CREATED & PUBLISHED BY THE FLORIDA MENTAL HEALTH COUNSELORS ASSOCIATION
JANUARY 2024
2 | InSession- January 2024 | FMHCA.org
Happy New Year! Greetings FMHCA Members!
connections, organizing our annual conference and virtual summit, hosting regional trainings, and advocating for your interests at the legislative level.
As we usher in the dawn of a new year, we find ourselves reflecting on the incredible journey we have shared this past year as the Florida Mental Health Counselors Association (FMHCA). It is with immense pleasure and gratitude that we extend warm wishes for a Happy New Year to each and every one of you. We take great pride in representing an association of such dedicated and passionate mental health professionals. Your commitment to the field and the well-being of individuals and communities across Florida is truly commendable. Together, we have formed a community that strives for excellence, compassion, and positive impact. Looking back on the past year, we are filled with a sense of achievement in the collective progress we've made. As we navigate the evolving landscape of mental health, FMHCA remains steadfast in its mission to support, empower, and elevate our members. We are proud to be your voice, your advocate, and your partner.
In the spirit of growth and renewal, we are thrilled to welcome new members to our esteemed Board of Directors. These individuals bring with them a wealth of experience, fresh perspectives, and a shared commitment to advancing the goals and vision of FMHCA. Their dedication to the field and their diverse expertise will undoubtedly enrich our association and contribute to the continued success of FMHCA. We look forward to the collaborative efforts that will emerge as we work together to serve you better. In the spirit of unity, we express our gratitude for the trust and confidence you have placed in FMHCA. As your association, we are committed to serving you with excellence and enthusiasm throughout the coming year and beyond.
As we step into the new year, we are excited about the opportunities and challenges it will bring. The FMHCA team is dedicated to continuing our tradition of providing high-quality continuing education, fostering valuable networking
Here's to a New Year filled with professional achievements, personal growth, and collective triumphs. May it be a year of continued success, joy, and fulfillment. Sincerely, The FMHCA Office
Join us for the first PAC Fund Run (or Walk!)- a virtual event taking place from May 6th through 17th to raise awareness of FMHCA’s Political Action Committee (PAC) Fund. Whether you are a runner or walker, we hope that you will join us and counselors across the state as we run/walk 1,000 miles to raise $5,000 for FMHCA’s vital mission to Let Your Voice Be Heard!
LEARN MORE/ SIGN- UP HERE
InSession- January 2024 | FMHCA.org | 3
INSESSION
Page 8 How Productivity Standards Can Impact Our Profession Page 11 Mentorship and Reducing Counselor Burnout Page 15 Men’s Mental Health
Page 17 Spirituality in the Counseling Setting Page 21 FMHCA Committee Updates Page 26 Welcoming Dr. Kathie Erwin (Feature Article) Page 29 The Aftermath: Homicide Survivors Bonding over Loss Page 34 FMHCA’s Favorites Page 37 Using Virtual Reality to Enhance Your Therapy Page 43 Navigating the Psyche: A Counselors Guide to Veterans’ PostService Transition Page 48 A Balanced View of Pathology and Client Capability 4 | InSession- January 2024 | FMHCA.org
MAGAZINE Page 50 Building Endurance: Sustaining a Mental Health Private Practice Group for Decades
Page 53 Quarterly Legislative Update with FMHCA Lobbyist- Corinne Mixon
InSession Magazine is created and published quarterly by The Florida Mental Health Counselors Association (FMHCA). FMHCA is a 501(c)(3) non for profit organization and chapter of the American Mental Health Counselors Association. FMHCA is the only organization in the state of Florida that works exclusively towards meeting the needs of Licensed Mental Health Counselors in each season of their profession through intentional and strengthbased advocacy, networking, accessible professional development, and legislative efforts. Let your voice be heard by becoming a FMHCA Member today! Click here to view FMHCA's current Bylaws.
CONTRIBUTE: If you would like to write for InSession magazine or purchase Ad space in the next publication, please email: Naomi Rodriguez at naomi@flmhca.org
THE INSESSION TEAM: Naomi Rodriguez- Editor Victoria Siegel, LMHC- Expert Advisor
ANTI-DISCRIMINATION POLICY: There shall be no discrimination against any individual on the basis of ethic group, race, religion, gender, sexual orientation, age, or disability.
DISCLAIMER: Information in InSession Magazine does not represent an official FMHCA policy or position and the acceptance of advertising does not constitute endorsement or approval by FMHCA of any advertised service or product. InSession is crafted based on article submissions received. Articles are categorized between Professional Experience Articles & Professional Resource Articles. Professional Experience Articles are writer's firstperson pieces about a topic related to their experience as a mental health professional, or an opinion about a trend in the mental health counseling field. Professional Resource Articles are in-depth pieces intended to provide insights for the author's clinical colleagues on how to be more effective with a particular type of client or a client with a particular disorder, or tips for running their practice more efficiently. Each article is labeled with their article type.
InSession- January 2024 | FMHCA.org | 5
6 | InSession- January 2024 | FMHCA.org
FMHCA's Mission Statement The Florida Mental Health Counselors Association (FMHCA) is the State Chapter of the American Mental Health Counselors Association (AMHCA). FMHCA is the only organization dedicated exclusively to meeting the professional needs of Florida’s Licensed Mental Health Counselors. The mission of the FMHCA is to advance the profession of clinical mental health counseling through intentional and strengthbased advocacy, networking, professional development, legislative efforts, public education, and the promotion of positive mental health for our communities. Its sole purpose is to promote the profession of mental health counseling and the needs of our members as well as: Provide a system for the exchange of professional information among mental health counselors through newsletters, journals or other scientific, educational and/or professional materials Provide professional development programs for mental health counselors to update and enhance clinical competencies Promote legislation that recognizes and advances the profession of mental health counseling Provide a public forum for mental health counselors to advocate for the social and emotional welfare of clients Promote positive relations with mental health counselors and other mental health practitioners in all work settings to enhance the profession of mental health counseling Contribute to the establishment and maintenance of minimum training standards for mental health counselors Promote scientific research and inquiry into mental health concerns Provide liaison on the state level with other professional organizations to promote the advancement of the mental health profession Provide the public with information concerning the competencies and professional services of mental health counselors Promote equitable licensure standards for mental health counselors through the state legislature
The FMHCA Team
Maria Giuliana
Laura Peddie-Bravo
Melissa Riesgo
Dr. Bridget Glass
en liam taria ar
a gion l Direc Re
gional Dire Re
al gion Direc Re
gional Dire Re
Mark et
Exe c
Outrea ch
Naomi Rodriguez
Kerry Conca
n & Event C tio
rd. oo
Laura Giraldo
g& in
ord. Co
Diana Huambachano
Admini st ive ut
tor ra
utive Direct ec
Liza Piekarsky- Brown
Joe Skelly
Edu ca
NW
NE
Grace Wilson Cantor
or
Ex
P
r to
n
Michael Holler
SW
Dr. Kathie Erwin
SE
retary Sec
or ct
asurer Tre
r to
res st-P ident Pa
or ct
ent-Ele esid c r P
t
id Pres ent
Samantha Samarelli
InSession- January 2024 | FMHCA.org | 7
How Productivity Standards Can Impact Our Profession Professional Experience Article
Becoming a therapist was something I aspired to be. Back when I was a graduate student, studying to become a marriage and family therapist, I dreamed about the day I would sit in that therapist’s chair. I thought about all the theories and techniques that I learned and how I was going to use them to help create a better world. I had big dreams and big aspirations, and graduate school gave me the tools to become a successful therapist—well, every tool except one.
time, extra-clinical issues. I quickly learned that productivity standards are the amount of billable face to face minutes that a therapist spends with their client (Franco, 2015; 2016; 2023). I also quickly learned that, to our program manager, our company, and even our county, productivity standards were the primary measuring stick for a therapist’s worth. For a new therapist, this was a hard pill to swallow, but I was not alone.
I was blissfully ignorant of this need until my first day at work. On my first day, the receptionist enthusiastically gave me twelve referrals so that I could schedule assessments for the rest of the week. Mind you, I started on a Wednesday. She further said that these assessments would help me meet my productivity standards for that week. This was the first time I ever heard the term “productivity standards.”
Over the years, as a pre-licensed therapist, licensed therapist, lead clinician, clinical supervisor, and even clinical director, I have seen the impact of productivity standards on myself, my colleagues, and my supervisees. I have seen how the stress of productivity standards has led to burnout and therapists leaving their jobs—sometimes even leaving the profession. In fact, I knew a therapist who left the profession to go back to her restaurant business because it was less stressful.
In graduate school, I learned how to use theories and techniques to help clients succeed in treatment, but I did not have the tools necessary to deal with, what I thought at the
The research available echoes this sentiment. Researchers such as Jenaro, Flores, and Arias (2007) and myself in my own research (Franco 2015; 2016; 2023) have investigated the impact
8 | InSession- January 2024 | FMHCA.org
of productivity standards on therapists. In my research, I have found that productivity standards negatively impact a therapist’s satisfaction at work and are related to an increase of therapist leaving their jobs (Franco, 2015). While the data is compelling, anecdotal experience from myself and others that I have talked to in the profession adds a chilling, human component. I have seen many of my peers develop chronic symptoms of burnout at work. Symptoms like feeling tired, getting sick easily, feeling down. I saw fellow interns increasingly call in sick and then, one day, not come back to work. I have seen fellow licensed therapists cry in fear of losing their jobs because they were not meeting their monthly productivity standards. I have had supervisees who began to question their worth as a therapist because they were not meeting their monthly quota. I was not immune to this and, when I was an intern, experienced the signs of burnout. It was this and seeing my fellow therapists, all very good at their work, doubt themselves that inspired me to pursue a PhD in industrial and organizational psychology rather than go through the traditional clinical psychology route. I wanted to research the impact of productivity on therapists to bring awareness and address this issue. As a community of therapists, it is important for us to continue this conversation and address that elephant in the room. It can start in the classroom where professors can prepare students for
what they may experience at work. Clinical supervisors can lend an empathic ear to supervisees and focus on building their selfefficacy, which has been found to soften the impact of productivity standards (Franco 2015; 2016). Policy makers responsible for setting performance standards, such as productivity, may want to revisit this issue and find alternative forms of performance measurement. Most importantly, we, as a community of therapists, must address the issue and advocate for change. If we do not, then we are in danger of losing therapists when we need them the most. References Franco, G. E. (2015). Productivity Standards, Marriage and Family Therapist Job Satisfaction, and Turnover Intent. Dissertations and Doctoral Studies. Franco, G.E. (2016) Productivity standards: Do they result in less productive and satisfied therapists? The Psychologist-Manager Journal, Vol 19(2), May 2016, 91-106. http://dx.doi.org/10.1037/mgr0000041 Franco, G. E. (2023) The impact of productivity standards in psychotherapy. Frontiers in Psychology, 14, 1229628. Jenaro, C., Flores, N., and Arias, B. (2007). Burnout and coping in human service practitioners. Prof. Psychol. Res. Pract. 38, 80–87. doi: 10.1037/0735-7028.38.1.80
Written By: Gilbert E. Franco, Ph.D., LMFT Gilbert Franco is a licensed marriage and family therapist in the state of Florida. He also has an inactive licensed marriage and family therapist license in California. Gilbert obtained a PhD in industrial and organizational psychology to study therapist work environments. Gilbert has published peer-reviewed articles on this topic. His counseling specialties are trauma, substance abuse, psychosis, and family therapy.
InSession- January 2024 | FMHCA.org | 9
10 | InSession- January 2024 | FMHCA.org
In the past several years there has been a lot of research done on mental health counselor burnout. More attention has been placed on it since the COVID-19 pandemic. Burnout is described as decreased work engagement, job dissatisfaction, and reduced empathy toward clients (Bardhoshi et al., 2019). As the amount of research on burnout among mental health counselors increases, the solutions are not increasing in proportion to the research. In fact, most research agrees with the conclusion that there is more work to do in the field to shore up counselors and keep them from burning out (Dreison et al., 2018). The research has been turning up the same answers of boundary setting, time management, and self-care routines. These are great ideas, but they are only suggestions. Consider the history of mentoring and some of the benefits. Mentoring has existed for centuries. It dates all the way back to Ancient Greece there are records of people being mentored. It has served as not just an instructional relationship but also one that provides psychosocial support. According to the American Counseling Association a mentor is someone who has expertise and experience and is willing to share their knowledge and promote professional development (American Counseling Association [ACA], 2012). How is mentoring different from supervision? Supervision has an evaluative component as well as defined hierarchy. Mentoring lacks that ranking component.
Mentorship and Reducing Counselor Burnout Professional Experience Article
Here is a very real scenario. A counseling student goes into an agency, and they begin working and collection hours. The clinical director is overworked, short staffed, and showing signs of burnout. The student is paired with a counselor who is feeling the stress of their own case load, stretched to capacity to keep up with a group that has become 18 people instead of eight, and now must help the student learn the system. Now the student is being trained by people who are burned out. Wardle and Mayorga (2016) found that 85% of counseling students showed signs of burnout when they graduated. Despite our constant talk about selfcare, are we really modeling it for our students?
