Monday, January 24, 2011
We recognize the sense of urgency that people feel to re-examine the workings of our “mental health system.” We welcome the discussion; it is long overdue. At the same time, it is important to remember that there are reasons why in our free society taking away someone’s freedom is a difficult and deliberative process. Forcing someone to get treatment must always be done carefully and based on specific, objective criteria. While many precise tools and measurements are available to assess physical health, fewer exist for mental health conditions. Hospitalizing someone involuntarily or forcing someone to get treatment for a mental disorder, ultimately involves the judgment of a clinician, and the criteria are often subjective.
We continue to hope that the dialog following the horrible events of the past week will result in a re-examination of our public priorities. It has been too easy for too long for government leaders at all levels to balance their budgets or fund their more popular projects at the expense of our healthcare systems, particularly those devoted to mental health. To have the kinds of responsive and effective mental health systems that are being demanded in the wake of this recent tragedy, significantly more resources will be needed and significantly more funds must be allocated. Just as freedom does not come for free, neither does healthcare, whether mental or physical.
Finally, we are heartened by the nature of some of the discussion that has started to emerge. It is encouraging to see people begin to talk with each other rather than yell at each other. Healing requires that we all fully acknowledge, process, and digest all aspects of our experience — physical, mental, and emotional. To do so, we must be able to verbalize our experience in an atmosphere of acceptance and support. Healing only takes place when people feel heard and understood. This is why psychotherapy is called “the talking cure.” As mental health counselors, we are prepared to do our part. Our greatest hope now is that the yelling can finally subside and that the talking and listening can continue.
Friday, December 4, 2009
Don Durkee, Ed.S., LPC, NCC
“It’s a good thing couches are too heavy to throw, because the fight brewing among therapists is getting ugly.” This is the opening line of Sharon Begley’s recent editorial entitled “Ignoring the Evidence: Why do psychologists reject science?” Writing in the October 12 issue of NEWSWEEK, Ms. Begley speaks of an issue among “psychologists” (by which she clearly means therapists in general), and she refers to “years of research” on therapeutic outcomes that have divided the professional community. On one side of the argument are those who believe in evidence-based approaches to therapy (EBT), and on the other are those who view those approaches as leading to more mechanical and less personal forms of therapy.
The argument over evidence-based therapy has gone on for some time in the therapeutic community, with strong voices on both sides. At a recent Networker Symposium, Marsha Linehan, the developer of Dialectical Behavior Therapy (DBT), reportedly claimed that any clinician not using evidence-based methods should be considered guilty of an ethics violation. Yet Irvin Yalom, noted therapist, author, and lecturer in his book The Gift of Therapy has warned against the “EVT [empirically validated therapy] Bogeyman,” raising doubts about the research methods used or the applicability of this approach to in-depth therapy.
Not surprisingly, much of the impetus behind the promotion of evidence-based methods comes from insurance companies. In the name of establishing “best practices,” many of the major managed care networks are encouraging use of EBT, with practitioners regularly required to record client progress in some central data base. One company clearly states their “belief that patient outcomes are the most important indicator of quality” of the clinician’s work. It is not hard to envision a future in which authorizations for therapy and numbers of sessions approved would be made in anticipation of these “best practices.”
Whatever your position on the issue, it is clear that what has been until now an arcane discussion within the therapeutic community has finally crossed the line into the “mainstream media.” It is one thing for the issue to be debated in a clinical journal or at a professional conference; it is quite another for it to be a subject in NEWSWEEK. With all the public attention being paid to “health care reform” and the need for “greater efficiency and accountability,” it is increasing likely that counselors will soon be getting some pointed questions: How do you practice therapy? What methods do you use, and are those methods evidence-based?
We should also remember that the issue of EBT is just one of several that will soon be confronting our profession. As the major public voice for counselors in Georgia, LPCA must take an active role in making sure that the issues are clear and that the debate is thoughtful. It is equally important for all of us as members to study each issue carefully and be prepared to articulate our positions clearly to ordinary people. This is a time when our professionalism must be on public display. Each of us has a part to play. Let’s not wait until there are articles in TIME and U.S. News.
