Anthony Centore

While some counselors today are reaching for their pens and notepads, others are reaching for their laptops. With the help of Electronic Health Record (EHR) and Practice Management (PM) software, counselors are trashing their metal filing cabinets and announcing that they’re “going green!” Eco-friendship aside, a good EHR-PM program can help a practice to organize files, improve treatment planning, measure client sessions and attrition, monitor client balances and accounts relievable, track authorizations, file insurance claims, schedule appointments, and more…or at least that’s what it says on the box!

The technological learning curve aside, counselors today face numerous roadblocks implementing EHR-PM software into their practices. This column will address those roadblocks, and share the experiences of several counselors’ journey into the paperless.

Roadblock One: The Cost

“Go paperless and earn up to $44,000 in incentives.” This is the sales pitch of many EHR software companies today. And it’s true. In 2009, President Obama signed into law the Health Information Technology for Economic and Clinical Health Act (HITECH). Under HITECH, qualified providers can receive up to $44,000 in Medicare bonus incentives if they demonstrate the “meaningful use” of an EHR system.

But wait…did you catch that? Medicare. Counselors can’t accept Medicare! In fact, even if they could, a “qualified provider” is a physician—not an LPC. Unfortunately, the HITECH stimulus package doesn’t account for mental health professionals trying to turn the electronic corner. Worse yet, the generous incentives have served to inflate the price of EHR programs across the board. This makes sense when considering that even if an EHR-PM software suite costs $50,000, a group practice of four MDs will still turn a 6-figure bonus for implementing the EHR-PM software.

Journey into the Paperless

Wendy Molinaroli, a counselor in Charleston SC, is no stranger to EHR. In fact, she’s been looking for suitable software for her solo private practice since 2000, and has logged hundreds of hours in the search. One of her findings: most EHR-PM programs are priced too high for counselors. For example:

• Amazing Charts: $1999 per year for the first provider, $995 for each additional provider.
• All Scripts: $699 per month per doctoral-level provider, $474 for masters level.
• Soapware: $3000.00 per year, per provider.
• Praxis: $6995.00 per year for the first provider, $2995.00 for each additional provider.
• AdvancedMD: Nearly $1000 per month, per provider.

What’s notable is that many programs aren’t just expensive; the prices are incompatible with counseling practices of any size. Specifically, the rates are so high on a per-user basis, that even if a group counseling practice made infinity dollars, the practice still would not be able to afford the per-user cost because masters-level clinicians don’t bill enough to justify a software fee of several hundred (or thousand) dollars a month (this is particularly true for practices that include part-time clinicians).

Roadblock Two: Software Problems

Fred Porter*, owner of a New England psychiatry practice paid thousands to get started with his web based EHR-PM program. But when he loaded his patient list of several thousand into the system, it slowed to a crawl. Fred explains, “We would watch the appointment calendar load, one line of text at a time. It could take 10 minutes to check a patient in.” In addition, there were state specific regulations for filing insurance claims that the out of state software vendor wasn’t used to—so claims were getting denied. And so began a ritual for Fred, of finding bugs and calling the software company to try and get them fixed. Fred explains, “If you deal with a larger company like Siemens you won’t have delays, and they have experience with practices nationwide; but a small practice can’t afford that. So I’d call them and say ‘this or that doesn’t work’ and they’d say they’d look into it—it felt to me like I was teaching the vendor.” A month into his implementation, Fred received an unexpected bill in the mail for customer support! “I couldn’t believe it—I’m helping them fix their software. But what are you going to do? Once you’ve committed to a program, had it installed, trained your staff—it’s a nightmare to switch. They not only have all your data, all your insurance claims are in their software!”

It’s hard to believe the lack of viable programs when an Internet search will turn up pages of results. In the last year, Wendy and I have both test-driven dozens of programs, sharing our notes (and disappointments) about each. Names have been removed to protect the guilty, but the problems are numerous, pervasive, and render many EHR-PM software options on the market unusable. Here are some of the problems we encountered:

• Help tickets go unanswered
• Software has downtime
• Software is cripplingly slow
• Broken features
• Basic features missing
• A difficult to use interface
• Billing claims sent improperly, or not at all
• Billing claims sent repeatedly (in error)
• Reports are faulty, or altogether unavailable.

Wendy explains, “Some software is okay on the notes [EHR] side, but the practice management and billing side is poor. Some software is the other way around. No one seems to have a complete usable package.”