Mentoring has proven to improve employee engagement, reduce employee turnover, and increase morale (Parker & Vetter, 2020). In other words, it directly counters the symptoms of burnout. Up to now there have been no studies have looked at the impact of mentoring on burnout in mental health counseling. It is widely accepted that supervision is a protective factor and several studies that support the idea (Bernard & Goodyear, 2019). Is it possible that we have missed this as a method to fortify counselors against burnout? Despite its obvious benefits it is not emphasized. Mentoring does not seem to be discussed as often in master’s level programs. It is lost in the concept of supervision but even after licensure the newly minted counselor is now expected to navigate the clinical world and the challenges of third-party payers or finding connections in the community. Some will say that the clinical supervisor should be mentoring the neophyte counselor, but referring to the opening example, there are counselors and supervisors who simply check the box and move forward. The hypothesis is simple. Mental health counselors are at a higher rate for burnout than other professions (Bardhoshi et al., 2019; Dreison et al., 2018). Mentoring has been shown to offer psychosocial support as well as helping individuals learn new InSession- January 2024 | FMHCA.org | 11
skills. It offers benefits to both the protégé and the mentor (Pomerenk & Chermak, 2017). If mentorship has shown to improve what are identified as signs of burnout, then as a field we need to leverage that as another tool to keep counselors in the field and to prevent bringing counselor trainees into offices that are already burned out. References American Counseling Association. (2012). ACA graduate student committee launches mentorship initiative. Counseling Today, 54, March, pp.68–69. Bardhoshi, G., Erford, B. T., & Jang, H. (2019). Psychometric synthesis of the counselor burnout inventory. Journal of Counseling & Development, 97(2), 195–208. https://doi.org/10.1002/jcad.12250 Bernard, J. M., & Goodyear, R. K. (2019). Fundamentals of Clinical Supervison (6th ed.). Pearson Education. Dreison, K. C., Luther, L., Bonfils, K. A., Sliter, M. T., McGrew, J. H., & Salyers, M. P. (2018). Job burnout in mental health providers: A meta-analysis of 35 years of intervention research. Journal of Occupational Health Psychology, 23(1), 18–30. https://doi.org/10.1037/ocp0000047 Mullen, C. A., & Klimaitis, C. C. (2019). Defining mentoring: A literature review of issues, types, and applications. Annals of the New York Academy of Sciences, 1483(1), 19–35. https://doi.org/10.1111/nyas.14176
12 | InSession- January 2024 | FMHCA.org
Parker, L., & Vetter, D. (2020). Mentoring each other: Teachers listening, learning, and sharing to create more successful classrooms. Pembroke Publishers . Pomerenk, J., & Chermak, H. (2017). Using mentoring to encourage others (and ourselves). College and University, 92(2), 31–36. Wardle, E. A., & Mayorga, M. G. (2016). Burnout among the counseling profession: A survey of future professional counselors. i-Manger’s Journal on Educational Psychology, 10(1), 9–15. https://doi.org/10.26634/jpsy.10.1.7068
Written By: Jeff Rice LMHC, MCAP, ACS, NCC, BC-TMH, CCISM Jeff Rice, Clinical Director at Homestead Counseling and Adjunct Faculty Member, is dedicated to helping first responders and veterans through trauma recovery. With a profound commitment to mental health, Jeff employs his expertise to create therapeutic environments that foster healing. Through his role at Homestead Counseling and as an adjunct faculty member Jeff works to empower individuals to overcome the challenges of trauma, ensuring a brighter and more resilient future for those who have served and sacrificed.
InSession- January 2024 | FMHCA.org | 13
14 | InSession- January 2024 | FMHCA.org
Men's Mental Health Professional Experience Article
“I believe the biggest stigma right now, with mental health is that a lot of men are not talking about it” Mauro Ranallo. In 2021, it was estimated that about 18% of men in the United States had some type of mental illness. Unfortunately, in the United States, 65% of men do not ask for the help when needed. Men face challenges when asking for help because they are taught to pursue any self-reliance. The fear of being incompetent or seen as less capable of what a “Man” should be. Growing up the terms “man-up” were often heard within the family system. The “idea” of being a man was often associated with being loud, dominant, and close minded with their feelings. “Men shouldn’t be overly emotional”. At what point in time did society ask men to shut off their feelings and encourage them to process their emotions internally. To feel as if they aren’t enough or won’t live up to others’ expectations. Whether it is culturally, financially, emotionally, everyone has pain and trauma. Each year, November is dedicated to men’s mental health. It shouldn’t be a month but an everyday awareness where men can redefine their own mental schema of vulnerability. Any predisposed definition that was placed by society in a man’s mind can be redefined by what they deem appropriate. Men should be encouraged to discuss their fears, abandonments, griefs, and thoughts. It should never be considered as “complaints”.
when it comes to vocalizing their feelings. The pressure and contradicting thoughts fill their head while they attempt to embrace their vulnerability. Breaking down these thoughts and barriers often take us back to early childhood and what they were taught. At times it was to not be afraid, to be strong and to not cry. How does a child begin to process those words and the definition behind them? No other definitions or words are given as they continue to age. At early adulthood, these thought processes begin to resurface and they are left with processing them on their own and reparenting themselves. Men deserve the love and patience to heal themselves in this world and to know that they are not alone. Speaking about awareness can aid in spreading the message, but showing other men how to be vulnerable can change the perception of those who need it. Written By: Jessmary Echevarria, LMHC Jessmary is a Licensed Mental Health Counselor in Orlando, Florida. She currently works in a mental health agency with kids, teenagers, and adults. She specializes in working with depression, Bipolar and Post Traumatic Stress Disorder. She is certified in EMDR and has taken trainings to better her understanding of human behavior. She believes that a different perspective can change how we perceive our stress and how to manage them more efficiently.
As a clinician, I have seen men uptake negative self-talk. Even InSession- January 2024 | FMHCA.org | 15
16 | InSession- January 2024 | FMHCA.org
Spirituality in the Counseling Setting Professional Resource Article
Historically, the integration of spirituality into counseling has created both opportunities and challenges for the client and the counselor. The importance of the integration of spirituality/religion into counselor’s scope of practice has been studied extensively, counselor education programs have begun to train counselors in the area, and ethical codes have been established that address the ethical necessity of including spiritual/religious concerns in the therapeutic process. Research in the area has been focused on the counseling process and the client’s experience rather than on the counselors’ intrapersonal experience during the therapy session. While the integration of spirituality into counseling for the benefit of the client is increasingly understood as beneficial, the counselor’s experiences during this type of therapeutic engagement remains poorly understood. Looking at counselor experience through an analytical lens provides a foundation for insight into the practice of integrating spirituality in counseling and how professional counselors respond clinically and emotionally when the client engages them in discussions of religious or spiritual matters.Although counselor education programs have begun to integrate strategies for working with clients’ spirituality into their curriculums, it remains unclear how the counselor experiences dealing with these issues personally. Researchers have found that the kind of treatment that the counselor chose directly correlated to the counselor’s personal spirituality and the training the counselor received on the subject. It was also found that clinical training often prohibited the counselor-in-training to express his or her own views on the subject of spirituality and counselors were not necessarily encouraged to delve into their own belief systems regarding spirituality.
Spiritual transcendence for both the clinician and the client involves stepping outside of oneself and viewing life in a broader more interconnected perspective. Spiritual moments transcend this taught relationship and these moments facilitate powerful change. These highly charged moments arise and have significant consequences to the well-being and healing of the client. Understanding more about how some counselors respond to these moments gives valuable insight into how discussions of religion or spirituality impact the counselor’s side of the therapeutic relationship. Research, as it relates to the counselor, pertains to clinical supervision and examines the needs of counselor trainees in practicum and internship settings. Not only have trainees been taught to avoid imposing their values on the clients in past ethical codes, but were also taught to avoid the topic of spirituality all together. When looking at the thoughts, emotions, and values of the trainee counselors, the investigators found that trainees stated they were experiencing things that they had not felt before and hearing the client’s stories was quite painful. These new counselors also stated that when hearing these stories, they were not prepared for the feelings they were experiencing. More recently, the value of engaging the client on spiritual matters has been recognized with the new changes in the 2014 ACA Code of Ethics. Several professional organizations, such as the Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC) have identified competencies for practitioners to follow when using spirituality in counseling, and these competencies have been approved and accepted by the ACA. These competencies enhance evidence-based skills InSession- January 2024 | FMHCA.org | 17
and run parallel with the best practices required in counseling. Other organizations such as the Council for Accreditation of Counseling and Related Educational Programs (CACREP) have followed suit and stated in the CACREP 2016 standards that the counselor should be aware of the impact of the spiritual beliefs on client and counselor worldviews. While acknowledging the importance of spirituality in counseling practice, research has generally focused on client experiences, leaving intrapersonal encounters with counselors unexplored. Recent modifications to the ACA Code of Ethics in 2014 emphasize the significance of engaging clients in spiritual topics, which is reinforced by competencies from organizations such as ASERVIC and CACREP. Understanding how counselors personally approach spiritual topics becomes increasingly important as the ethical landscape advances. Recognizing the impact of spirituality on the well-being of clinicians and clients is critical for developing meaningful therapeutic connections and facilitating powerful moments of spiritual transcendence within the growing counseling paradigm. The Lived Experience of the Licensed Professional Counselor When the Client Introduces Spirituality in the Counseling Setting was aimed at investigating the interconnectedness of spirituality, religion, and counseling. This qualitative study focused on eight experienced Licensed Professional Counselors, each with at least five years of professional experience. The research revealed a significant gap in the awareness of these seasoned professionals of the changes in the 2014 ACA Code of Ethics, and none of the participants appeared to be aware of these significant alterations. This research attempted to provide a full understanding of the counselor's experience with spirituality and religion, utilizing ideas from the aforementioned study. The experiences of participants, as well as the ramifications of unacknowledged changes in ethical rules, was and continues to be explored. Having established the contextual backdrop, let’s delve into the findings gathered from the research. The youngest participant was 34 years of age, and the oldest two were both 57. Four participants were male, and four participants were female. Of the eight participants, two were African American, and six were Caucasian. All the participants had reported that they had their licenses for five years or more with over half of those interviewed (67%) having ten or more years of experience. Their work profiles included private practice, case management, community mental health agencies, and drug and alcohol treatment. The counselors in the study had difficulty identifying their own emotional reactions as their clients discussed spiritual or 18 | InSession- January 2024 | FMHCA.org
religious issues in their counseling sessions. All the counselors in this study claimed to feel “comfortable” when their clients chose to address matters related to spirituality or religion. However, despite reporting that their personal spiritual developmental journey played a major role in their personal lives, five of the eight counselors in this study expressed concerns related to the appropriateness of including spirituality or religion as part of counseling. Some felt that they lacked education (and did not desire education) in the area while some said it was nonclinical, and it would be unethical if the counselor introduced spirituality or religion in the counseling session. Three of those in the study expressed confident and positive feelings about the appropriateness of working with clients in the areas of spirituality and religion and would initiate that conversation even if the client did not. Additionally, these three felt that working with spirituality and religion as a therapeutic intervention was beneficial to their clients and was not unethical. In the field of counseling, meaning-making and understanding feelings are core tenets of the counseling process; yet, participants in this study had difficulty describing and discussing their feelings. Little research was found on the topic of what the counselor feels and experiences during the counseling session, and the existing research that was found pertained to counselors-intraining in internship settings, not to licensed counselors. Selfawareness and self-reflection are considered important facets to the counselor's growth yet, the participants had little selfawareness of their feelings or the ability to talk about their feelings. There appeared to be a major difference with those individuals who have not done drug and alcohol counseling and those who have had experience with drug and alcohol counseling. Those that have experienced 12-step programs automatically bring spirituality into the counseling setting and have a better understanding of their personal life experience and their personal emotions. Those individuals who have used these skills in their own lives reported being better equipped to use these skills with others in the counseling setting. Consistent with the research, five of the eight participants in the current study said that they avoided the topic of spirituality and religion until the client brought it up. The participants in this current study stated that they had received no education on the topics of spirituality and counseling, but contrary to the findings of researchers who found that students, faculty, and directors of education programs were asking for training, the participants in this research stated that they were not interested in any training. Three participants questioned if the topics of spirituality or religion could even be taught and pondered on what that
program would look like in a counselor education setting. Three of the participants in this current study felt that there were benefits to be derived by including spirituality and religion in counseling. This is consistent with the literature. When looking at chronic illnesses, examining a good death experience, or advocating for training in both medical and mental health settings, the research indicates that spiritual discussions help the individual cope. When discussing the research in mental health settings, it was stated that religious and spiritual functioning increases the client's well-being and coping strategies. Additionally, it has been found that for those with severe mental illness, religious or spiritual support system often is the only care available to them. Extensive research on PTSD also revealed the positive impact of spirituality for clients to achieve Posttraumatic Growth (PTG) and high levels of resilience may be attributed to positive religious coping. Discussion on the emotions of the counselor may be important throughout all the difficult topics clients bring into the counseling session. Counselors are ill-prepared for the gamut of stories that they will encounter in the counseling session and the new counselor needs to be prepared. Spirituality and religion are just one of the many topics that may arise. As counselors, it is important to not be fearful of self-reflection as emotions arise in the counseling setting. Personal feelings of the counselor affect treatment and burnout in the counseling profession. It is also important as seasoned counselors, that supervise and educate, that we address what new counselors are experiencing emotionally. Further research is needed, with a larger sample of counselors, to explore both the clinical and interpersonal development of counselors. Areas for additional research regarding the professional and personal development of the practicing counselor could include at least two major topics: (1) helping counselors develop deeper self-awareness and insight about communicating their own feelings, and (2) helping counselors understand the effect that their personal spiritual development and personal religious experiences may have on how they manage these issues when their clients present them.