Tuesday, August 4, 2009
Confidentiality and the rights of clients remain the responsibility of clinicians. According to the Composite Board Rules 135-7-.01, a licensee’s primary responsibility is to the client. As such, clinicians serve as the vanguard of the rights and confidentiality of their clients. Clinicians follow the basic tenet of do no harm. Yet this basic tenet can create the potential for a clinician to encounter ethical dilemmas regarding safety and disclosure of confidential information.
Consider the following case: A male schedules his first appointment with a female clinician to receive counseling for his sexual behavior. During the first session, he exposed himself to the counselor after becoming aroused as he described his recent sexual activity. The counselor immediately terminated the session and requested the male leave her office. The counselor was unable to convince him to leave of his own volition and she contacted building security to escort the male from the building. The counselor filed a report with building security and local police, but remained concerned regarding her duty to warn should this male schedule with other female counselors and his behavior escalate to physical harm. What are the responsibilities of the counselor? Does “duty to warn” apply in this situation?
The most common example stems from Tarasoff v. Regents of the University of California in which it was determined counselors have the duty to protect third parties against whom a client may have made a threat and requires breach of confidentiality. This ruling has sparked great interest outside of California, and while enacted in several states it has not been implemented as law in Georgia. Therefore, counselors become legally and ethically bound to the laws and rules enacted by the Georgia Composite Board regulating the counseling profession.
According to rule 135-7-.03, subsection (2)4, confidentiality may be breached, “where there is clear and imminent danger to the client or others, in which case the licensee shall take whatever reasonable steps are necessary to protect those at risk including, but not limited to, warning any identified victims and informing the responsible authorities.” In this case, the counselor assumed the necessary responsibility to ensure her own safety and notified the appropriate legal authorities.
In this instance, the individual can be considered a criminal instead of a client allowing for the clinician to disclose identifying information of the male to police in order to facilitate their investigation. Yet the dissemination of his identifying information via mass communication with colleagues creates the risk for libel and the potential for distortion of facts. Vague examples of safety concerns may be discussed with clinicians in order to foster the development of safety plans. Clinicians should also contact their professional association to obtain additional support and guidance in developing safety plans and navigating the legal recourse for similar situations.
The Ethics Chair for LPCA’s Board of Directors, David Lane, will provide a follow up article to this email notification in the September edition of the LPCA newsletter to further discuss safety planning for clinicians. If you have additional questions or wish to comment on this email blast, please contact LPCA staff at (404) 370-0200 or LPCA@mindspring.com.
By Nicole Urbanek, License-Eligible, email@example.com
LPCA Office Manger
Thursday, February 12, 2009
This year those who suffer from mental illness will not have many gifts under the tree. In past year’s they would have nicely wrapped gifts of day treatment programs, respite care, job training, and state funded in-patient hospitalization beds. Now the tree is barren and empty. The only thing left is the memory of past years of fullness when all who asked; got what they wanted.
Georgia is the grips of one of the worst economic crisis in years. According to a November 19, 2008 document titled Hospital Game Plan Update, the state has the following four strategies to deal with the economic shortfall:
· Consolidate hospital populations
· Shift the front door from the hospitals to the community
· Privatized to construct new facilities
· Close some hospitals
The state says that this plan will:
Provide new hospital infrastructure to replace outdated and inefficient facilities
Expands and enhance treatment alternatives in the community
Position the state hospital to be used only after community options have been exhausted
In 2008 the state hospital system has 580 mental health beds, 588 forensic beds, 929 development disability beds, 56 child and adolescent beds, and 210 skilled nursing facility beds. By 2012, the state projects the numbers to be 450, 600, 250, 0 (zero), and 210 respectively. The state further wants to increase by 2012 the number of crisis stabilization beds 48% to 172 total beds, create six new social detoxification programs, increase the number of mobile crisis teams 154 % to 68 counties, increase the number of ACT teams 114% to eight teams with each team having a caseload of 70, and increasing the transportation budget to $700,000.
No one in the advocacy community questions the need for changes. What is in question is speed of the changes and how the state will implement this plan. Another concern is that in other states where privatization occurred it failed and the system left the most vulnerable without services.