Making it Work

Ryan Neace, a Central VA based counselor, has gone paperless without the use of EHR software. In his practice, every therapy office is assigned its own iPad, on which is loaded a simple note-taking program called “smartNote,” available in the iTunes app store, for $2.99. Ryan explains, “The client files are password protected. Besides that, the application couldn’t be more basic. It can’t run reports, such as sessions booked, and it has no billing capabilities whatsoever. The program works for us because we don’t need much in the realm of reporting, and because we’re a cash-only practice.”

Counselor Wendy is on her fourth software suite in as many years. Her first software had “updating and synching” problems, the second company went out of business, the third software never ran properly (according to Wendy, “they blamed Bill Gates for their software being crappy”), and as for the fourth program, the note-taking side works well, but the PM side has so many serious billing problems that Wendy is being forced to switch software vendors again. Wendy laments, “Even after all my searching, I haven’t found a single software program I could recommend to counselors!”

Fred has stuck it out with his software provider through what he describes as “a year and a half of struggles.” The PM side of the software is working, but he has yet to begin using the EHR. Fred explains, “because the financials weren’t working, I wasn’t going to tie myself to the EHR. I’m already paying for it—I’ve just been reluctant to use it.” He says he feels fortunate that his software developer ‘got it’ and was able to make adjustments to the software. He plans to begin using the EHR soon, and is excited about some other features, such as automated reminder calls. Fred says “Reminder calls keep the no show rates down to 5%, but it takes an enormous amount of resources for receptionists to manually make each call.” As a final issue for Fred, even choosing a small EHR-PM vendor, one ad-on feature is still out of his budget. Fred says, “The electronic prescription writing is a bit expensive. It’s $60 a month per provider. I have 12 prescribers, but some only work one day a week, so I can’t justify the cost.” Still, Fred is positive about the prognosis, saying, “We’re getting there. Slower than I had hoped but we’re getting there…”

As for my practice, we began using EHR-PM software in 2009. We thought that an EHR system would help us to better organize records, and would make records easier to retrieve when clients request them. As director, I also saw value in having a solution that combines note taking with insurance billing.

In choosing an EHR-PM platform, our team sorted through what features would be most helpful for our practice. We wanted to find a web-based program that didn’t need installation on every office computer. This eliminated many options. Price eliminated others. Trying demo-versions of various suites eliminated even more, as many look like a flashback to DOS. In the end, we found a low cost program called “Office Ally” (Cost for EHR is $29.95, plus $15 per provider, per month. The PM software is basically free).

The team was excited about the program. However, once implementation began, the excitement waned. The software was not nearly as user friendly as we had hoped, and the learning curve was brutal. There is a lot of dialogue during the training process that sounds like: “you need to click here, then here, then click the drop down menu here, and ignore those sections there because those features don’t apply to us.”

Today, several years into our Office Ally subscription, our staff still dislikes it, as does our in-house billing department, who warns that the software will become decreasingly able to meet our needs as the practice grows. Also, it only works well on Internet Explorer, and it has regular bugs, crashes, and downtime.

In an attempt to phase out Office Ally, in 2011 we tested a new software program with a handful of staff. While the notes side worked well, the PM side was wrought with problems. We are now in the process of implementing a third software program. This time, the practice purchased a higher-priced solution, with hopes that it will lead to better outcomes. In the next year we will be spending north of $10,000 on EHR-PM software (we’ll let you know how it goes).

Despite the troubles, overall EHR-PM software has helped the practice. Note taking has improved, as has the organization of client files. We can view a history of sessions at a glance, and how much has been paid to each clinician from insurance and co-pays. It’s also a nice perk not to have a growing mountain of filing cabinets crowd the office.

No One’s Missing the Boat

Sometimes it’s not worth being at early adopter. As someone who has spent hundreds of hours searching for and testing EHR-PM programs, it’s infuriating to know that at some point in the future—perhaps even soon—there will be a clear industry leader. Choosing software will be quick, easy, and maybe even affordable. So, if you feel like you’re missing the boat on EHR–PM software, you’re not. The boat isn’t even in the water yet!

*name changed

Anthony Centore is a counselor, and helps other counselors build successful practices. For more information on private practice and insurance panels go to http://thriveworks.com .

Andrea Holyfield

So I have a bold statement to make; so bold in fact that I am slightly hesitant about voicing my opinion on the matter. When I let these words trickle off my lips I find myself covering my mouth and looking around nervously to see if anyone caught them, but oh well. It’s time to come out of the closet with my beliefs. Who am I if I am not at least honest? Here we go… I think that I have one of the most important jobs in the world and I think EVERYONE should have a Career Counselor.

