ACA Blog

Back when I started my degree last January, one of my teachers spoke about what happens when she gets on an airplane and ends up telling her seat partner what she does for a living--either the person has no idea what a counselor does, or the person wants her to solve all of their problems. Either way, this can be a fairly irritating situation for her, and probably most counselors. She told us she finally decided to say something vague, like she works with kids. Other teachers have shared what they do to avoid certain types of self-disclosure in addition to dodging tricky questions, like putting away family pictures before seeing certain clients.

This topic has been on my mind lately. The fact that ONLY LISW can treat Medicare clients while PCCs cannot. We are trained to treat many issues; in fact we may have more knowledge than LISW’s on some issues. I have my PhD in counseling yet am not allowed to work with Medicare clients. I had a few of my clients go to Medicare and I could no longer treat them because I’m not an LISW. I am an LSW (Licensed social worker) and a PCC-S. Why do I not qualify?

The September 2012 issue of Counseling Today has a comprehensive article called ‘Should counseling practice be evidence based?’ The answer of course is Yes. I have never met a counselor who does not want to be effective and to be effective each of us uses the best evidence we can get given who we are and who our client is. However, those who use this phrase usually mean something more narrowly defined—should results from randomized clinical trials (RCT) be the gold standard for discerning information about what works and what does not in a counseling situation.

You’re a professional counselor in private practice. You’ve worked hard to build a solid reputation as a caring, ethical provider of top-notch behavioral health services. Then one day you notice a drop in new client calls and referrals. You do a name search on yourself on the Internet, and...low and behold!...someone has posted a nasty review about you that has wormed its way onto a number of “business rating sites.”

Hayley Wilson wrote a timely ACA blog post this past week on the questionable merits of counselors using Facebook. After going through a huge social media learning curve this past year, originally spurred on by trying to promote my latest book, I have come to appreciate the power of social media to promote positive messages of emotional wellness. As a graduate student back in the 70s, I never could have envisioned that mental health could be promoted in such an extraordinary way to reach people in every corner of the globe! In this age of increasing use of social media, Hayley’s post was just the impetus I needed to outline some ethical ways to promote mental health and wellness using social media.

I will be the first one to admit that I am an avid Facebook user. Not a day goes by where I don’t log in and check status updates or photo uploads, or simply flit from page to page, like an overeager butterfly. While most of my friends say they don’t use Facebook nearly as much as I do, their hourly comments tell another story. And I should know, I’m commenting too.

It was going to be a tough case. During intake, the client had been particularly resistant to any sort of disclosure. To be honest, given his tight-lipped demeanor, I was not really sure why he sought therapy. His unwillingness to do more than moan and just sit there expressionless, near-catatonic, dead to the world, made me believe something was not as it seemed and there were deeper issues at play.

I know we have all been taught about boundaries in therapy and keeping a professional detachment to our clients in which we are warm, compassionate, empathetic but do not get too close to our clients; they are not our friends and they are not our children. We know that such an attachment can interfere with judgment and open us up to litigation. I get that. I also get that there are different levels of boundaries based on treatment setting. For instance, in a not for profit community based program model it is not uncommon to have volunteers help with many non clinical projects. Most of us have come into such programs on our days off, or have been asked to cancel clinical appointments for a day to assist with community projects that find us elbows deep working with clients. To me, once you have broken bread with or built a room with volunteers there is a certain bond that may develop that you would not see otherwise. You are still professional and keep your boundaries but it is akin to Dorothy peeking behind the curtain in OZ, after she saw the bells and whistles she realized that behind the façade was just another person.

Did you know that the research design for the DSM-5 field trials is seriously flawed? The DSM-5 field trials are currently underway to evaluate the proposed revisions. In these trials, the DSM-5 work groups are evaluating test-retest and interrater reliability of the disorders.

I have to admit, I am all about technology. I am wired up, hooked up and linked up with more devices and sites than I can keep up with. If texting had been around when I was younger, I would have been that kid sitting across from the counselor because he/she has a 10,000 a month text habit and the parents are freaked out. I’ve so enjoyed the blogs from my fellow bloggers about the pros and cons of using electronic communications and social media with our clients. As great as technology is, it continues to present new ethical and practical challenges as we incorporate new ways to communicate into our professional practice. So, when a client recently asked me about Skype, I found myself face-to-face with my own challenge.