professional colleagues who share similar Submitted by Robin Rumancik interests, experiences and goals. Participation in the program can involve as [email protected] much (or as little) time as both parties are interested in committing. Please email The Texas College Counseling [email protected] to receive an electronic link to the online application Association is pleased to announce form. It only takes a few minutes to complete the application, but please have your the fourth annual College Counseling ACA member number handy because you will need to enter this information. Conference in Austin, Texas, to be To help with the mentoring process, Graduate Student Committee members also held May 19-20 at the Austin Marriott have compiled useful resources, which are posted to the COUNSGRADS Listserv South. This year’s theme is “Challenges on a monthly basis. The committee co-chairs, Victoria Kress and Nicole Adamson of College Counseling.” Attendees will (the first graduate student in history to chair an ACA committee), have worked have the opportunity to earn at least tirelessly to get this program up and running and to follow up with the mentoring nine CEUs. All programs are specifically pairs, offering resources and questions for potential discussion. The mentoring designed to address the unique interests commitment officially runs for one year, from the beginning of July to the end of and continuing education needs of the following June, but the relationship can continue indefinitely if both parties so professional college counselors, student choose. Current mentoring pairs are reporting numerous personal and professional rewards from their participation in the program. service personnel and those working in So make a difference in the professional development of a student or new college counseling settings. professional colleague. Volunteer today to be a mentor through the ACA If you find yourself concerned mentoring program. You will become an inspiration and help make all the about the rising number of campus difference in the lives of the next generation of professional counselors. Type in crises, diminished budgets, suicidal [email protected] and hit “Send.” It will change your life. It will change the students, doing more with less and counseling profession. u threat assessments, then this conference is a perfect fit for you. Programs will also address higher education changes, Submit your news and upcoming events counselor self-care and case management, among other topics. The 2013 College All divisions, regions and branches of the American Counseling Association Counseling Conference opens on May 19 may submit monthly news articles of 350 words or less to “Division, Region at 2:30 p.m. and closes May 20 at 3:30 & Branch News.” In addition, divisions, regions and branches are invited to p.m. Preregister for just $100 by May 6. list their upcoming events in “Bulletin Board.” For submission guidelines, contact Heather Rudow at [email protected]. Be advised of the following Onsite registration is available for $130. upcoming deadlines for submitting items to either section. The conference is co-hosted by TCCA and the Texas Counseling Association. May issue: April 1 at 5 p.m. ET July issue: May 30 at 5 p.m. ET For complete conference details, visit June issue: April 25 at 5 p.m. ET August issue: June 27 at 5 p.m. ET txca.org/CCC. u