I mean I’m not sure how you define important, but when I look at my scale of importance my responsibilities are looking mighty heavy. Let’s examine why I believe that I have one of the most important jobs in the world:
1. The economy is bleak. We’re frequently reminded about the unemployment rate and the declining amounts of wage-earning opportunities afforded to American.Now more than ever people are looking for ways to support their families without totally burning themselves out. A major role of a Career Counselor is to assist a client in navigating options and making a career choice that works for their unique needs.
2. Sometimes work sucks. Partly because so many of us are working outside of our passions, natural skills set and desired environments, many people do not enjoy their work. USA Today published a study in January 2010 that revealed that 55 percent of Americans were dissatisfied with their work. Fears about the economy and lack of opportunity keep many people in positions that cause them mental stress. Stress can manifest itself in a variety of emotional and somatic discomforts. A Career Counselor can assist those millions of Americans with developing coping skills and even transitioning into more rewarding opportunities.
3. The expectations put on today’s mothers are extraordinary. In 2008 64 percent of mothers with children under the age of 6 and 78 percent of mothers with children ages 6-17, were in the labor force according to a report developed by the U.S. Congress Joint Economic Committee. This startling number just confirmed for me that there are a lot of mommies pulling daily double shifts. I’m one of those women. I always joke that I leave my 9 – 5 and head to my 24/7. Juggling caregiving responsibilities, work, parents, relationships, church and community involvement and activities can be extremely taxing. It is imperative that all of these workers have the proper resources to manage their responsibilities or else everyone suffers. The world is better off because Career Counselors are there to offer assistance.
4. People just don’t know. Most people, even after gaining years of academic theory and knowledge, need help understanding how to make a living off of their skills. I am constantly tickled by the question, “You mean someone will pay me to do that?” Where would the world be without me and my colleagues out there assisting in career excavations with poor lost souls across the planet?
5. I save lives. I know, I know. I don’t save lives in a Dr. McDreamy, Grey’s Anatomy kind of way, but finding meaning in your work has been proven to definitely improve the quality of life for individuals. I have had clients on the brink of a mental breakdown due to their jobs. I have worked with women who were so overwhelmed by work and life that they were severely depressed. I have worked with clients who were participating in potentially damaging behavior because of the unhappiness that they were experiencing related to work. When their path is uncovered and they can sleep, digest food, stop taking medication for ulcers and headaches, spend quality time with their children they discover a life anew. Career counselors do that. Yes. We rock!

If done right career counseling is not only personal counseling, but one of the most important jobs on earth!

Andrea Holyfield is a counselor specializing in career counseling and womens’ empowerment. For more information go to www.LiveWellCPS.com

Nancy White

Almost twelve years ago I was given the opportunity to participate in planning the City of Kansas City, Missouri’s mental health court. It was originally designed for the mentally ill, who had been charged with city ordinance violations in Kansas City, Missouri. The program has expanded to include low level felonies from Jackson County Drug Court, and city ordinance violations in Lee’s Summit Municipal Court, Raytown Municipal Court, Grandview Municipal Court, and Blue Springs Municipal Court, all Jackson County, Missouri cities that are suburbs to Kansas City, Mo.

I first began volunteering at the City of Kansas City, Missouri city jail as a practicum student in Counseling and Guidance. In those days the city jail was somewhat of a “drunk tank.” Mostly men involved in violations while they were intoxicated were sentenced to the jail. I remember meeting my first client with schizophrenia at the jail. He was not the norm and nobody at the jail really knew how to help him. We had health care services at the jail, but no psychiatric services.

After my two volunteer semesters at the jail I got a job working for the city department that ran the city jail and worked there for another year, and then eight years for the court. Now fast forward twelve years and I am back at the city jail. The jail population looks totally different, and now it is estimated that over 50% of the city jail’s census on any given day has a mental illness.

I am amazed that in such a short period of time the population at the jail changed so drastically. Mental Health Court appears to be a viable program for those who wish to participate. “In looking at the quarterly report from January – March, 2012 Mental Health Court, now a 10 year old program, continues to successfully divert persons with mental illness, who have been arrested for city ordinance violations (or low class felonies from Drug Court), from incarceration to a mental health treatment program.” I am proud to say that the City of Kansas City, Missouri cares enough about their citizens to give them the opportunity to participate in Mental Health Court!

Resource Development Institute. (2012, April). Jackson County Mental Health Diversion Court: Quarterly Evaluation Report (January – March 2012). Kansas City, MO: Author.