Barker, S. L., & Floersch, J. E. (2010). Practitioners' understanding of spirituality: Implications for social work education. Journal of Social Work Education, 44(3), 357370. doi:10.5175/JSWE.2010.200900033 Bartoli, E. (2007). Religious and spiritual issues in psychotherapy practice: Training the trainer. Psychotherapy: Theory, Research, Practice, Training, 44(1), 54-65. doi:http://dx.doi.org.libproxy.edmc.edu/10.1037/0033-3204.44.1.54 Borman, J. E., Lin, L., Thorp, S. R., & Lang, A. J. (2011, August 28). Spiritual wellbeing mediates PTSD change in veterans with military-related PTSD. International Journal of Behavioral Medicine, 19, 496-502. doi:10.1007/s1259-011-9186-1 Cashwell, C. S., & Young, J. S. (2011). Integrating spirituality and religion into counseling (Second Edition ed.). Alexandria, Virginia: American Counseling Association. Corrigan, P., McCorkle, B., Schell, B., & Kiddler, K. (2003). Religion and spirituality in the lives of people with serious mental illness. Community Mental Health, 39(6), 487499. Retrieved from https://login.libproxy.edmc.edu/login? url=http://search.proquest.com.libproxy.edmc.edu/docview/228299959? accountid=34899 Crook-Lyon, R. E., O'Grady, K. A., Smith, T. B., Jensen, D. R., Golightly, T., & Potkar, K. A. (2012). Addressing religous and spiritual diversity in graduate training and multicultural education for professional psychologists. Psychology of Religious and Spirituality, 4(3), 169-181. doi:1.1037/a0026403 Delaney, H. D., Miller, W. R., & Bisono, A. M. (2007). Religiosity and spirituality among psychologists: a survey of clinician members of the american psychological association. Professional Psychology: Research and Practice, 38(5), 538-546. doi:10-103707357028.38.5.59 Dobmeier, R. A., & Reiner, S. M. (2012). Spirituality in the counselor education curriculum: A national survey of student perceptions. Counseling and Values, 57(1), 4765. doi:10.1002/j.2161-007X.2012.00008.x Fallot, R., & Heckman, J. (2005). Religious/spiritual coping among women trauma survivors with mental health and substance use disorders. Journal of Behavioral Health Services & Research, 32(2), 215-226. doi:http://ProQuest document ID 205240855 Hall, C. R., Dixon, W. A., & Mauzey, E. D. (2004). Spirituality and religion: Implications for counselors. Journal of Counseling and Development, 82(4), 504-507. doi:http://dx.doi.org.libproxy.edmc.edu/10.1002/j.1556-6678.2004.tb00339.x Piedmont, R. L. (2013). A short history of the psychology of religion and spirituality: Providing frowth and meaning for division 36. Psychology of Religion and Spirituality, 5(1), 1-4. doi:10.1037/a0030878 Powers, R. (2005, April). Counseling and spirituality: A historical view. Counseling and Values, 49, 217-225. doi:10.1002/j.2161-007x.2005.tb01024.x Sperry, L. (2012). Spirituality in clinical practice. New York, NY: Routledge. Sperry, L., & Shafranske, E. (2005). Spiritually oriented psychotherapy. Washington, DC: American Psychological Association.
Written By: Julie Vogel EdD, LMHC, LPC, NCC Dr. Vogel has been teaching at South University since July 2018. She recently moved to West Palm Beach and is currently teaching in the Clinical Mental Health Counseling program at South University West Palm Beach. She also has a private practice, Julie Vogel Counseling. She received her EdD from Argosy University in Nashville, TN. Before receiving her EdD Dr. Vogel owned and operated a private practice in both Nashville (2 years) and
References
Cookeville (2 years) Tennessee. She has worked as a Case
American Counseling Association. (2014, May 17). American Counseling Association. Retrieved from American Counseling Association Web site: http://www.counseling.org Ano, G. G., & Vasconcelles, E. B. (2005). Religious coping and psychological adjustment to stress: A meta analysis. Journal of Clinical Psychology, 61(4), 461-480. Retrieved from https://login.libproxy.edmc.edu/login?url=https://search-proquestcom.libproxy.edmc.edu/docview/236907592?accountid=34899 Association for Spiritual, E. a. (n.d.). Association for Spiritual, Ethical, and Religious Values in Counseling. Retrieved July 31, 2015, from ASERVIC Web site: http://www.aservic.org/
Manager, Community Organizer, and was the regional director of an adoption agency in New York. Dr. Vogel received her Master's degree from Long Island / CW Post University in New York. She was born and raised in Wisconsin, moved to Long Island, NY, and then moved to Tennessee. She began her career teaching at South University in Virginia Beach. Dr. Vogel holds licenses in Tennessee, Virginia, and Florida.
InSession- January 2024 | FMHCA.org | 19
20 | InSession- January 2024 | FMHCA.org
FMHCA Committee Updates Provided by Committee Chairs
Registered Intern & Graduate Student Committee Committee Chair: Laura Peddie-Bravo, LMHC, NCC
face psychotherapy and 100 hours of face-to-face supervision in no less than 100 weeks, etc.).
The Graduate Student and Registered Mental Health Counselor Intern Committee is pleased to announce two new co-chairs to the committee. Please welcome Jessi Broom, a Graduate Student at Florida Atlantic University, and Lauren Malone, Registered Mental Health Counselor Intern. In our most recent meeting, we covered topics such as: Artificial Intelligence in the field of counseling, a Counseling Compact update, and much more! We are currently planning a committee meeting in January (2024) and we are also planning to meet in person during the 2024 FMHCA conference. Additionally, our committee has its own Forum on the FMHCA website. In our committee forum, we post recordings of past meetings, resources, important announcements, updates, and much more! Joining this committee is simple! To join and obtain access to the committee’s forum and meetings, please contact the FMHCA office at Office@FLMHCA.org and our administrative team will be happy to connect you!
Rep. Traci Koster just field the House companion bill for this legislation, HB 827.
Government Relations Committee Committee Chair: Aaron Norton, PhD, LMHC, LMFT Issue #1: Renaming Registered Interns and Interns Needing a Licensed Professional "on the Premises" for Clinical Services We previously announced that SB 210 had been filed by Senator Burgess. If passed, this bill will rename "registered mental health counselor interns" as "licensed associate mental health counselors." We believe this title change will (1) contribution to the universalization of counseling terminology, as more states use "licensed associate" verbiage than "intern" verbiage, (2) clear up confusion among the public, allied health practitioners, and legislators who mistakenly believe that registered interns are college students, and (3) render the statute requiring registered interns who work in private practice to have a licensed mental health professional on the premises when providing clinical services (even if those services are delivered via telehealth) obsolete. However, all other requirements for interns remain the same (i.e., must have a qualified supervisor, meet with supervisor at least once every 2 weeks, provide at least 1,500 hours of face-to-
FMHCA’s GRC has formed a subcommittee that is working on creating a training teaching FMHCA/SMHCA members how to meet with/contact legislators to support this bill and others, so stay tuned for updates. Issue #2: Adding 491 Board Licensees to List of Healthcare Professionals the Court Can Appoint as Experts in Criminal Cases Currently, F.S. 916.115 reads, "To the extent possible, the appointed experts shall have completed forensic evaluator training approved by the department, and each shall be a psychiatrist, licensed psychologist, or physician." This requirement applies when the court is appointing experts "to determine the mental condition of a defendant in a criminal case, including competency to proceed, insanity, involuntary placement, and treatment." We believe this outdated statute (which we believe to have originally been written in 1980, 7 years before Florida started licensing counselors) needs to be updated to include the 491 Board professions, as (1) our scope of practice permits us to diagnose and treat mental disorders, (2) the majority of licensed mental health professionals in Florida are 491 board licensees, (3) there are shortages of forensic mental health experts in some judicial circuits in Florida, and (4) our unique training and expertise can be helpful in the court system. We are communicating with legislators in an effort to include this statutory update in a criminal justice bill and will apprise members of our progress. Other Bills of Importance FMHCA's GRC is also monitoring and analyzing the following bills that are relevant to our profession: SB 66: Naloxone Awareness Day Naloxone Awareness Day; Citing this act as “Victoria’s Law”; designating June 6 of each year as “Naloxone Awareness Day”; authorizing the Governor to issue an annual proclamation; encouraging the Department of Health to hold events to raise awareness of the dangers of opioid overdose and the availability and safe use of naloxone as an effective way to rapidly reverse the effects of opioid overdose, etc. InSession- January 2024 | FMHCA.org | 21
SB 68: Social Work Licensure Compact Social Work Licensure Compact; Creating the Social Work Licensure Compact; specifying requirements for state participation in the compact; requiring member states to designate the categories of social work licensure which are eligible for issuance of a multistate license in such states; establishing the Social Work Licensure Compact Commission; providing for commission enforcement of the compact, etc.
starting Jan. 1, 2024!
SB 70: Public Records and Meetings/Social Work Licensure Compact Public Records and Meetings/Social Work Licensure Compact; Providing an exemption from public records requirements for certain information held by the Department of Health or the Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling pursuant to the Social Work Licensure Compact; authorizing the disclosure of such information under certain circumstances; providing an exemption from public records requirements for recordings, minutes, and records generated during the closed portions of such meetings; providing for future legislative review and repeal of the exemptions; providing statements of public necessity, etc.
After a long advocacy effort and passage of the Mental Health Access Improvement Act, MHCs and MFTs have finally become recognized providers in the nation’s largest health insurance program. This is an incredible accomplishment that will expand access to much-needed mental health services.
SB 164: Solutions for Mental Health Professional Shortages Solutions for Mental Health Professional Shortages; Establishing a mental health profession scholarship and loan forgiveness program within the Department of Health for a specified purpose; providing for applicant eligibility and the award of scholarships; specifying service obligations for scholarship recipients; providing for applicant eligibility and the award of loan repayments, etc. SB 252: Psychiatric Treatments Psychiatric Treatments; Defining the terms “electroconvulsive treatment” and “psychosurgical procedure”; providing that only a physician may perform electroconvulsive treatment and psychosurgical procedures; prohibiting the performance of electroconvulsive treatment and psychosurgical procedures on minors, etc. Medicare Rules Update This email was sent by NBCC's Government Affairs office on 11/3/23: We are excited to announce that on Nov. 2, the Centers for Medicare & Medicaid Services (CMS) issued the 2024 Medicare Physician Fee Schedule (MPFS) final rule. This means that individuals who meet the MFT or MHC eligibility requirements embodied in the Final Rule can begin submitting their enrollment applications today via the Form CMS-855I application to be reimbursed for their services 22 | InSession- January 2024 | FMHCA.org
The MPFS is an annual Medicare regulation that lists the fees used by the program to pay providers for their services. It begins each year as a proposed schedule but does not become government policy until the final rule is published in the Federal Register. The MPFS also contains specific instructions for practitioners on how to enroll in the program. You can read the summary of its key provisions here.