April 2013 | Counseling Today | 67 Bulletin Board

Coming events Young Child Expo & Conference Attendees can earn at least nine CEUs. If April 17-19 you are concerned about the rising number CCA Annual Conference New York City of campus crises, diminished budgets, April 5 The 10th annual Young Child Expo suicidal students, doing more with less and Mystic, Conn. & Conference will be held at New York’s threat assessments, then this conference Join the Connecticut Counseling Hotel Pennsylvania. The conference will is a perfect fit for you. Programs will Association at its annual conference, bring together attendees across various also address higher education changes, “Counseling Connections 2013: Changing disciplines to integrate learning about counselor self-care and case management, Tides — Fostering Resiliency and Finding typically developing children and those among other subjects. Preregister by Inspiration.” We are excited to be visiting with special needs. For more information May 6 for $100. Onsite registration is Mystic this year and hope that your or to register, visit youngchildexpo.com or $130. The conference is co-hosted by visit will not only include networking call 212.787.9700 ext. 333. the Texas College Counseling Association and educational workshops but also and the Texas Counseling Association. For opportunities to have fun with your NJCA Annual Conference colleagues in the evening hours. This April 19-21 complete conference details, including New England town is family friendly, so Lincroft, N.J. hotel information and to register, visit book a room at the Mystic Hilton at the The 2013 New Jersey Counseling txca.org/CCC. special conference rate and bring your Association Annual Conference will take IAMFC Northampton Institute family along to spend time at the Mystic place at the Donald D. Warner Student Life May 29-June 3 Aquarium and Olde Mystic Village. Center at Brookdale Community College. Northampton, England Registration is priced low, and CEUs are The conference brings together students The International Association of available. Student scholarships are available and professionals in counseling-related Marriage and Family Counselors is pleased to CCA members. Email ccaconference@ programs and careers for thought-provoking to announce its 10th annual Northampton hotmail.com or visit ccamain.org for more seminars, workshops and relationship Institute, to be held at Park Campus, information. development. The conference will continue University of Northampton. The theme the tradition of providing attendees with MeCA Annual Conference will be “Families and Diversity.” This event interesting and diverse speakers and experts April 8-9 will bring together an international group in a variety of specialties within mental Rockport, Maine of counseling professionals, students and health and related fields. The National Join us in beautiful Rockport for the educators who share a common interest Board for Certified Counselors will approve Maine Counseling Association Annual in family counseling research, education programs for continuing education credits. Conference. Our keynote speaker, Mark and practice. In addition to presentations Visit njcounseling.org for more information. Tappan, a Colby College professor on family counseling-related topics, and author, will discuss a key topic: International Counseling the institute will provide an immersion “Engaging Boys: Resistance, Relationships and Education Conference experience into English culture, including and Getting Real.” In addition to May 2-4 escorted day trips to sights in central this wonderful keynote, we will have Istanbul, Turkey London and rural Northamptonshire. a multitude of session offerings that The American Counseling Association The $795 fee includes five nights at the will serve as professional development is co-sponsoring the second International Sunley Centre, a modern, on-campus opportunities for mental health counselors, Counseling and Education Conference, to hotel facility. IAMFC invites proposal K-12 school counselors and admissions be held at Istanbul Commerce University. submissions from educators, clinicians and counselors. For more information, visit ACA President Bradley T. Erford will others. For more information, visit nsi. maineca.org. present a workshop on the “35 Techniques vpweb.com or email [email protected]. Every Counselor Should Know.” For more ACAM Annual Conference AHC Summer Conference information, email icecconference@gmail. April 11-13 June 7-8 com or visit ice-c.net. Jefferson City, Mo. New York City ACA of Missouri’s Annual Conference TCCA and TCA College The Association for Humanistic and the Missouri Career Development Counseling Conference Counseling’s 2013 Summer Conference Association Exposition Day will be held at May 19-20 will be held at the New York Institute of the Capital Plaza Hotel. John Krumboltz Austin, Texas Technology. The theme is “Humanism in and Howard Rosenthal will present as The fourth annual College Counseling the Counseling Profession.” Presentation keynote speakers. For more information or Conference will be held May 19-20 at topics related to counselor wellness, to register, visit counselingmissouri.org. the Marriott South in Austin, Texas. graduate counseling students, career

68 | ct.counseling.org | April 2013 counseling, school counseling, clinical FYI Call for submissions mental health, and counselor education The Association for Lesbian, Gay, Call for editorial board members and supervision will be offered. For Bisexual and Transgender Issues in The Journal of Counseling & more information, contact Michele Counseling invites submissions for the Development (JCD) is seeking applications Perepiczka at [email protected] or visit Journal of LGBT Issues in Counseling. The for positions on its editorial board. Board humanisticcounselor.com. intent of this journal is to publish articles member appointments begin July 1 and both relevant to working with sexual International Career Conference extend for a three-year term, including minorities and of interest to counselors, June 20-22 review responsibilities during the summer. counselor educators and other counseling- Padova, Italy Reviewers must hold membership in the related professionals working across diverse The American Counseling Association American Counseling Association and is partnering with the Laboratory of have experience publishing in counseling- fields. Topic areas include new research, Research and Intervention in Vocational related journals. Preferred qualifications new or innovative practice, and theoretical Guidance (La.R.I.O.S.) and organizations include experience with quantitative, or conceptual pieces, including literature from around the world for the qualitative, mixed-methods or single-case reviews that reflect new ideas or new international conference “Life Designing research designs, and/or expertise in the ways of integrating previously held ideas. and Career Counseling: Building counseling field with respect to theory and The journal is distributed quarterly. For Hope and Resilience.” Themes include practice. Because the journal utilizes an detailed submission guidelines, contact hope and optimism in times of crisis, electronic review process (Scholar One), Ned Farley at [email protected] or visit positive psychology in career counseling, applicants must have email capabilities tandfonline.com/action/authorSubmission?jo career counseling and life designing for and access to the Internet. Please email urnalCode=wlco20&page=instructions. unemployed and underemployed workers, a letter of application specifying areas of and much more. For more information, expertise and qualifications, including Bulletin Board visit larios.psy.unipd.it. ACA membership number, commitment submission guidelines NASAP Conference to board service and a current curriculum Email [email protected] for June 20-23 vita, to ShinHwa Lee, editorial assistant for submission guidelines. See page 67 for San Diego JCD, at [email protected]. upcoming submission deadlines. u The 2013 North American Society for