Nancy White is a counselor who has spent much of her professional life working in corrections.

Deb Del Vecchio-Scully

In a recent blog , I shared my view regarding the overlap between traditional counseling theory and yoga philosophy. Today, I will share how breathwork is a key element to yoga and to counseling. From a yogic perspective, the breath (pranayama) is the core element in yoga practice, more important than the postures themselves (asanas). I often remind my yoga students and my counseling clients, “remember to breathe”.

When under stress, most of us tend to hold our breath or breathe shallowly which intensifies anxiety and physical tension; this is a part of what occurs during a panic attack. Taking a single deep breath sends a signal to the sympathetic nervous system to turn off the stress reaction. Focusing on deep breaths for a few moments can trigger the Relaxation Response. The Relaxation Response was defined in 1974 by one of my mentors, Herbert Benson, M.D., founder of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital.

Dr. Benson found that when individuals focused on their breathing and used a mental focus such as a mantra, neuro-chemical changes in the brain occurred; the opposite state of the stress reaction. The parasympathetic nervous system became “turned on” releasing dopamine, serotonin and endorphins – the body’s feel good chemicals. Unlike the stress reaction which is automatic, the Relaxation Response can be evoked at will through the practice of simple techniques including yoga and basic breathing technique instruction. In yoga, we refer to the basic breath which is a deep full breath into the belly, also known as diaphragmatic breathing and belly breathing.

Basic Breathing Instructions:
1. Invite your client to assume a comfortable position with their feet on the floor.
2. Ask them to place their hands on their lower belly, above the diaphragm, below the belly button.
3. Ask them to take as full a breath in through their nose as they comfortably can, and release it with a sigh. This is a great way of releasing emotional and physical tension.
4. Repeat, repeat, repeat.

At times, someone new to this technique may express lightheadness; if this occurs, coach them to reduce the depth of their inhale and this will quickly dissipate. Invite them to notice the difference in how they are feeling. The most common response elicited is more relaxed, calmer. I then use ego strengthening in my response to affirm their ability to manage their stress, anxiety and much more.

The technique can be expanded to add a mental focus. One of my favorites is to silently repeat “I am” on my in-breath and “at peace” on the out-breath. Counting down from 10-1 is another way. Some people relate more to numbers than words – having options is helpful.

It’s useful to have clients set reminders to take a moment to pause to breathe between sessions which can be created on cell phones, computers or by posting sticky notes in unexpected places. Breathing mindfully is a powerful therapeutic tool – we are breathing anyway, adding an intention to calm and soothe is simple. Namaste.

Deb Del Vecchio-Scully is a counselor and writer who focuses on healing the mind, body and spirit. She specializes in PTSD, Chronic pain and mood disorders. For more information: www.anschealthandwellness.com

Warren Corson III

Many of you reading this are likely doing so just to find out what the heck I am talking about. I would guess that the majority of you have never heard of many of the words in my title. You may feel a bit lost, confused and possibly frustrated; I assure you that this was by design so that I could illustrate my point.

As clinicians we all have advanced degrees and specialty training. Some of us have the minimum requirements for our craft while others have many additional ones as well based on our needs for our jobs or personal desires. As advanced practitioners we have learned some complex terms and have learned the verbal shorthand that comes with it. We speak with our peers and freely make reference to “our” words while doing so. Many of us catch ourselves using our word salad with clients; hopefully we catch ourselves and in a noncondescending way we educate the client on what we said, its meaning and use. If not, they may be as lost as many of you were with the title.

I am not suggesting that we “dumb down” what we do but instead that we make it a point to use “normal” language whenever possible and when we use technical terms that we make sure our client knows what we are doing. For instance, most of our clients have not heard about the DSM IV TR, though we use it all the time. They may not know what multiaxial assessment is nor what the term Anxiety D/O NOS refers to, though we likely have said those things to at least one client. As for me, I tend to explain to people what I am doing when the assessment starts, what the aim of it is, the process etc. If they show an interest I will explain the five axis, their meaning etc. as we go over their diagnosis and rationale for it. Few people show no interest while many express and appreciation for being “allowed” to know just what it is that we have been doing. At times this can be a very good learning tool and it helps to foster a sense of belonging and partnership between the clinician and client.

When working with new clinicians I try to help them to always try to think about how it would feel to be on the other side of the session. If they never studied psychology would they be able to get through a session with someone like they are when they perform a session? Do they use large words in sentences that give not a smattering of a clue as to their meaning? In a nut shell, do they come across as a regular person who is also a scholar or do they come across as purely an academic?