Other Activities of the GRC in the Past Month This month, FMHCA's GRC has also: Formed a subcommittee that is working on an counseling degree program accreditation and NCMHCE pass rate tool (which will be shared with the 491 Board) Represented FMHCA at a the 491 Board meeting on 11/8 Met with the Chair of FCA's Public Policy Committee to discuss legislative priorities and FMHCA's efforts to educate members about issues impacting LGBTQI+ clients Met with the AAMFT Florida Family TEAM Leader to align legislative priorities for this legislative session Formed a subcommittee that's working on training members on lobbying activities Formed a subcommittee that has been assessing a request from FPA to endorse an approach to addressing mental health crises in schools Ethics Committee Committee Chair: Michael G. Holler, MA, NCC, CFMHE, CCCE, CCMHC, LMHC As usual, the Ethics Committee continues to take questions or concerns, regarding ethics from our professional population. There has been an interesting change in the presentation of these questions, as most of them have not been ethics questions, but continue to be legal questions regarding information that is in the statute (F.S. 491) and the rule (Chapter 64B4). In the past, these questions were frequently answered by the board, but they seem to have begun transferring them over to us. Last year we developed the FMHCA Ethics Consult Form. The Ethics Policy, which was established in 2021, changed to require that ethics consults be submitted in writing to the Ethics Committee. Consequently, the Ethics Committee will recommend that the ethics policy be amended to include the
ethics consult form. Consequently, I am again including the ethics consult form in this article. Mental Health Counselors, and Registered Interns who are FMHCA members will be required to submit this form in its entirety when submitting a request for an ethics consult. The policy is that it needs to be reviewed by the ethics committee, which takes some time. While I am not saying that, if you have a difficult situation, you should not attempt to contact us and see how quickly we can do this, please be realistic. I do realize that sometimes situations do come up and are thrown in your face and need to be dealt with as soon as possible. But we must be reasonable with our expectations as to how quickly things can get done. It is of note that the number of requests for ethics consults has dropped off considerably. As previously mentioned, the majority of the questions being posed at this time or not really ethics, or concert concerns, but statutory questions. If we can answer those questions quickly and affirmatively based on facts, we will certainly do so. Those do not necessarily require the review of the ethics committee, as the answers are in statute and are pretty cut and dried. I would encourage you to look at the statute and see if your answer is there first. If the answers are available clearly in the statute, we are happy to answer without the necessity of submitting the forms. However, statute is very clear most of the time, whereas ethics can be much murkier. We would also ask you to bare in mind that opinions rendered are not necessarily the opinions of the entire organization, as they are not voted on by the board, nor the general population. They are the best that we can do given the information at hand. And the better information you give us, the better we can render an opinion. If the information is very vague, we will not render an opinion. You also need to understand that FMHCA takes no liability for answers to questions. They are simply opinions rendered based on statute and expertise. Indigenous Mental Health Outreach Committee Committee Chair: William F. Gouveia, Ph.D, CCJAP This quarter the FMHCA Indigenous Mental Health Outreach Sub Committee continued partnering with the Clinical Directors of the Seminole Nation of Florida and the Miccosukee Tribe of Florida as well as NAMI, SAMHSA’s TTAC-Tribal Technical Advisory Committee, MMIWG-Murdered and Missing Indigenous Women and Girls, and NICWA -The National Indian Child Welfare Association. Dr. Gouveia recently joined The National Native American Law Enforcement Association, the organization that is responsible
for mental health interventions on Florida reservations. In addition, he represented the FMHCA at a recent webinar of the Society of Indian Psychologists exploring CBPR-Community Based Participatory Research focusing on the role of mindbody-spirit in mental health treatment that respects Cultural Tribal Sovereignty. Cultural sensitivity involves tribal activist and reactivist style mental health modalities. Trauma informed care (TIC) on the reservation should be evidence based practice focusing on “The Wounded Healer” in which the therapist shares experienced oppression that the client may have also experienced. Dr. Gouveia continues to mentor indigenous doctoral students researching mental health treatment options that are most effective with indigenous clients facing racism, substance abuse, sexual abuse, unemployment, anxiety, and depression. The committee continues communicating with indigenous studies programs at Florida universities. The subcommittee’s next quarter goals will include, in April 2024, a presentation by Dr. Gouveia who will partner with Dr. Mark Baez, Mohawk APA mental health therapist and Dr. Art Blume, the leading American Indian Fellow at the American Psychological Association, to present a webinar addressing the most effective therapeutic models to address the needs of indigenous clients facing substance abuse challenges. The webinar will include input from the directors of outpatient and inpatient substance abuse/mental health clinics of the Seminole Nation of Florida and the Miccosukee Tribe of Florida. Finally, as always, an invitation stands to an FMHCA member interested in serving as a member of the FMHCA Indigenous Mental Health Outreach Subcommittee. Participation is open to any person, either indigenous or non- indigenous, but simply interested in the issue of mental health outreach to the Florida indigenous community.
Get Involved! Joining a committee is a great way to participate in FMHCA and increase your presence in our community. We have several committees that we would love you to participate in! Here is a list of all our committees, their purpose, and their chairperson. We invite you to contribute your efforts as there are numerous opportunities for you to get involved and make a difference. For more information on how to participate right away, please contact the chair committee or fill out this form. InSession- January 2024 | FMHCA.org | 23
2 24
ANNUAL FM
FEBRUAR
Engaging minds since 1999! Join us back in Lake Mary for our 2024 Annual FMHCA Conference. Return home with up to 29.5* CE credits earned over 3 days of learning! (February 1st-3rd). The Florida Mental Health Counselors Association (FMHCA) is the leading organization advocating for mental health professionals in the State of Florida. Our objective is to provide education, legislative oversight, and networking opportunities to mental health professionals in our state (and sometimes beyond!). The FMHCA Annual Conference will be held on February 2nd-3rd with optional pre-conference workshops held on February 1st. This is the premier gathering for sharing ideas, discussing challenges, gaining insight, and finding solutions in the mental health field. Sessions will tackle the key policy issues impacting the profession today and provide valuable pragmatic advice across the full range of services offered by mental health professionals in both public and private practices. *Attendees have access to up to 21.5 CE credits in General Conference Sessions (2/2-2/3) and up to an additional 8 CE credits in the Pre-Conference Sessions on 2/1 (Additional Fees Apply).
Early Bird Rates End November 1st 2023
REGISTER NOW
24 | InSession- January 2024 | FMHCA.org
MHCA CONFERENCE
Y 2-3 LAKE MARY, FL
Pre Conference Workshops *Separate registration required. Not included in general conference registration EMDR Therapy Refresher Course We Are Memory Workers- Introducing Neurocise®, EyePointing™ & NeuroPointing™ - Guided Eye Movement Strategies to work with Traumatic Events & Memories Becoming a Sexually Competent Therapist: Function, Dysfunction, LGTQIA Affirmative Therapy, & Sexual Trauma Required State of Florida Clock Hours for Re-Licensure (Ethics, Medical Errors, Laws & Rules) The Clinical Mental Health Counselor’s Guide to Psychological Testing Qualified Supervisor Training (QST) General Conference Workshops (Saturday 2/3) Self-Care is Not an Option: Protecting Against Secondary Trauma General Conference Workshops (Friday 2/2) and Burnout Healing Emotionally with Self-Compassion and Laughter Integrating Mindfulness and Creative Expression to Foster Cultural Competence Clinical Intervention Emotional Resilience in Youth "They Won't Leave Me Alone": An Examination of the Link The Great Escape: Domestic Violence and Human Trafficking Between Domestic Violence and Stalking Exploring Therapeutic Presence and Polyvagal Theory to be a Cultivating Resilience in Clinical Supervision: Integrating SelfClinical Super Co-Regulator Care Practices to Protect Counselor Well-Being EMDR Protocols and Disaster Trauma: Hope for the The Essence of the HEART Model: Gestalt Underpinnings, SelfDisillusionment Dilemma Forgiveness, and Spiritual Awareness. Healing Sexual Trauma, A Awards Luncheon, Annual Membership Meeting, & Legislative Faith-Based Model. Update From Birth to Brilliance: Reconnecting with Your Highest Self Telehealth Update: Using Screen-Sharing to Reach Clients on a An Ethical Approach for Overcoming Trauma and Insecure Deeper Level Attachment Responses Impact of Generational Trauma on Immigrants, Refugees and The Seven Segments of Self-Love: A Practical Approach to Cross-Cultural Families Cultivating Self-Love and Mental Wellness Uncovering Hidden Gems: Using Psychodrama as a strengthFamily Play Therapy based tool for Post-Traumatic Growth HYPNOTIC EVENING - Taking Care of Trance™
InSession- January 2024 | FMHCA.org | 25
26 | InSession- January 2024 | FMHCA.org
Welcoming Dr. Kathie Erwin The Florida Mental Health Counselors Association (FMHCA) warmly welcomes Dr. Kathie Erwin as its new president, bringing with her a wealth of experience and a passion for making a positive impact in the field of mental health counseling. In a recent interview, Dr. Erwin shared insights into her background, her vision for FMHCA, and the key initiatives she plans to prioritize during her tenure. A Unique Journey to Mental Health Counseling Dr. Erwin's journey to mental health counseling took a unique path, starting with her involvement in campus radio and eventually, a successful career in major radio. The women's movement in the '70s opened doors for her, allowing her to work in the news business for a decade. However, her interest in counseling was sparked by stories of tragedy, where she found fulfillment in comforting and helping people. Eventually, her desire for a family led her to reconsider her career path, and she transitioned back to school, discovering a more fulfilling role in mental health counseling. Vision for FMHCA As the newly appointed president, Dr. Erwin envisions FMHCA as a dedicated and focused organization, much like a bee— productive and essential to the ecosystem. Her primary goal is to increase involvement with faculty teaching mental health counseling, recognizing them as the frontline educators for future professionals entering the field. Key Goals and Initiatives Dr. Erwin plans to strengthen FMHCA's presence in universities, emphasizing its role as a key organization for mental health counselors. Additionally, she aims to raise awareness of mental health issues and improve access to services, especially through regional directors and the Military Services Committee. Advocating for Mental Health With a superior Government Relations Committee (GRC) in place, Dr. Erwin wants to leverage regional directors to address specific needs in different areas of Florida. She highlights the importance of connecting with policymakers, GRC, and lobbyists to shape mental health policies that benefit both
counselors and clients.
Challenges and Opportunities While acknowledging the progress made with the counseling compact, Dr. Erwin recognizes the challenges ahead in some states. She emphasizes the importance of local engagement and encourages members to communicate with their local offices to shape mental health policies effectively. Strengthening Member Well-being Dr. Erwin sees FMHCA's role in supporting mental health professionals' well-being as crucial. She aims to expand the association's reach in local regions, providing opportunities that align with members' goals and contribute to their personal and professional growth. Professional Development and Continuing Education The president acknowledges FMHCA's strong Continuing Education system and emphasizes the convenience factor. Dr. Erwin encourages members to share their expertise and contribute to professional development opportunities. Engaging Members and Building Community Dr. Erwin values the input of FMHCA's staff and members, expressing her commitment to continue the association's successful initiatives while encouraging active participation. She envisions a growing conference where counselors can connect, share experiences, and support each other in a safe space. Keeping Abreast of Developments As a professor, Dr. Erwin emphasizes the necessity of staying current with the latest developments in the dynamic field of mental health. She pledges to ensure FMHCA members have access to the latest knowledge and resources. Closing Message to the FMHCA Community In closing, Dr. Erwin expresses gratitude to active members and extends an invitation to those not yet involved. She aims to showcase FMHCA as a leading organization, emphasizing the importance of collective effort and a long-term perspective to address the diverse needs of the mental health counseling community in Florida. InSession- January 2024 | FMHCA.org | 27
28 | InSession- January 2024 | FMHCA.org
The Aftermath: Homicide Survivors Bonding over Loss Professional Resource Article
Introduction
Prolonged Grief
Group work can help grievers better cope with their circumstances when used as part of treatment. Grief caused by tragic deaths may be better treated if survivors are offered support in a safe setting. The potential benefits of group work can come from helping the person cope with their grief and group participants relating to others in similar circumstance. Additionally, helping to break the negative stigma of grieving and how a person should address mental health issues is a potential benefit. This article will explain the group origin of five mothers surviving the death of their children and participating in a reciprocal/interactional model.
Prolonged grief is also known as complicated grief. According to Shear et al., (2011) it is a psychiatric disorder which one feels life has lost meaning without the deceased (as cited by Baddeley et al., 2015). Some common symptoms of prolonged grief are bitterness of the death, survivor’s guilt, and difficulty coming to terms with the death of the deceased (McInnis-Dittrich, 2020). Some studies define prolonged grief as symptoms being present for more than 12 months after the loved one’s death (Mutabaruka, Séjourné, Bui, Birmes, & Chabrol, 2012). According to Zakarian, McDevitt-Murphy, Bellet, Neimeyer, & Burke (2019), mourning for a death of a family member is set less than a year for a loss. This can vary depending on the person and the relationship. Depression and anxiety may accompany those who experience prolonged grief and increase chances of suicidal ideations (Heeke, Kampisiou, Niemeyer, & Knaevelsrud, 2019).
Group Work Group work is defined as bringing people together for a common purpose. In practice, it can begin formally, with several people coming together at a specific time and place for a specific goal. Groups can also be created informally, two or more people coming together, inadvertently. However, the origin of the aim of a group population is to address the socioemotional needs by accomplishing a goal. Group work may begin focusing on a person, ultimately benefitting the whole group in its environment (Toseland and Horton, 2013).
People who are likely to experience prolonged grief have experienced loss in the form of homicide, suicide, or a fatal accident (Baddeley et al., 2015). Zakarian et al., (2019) state, “homicide loss is distinct from other forms of bereavement in that it is violent, transgressive, and intentional” (p. 280). InSession- January 2024 | FMHCA.org | 29
Thoughts of reunification with the deceased are common themes experienced by people with prolonged grief (Baddeley et al., 2015). There is some evidence that these common themes are activating neuronal reward pathways in those with prolonged grief (Baddeley et al., 2015). An aspect that mental health professionals should consider while exploring prolonged grief is to discuss diversity and social justice issues associated with the literature regarding these concepts. People who experience prolonged grief and do not receive help may have increased mental health costs and less productivity due to the incident as time passes (Williams & Rheingold, 2015). The following factors play a role in prolong grief: age, traumatic events, relationship to the deceased, time since loss, depression, PTSD, anxiety, global psychopathology, avoidance, social support, attachment avoidance, and counseling experience (Heeke et al., 2019). Research suggests that African Americans are more likely to be affected by homicide-related prolonged grief, however, prolonged grief could affect anyone. African Americans are more adversely affected than other groups is a social justice issue. Effective treatment and intervention for prolonged grief is possible. According to Boelen, Olff, & Smid (2017), a preferred and successful treatment for prolonged grief is cognitive behavioral therapy (CBT). According to Zakarian et al., (2019), a person who finds meaning to the loss is more likely to adjust to their loss or not experience prolonged grief. Higher education levels could lead to lower levels for people who experience prolonged grief, than people who do not have higher education levels (Heeke et al., 2019). Religion was shown to help decrease the effects of prolonged grief (Heeke et al., 2019). Social support may increase resiliency towards prolonged grief (Heeke et al., 2019). Various Types of Grief In this group, each mother had various types of grief to include collective grief, secondary losses in grief, and disenfranchised loss. Collective grief is felt by many people within a community, city, county, or state (Elizz, 2022). Collective grief can have a larger reach such as a homicide being televised for the entire nation, or world to see. Secondary losses in grief are the aftermath of experiencing the primary loss (Elizz, 2022). An example of secondary loss could be the loss of income when the who earned the income for the household is no longer. Disenfranchised loss happens when a person minimize or don’t acknowledge the loss (Elizz, 2022), for example, a mother being told, “You can have another child”. The chart below shows the multiple grief experiences the mothers exhibited. In this group, eighty percent of the mother’s experience 30 | InSession- January 2024 | FMHCA.org
collective losses.