Some say the mental health system in this state has reached a tipping point. The system has reached a critical mass. The system must change or many will suffer. All those who suffer with the pain and shame of mental illness need an advocate at this time to ensure the quality of their life. We need you. During the 2009 legislative session, the three biggest concerns for our constituents are the budget, the re-organization plan of DHR/MH/MR, and the closure of the state hospitals. Hopefully you can find some passion in one of these causes to fight for. Please join us in this fight.
Johnnie L. Jenkins, III, MA, NCC, RPT, LPC
Wednesday, December 17, 2008
by Don Durkee
“Who am I, and why am I here?” Most of us have encountered a client struggling to establish a sense of identity and a corresponding feeling of self-worth. This is often a difficult, even anxiety-ridden effort. But when it comes to having an identity crisis, it’s hard to beat the level of angst to which counselors can rise. If you believe everything written about who we are and what we do, you could get the idea that we all have knowledge and skills enough to provide almost any kind of service in almost any kind of setting. Not only that, we work with populations so varied, they would almost seem to have nothing to do with each other. Possessing incredible powers of empathy and insight, we psychic superheroes can be found in hospitals, schools, business offices, churches, public treatment centers, and various other facilities. In these far-flung settings we dispense aid and comfort to everyone from chronic schizophrenic patients to troubled second-graders to addiction suffers to working citizens unhappy in their jobs. In short, we do it all for everyone everywhere. It is axiomatic, of course, that when you set out to be everything for everyone, you are not likely to be anything for anyone. Small wonder then that the public has such difficulty understanding who counselors are and what we do.
My suspicion is that the problem begins with what we call ourselves, or rather with what we don’t. In the past month, I had occasion to meet several people who asked what I do. When I replied that I am a Professional Counselor, one asked me to represent him in his divorce and another inquired what I do in the off season when I’m not teaching children to swim. When I quickly added, “I’m a shrink,” both people nodded and gave me a look of recognition. “Counselor” wasn’t clear to them, but “shrink” was.
Since “counselor” can be taken in so many different ways, many states qualify the term used for licensure with “mental health” or some variation thereof. We should also note that LPCA is the Georgia chapter of the American Mental Health Counselors Association (AMHCA). The reason this is important is that the focus on mental health is our common thread; it is what provides consistency whether the counselor works in a school or a hospital or a private office.
Lacking a title that specifies “mental health” as a focus, it behooves counselors in Georgia to be able to state clearly and simply exactly what we do and why it matters. It turns out, however, that counselors have not done very well with this — in Georgia or elsewhere. If you consult Wikipedia, you find a description of counseling that lists ten specific job tasks with no indication as to why someone might want counseling. In 1997 ACA adopted a definition of counseling as “the application of mental health, psychological, or human development principles, through cognitive, affective, behavioral or systemic intervention strategies, that address wellness, personal growth, or career development, as well as pathology.” While it is less complicated than the statement in Wikipedia, it is no more helpful.
Naturally each state has its own definition of counseling. One state licensing board describes counseling as “involving the application of clinical counseling principles, methods, or procedures to assist individuals in achieving more effective personal, social, educational, or career development and adjustment.” Another state board insists that “’Licensed professional counseling’ means the application of counseling, human development, and mental health research, principles, and procedures to maintain and enhance the mental health, development, personal and interpersonal effectiveness, and adjustment to work and life of individuals and families.” The board in a third state defines the practice of “clinical professional counseling” as “the provision of treatment, assessment and counseling, or equivalent activities, to a person or group of persons to achieve mental, emotional, physical and social development and adjustment. The term includes counseling interventions to prevent, diagnose and treat mental, emotional or behavioral disorders and associated distresses which interfere with mental health.”
If you think these statements are convoluted and confusing, just consider the definition of counseling included in Georgia law. Frequently called our “scope of practice” statement, this Herculean effort consists of a single sentence containing 134 words. It begins, "Professional counseling means that specialty which utilizes counseling techniques based on principles, methods, and procedures of counseling that assist people in identifying and resolving personal, social, vocational, intrapersonal and interpersonal concerns; utilizes counseling and psychotherapy to evaluate and treat emotional and mental problems and conditions, whether cognitive, behavioral, or affective; …” It goes on from there. By the time you get to the end of this sentence, it’s hard to remember why you began reading it.