As the risk of becoming a bladderskate, I will close this blog. Have a great week!

(I chose some “forgotten English” from the book of the same name by Jeffery Kacirk. For our discussion Inkornism is from the 16th and 17th century and meant overworked or unnecessarily intellectual. Tickletail was slang for a switch that was used to hit with as a form of punishment, Bladderskate referred to indistinct or indiscreet talking and a Cock-Penny was a penny paid to a teacher in lieu of providing an actual Cock (rooster) to a teacher who would use it in a Cock fighting match).

Warren Corson III (Doc Warren) is a counselor and the clinical & executive director of a community counseling agency in central CT (www.docwarren.org).

Debbie Carter

This week of working with my young clients took my thoughts back several years to leave me reflecting on my first class in Counseling Theories. Early on, I identified myself as a Rogerian. In the years following this first class, I began to resonate with parts of other theories, and found myself practicing and using various techniques. It was almost as if I had begun to take the therapeutic relationship for granted and assume it’s necessity, but not look carefully at its’ extreme and important impact.

This week’s schedule brought me my usual 4-6 year old clients who deal with depression, or anxiety or PTSD symptoms on a daily basis. It was one client in particular, however, which caused me to recognize the importance of the therapeutic relationship. Suffice it to say that this 6 year old child has suffered various forms of abuse and neglect since birth, and is currently under great stress due to reminders of both past and recent traumas.

After this week’s session, I felt somewhat defeated as reminders of her most current losses never seem to end, and her behavior was regressing after what appeared as weeks of progress. Also, despite the adoptive parents’ understanding of trauma triggers, they are at their wit’s end over my client’s extreme tantrums, contributing to the stress throughout the family system.

Much to my surprise, I received a call from this child the day after her session. She had asked her adoptive parents if she could call me after her latest tantrum. I had left her one of my business cards several weeks before when I noticed she was having a difficult time ending each session. This has proven to be a great transitional object for the children to hang onto until the next week, with the reassuring words that “they can call me, if needed”. Within about 5 minutes of talking with the client, she had shared her sadness and feeling of being ‘little’ (which she had described to me the day before) as she drew a tiny version of herself. Also, she had become calm, received reassurance that she would be okay, and agreed to try the child friendly versions of some relaxation techniques we had practiced the day before. As I closed the phone call with a conversation with the adoptive mom, this mom recounted to me how she advocated for her daughter at her elementary school that day, and how she had recognized that her tantrums were directly connected to her recent reminders of loss…two small steps at first glance, but really two huge steps for this overwhelmed adoptive mom.

So, despite what initially appeared to be an unsuccessful attempt to talk to the adoptive parents, and my apparent insufficient time practicing breathing with my client…what was operating underneath and all around these ‘techniques’ was the therapeutic relationship. It was this relationship which caused the client to desire to reconnect with the calm voice she remembered the day before. It was this relationship which caused the adoptive parents to mull over my words, and sort out what did and did not make sense for them. And, further, it was this therapeutic relationship which caused me to take a risk in the first place, to offer to ‘be there’ for my client, and offer some difficult but necessary parenting information.

Later, I reviewed my other client’s sessions of the past week, some with what I considered a successful use of techniques and some with a lack of what I considered successful. But, underneath and covering all of this was the therapeutic relationship, which proved to each child that I was there today and going to be there in all the future weeks, as well as when they need extra support. My being there won’t depend on their progress, or their behavior or their lack of fear or level of depression, nor will it depend on these factors being present or absent in myself. That in itself is comforting to me…and appears to be comforting to them, as well!

Debbie Carter is a counselor-in-training who is interested in helping children and families heal from trauma, grief, and loss through play therapy; for more information http://www.linkedin.com/pub/debbie-carter/23/7a6/801.

Stacee Reicherzer

Having lived out for the last 25 years, first as a gay boy, and very shortly after as a transsexual woman, I tend to maintain a level of cautious optimism about the LGBT liberation struggle. There’s always something in the news about our community, and I am very grateful that it’s no longer a given that we’re referred to using terms like “homosexuals” (in the cases of gay men and lesbian women) or “transvestites” (in the cases of transsexual women). Yet, there always seems to be another shoe that drops when we make any progress: a state or nation supports gay marriage, some entity vows to fight it and does so; schools make an effort to reduce bullying of LGBT youth in schools, someone in a position of legislative authority opposes it and fights it. The shoe that dropped this week, however, was that of none other than the President of the United States, Barack Obama, who declared his support of same-sex marriage.