Forty percent of the mother’s experience secondary losses. Moving into Groupwork After several counseling sessions, it became apparent that giving the opportunity for each mother to share with one another in a group setting, was a great benefit. The process of starting the group first began with asking each individual mother how she felt about attending a group with others. One aspect to be confident in mothers attending was reassuring information shared in individual counseling remains confidential, and would not be a part of the group process. While groups are beneficial, some participants are not as comfortable with sharing within a group. Groups can help participants look inside themselves and relate to other participants who can verbalize the feelings they are having. (Kerslake, 2021) Each mother was eager to attend the group, as if she were relieved there were other mothers who experience the same thing. The facilitator set a ground rule that information the mother shared within the time of the group setting would be each mother’s choice. The group was in a public place, within the commonality of attending the same primary care physician’s office. Pre-group work for facilitators consist of mailing a letter to the home of the mother, a reminder phone call about the group was made prior to the group meeting, and later signing in when arriving at the group meeting. According to Zakarian et al., (2019), more African American mothers will face homicide loss due to the number of African American sons homicide rates are higher than other ethnicities. 80% of the mothers in this group identified as being a minority. Once the group started, two additional group mothers joined for a total of five active group participants. Two invited mothers, never attended a group, after receiving an invitation at least three times. It is assumed the two invited mothers were not ready to publicly talk about their child’s murder. Survivor’s Traditions Many mothers shared experiences and reactions from family, the community, and strangers within the group. Sometimes
people’s first reaction of the homicide overwhelmed the mothers due to people over asking about their grief or total avoidance of the “elephant in the room”. Traditions are ways to honor the mothers’ children who tragically died due to homicide; it is a way of allowing the victim’s memory to live on, while processing the idea of their child not being physically present anymore. Some mothers choose to celebrate their deceased loved one’s birthday or favorite holiday. They may take on the role of participating in an activity that their loved one took enjoyment in participating in. For example, one mother honored her son by giving food to people in the homeless shelter. The mother was eager to share the information to the group. The group could see the pride the mother took by the smile on her face. Another mother displayed American flags during Memorial Day to celebrate the life of her son. Most mothers believed attending the group was a helpful intervention and validating their thoughts and beliefs. Group attendance decreases blame, guilt, and shame associated with the death of the child. Significant days and events can also have an opposite effect as the grief cycle is constantly in process. Some mothers may avoid these specific occasions because of the pain it reminds them of while other mothers will over extend themselves to cover up the pain and longing of their child’s presence. Research shows the grief cycle does not always run its course in a specific order. Because of this, these special events can stir up emotions that the mothers really may not even realize they were still processing. Grief is an ongoing process however a mother’s coping skills will develop over time causing that mother to effectively handle their feelings as they come and go. Implications of Future Development with Groups The group participants brought educational opportunities and universal impact through their shared experiences over time. Gaining more insight into the pros and cons of this group focus on homicidal survivors. The more the mothers navigated through certain discussions the more they found it easier to express themselves while slowly regaining their power back. This group allowed the facilitators to become aware of the gaps that could be improved and expanded on over time. This homicide support group exposed different issues that, mental health professionals on the outside looking in, may have not considered to be barriers to these mothers. In real time, mothers shared going to the court house and leaving with many unanswered legal questions after attending court hearings. This group displayed how collective thinking helps direct mothers into a more positive accepting view of their own struggles. Through working together and discussing their thoughts,
mothers were able to work through some of the obstacles they faced while helping other mothers work through their own obstacles. This group gave mothers protective space to really examine their situation and use a different way of thinking to process issues that they were going through. From individual sessions to group sessions, these mothers were able to gain knowledge and healthy coping skills they could implement daily. While these mothers will never be able to go regain lives prior to the homicide of their child, but will be able to take what they have learned from the group and apply it, when it is needed. References Baddeley, J., Williams, J., Rynearson, T., Correa, F., Saindon, C., & Rheingold, A. (2015). Death thoughts and images in treatment-seekers after violent loss. Death Studies, 39(2), 84–91. https://doiorg.libproxy.troy.edu/10.1080/07481187.2014.893274 Boelen, P. A., Olff, M., & Smid, G. E. (2017). Traumatic loss: Mental health consequences and implications for treatment and prevention. European Journal of Psychotraumatology, 8, N.PAG. https://doiorg.libproxy.troy.edu/10.1080/20008198.2019.1591331 Cacciatoe, J. Thieleman, K., Fretts, R. & Jackson, L. B. (2021). What is good grief support? Exploring the actors and actions in social support after traumatic grief. (PlasS One, 16 (5), e0252324. Center for Victim Research. (2019). Losing a loved one to homicide: What we know about homicide co-victims from research and practice evidence. CVR Research Syntheses_Homicide Covictims_Report.pdf (dspacedirect.org) Elizz (2022). Types of grief and losses. Retrieved from elizz/caregiver.resources/types-of-griefand-loss Encyclopedia of Social Work (2013). Group Work Toseland and Horton Retrieved https://doi.org/10.1093/acrefore/9780199975839.013.168 Geown, G. Jun, S., Finger, S. and Rose, C. (2017). Towards effective group work assessment: even what you don’t see can bias you. Int J Technol Des Educ (2017) 27:165–180 Glanz, K., Rimer, B., & Lewis, F. (2008). Health behavior and health education. Theory, Research, and Practice (4th). Somerset, NJ:Wiley & Sons, Inc. Heart House Hospice. (2020). How to facilitate a grief group. RunningAGriefGroupToolkit.pdf (hearthousehospice.com) Heeke, C., Kampisiou, C., Niemeyer, H., & Knaevelsrud, C. (2019). A systematic review and meta-analysis of correlates of prolonged grief disorder in adults exposed to violent loss. European Journal of Psychotraumatology, 10(1), 1583524. https://doiorg.libproxy.troy.edu/10.1080/20008198.2019.1583524 Healy, P. (2017). The Attribution Fundamental Error: What is it and how to avoid it. Retrieved from online.hbs.edu/blog/post/the-fundamentalattribution-error Kerslake, R. (2021). 5 benefits of group Therapy. Retrieved from psychcentral.com/lib/benefits-of-group-therapy McInnis-Dittrich, K. (2020). Social Work with older adults: A biopsychosocial approach to assessment and intervention. Pearson Education, Inc. Mutabaruka, J., Séjourné, N., Bui, E., Birmes, P., & Chabrol, H. (2012). Traumatic Grief and Traumatic Stress in survivors 12 years after the
InSession- January 2024 | FMHCA.org | 31
Genocide in Rwanda. Stress & Health: Journal of the International Society for the Investigation of Stress, 28(4), 289–296. Psychology Today (2021). Empathy. Retrieved from www.psychologytoday.com/us/basics/empathy Scott, E. (2020, November 23). The different types of social support. Verywell Mind. How Do Different Types of Social Support Work? (verywellmind.com) SocialWorkin. (2021, December 3). 7-models of social group work. 7Models of social group work (socialworkin.com) Thoits, P. (1995). Stress, coping, and social support processes: Where are we? What next? Journal of Health and Social Behavior, (Extra Issue), 5379. United States Department of Justice ( 2022). Victim Impact Statements. Retrieved from www.justice.gov/criminalvns/victim-impact-statement Williams, J., & Rheingold, A. (2015). Barriers to care and service satisfaction following homicide loss: Associations with mental health outcomes. Death Studies, 39(1), 12–18. https://doiorg.libproxy.troy.edu/10.1080/07481187.2013.846949 Zakarian, R. J., McDevitt-Murphy, M. E., Bellet, B. W., Neimeyer, R. A., & Burke, L. A. (2019). Relations among meaning making, PTSD, and Complicated Grief following homicide loss. Journal of Loss & Trauma, 24(3), 279–291. https://doiorg.libproxy.troy.edu/10.1080/15325024.2019.1565111 Zisook, S., & Shear, K. (2009). Grief and bereavement: what psychiatrists need to know. World psychiatry : official journal of the World Psychiatric Association (WPA), 8(2), 67–74. https://doi.org/10.1002/j.20515545.2009.tb00217.x
Written By: Kaaren Royster, LMSW, Johnny Jefferson, LMSW, Meredith Lewis, PhD, LICSW-S Kaaren is a Licensed Masters Social Worker. She has experience with mental health, families and children in adoption, providing therapy to prisoners and people struggling with addiction. Ms. Royster is currently working at a state mental health hospital where she helps her clients become stable and find recourses that will help aide them in their community and live a healthy life. Johnny is a Licensed Masters Social Worker and has his alcohol and drug counselor certification. He has experience with addiction, assisting with recidivism, and community mental health with aspirations of empowering the community. Mr. Jefferson’s future goals are to obtain his clinical license in social work and to own his private practice. Dr. Meredith Lewis is a Licensed Clinical Social Worker in the State of Florida, Alabama and Tennessee. She has over 19 years of experience working with therapeutic foster care, veterans, family therapy, substance abuse, outpatient mental health, school system, unhoused individuals, aging population, non-medical home care, and teaching college courses. Dr. Lewis currently provides psychotherapy in the outpatient setting for people with anxiety, depression, and adjustment symptoms.
32 | InSession- January 2024 | FMHCA.org
InSession- January 2024 | FMHCA.org | 33
FMHCA's Favorites The Ultimate Reading Challenge Reading gets even more rewarding with 25 challenges that each come with a special prize. Complete the 25 challenges in any order, at any pace. Prizes include a laser-engraved bookmark, a mini notebook, greeting cards, and more. Partake in challenges, like rereading a book from your childhood, cooking a meal from a book, and asking for a recommendation at your local bookstore. Order yours here.
Meditation Box
Get every ounce of delicious juice from lemons and limes with an inventive easy-squeeze juicer. Doing double duty as a funnel, the built-in seed catcher prevents unintended additions to drinks and recipes, plus the whole thing folds flat for space-saving storage. Order yours here.
Create a calming oasis with this box filled with fine grains of sand that shift with your every inspiration. Order yours here.
Weighted Blackout Heating and Cooling Eye Mask Self-care begins with the eyes. Treat yours to some muchneeded downtime with an eye mask that delivers either hot or cool relief. Helps block out light and is believed to provide relief from eye strain, muscle tension, migraines, and more. Order yours here.
Hack Your Nervous System: Anti-Anxiety Deck A deck of cards filled with mindful practices and tools to cope with whatever life throws your way. Based on Polyvagal Theory, the leading view in psychology today of understanding, mapping, and regulating the nervous system. Choose from 60 different cards reduce stress and promote self-awareness, like holding, breathing, and tapping exercises. Order yours here.
Paint 100 Things to Your Pet Do For Your By Number Wellbeing You can create an If well-being hasn’t been a priority in your life, here’s a sign—or in this case, a poster. This artful design doubles as a fun list of ideas to nourish your body, mind, and soul. From watching the sunrise to writing a poem, each scratch-off square reveals a restorative task and sweet illustration. When you’ve completed them all, frame the colorful collection and let it inspire more mindful activities. Order yours here.
Blooming Book Magenetic Bookmark
This blooming garden of felt flowers marks your latest page while adding a vibrant splash of color to any bookcase. Order yours here. 34 | InSession- January 2024 | FMHCA.org
Every Last Drop Citrus Juicer
original masterpiece from one of your favorite pet pics. The process transforms your digital image from pixels to a step-by-step guide that even the most inexperienced artist can follow and enjoy. Order yours here.
Automatic Pan Stirrer
When a recipe calls for continuous stirring, put this automatic stirrer to work. Pick the battery-powered or rechargeable option, the latter of which lasts 3.5 – 9 hours, depending on speed, and takes about four hours to charge back up. Place it in your pan with any simmering or low-heat liquid, and go do the million other things you need to do. Order yours here.
Countertop Living Composter Designed scientifically, this odorless, biomorphic composter turns food scraps into fab fertilizer. Drop fruit and vegetable peelings, grain foods, and tea bags into a top opening. The worms-in-residence will eat at least half of their own weight of scraps per day. Spread the easily removed compost next to your plants or in pots, and watch those babies grow. Order yours here.
Shower Affirmation Set
Adjustable Height Auto-Timed Grow Light Give indoor plants the illumination they need to thrive with an adjustable, space-saving grow light. To use, simply insert the stake into your planter’s soil (it works for almost any size pot) and secure it with the clamp. The light should sit about 4” to 6” above your greenery. Set your light to shut off after 8, 12, or 16 hours with the auto timer. Order yours here.
Café Quality Milk Foamer
Renew and refresh your inner and outer selves with this spa-inspired affirmation bundle. Each deck includes 20 waterproof cards with sayings that inspire confidence and well-being, such as “I do not need outside validation. I am confident in my life.” Once moistened with water, mantra cards will stick to your shower wall with no adhesive or bleeding colors. Order yours here.