Adlerian Psychology Conference will be held at the Town and Country Resort. The theme will be “Encouraging Each Other, Healing Our World.” Both Alfred Adler and Rudolf Dreikurs emphasized the importance of encouragement for healthy human growth and development. For more information, visit alfredadler.org/ conference-2013 or email [email protected]. STUDY GUIDE AADA Summer Conference for the NCE & CPCE July 18-19 and New York City The Association for Adult Development and Aging’s 2013 Summer Conference GUÍA DE ESTUDIO will be held at the Roosevelt Hotel in PARA Manhattan. The theme is “Adult Identity Evolution: Diversity Within Personal NCE y CPCE and Professional Transitions.” On July Dr. Andrew Helwig’s very popular Study Guide for the NCE and CPCE 18, there will be two preconference (2011, 6th ed.) is also available in Spanish. This book has all eight CACREP workshops, one addressing supervision content areas as well as information about the NCE and CPCE. Included and the other focusing on professional are exam-taking tips, study strategies, 2 practice exams and the ACA Code ethics. Presentations addressing a wide of Ethics. This user-friendly Study Guide has 400 pages (430 Spanish). variety of counseling issues related to PDF FORMAT FOR DOWNLOAD TO YOUR COMPUTER adults across the life span will be presented July 19. For more information, contact NOW AVAILABLE Catherine Roland (rolandc@mail. For more information or to purchase the Spanish or English editions of the Study Guide ($79.95) or Workshop DVDs, visit: www.counselor-exam- montclair.edu) or Suzanne Degges-White prep.com. E-mail Dr. Helwig at: [email protected]. ([email protected]), or visit aadaweb.org.

April 2013 | Counseling Today | 69 Letters continued from page 9 issue of abortion discussed instead of normalizing these feelings of grief is Letters policy swept under the rug, I would be hesitant essential. to endorse a technique of counseling that Regardless of whether we are pro- Counseling Today welcomes letters is not empirically supported at this time life or pro-choice — and whether we from ACA members; submissions from by the research literature. are acting in a professional or personal nonmembers will be published only on capacity — we need to be honest and let rare occasions. Only one letter per person Lauren women know that having an abortion is per topic in each 365-day period will be Conroe, Texas not without its potential consequences. printed. Letters will be published as space The more information a woman has, permits and are subject to editing for both I was both pleased and interested to the more confident she may be in her length and clarity. Please limit letters to 400 read the article on abortion aftercare in the decision — and the more likely she will words or less. Submissions can be sent via 21st century. I believe it is a topic that has be to seek help in her healing. email or regular mail and must include the been swept under the rug for too long. individual’s full name, mailing address or I agree with most of what Ms. Johnson Amanda, LPC email address and telephone number. wrote. Women need to be accepted Ann Arbor, Mich. ACA has the sole right to determine if and treated with respect and without Defining Adler and a letter will be accepted for publication. judgment. However, the blame and shame Freud’s relationship Counseling Today will not publish any letter Johnson spoke of that keeps women from I would like to correct a statement that contains unprofessional, defamatory, addressing their grief in counseling comes made in the December 2012 “Through incendiary, libelous or illegal statements or not only from pro-life messages but also a Glass Darkly” column in which Alfred content deemed as intended to offend a pro-choice messages. If you are unaware Adler is described as a “famous student” person or group of people based on their of the pressure and judgment from both of Freud’s (“The continuing evolution of race, gender, age, ethnicity, religion, sexual sides, you may lack the ability to truly ‘great’ counseling”). This is a most often orientation, gender identity, disability, connect with your client. noted mistake about Adler, who was not language, ideology, social class, occupation, The author did a good job describing a student of Freud’s. Adler made this very appearance, mental capacity or any other the message from the pro-life side of the clear in his writings. In fact, Adler was distinction that might be considered by some as a liability. ACA will not print letters debate but ignored messages from the known to carry the invitation note from that include advertising or represent a copy pro-choice side, which says that abortion Freud in his shirt pocket for many years of a letter to a third party. The editor of is in itself the solution to a woman’s that identified the relationship as collegial, Counseling Today will have responsibility for problems and therefore brings healing. I not pedagogical. determining if any factors are present that Any accurate discussion of the evolution believe a strong message is sent that if a warrant not publishing a letter. of counseling would be expected to pres- woman is in control of her body and her Email your letters to [email protected] ent this detail correctly. decision, she should be happy. Grief is or write to Counseling Today, Letters to the never brought up, and a woman may feel G. Thomas Vaughn, LPC/S, NCC, ACS, Editor, 5999 Stevenson Ave., Alexandria, guilty or weak for having these feelings. CEAP VA 22304. I believe that in helping a client to heal, [email protected] u

