Bob Stahn

My wife and I refer to actions that add or detract from the quality of our relationship as deposits into or withdrawals out of our relationship account. We want to regularly make deposits and make as few withdrawals as possible. We want to keep the balance very high to keep our happiness in our marriage very high.

In order to have our “finger on the pulse” of the quality of our marriage, we try to let each other know as soon as a deposit or withdrawal happens. (Even though I am the counselor by profession, she is much better at announcing when a deposit happens than I am!) After all, the deposit or withdrawal is in the eye of the receiver. Just because I intend an act to be a deposit does not necessarily mean that it will end up as one.

My clients have used various gestures or statements to tell the partner that he or she has made a deposit in their relationship account. To inform me that a deposit has occurred, my dear wife says, “Cha-ching!” It is onomatopoeia for the sound of the opening of the old cash registers. With that word, she indicates that whatever I just did added to the balance of the love in our account.

For example, I tell her I like the way she looks—“Cha-ching!” she says. My wife sits down and inquires about a project I am working on—“Cha-ching!” I say. I phone her to see how her day is going—“Cha-ching!” While we sit next to each other in an informal setting, she drapes her leg over mine—“Cha-ching!”

There are times that I am surprised to hear a “Cha-ching!” because I had not intended to make a deposit. However, it is wonderful to know that one occurred so I can make a note to do it again later. Her “Cha-ching!” helps me to know she not only appreciates what I do, but it also tells me that my efforts are effective.

Knowing and speaking our “love languages” help tremendously, but if we did not express to the other when a deposit is made, the other will not likely know of its impact and the action will not as likely be repeated.

In my life I have found that it is not only important to often make deposits into our relationship account, but it is just as important to know when one has been received. That way I can be more efficient in the use of my energy because each intended deposit will be received as one. For me there are few things that are as delightful to hear as “Cha-ching!”

Bob Stahn has a general counseling practice. He specializes in relationship counseling and most recently PTSD and trauma.

Bob Stahn

Adolescent clients often have a hard time making good decisions, so I developed a little something that has helped me help them. I call it my “$100.00 Decisions” exercise. I’ll walk you through how I present it to a young man. I ask him to picture someone he knows who is two or three years old. If I were to ask the child to choose between having a handful of candy (like “M & M” candies) that the child could have right now or having a two-pound bag of the same candy after waiting fifteen minutes, which would the child pick? The teenager would accurately say, “The handful now.” I respond, “Yes. Every single time.” Then I ask, “Why? There is so much more in the two-pound bag.” The response is usually, “Because the child can’t wait.”

I then teach the principle that being able to postpone gratification is a mark of maturity. I also state that the teenager is more mature than the child and can therefore make wiser choices because he can better postpone gratification.

Next I toss my client a quarter-dollar coin. I ask him to consider two plans. Plan A is the twenty-five cent plan where he can receive a quarter every hour for twenty hours each day. This plan includes making easy decisions and he can spend the quarters immediately on whatever is available or he can save them up for later. Plan B (I pull out a $50.00 bill and let my client examine the money while we talk) is the $100.00 plan where you have to make good decisions and wait until the end of the week to get the $100.00. Which plan would you choose?

My client usually replies, “The $100.00 plan, of course, because it is more money.” I remind him that it is the harder plan and he would have to think well before choosing and he may tell me that it would still be worth it.

We then discuss a scenario of me driving an hour to work each way five days per week. I want to save time, so I drive over the speed limit enough to save ten minutes each way. If I do that for an entire year, I save myself over 85 hours. Is that type of driving representative of twenty-five cent decisions or $100.00 decisions? We review the handout and see that it certainly fits the criteria of twenty-five cent behavior. We discuss what would likely be the result of that type of driving—speeding citations; loss of license and independence; increased costs of legal fees, insurance premiums, and other types of transportation; more time involved arranging rides; etc. Under those circumstances, how quickly would I burn up 85 hours? Very quickly. So, in the end, I would lose much more than I gained.

Then I bring it close to home for the teenager. I ask him what $100.00 decisions he has made today. I add to his response those choices of which I am aware—getting himself ready for the day, going to school, keeping his appointment with me, etc. Then I ask him what twenty-five cent decisions he has made recently.