Self-Care Truth or Dare
A battery-powered, handheld device that helps re-create all your creamy, microbubble-filled favorite drinks. 100 truths or dares on 50 sticks—each side has Handheld milk frother powered by two AA batteries a thought-provoking question on one side and Includes two different attachments that produce various a challenging but achievable dare on the other. degrees of café-quality microfoam. Order yours here. Order yours here.
Pasta Art Kit
Follow the instructions to make your dough with the included 00 flour (the finest ground), then let your imagination run wild (or poke through the included booklet to jump-start your inspiration). Order yours here.
Collagen Foot Mask These vegan collagen masks will give your feet the love they deserve. Infused with vegan collagen, argan oil, and floral extracts, these socks will help restore softness and retain moisture to keep your skin soothed and hydrated. Just 15 minutes will nourish and hydrate dry, cracked skin. Socks feature tear-off toe tips for easy pedicure access. Order yours here.
Hotel Inspired Fragrance Machine Fill your space with scents inspired by the fragrances of luxury hotels. Control the diffuser via app and Bluetooth-enabled smartphone, and even set a schedule of when it turns on and off. Order yours here.
No-Charge Outlet Speaker The music never stops when you no longer need to power up. This super-compact Bluetooth® audio module plugs directly into an electrical socket. Order yours here. InSession- January 2024 | FMHCA.org | 35
36 | InSession- January 2024 | FMHCA.org
therapy room. Then came the day that a therapist in my practice who specializes in exposure and response therapy for obsessive compulsive disorder (OCD) and anxiety disorders told me that he had a client who was agoraphobic because everywhere she went, she was exposed to stimuli that reminded her of her exboyfriend. He created a hierarchy of exposure exercises involving those stimuli and systematically exposed his client until she habituated to them. One of the activities on her hierarchy involved using an app that integrates Google Street View into a virtual reality environment to walk around in front of her former boyfriend’s house until her anxiety level started to decrease. I thought his idea was brilliant, innovative, safer, more practical, and more confidential than having his client actually walk around outside her ex-boyfriend’s home. From that point forward, I dedicated part of my practice to researching, training, experimenting, and using VR technology for therapeutic purposes. Defining VR, AR, and MR Therapies, and How They Are Used for Therapy
Using Virtual Reality to Enhance Your Therapy Professional Resource Article
In 2018, I purchased my first virtual reality (VR) headset. I thought it would be fun if my brothers and nieces and nephews got headsets so that we could all play games together even though we lived in different states. What could be better than teaming up with family members to defend yourselves against zombie hordes while immersed in a virtual world? I quickly fell in love with the technology. I was moved by the vibrant colors, the landscapes, and the 3D sound that VR offers. I found some apps relaxing and others exhilarating—even scary. It didn’t take long for me to think about how I could use this technology in my therapy practice to accomplish things that would otherwise be difficult or even impossible to do in a
Amelia Virtual Care, a company dedicated to VR therapy, defines VR—and its close cousin augmented reality (AR)—as “sets of three-dimensional environments with which a person interacts in real time, generating a sense of immersion similar to real life.” VR replaces your field of vision with a fictional environment, and AR adds to your field of vision by imposing fictional objects into your otherwise “real” field of vision. If you see someone wearing a headset that completely covers their eyes, then they’re probably using VR. If, however, you see someone wearing glasses with space around the edges or using an app that imposes fictional objects into “real world” through the screen and the phone’s camera, they’re using AR. Mixed reality (MR), according to Meta, involves wearing a headset that covers your field of vision but also uses cameras on the outside of the headset to integrate “real” footage into your fictional environment. The shorthand term for all three—VR, AR, and MR—is extended reality (XR). I know, it sounds confusing, doesn’t it? But if you Google these terms and watch a few videos, it will only take a few minutes to gain a good understanding of these different technologies. Using VR With Clients I use VR in fve diferent ways in my therapy practce: InSession- January 2024 | FMHCA.org | 37
1. Relaxation training (aka somatic quieting) 2. Exposure therapy 3. Behavioral activation 4. Building social skills and social supports (i.e., socializing) 5. Psychoeducation Here is a brief overview of each of these approaches.
1. Relaxation training (aka somatic quieting) 2. Exposure therapy 3. Behavioral activation 4. Building social skills and social supports (i.e., socializing) 5. Psychoeducation Here is a brief overview of each of these approaches.
VR for Relaxation Training
VR for Relaxation Training
When teaching clients relaxation techniques, I offer to introduce them to VR in session. I use an app that allows clients to choose a relaxing natural environment, such as a tropical island, a green forest, a savannah, a snowy forest, the mountains, underwater, or even outer space. Clients can glide through the landscape, listening to nature sounds and watching animals poke around against the background of quiet, ambient music. There are also apps for guided meditation, breathing exercises, and even tai chi.
When teaching clients relaxation techniques, I offer to introduce them to VR in session. I use an app that allows clients to choose a relaxing natural environment, such as a tropical island, a green forest, a savannah, a snowy forest, the mountains, underwater, or even outer space. Clients can glide through the landscape, listening to nature sounds and watching animals poke around against the background of quiet, ambient music. There are also apps for guided meditation, breathing exercises, and even tai chi.
Many clients who struggle with guided imagery and traditional breathing exercises find these apps very helpful. The apps are also great for therapists to use for self-care during a break between clients or after a long workday.
Many clients who struggle with guided imagery and traditional breathing exercises find these apps very helpful. The apps are also great for therapists to use for self-care during a break between clients or after a long workday.
VR for Exposure Therapy
VR for Exposure Therapy
One commonality among all evidence-based psychotherapies is that they involve intentionally and directly encountering troubling issues. Our clients don’t recover by avoiding their problems and stressors—they do so by directly addressing them. Exposure therapy (ET) is defined by the American Psychological Association as “a psychological treatment that was developed to help people confront their fears.” ET is an evidence-based therapy commonly used for phobias, panic disorder, social anxiety disorder, OCD, posttraumatic stress disorder (PTSD), and generalized anxiety disorder. ET can be provided through:
One commonality among all evidence-based psychotherapies is that they involve intentionally and directly encountering troubling issues. Our clients don’t recover by avoiding their problems and stressors—they do so by directly addressing them. Exposure therapy (ET) is defined by the American Psychological Association as “a psychological treatment that was developed to help people confront their fears.” ET is an evidence-based therapy commonly used for phobias, panic disorder, social anxiety disorder, OCD, posttraumatic stress disorder (PTSD), and generalized anxiety disorder. ET can be provided through:
In vivo exposure: Exposing clients to aversive stimuli in “the real world” VR exposure: Exposing clients to aversive stimuli through VR technology Imaginal exposure: Prompting clients to imagine themselves encountering aversive stimuli Interoceptive exposure: Prompting clients to replicate the somatic symptoms of distress (e.g., rapid/shallow breathing) associated with exposure to aversive stimuli.
In vivo exposure: Exposing clients to aversive stimuli in “the real world” VR exposure: Exposing clients to aversive stimuli through VR technology Imaginal exposure: Prompting clients to imagine themselves encountering aversive stimuli Interoceptive exposure: Prompting clients to replicate the somatic symptoms of distress (e.g., rapid/shallow breathing) associated with exposure to aversive stimuli.
When I started examining meta-analyses (i.e., statistical analyses that combine the results of multiple studies exploring the same research question) related to the efficacy of exposure therapies, I assumed that the effect size (i.e., the magnitude of the therapeutic effect) of in vivo exposure would be superior to
When I started examining meta-analyses (i.e., statistical analyses that combine the results of multiple studies exploring the same research question) related to the efficacy of exposure therapies, I assumed that the effect size (i.e., the magnitude of the therapeutic effect) of in vivo exposure would be superior to
38 | InSession- January 2024 | FMHCA.org
the effect size of VR exposure, which, in turn, would be greater than the effect sizes of imaginal and interoceptive exposure. I was wrong. To date, I have not found a single meta-analysis that concluded that in vivo exposure was more effective than VR exposure. To this day, this perplexes me, but it is a testimony to just how effective VR therapy can be—exposing our clients to aversive stimuli through VR appears no less effective than exposing them to aversive stimuli in “the real world.” Don’t take my word on this. Visit scholar.google.com; type keywords such as “meta-analysis,” “virtual reality,” and “exposure therapy”; and check out the conclusions of various studies for yourself. Here are a few examples of VR exposure activities involving clients that I have incorporated into sessions: A client diagnosed with prolonged grief disorder and agoraphobia involving her son’s death by suicide and related avoidance used VR to repeatedly “travel to” and “stand at” places she was avoiding in her community because of troubling memories involving her son. Once her level of distress abated, she then started going out “in real life.” A client who wanted to discuss his traumatic experiences in his home country of Cuba was able to do so after using a VR headset to walk me through familiar places in his old neighborhood. A client with amaxophobia (i.e., fear of driving) “drove” using VR through multiple environments with varying difficulty levels. A client who was too anxious to get a vaccination was able to do so after multiple rehearsals using a VR headset. A client who was claustrophobic and avoiding an MRI scan was able to “attend” her MRI appointment in virtual reality and then did so in vivo. VR for Behavioral Activation According to the Society of Clinical Psychology, behavioral activation is an evidence-based approach to the treatment of depression that yields a strong level of efficacy and “seeks to increase the patient’s contact with sources of reward by helping them get more active and, in so doing, improve one’s life context.” There is no shortage of research on the impact of exercise on psychological well-being, and therapy rooms (whether virtual or in-person) are filled with clients who struggle to implement and maintain an exercise regimen. I have found that many clients who struggle with initiating and maintaining physical exercise find it much easier to do so when
using VR applications. When an object is flying through space and looks like it is about to hit you in the face, your natural tendency is to physically react. I use apps related to boxing, kung fu, baseball, and other physical activities to “trick” my brain into thinking that my body must react to avoid pending doom, and so have many of my clients. I can easily (or not so easily) burn 500 calories in 30 minutes using such apps, and these actvites are often much more rewarding than running on a treadmill in a room while going nowhere. VR for Building Social Skills and Support In April 2020, my county was on lockdown due to the COVID-19 pandemic. I put on my VR headset, and I opened an app that allows users to access virtual movie theaters. Scrolling through the list of theaters, I saw a “Star Trek Theater.” I’m a fan of the show, so I clicked on it. Within seconds, I found myself transported to a movie theater on a spaceship traveling rapidly through space. Looking ahead, I saw a giant screen projecting Lt. Commander Data and Captain Jean-Luc Picard interacting during a scene from an episode of “Star Trek: The Next Generation.” I turned to my right, and I saw the avatar of a woman, who turned to me and waved. We introduced ourselves, and I discovered that she was in South Africa. We enjoyed watching the show together. Neither of us felt alone that night. Many individuals with mental disorders struggle to connect in healthy ways with other people. VR headsets provide a medium in which they can meet and interact with people all over the world with common interests. I have assigned clients to meeting and interacting with people through their VR headset, or even joining groups in which they collaborate on a common goal, such as maneuvering through an escape room. Psychoeducation Well-intentioned therapists sometimes suggest to clients that they read a book or a website on a problem they’re struggling with or an approach that could be helpful. Many clients seem to have a natural resistance to “homework” assigned by their counselors. VR videos and exercises often provide clients with a more immersive and engaging environment than a book or website. VR and Diverse Populations My research on the efficacy of VR exposure therapy in a variety of countries and cultures yielded similar results as those focused on populations within the United States. For example, a quick search in Google Scholar yields successful results from studies using VR exposure therapy in Brazil, China, Iran, Ireland, Israel, Malaysia, Mexico, Norway, and South America, InSession- January 2024 | FMHCA.org | 39
just to name a few. The capacity for the human mind to experience change through immersion seems universal. Case Example: Therapeutic use of VR A colleague of mine, Dr. Csaba Osvath at the University of South Florida, created a video about his personal therapeutic use of VR for my students to watch (watch the video at htps:// youtu.be/JE3FuOILzUM). In this video, he discusses how he uses VR to address his fear of heights, self-care through artistic and creative endeavors, homesickness as an immigrant from Hungary, and grief related to his grandmother’s death. He has published an extensive volume of videos on his YouTube channel highlighting the use of VR for education and personal wellness, which can be accessed at htps://bit.ly/3FxYgIF Advantages of VR Therapy VR therapy is non-invasive and relatively safe (i.e., clients may feel at times like they are in danger, but they aren’t). Depending on the platform used, it is customizable and controllable by the therapist. For example, in a scenario involving public speaking, one platform I use (Amelia Virtual Care) allows me to control the size of the audience, how distracted or “bored” attendees in the audience are, and the degree to which audience members ask challenging versus supportive questions. In a driving scenario, I can control whether the weather is clear or rainy, how crowded the roads are, and whether there are emergency vehicles or traffic jams, allowing for me to incrementally expose clients to more challenging scenarios. Confidentiality and privacy can be more effectively safeguarded in VR. For example, clients using an in vivo approach who visit a crowded area with their therapist for a social anxiety-related exposure can be seen or overheard by others in public engaging with their therapist, but this is not the case when the exposure is conducted in VR. VR also enables LCMHCs and other therapists to recreate or reproduce anxiety-provoking circumstances that are difficult to replicate in vivo. For example, a therapist can’t safely or meaningfully recreate the experience of a device exploding and killing the friend of a military servicemember in Iraq, but they can do so in VR. Contraindications for VR Therapy Some clients experience motion sickness during VR therapy. This is especially true for clients who experience motion sickness in “real life” (e.g., on boats or in cars). Though many clients experiencing motion sickness eventually adjust with 40 | InSession- January 2024 | FMHCA.org
continued use of VR, some struggle to do so. According to Amelia Virtual Care, some clients also experience slight dizziness, blurred vision, eye strain, or headaches. A very small percentage of clients (i.e., 0.025%) may also experience seizures, nausea, or disorientation when using VR. Personally, I do not generally favor using VR therapy for clients who have gaming and fantasy addictions, because it seems counterproductive to introduce them to another medium in which gaming and fantasy are even more immersive. I also tend to avoid it with clients with compulsive or addictive use of pornography, as 3D VR pornography is readily accessible and may feel even more life-like. How to Get Started With VR Therapy You and your clients can access VR technology for therapeutic purposes in three ways: Using the client’s smartphone as a screen that can be inserted into a smartphone VR headset. VR headsets can be purchased inexpensively on www.Amazon.com for between $10 to $50, depending on the features you want. The client would download one or more VR apps on their phone, enable “VR mode” on their phone, and then insert their phone into the headset. You may find videos in the YouTube VR video library that can be used for exposure exercises. This is an affordable way for you and your clients to access VR for sessions and for therapeutic homework. Using Commercial VR headsets, which tend to range in cost from about $300 to as much as $1,000. A lot of people prefer models such as the Meta Quest 3 (released in October and priced at $500 to $650), Meta Quest Pro, or HTC VIVE, which are completely portable and do not need to connect to a computer or other device. One drawback to the use of commercial headsets is that they are not specifically designed for healthcare applications, so therapists cannot meet with clients in virtual space without potentially violating HIPAA/HITECH regulations and should therefore exclusively use the headset when the client is physically in the therapy office or as therapeutic homework instead of remote counseling. A company called Meta Wellness (htps://www. metawellness.space/), however, offers to rent or sell therapists a VR office in which they can meet with their clients in a HIPAA-compliant setting. Offices can be filled with objects for play therapy, the therapist’s logo on the wall, a basketball court outside allowing therapists and clients to “shoot hoops” while processing, and a beachside for walk-and-talk therapy, all without compromising confidentiality.