Advertiser Index ACA Conference...... 51 Understanding People in Context: HPSO Insurance...... c2 Call for Proposals...... 65 The Ecological Perspective in International Institute of Souldrama.53 DSM-5 Webinar...... 57 Counseling...... 32 Mental Health Academy...... 19 ACA Publications Advertisers Mississippi College...... 21 Association for Advanced Training Counselor and the Law: A guide to Somatic Experiencing Trauma Legal and Ethical Practice...... 28 in the Behavioral Sciences...... c4 Counseling and Psychotherapy: California Southern University...... 33 Institute...... 61 Theories and Interventions...... 38 California University of Pennsylvania.23 Tame Your Practice...... 11 Family Violence: Explanations and The Chicago School...... 43 Therapysites.com...... c3 Evidence-Based Clinical Practice... 25 Exam Prep Study Guide by Thriveworks...... 27 Hot Off the Press from ACA...... 6 Andrew Helwig, Ph.D...... 69 University of Phoenix...... 15 Developing & Managing Your Excelsior College...... 45 School Guidance & Counseling Grief, Inc...... 61 Walden University...... 35 Program, 5e...... 14 Grief Recovery Institute...... 47 Walsh & Dasenbrook Consulting.... 13

70 | ct.counseling.org | April 2013

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THEORIES OF PSYCHOTHERAPY The Association for Advanced Training in the Behavioral Sciences

Unit of Focus/ View of Theories/Lead Main Idea Therapist’s Process of Interventions Stages of Length of Key Terms Maladaptive Goals Figures (Primary Concepts) Role Change/Insight Treatment Treatment Behavior

Extended Extends family systems beyond Current and extended family Differentiation of self and fusion, emotional triangle, De-triangulated Insight gained through Behavioral disorders are Beginning: Evaluation, trans-generational Reduce the level nuclear family – multigenerational. therapy. nuclear family emotional system, emotional cutoff, sibling coaching. Supervisor. rationale/cognitive the result of a multi- exploration, identification of individualized of anxiety and Family Systems: position, family projection process, multigenerational processes leading to generational transmission member. alleviate symptoms. Long/short term. transmission process, genogram, family ego mass, society differentiation and process in which Early/Middle: Teach differentiation, Self-differentiation • Murray Bowen emotional process. understanding of family progressively lower individuation. genogram, therapy triangle, within the context of of origin. levels of differentiation relationship experiments, coaching and “I” the family. are transmitted from one statements. generation to the next. End: Reporting back. Closure.

Experiential/ Primary concept is self-esteem – Family. Self-esteem, self, primary triad, mind, soul, body triad, Active facilitator of Family possesses all Dysfunctional behaviors Beginning: Assessment: family history/key Raise self- an innate drive either fostered maturation, seed model, threat and reward model, communication and resources needed for growth. are conceptualized as relationship issues. Develop relationship and esteem, improve Communication: or not fostered as a result of the Long term/short term. placating, blaming, computing, distracting. leveling, rescue growth. Promotes Looks for suppressed resulting from failure to establish goals. communication, communication and early experiences games, coalition games, lethal games, growth games, spontaneity, creativity, feelings and emotions that fulfill one’s potential for Early/Middle: Treatment focuses on growth: growth, identify • Virginia Satir a child receives from his/her parents. sculpting, family reconstruction, labeling assets. autonomy and ability block growth & fulfillment. personal growth. sculpting, family reconstruction, teaching and modeling family roles and to play. Coaches Experiential awareness effective communication, use of metaphors, use of how they promote • Carl Whitaker and teaches. important for growth. drama, role play, therapist use of self, art therapy, symptoms. “I value you” statements, labeling. End: Provide closure.

Structural Directive, change-oriented therapy, Nuclear family only. Family structure, subsystems, boundaries/degree of Active director of Behavioral change is based Individual symptomology Beginning: Acceptance of therapist by family. Primary concerned with symptoms in terms of permeability, diffuse boundaries and enmeshment, rigid therapy. Promoter on action – action precedes or family dysfunction are Evaluate/assessment. accommodating, mimicking, long-term goal is Family Therapy: family system dynamics – assumption Short/brief term. boundaries and disengagement, alignments, triangle, of change in understanding. viewed as the result of an joining, mapping, challenging the symptom. to “restructure” that if you change the organization or power, coalition, joining, mimesis, tracking, enactment, family structure. inflexible family structure Early/Middle: Enactment, reframing, unbalancing, the family. • Salvador Minuchin structure of the family, then the family’s re-framing, unbalancing. that prohibits the family redirection. Challenge the family structure. symptoms will be alleviated. from adapting. End: Review progress made. Reinforce structure and reorganization and provide tools for the future. Setting up referrals or groups.