I often wonder if the reason counselors struggle so much with these statements of service is that we write them more to satisfy lawyers or law makers than to reach the people we actually serve. Or maybe we are hoping to find a means of reassuring each other that we truly have a clear identity as mental health professionals. Whatever the reason, the results are consistently overly complicated, expressed in something akin to “legalese,” and full of everything-for-everybody provisions. Most of us would not even consider inflicting such a statement on an existing or prospective client.
In a former life, I spent some time as a consultant, and I learned a lot about an important tool known as an “elevator statement.” The idea is to be able to describe your service and how it will benefit someone in the time it takes for the two of you to ride from one floor to the next in an elevator. For a consultant, failure to get your message across in that time means losing an opportunity, and probably a client.
Perhaps we counselors should consider creating our own elevator statement. To do this, we would have to discard the details and the variations and the legalese. Instead, we would have to state our common focus and how it applies in what we do for our clients. In my own practice I have constructed such a statement. I simply say, “As a Professional Counselor, I help people with mental health problems heal and grow and feel better about themselves, so they can have a better quality of life.”
I consider my elevator statement to be a work in progress, which I think it will be for as long as I am in practice. And for all the counselors reading this piece, I offer you a challenge: Create your own elevator statement and share it with others. In doing so, you can help us all be clear in our thinking and shape the way we communicate with all the people who truly need our services. This clarity will help both the public and the profession; it might even enable us to resolve our own identity crisis.
Wednesday, August 20, 2008
by Sally Kearsley
Want to do something great for your future job hunt and your career? Consider joining a professional association--or the student chapter of a professional association! There is a professional association for almost any career field you can mention and you can join at any time, freshman to senior year (or beyond).
You can check with the staff at your career center for on-campus and local chapters of professional associations or use the directory called National Trade & Professional Associations (published by Columbia Books).
You may do a web search as well, searching by the career field plus "professional association."
There are some excellent reasons for joining one in your chosen field
Professional associations publish journals and/or newsletters (which often are a benefit of membership) are helpful to:
- Keeps you up-to-date on issues and developments in your field. If you are interviewing, this can be invaluable information!
- Shows you who the "movers and shakers" are in your field.
- Tells you out about companies--or individuals--with whom you would like to work.
- Offers information about upcoming conferences and professional development opportunities.
- With your membership, you will often have access to member information. Contacting someone in your field about possible employment as a fellow member of the association may open a door.
- Professional associations often have some mechanism for sharing job listings. This could be a "classified" section in the journal or newsletter, a section on a web site, or a separate publication available to members only.
- As a member, you will be eligible to attend the group's conferences. Whether at the state, regional, or national level, professional conferences offer excellent opportunities to:
- Build your network of professionals in the field.
- Learn the latest developments in your field.
- Take professional courses and seminars.
- Professional membership is an excellent addition to your resume! There are few better ways to show your serious commitment to the field.Local chapters of associations often sponsor programs, maintain alumni networks, and provide other valuable advantages.
- Many professional associations have substantially reduced membership fees for students who are still in college. Fees can get a little pricey if you wait until after you graduate.
Licensed professional counselors help people deal with problems or conflicts they are unable to solve alone, including substance abuse; family, parenting, and marriage conflicts; managing stress; depression; suicidal thoughts; career concerns; and problems with self-esteem. Mental health counselors collect information through interviews, observations, and tests, and then decide how best to treat patients. The counselor may work with individuals, couples, families, or in group sessions of people with similar problems. They work closely with other mental health professionals, such as psychiatrists, psychologists, and social workers, to care for patients.
Most licensed professional counselors work in private practice, counseling centers, group practices, family service centers, health maintenance organizations (HMOs), hospitals, and government agencies. A 40-hour workweek is standard, with some evening and weekend hours required for the convenience of clients.
Job Outlook Growth in this field is faster than average. These professionals may be in even greater demand if present trends such as high divorce rate, alcoholism, drug abuse, and child abuse continue.
Length of Training/Requirements
The minimum education requirement is a master's degree of arts or sciences. A doctoral degree is rapidly becoming required in the field. After completing course requirements, individuals must complete a years internship before graduating. Then an additional Three years of Supervision before Licensure is granted.