Using a VR headset and platform that is specifically designed for therapy, such as those offered by Amelia Virtual Care (www.ameliavirtualcare.com). This is a somewhat costly option for therapists, as it ranges from $250 to $350 a month with a minimum contract of 12 months. However, the Amelia platform offers therapists: Ownership of a VR headset for in-person sessions A range of therapeutic environments and exercises with a great degree of customization options The ability to assess progress using subjective units of distress (SUDs) Extensive and complimentary training opportunities and opportunities to interact with and learn from other VR therapists Client access to virtual environments for therapeutic homework between appointments Coaching on how to bill insurance for VR therapy at a higher rate than standard therapy (including the ability to bill for clients’ homework sessions when the therapist is not present) The capacity to track the client’s degree of sweat excretion as a biometric measure of physiological arousal The ability to monitor the client’s attentional focus when immersed in a VR environment, all in a HIPPAcompliant platform.
A Call for Counselor Competency The AMHCA Code of Ethics (htp://connectons.amhca.org/ events/publications/ethics) calls on LCMHCs to develop competency in the appropriate use of technology-supported counseling. VR therapy is an effective tool that offers a seemingly limitless arsenal of therapeutic tools, but few clients have access to it due to the shortage of LCMHCs who offer VR therapy. I’d love to see more of my colleagues providing helpful, potentially life-changing services through VR. I encourage you to explore the option, both personally and professionally. This article was re-published with permission from the American Mental Health Counselors Association’s Advocate Magazine. Written By: Aaron Norton, PhD, LMHC, LMFT, MCAP, CRC Dr. Aaron Norton is a Licensed Mental Health Counselor and Licensed Marriage and Family Therapist with 20 years of experience in the field. He is an Assistant Professor of Instruction at the University of South Florida's Dept. of Mental Health Law & Policy, the Southern Regional Director of the American Mental Health Counselors Association, and FMHCA's Government Relations Committee Chair.
InSession- January 2024 | FMHCA.org | 41
42 | InSession- January 2024 | FMHCA.org
Navigating the Psyche: A Counselors Guide to Veterans' Post-Service Transition Professional Resource Article
Imagine a soldier, let's call him John, returning home after years of service. He's seen the world but now faces a new challenge: reintegration into civilian life. This transition, often laden with emotional and psychological hurdles, starkly contrasts with the structured military environment he's accustomed to. John's story is not unique; it reflects what many veterans experience as they transition from military to civilian life. Adapting to Civilian Norms and Society The transition for veterans like John from the highly structured, predictable confines of military life to the dynamic, often unpredictable civilian world presents a unique set of challenges. Military life, with its stringent rules, routines, and hierarchy, offers a sense of security and stability. In contrast, civilian life, despite offering greater freedom, can initially seem chaotic and overwhelming to those accustomed to military discipline and order. In the military, social interactions are typically formal, governed by a clear rank structure and established protocols. The civilian world, in contrast, is characterized by more casual, egalitarian social and workplace interactions. This shift can result in confusion and unease for veterans, who must acclimate to a society where expressions of authority and respect are less rigid and more nuanced. Within the military's strict command hierarchy, individual decision-making is often limited. In civilian life, however, personal autonomy and self-determination are emphasized. This transition to making independent choices, devoid of the familiar military structure and guidance, can be daunting for veterans, potentially leading to uncertainty and apprehension
in their decision-making processes. Integrating into civilian society, veterans frequently encounter stereotypes and misconceptions about their military service. These misguided beliefs can fuel feelings of alienation and misunderstanding, creating barriers to seamless integration into civilian life. Mental health professionals play a critical role in helping veterans navigate these challenges, fostering understanding and acceptance in their new environment. The transition to civilian work culture involves adapting to a myriad of new norms—from dress codes and communication styles to perspectives on work-life balance and organizational hierarchy. These differences can be striking for veterans who are used to the distinct professional culture of the military, necessitating guidance and support as they familiarize themselves with civilian workplace practices. The shift from a primary identification as a service member to a multifaceted civilian identity is a profound and complex process. Mental health professionals are instrumental in assisting veterans with this identity transition, helping them to explore and integrate new roles and aspects of their personalities into their post-military lives. It is essential for both veterans and their support systems to understand that adapting to civilian norms and society is a progressive journey that demands patience and resilience. This adaptation is a gradual process of learning and personal growth. Mental health counselors are key in providing the necessary support, encouragement, and strategies to effectively manage the frustrations and challenges that arise during this transition period. InSession- January 2024 | FMHCA.org | 43
The Struggle with Family Reintegration Returning to family life can pose a significant hurdle for veterans transitioning out of military service. During their time in service, both the veteran and their family members evolve and adapt separately, creating potential gaps in shared experiences and understanding. Veterans might return home feeling like outsiders, struggling to fit into a family dynamic that has shifted in their absence. This disconnection can be profound and disorienting, leading to feelings of isolation, frustration, and misunderstanding. Effective communication is key in bridging the gap between veterans and their families. Counselors play a vital role in facilitating open dialogues, helping veterans articulate their experiences and feelings, and guiding family members in expressing their own changes and challenges during the veteran's absence. This process can help both parties understand each other's perspectives, promoting empathy and mutual respect. Veterans often return to find that roles within the family have shifted. They may struggle with changes in responsibilities or expectations, both as perceived by themselves and by their family members. Counselors can assist in setting realistic expectations and navigating these changed dynamics, ensuring a smoother reintegration process. For families of veterans dealing with PTSD or other mental health issues, reintegration can be particularly challenging. The veteran’s behavior and emotional state can impact family dynamics significantly. Mental health counselors must be adept at recognizing these issues and providing strategies and support not only to the veteran but also to the family members affected by these changes. Re-establishing intimacy and trust is another critical aspect of family reintegration. The emotional distance that may have developed during deployment can create barriers in relationships. Counselors can guide veterans and their families in rebuilding these connections, through activities that encourage bonding, shared experiences, and open communication. For many veterans, returning to their roles as spouses and parents can be challenging. They may need guidance in understanding the emotional and developmental needs of their partners and children, who have also experienced their own challenges during the veteran's absence. Counselors can provide resources and strategies to help veterans reconnect with their partners and children, fostering healthy family dynamics. 44 | InSession- January 2024 | FMHCA.org
The journey of family reintegration is often a gradual process that requires patience and resilience from all involved. Mental health professionals can support this journey by helping veterans and their families set achievable goals, celebrate small victories, and cultivate a supportive and understanding home environment. Creating Community and Social Connections Many veterans face a profound sense of isolation upon returning to civilian life. The tight-knit camaraderie and shared purpose experienced in the military are often absent in civilian settings, leaving veterans feeling disconnected and alone. This isolation can exacerbate mental health issues such as depression and anxiety. Therefore, facilitating the development of new social connections is crucial for their overall well-being and successful reintegration. One effective way for veterans to build connections is through engagement in community activities. Counselors can assist by identifying local groups, clubs, or organizations that align with the veterans’ interests or backgrounds. This can include veteran-specific organizations, recreational sports teams, volunteer opportunities, or hobby-based clubs. Participation in these activities not only helps veterans form new friendships but also fosters a sense of belonging and purpose. Peer support groups are another vital resource for building social connections. These groups provide a space where veterans can share experiences and challenges with others who have similar backgrounds and understand the nuances of military life. Such groups offer not just social interaction, but also mutual support, understanding, and a shared sense of identity. In today’s digital age, online communities and social networks can also be invaluable in helping veterans establish connections. Counselors can guide veterans towards reputable online forums, social media groups, and virtual meetups where they can interact with others, share experiences, and receive support, all from the comfort of their own homes. Involving family members in the community-building process can also be beneficial. Activities that include family participation can strengthen familial bonds and simultaneously foster community ties. Additionally, counselors can encourage veterans to actively participate in community events and initiatives, further facilitating their integration into the social fabric of their local area. Veterans may face barriers to social connection such as social anxiety, lack of confidence, or uncertainty about how to engage with civilians. Counselors can provide guidance and skills
training in areas such as communication, social interaction, and relationship-building to help veterans overcome these challenges. Mental Health Issues: PTSD and Other Concerns Post-traumatic stress disorder (PTSD) is a significant concern among veterans, often resulting from exposure to traumatic events during military service. PTSD can manifest in various symptoms such as flashbacks, severe anxiety, uncontrollable thoughts about the traumatic event, and emotional numbness. The impact of PTSD extends beyond the individual, affecting family dynamics, social relationships, and professional life. Recognizing the signs of PTSD is crucial in providing timely and effective support. Depression is another common mental health issue that veterans face. It can stem from the challenges of readjusting to civilian life, feelings of isolation after leaving the military community, or as a reaction to traumatic experiences. Symptoms may include persistent sadness, loss of interest in previously enjoyed activities, changes in appetite and sleep patterns, and difficulty concentrating. Addressing depression in veterans requires a nuanced approach that considers their unique experiences and the complexities of their transition from military to civilian life. In addition to PTSD and depression, veterans may experience a range of other mental health issues, such as anxiety disorders, substance abuse, and adjustment disorders. These conditions can be interrelated, with one exacerbating another, creating a complex web of psychological challenges. It is vital for mental health professionals to adopt a holistic approach in assessing and treating these issues, considering the full spectrum of the veteran's mental health needs. Effective support for veterans with mental health issues involves integrating various therapeutic approaches, including counseling, medication, peer support, and family therapy. Tailored interventions that address the specific needs and experiences of each veteran are essential. Mental health professionals must also be aware of the potential for cooccurring disorders and the need for comprehensive treatment plans that address all aspects of the veteran's well-being. Early recognition and intervention are key in managing mental health issues among veterans. Encouraging veterans to seek help and providing accessible, veteran-centric mental health services can significantly improve outcomes. Mental health professionals play a critical role in creating a supportive environment where veterans feel understood and safe to discuss their challenges.