Strategic Three main models: MRI, Haley Participants in the problem. Circular questioning, neutrality, hypothesizing, Active, take-charge Focus of therapy is Focus on how Beginning: Identify the problem. Plan a strategy Change occurs and Madanes, the Milan Model. complementary, double bind concept, first order change, role. Power based. on alleviating current communication is for change. Four Stages: Social stage, problem stage, through action- Family Therapy: Relationships are characterized by Short/brief term. metacommunication, paradoxical communications/ symptoms through altering used to increase one’s interaction stage, goal setting. oriented directives a struggle for power to see who will prescription, positive connotation, prescribing the system, a family’s transactions control in a relationship. Early/Middle: Direct interventions/straight and paradoxical • Haley define or redefine relationship. relabeling, second order change, symmetrical. and organization. Symptom is interpersonal directives/assignments/tasks. Paradoxical interventions. * Insight considered rather than intrapsychic. directives to change dysfunctional behavior. % • MRI counterproductive as it Struggles for control Circular questioning, neutrality, hypothesizing. • Madanes increases resistance. become pathological when Address power struggles within family. Relabel control issues produce dysfunctional behavior. symptomatic behavior. End: Terminate. Presenting problem solved.

Narrative Therapy Focus on the stories of people’s lives Individuals, couples, Life stories, externalizing, who is in charge, reading between Collaborative listener/ Change and insight occur There is no one objective Beginning: Assessment. Externalizing – Client Reauthoring the and is based on the idea that problems families and groups. the lines, reauthoring the whole story, reinforcing the new investigator reporter. when a person’s story helps “truth” and there are tells their problem-saturated story. Therapist asks whole story. (Post-Modern): are manufactured in social, cultural and story, de-constructing dominant cultural discourses. Strong interest in him to regain his life from a multiple interpretations questions/encourages clients to ask questions. OFF political contexts. Externalize problem. No time line. Depends client’s story. problem in the end. Process of any event. People are Early/Middle: Externalizing – the person is not • Michael White Deconstruct story. Create new story. on clients and process of Uses questions. of uncovering key values, not their problems and the problem. Mapping the influence – problem’s retelling story. strengths and skills that lead to can develop alternative effects rather than causes. Determine how problem • David Epson an alternate direction in life. empowering stories once disrupts/dominates family? Discuss examples of they are separated from unique outcomes when clients could overcome their problems. problem. Reauthoring the story. Reinforcing the new story. Deconstruction. End: Document and support new story. Make referrals. ** Association for Advanced Training in the Behavioral Sciences 5126 Ralston Street, Ventura, CA 93003 | 800.472.1931 | www.aatbs.com | [email protected] Association for Advanced Training in the Behavioral Sciences 20Exam Prep Study Packages

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Association for Advanced Training (800) 472-1931 in the Behavioral Sciences WWW.AATBS.COM receive discount. Offer expires 04.30.13. aCCulturatioN: A process of change that occurs when two cultures come into contact. Occurs when an individual adopts the cultural traits (e.g., beliefs, attitudes, values, language) of his or her new culture.Association Most contemporary for Advanced models Training of acculturation emphasize that it is an ongoing process,in the involving Behavioral both Sciencesadopting the traits of the mainstream society and giving up the traits of the indigenous culture. (Items pictured not necessarily included in These aspects of acculturation are not necessarily correlated, however; i.e., an individual can adopt the traits of the dominantRElABEliNg: culture without Associated abandoning with the structuraltraits family therapy. Refers to de- of his or her native culture. When counselingfining a minority the symptomgroup client, in interpersonalthe counselor terms instead of the individual ones should determine the client’s degree of acculturation into the majority culture. usually presented by the family. Relabeling usually involves changing a packages, but may be purchased separately.) label from a negative one to a positive one. Generally, it is a process of Association for Advanced Trainingchanging the way a symptom(800) 472-1931 or set of behaviors is understood. For ex- in the Behavioral Sciences ample, an adolescent’sWWW. behavioraatBs.C describedoM by the parents as rebellious and antagonistic may be relabeled as normative “growing up.” **For information about pass guarantee Association for Advanced Training in the Behavioral Sciences Association for Advanced Training (800) 472-1931 in the Behavioral Sciences WWW.AATBS.COM restrictions, please visit our website. Association for Advanced Training in the Behavioral Sciences

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