The vote in North Carolina to enhance the language that forbids same-sex marriage (NC already had a gay marriage ban on the books from a few ago) was the kind of thing that we who provide counseling and advocacy for LGBT youth have come to understand as our cross to bear. We understand our responsibility and challenge to remind our youth, via efforts like the Trevor Project, that “It Gets Better,” even when some of these youth are the children of people who voted this new law into effect in NC. We understand how, in addressing the immediacy of teen hopelessness and subsequent risk that can in the face of such extreme and unexplainable human cruelty, we have to stretch ourselves in conveying the message of hope we want our youth to have. We often do the job that we wish all parents of LGBT youth would do, which is to provide loving support and take action that instills hope for the future. Last week, President Obama made all of our jobs a little easier. The other shoe that dropped fell squarely on those who oppose LGBT civil rights.

No matter what happens next with the sociopolitical climate in the struggle for LGBT rights, we cannot deny what President Obama’s support means in instilling support for our youth (it feels pretty nice for those of us for whom the bloom left the rose a few years ago, too). This is the leader of the free world making a declaration here about our rights. For even the most at-risk of LGBT youth who is seeing no visible hope or support in parents, teachers, or peers, President Obama’s message is a very clear beacon of hope that perhaps there’s a reason to live another day. I can’t predict what this means for the 2012 suicide statistics for LGBT youth, but as I said in the beginning of this blog, I approach this period with cautious optimism.

In the meantime, I also recorded my own “It Gets Better” video on YouTube at http://www.youtube.com/watch?v=L-poYVhgqv4

Stacee Reicherzer is a counselor, a faculty member at Walden University, and a private consultant with special interests that include: transgender issues in counseling, lateral (within-group) marginalization, and sexual abuse survival.

Jennifer Bingaman

When I was in my Practicum, I was one of the fortunate students. My clients came every week. I carried most of my clients over from the first semester to the second. I ended up terminating with only four clients over the course of two semesters. It was lucky to have those relationships continue as long as they did because I gained a rich experience, but I didn’t get a whole lot of experience terminating the counseling relationship.

Since working in addictions, I’ve terminated with almost twice as many clients in about half the time. It’s the nature of most addictions treatment. Thirty, sixty, maybe even ninety days I’ll get with my clients and then they’re gone. They are off into the wilderness of life and I hope to be a distant and helpful memory.
I’m struggling with the whole termination thing. I’m developing relationships with these clients and working on some pretty deep issues. I see my clients more often than I did when I was a Practicum student. Even when we’re not in session, we’re in groups and I see them on the property five days a week. There’s a familiarity I didn’t have before with my clients. I have to be vigilant about my friendliness and my candor around these clients. Rather than just keeping myself in check one to two hours a week, I’m constantly assessing my role as a counselor and how it works into the treatment paradigm of addiction.

So now they are leaving treatment. One at a time, they pack their bags and they go back to their homes or off to new opportunities. I feel a sense of connectedness to their narratives, a role of integration. It’s impossible not to feel that way. Even with clients who I do not personally see in session, I have a sense of who they are and what their core issues are as they leave treatment. It’s like any job you have where you see the same people day in and day out. You eventually develop a relationship with the person who shares the cubicle next to yours or the woman who sends the weekly newsletter. How could you not? It’s human nature, especially counselor nature, to connect with others.

I sit here typing this wondering about my clients and the adventures and struggles they are off to face. I want the best for them. It’s difficult to listen to someone tell you their deepest feelings and experiences and not connect with them in some way and invest in their narrative. I’ve struggled with how to handle this and where to draw the line. How much emotion should I give to this predicament? How must I conceptualize this to understand my role as a counselor?

I’ve begun to think of myself as a character in any narrative. I am not the protagonist. I am simply a supporting role. Like any supporting character, my presence in the plot must end with the chapter on treatment. However, it doesn’t mean that I was not integral to the outcome of the story. Like any supporting role, I’ve served my part and it’s time for the story to carry on without me, following the life of the protagonist – my client. I think of any book I’ve ever read, where I follow the protagonist, I hope for the best, but I recognize that at the end of the day the author has already written what is printed in my hand. I will read until the last page turns and the book is closed. I can only speculate about the lead character, but ultimately his path is not my path and I must trust my influence as his counselor will ripple throughout his story. I must trust the process.

Jennifer Bingaman is a counselor-in-training and freelance writer. She blogs about her experiences as a client and a counselor with a few life musings thrown into the mix at The Pursuit of Sassiness