Transition Challenges for the Post 9/11 Veterans About one in four veterans report finding the transition to civilian life to be at least somewhat difficult. This challenge is notably more pronounced among post-9/11 veterans compared to their predecessors. The reasons for this increased difficulty are multifaceted, including changes in the nature of warfare, societal shifts, and the unique experiences faced during service post-9/11. These veterans often return to a society that may not fully understand or relate to their experiences, leading to a sense of disconnection and difficulty in adapting to civilian norms and expectations. Veterans who have had direct combat experience or have been exposed to emotionally traumatic events face particularly daunting challenges in their transition. Exposure to lifethreatening situations and witnessing the horrors of war can lead to lasting psychological impacts, including post-traumatic stress disorder (PTSD). These experiences can profoundly affect a veteran's ability to readjust to civilian life, often necessitating specialized support and resources to cope with the lingering effects of trauma. Despite rigorous preparation and training for active duty, only about half of the veterans feel that they are adequately prepared for civilian life. The skills and experiences gained in the military do not always translate seamlessly into civilian contexts, leaving many veterans feeling underprepared for the challenges they face upon their return. This gap in preparedness can impact their ability to find employment, integrate into new communities, and adapt to a non-military lifestyle. Post-9/11 veterans are more likely to encounter financial and health-related challenges compared to those who served in earlier periods. These challenges include higher instances of substance abuse and difficulties in managing finances, such as paying bills. The reasons for these increased difficulties may include the economic climate, the nature of injuries sustained in more recent conflicts (such as traumatic brain injuries), and the complex process of navigating veterans' benefits and healthcare systems. These financial and health struggles can add significant stress to the already challenging transition process, underscoring the need for comprehensive support services tailored to these veterans' specific needs. The transition from military to civilian life presents a spectrum of challenges for veterans, particularly for those who served post-9/11. These challenges encompass emotional, psychological, and practical aspects, highlighting the need for targeted support and resources to aid in their reintegration into civilian life. InSession- January 2024 | FMHCA.org | 45
Carl Jung's Theories and Veterans The Collective Unconscious and Veterans' Experiences Carl Jung's concept of the collective unconscious offers a unique perspective on the shared experiences of veterans. This theory posits that universal archetypes and symbols are embedded in humanity's collective unconscious. By exploring these elements, counselors can gain deeper insights into the common psychological experiences of veterans, such as themes of heroism, sacrifice, and the warrior's journey. Understanding these shared archetypes can help counselors connect more profoundly with veterans' experiences and offer more resonant support and guidance. Individuation – A Journey of Self-Discovery Jung’s concept of individuation, the process of becoming aware and integrating different aspects of the self, is particularly relevant for veterans transitioning back to civilian life. This journey involves reconciling the military persona with their civilian identity, a process that can be both challenging and enlightening. Through individuation, veterans can explore and reconcile their experiences, values, and beliefs acquired in the military with their personal goals and identities in civilian life. This self-discovery and integration can be crucial for their mental health and overall well-being, aiding them in finding a sense of purpose and identity beyond their military role. Four Psychic Functions – Understanding Veterans' Mental Processes Jung identified four primary psychic functions: thinking, feeling, sensation, and intuition. Each individual tends to favor one or two of these functions, influencing how they perceive and interact with the world. For veterans, understanding which of these functions they predominantly use can be enlightening. Counselors can employ this framework to tailor their therapeutic approach, addressing the veteran's mental processes in a manner that aligns with their dominant psychic functions. This personalized approach can enhance the effectiveness of therapy, helping veterans process their experiences and emotions in ways that resonate with their inherent cognitive and emotional styles.
resolving them, which is especially beneficial for those grappling with PTSD and other trauma-related conditions. The Role of Religion and Spirituality in Veterans' Lives Many veterans find solace and identity in their religious beliefs and spiritual practices. Jung's theories, which often explore the role of spirituality and religion in the psyche, can offer a valuable context for understanding this aspect of a veteran's life. Integrating these beliefs into the counseling process can provide a more holistic approach, respecting and utilizing the veteran’s spiritual framework as a source of strength and healing. This consideration can lead to a more profound and meaningful therapeutic experience, facilitating deeper personal growth and healing. Carl Jung’s theories provide a rich and versatile framework for understanding and supporting veterans in their transition back to civilian life. From the exploration of shared archetypes to the personal journey of individuation and from understanding their mental processes to integrating their spiritual beliefs, Jung’s concepts offer valuable tools for counselors working with veterans, enabling a more empathetic, personalized, and effective therapeutic process. Ultimately, providing culturally competent care to veterans requires a deep understanding of their unique experiences and challenges. Integrating Carl Jung's psychological theories into counseling practices can offer a profound and empathetic approach to supporting these brave individuals in their transition back to civilian life. As mental health professionals, it is our duty to guide them with the utmost care, respect, and expertise on their journey towards healing and integration. Written By: Maria Giuliana, LMHC, BC-THP, Veteran Maria (she/her) is a Board Certified Tele-Mental Health Provider, and Certified Wellbeing Specialist. With licenses in both Florida and Iowa, Maria has a rich background, having served as a 20-year Retired Navy Veteran. As the founder of Beyond The Matter Counseling and Consulting Services LLC, Maria provides virtual counseling services in
Jung's Approach to Psychoanalysis in Counseling Veterans
Florida and Iowa. Her dedication to mental health extends
Jung’s psychoanalytical methods, which emphasize exploring the unconscious mind, can be particularly beneficial for veterans dealing with complex emotional and psychological issues. This approach can help uncover and address deeprooted traumas, fears, and conflicts that may be influencing their behavior and emotional state. By bringing these unconscious elements to the surface, veterans can gain a better understanding of their internal struggles and work towards
beyond her practice, as she actively serves as a board member
46 | InSession- January 2024 | FMHCA.org
and Military Services Committee Chair at FMHCA. Specializing in supporting Military Veterans and their families, as well as addressing the unique concerns of the LGBTQIA+ community, Maria creates an inclusive and safe space for all. As an Innate Wellbeing Specialist, Maria adopts a holistic approach that fosters lasting changes and empowers individuals to achieve and maintain emotional well-being beyond their sessions.
FMHCA 2024 WEBINAR SERIES
Join in on one of our upcoming webinars! Topics include: Psychological Testing, Compassion Fatigue, Family Estrangement, and more! Register Now
InSession- January 2024 | FMHCA.org | 47
Newer movements toward positive psychology and Third-wave therapies, as well as strength-based therapies such as solutionfocused therapy and narrative therapy, can give clients and practitioners a different frame for pathology. While understanding pathology is critical to effective therapy, the newer therapies quickly focus on such practices as radical selfacceptance, and uncovering strengths, inherent virtues in action. This can give the client as well as the practitioner a more efficient and confident outlook toward problem resolution. While some practitioners might view therapy from a rigid pathology or a rigid focus on strengths and capabilities, this writer argues that a synthesis of both frames are necessary for most effective practice. As therapists we must understand the condition the client presents to us with, and the intricate web of dynamics that holds it in place.
A Balanced View of Pathology and Client Capability Professional Experience Article
Much of psychological history focused on what is wrong with people. Before the turn of the century, much attention began to be paid to what is right with people. Diagnosis and a focus on client pathology can assist greatly in many ways. It can provide professionals with an understanding of the client condition and best treatment practices for it. On the client side, diagnosis can validate legitimacy for their suffering, and can also give the client clear avenues to learn more about a condition and get other forms of help for it. At the very same time diagnosis can begin a self-fulfilling prophecy both for client and practitioner. Many diagnoses are assumed to be temporary, yet they can follow a client around for years. Clients may take on the diagnosis as a part of their identity and perceive life through that lens, thus maintaining that focus. For practitioners, diagnoses such as Borderline Personality Disorder, which is eventually treatable and resolvable, can bias the practitioners outlook toward the client’s presentation in session. 48 | InSession- January 2024 | FMHCA.org
Clients however, very often misunderstand what a diagnosis is. Clients very often apply their own meaning to a diagnosis without the full knowledge the professional has. In fact, many teens in the modern Zeitgeist apply a self-diagnosis as a form of gaining identity. Much of what has been learned from the mental health awareness revolution integrated into society has been the easily misunderstood due to its emphasis on pathology. Many clients will come in to therapy already having labeled themselves falsely with a diagnosis due to a lack of understanding, or with an old diagnosis has become an identity despite the passage of time and symptom change. Immediate psychoeducation to clear up a client misunderstanding can help. Also, the practitioner can inwardly process the details of pathology, yet outwardly present information in the form of strength identification, the use of inherent virtues (even in vain) and client positive intention for “dysfunctional” symptoms. Symptoms are often old coping strategies that have been relied on for so long they have become reflexive kneejerk parts of the more reactive part of the brain. As a result, the symptoms happen before the client can rationally process other behavior choices. As well, what are symptoms other than client reported or observable common human behaviors, thoughts and reactions to visual, auditory, olfactory, gustatory and kinesthetic stimuli? As the Greek philosopher Aristotle opined, it is not a virtue in itself that defines an action as helpful or unhelpful, but whether the action is in moderation. Too much or too little of any common human tendency can become a symptom that begins to detract from the quality of life. Yet with client questioning and encouragement, clients can begin to be aware of their original positive intention of a once
trusted coping behavior that has now stopped working so well. For example, in a dangerous home environment, the ability to stay in a switched-on anxious brain can save a life. Yet later on in life, this trusted reflex becomes a detractor from quality of life when it is not needed anywhere near as often. Clients who become aware of the positive intention of a symptom or symptom cluster often stop judging themselves harshly for not resolving the issue on their own. As well, this takes away much of the inner resistance to symptom resolving behaviors as the reason to continue the symptom is brought to awareness.
Written By: Thomas Hofmann, PhD, LCSW, LMFT, NBCFCH, BC-TMH, ACSW Thomas is currently the Director of Behavioral Health Training and Education for Lee Health in Southwest Florida. He has over a decade of experience in creating, managing and teaching in a clinical mental health master's degree program. His clinical experience covers many inpatient and outpatient settings over time, including six years of outpatient clinic supervision. He is a licensed therapist in Florida.
InSession- January 2024 | FMHCA.org | 49
Building Endurance: Sustaining a Mental Health Private Practice Group for Decades Professional Experience Article
In the dynamic landscape of healthcare, sustaining a mental health private practice group for decades is a formidable yet achievable goal. Success in the business of metal health requires not just clinical expertise but also strategic planning, business savvy, long working hours, tedious amount of reading on latest insurance changes and state regulations and a deep understanding of the evolving needs of both clients and clinicians. This article explores basic key strategies for maintaining a thriving and resilient mental health practice over the long term, drawing from my personal experience since 2000.
involves encouraging and supporting continuous professional development among staff and being open to integrating new treatment modalities and technologies.
My Journey in Private Practice
Prioritize High-Quality Patient Care
Having been in private practice since 2000, serving initially the Miami Dade County area, I have witnessed firsthand the myriad of challenges and opportunities in this field. The practice later expanded to Orlando, Florida, marking a significant milestone in our growth trajectory. The subsequent expansion into Georgia and Texas, necessitated by acquiring licensure in these states, was a strategic move to broaden our reach and impact. This journey has been both enriching and enlightening, shaping many of the insights shared in this article.
The core of sustaining a practice is the quality of care provided to clients. This means not only employing evidence-based treatments but also ensuring that each client feels heard, respected, and valued. Practices should strive for excellence in client care, which in turn fosters client loyalty and referrals – key components for long-term sustainability.
Embrace Adaptability and Continuous Learning The field of mental health is constantly evolving, with new research, therapies, and methodologies emerging regularly. Practices that prioritize ongoing education and adaptability are better positioned to offer effective, up-to-date care. This 50 | InSession- January 2024 | FMHCA.org
Cultivate a Strong Team Culture The backbone of any successful practice is its team. Fostering a supportive, collaborative, and inclusive work environment is crucial. This includes regular team meetings, opportunities for peer supervision, and creating a culture where feedback is welcomed and valued. A positive workplace culture not only enhances staff retention but also attracts top talent.
Diversify Services and Client Base Diversifying the range of services offered can help a practice weather economic fluctuations and changes in demand. This might include offering group therapy, workshops, teletherapy services, or specialized treatments. Similarly, catering to a diverse client base can provide stability and reduce reliance on a single demographic or referral source. Effective Financial Management
Sound financial management is critical for long-term sustainability. This includes prudent budgeting, effective billing practices, and exploring multiple revenue streams such as insurance reimbursements, private pay, and possibly sliding scale fees. Regular financial reviews can help identify areas for growth and cost-saving opportunities. Invest in Marketing and Community Presence Building a strong brand and maintaining a visible presence in the community are essential for attracting new clients. This can be achieved through a combination of digital marketing, community outreach, and networking with other healthcare providers. An effective online presence, particularly in the era of social media, can significantly enhance a practice’s reach.
only protects the practice legally but also reinforces its reputation as a trustworthy and credible institution. In conclusion, sustaining a mental health private practice group for decades is a multidimensional endeavor that requires a balance of clinical excellence, effective business strategies, and a focus on the well-being of both clients and staff. By embracing adaptability, fostering a strong team, prioritizing quality care, and maintaining ethical and financial diligence, a practice can not only survive but thrive in the long term, making a lasting impact in the field of mental health. My journey, which began in Miami Dade County and expanded into Florida, Georgia, and Texas, stands as a testament to the resilience and adaptability necessary for such endurance.
Address Burnout and Foster Resilience
Written By: Luis Hines, Ph.D., D.Min., LMHC, LPC
Mental health professionals are not immune to the stresses and challenges of their work. Practices that prioritize the well-being of their staff, including initiatives to prevent burnout and promote work-life balance, are more likely to retain experienced, skilled clinicians.
Dr. Hines is a primary owner of Dr. Luis Hines
Emphasize Ethical Practices and Compliance
(worldwide Christian organization), provider for NFL and
Adhering to high ethical standards and staying compliant with all relevant laws and regulations is non-negotiable. This not
resident clinical counselor for Antioch Missionary Baptist
and Associates centralized in Coral Gables, Florida. Dr. Hines holds licensure in Florida, Georgia and Texas and sits on several national and boards and committees. Dr. Hines is served currently the Director of Counseling Service for Global United Fellowship
Church (Miami, FL) and AMHCA Director At-Large.
InSession- January 2024 | FMHCA.org | 51
52 | InSession- January 2024 | FMHCA.org
InSession Magazine will be back in April! To contribute an article, please do so here by March 15th Questions and ad inquiries can be emailed to naomi@flmhca.org