I ask him who benefits most by him making $100.00 decisions. He would likely reply that he does. I remind him that it is not his schoolmates, parents or other authority figures who benefit most by his good choices—He does. All it takes for him to gain those benefits is to pause, think about what is the best decision and do it—even it he has to postpone his immediate gratification. To the extent he makes great choices shows the level of maturity he has developed. Does he want to be an impulsive child or with a little thought behave more as an adult? It is up to him.

He is assigned the homework challenge to make only $100.00 decisions in the coming week. I demonstrate my confidence in his ability to do so and remind him that receiving the benefits of $100.00 decisions is completely in his hands.

He leaves my office with a better understanding of what he gains by making great choices and by delaying gratification. He also feels more confident and empowered to make it happen. And as a reminder to make $100.00 decisions, he also leaves with the quarter—I keep my $50.00 bill!

Bob Stahn has a general counseling practice. He specializes in relationship counseling and most recently PTSD and trauma.

Deb Legge

Last time my blog was quite a DOWNER! Most of us are very aware of the changes in employment opportunities for counselors and counselor-educators. Many of us have been affected directly by these changes. I guess it is just in my nature to always be looking for the opportunities that exist in any situation (good or not so good). Perhaps that is what has carried me through in this field for over 17 years. Here are a few options that exist in our “brave new world”; options that might give way to opportunities for you to broaden your horizons and make a better than decent living in 2010. Many of these things did not exist even five years ago, and more are being developed and introduced to us every day.

I thought I’d write about four of the options that quickly come to mind:
 Social Networking
 Online Counseling Services
 Online Training & Education Options
 The “New & Improved” Private Practice

Social Networking

FaceBook, LinkedIn, Twitter, Blogster, Classmases.com, Live.Journal, MyLife, MySpace, Ning, and the list goes on and on. You may choose not to participate, but rest assured, your colleagues are there! Sure, we can get our knickers in a knot about privacy and the therapeutic implications of our public presence and choose not to participate. Rest assured however, that (good or bad), social networking is how many people are meeting, communicating, and doing business in 2010.

You may be “out there” without even knowing it! How many of us can be found on RateMyProfessors.com or RateMyTreatment.com? How many of us can be found as the subject of some obscure blog in cyberspace?

So… we can stand steadfast and try to slay the beast, or… we can find out how to make Social Networking work to our advantage. There’s got to be some benefit – something good that can come of this multi-million dollar international obsession!

Here are five tips with regard to Social Networking:
1. If you do put yourself on FaceBook, MySpace or any other social networking site, do so as a professional. Don’t fool yourself into thinking that your students or your clients will never find you (or that you can block them from your content). You are a Professional, and your responsibility is to present yourself as such on the web as you would in any other aspect of your life. Many employers search FaceBook before contacting a prospective employee for a job interview. Don’t blow it before you get the chance to introduce yourself!

2. For goodness sake – GOOGLE yourself! Don’t be the last to know what about you is in plain sight for all to see! If you find erroneous information or disparaging postings, do what you must to remove them. Most reputable sites will work with you on this. You might have to toughen up though and accept that the more successful (published, cited, sought after) you become, the more you are open game for anyone who might be jealous or angry with you.

3. Social networking sites can be a great way to get your name out there! If you have a private practice or a business that you would like to promote, you might want to consider doing so on some of these sites. A key “tweet” or comment on FaceBook might provide helpful information to thousands of people and drive lots of potential clients/customers to your website! Posting your resume on LinkedIn might give you the break you’ve been waiting for.

4. Use Social Networking sites to look for jobs or to connect with people from your past or in your profession who might be helpful to your job search. You can reach so many more people with less effort through social networking than face-to-face meetings with folks. Clearly, there is room for both strategies when you are trying to connect with as many people as possible

5. Use Social Networking to stay in touch with what is really going on in your professional organizations and related groups all over the country. You’ll be surprised how much you can learn with just a few minutes of surfing the Social Networking sites. You can find out about workshops, trainings, conferences, and so much more just by reading some of the posts on the pages run by the ACA, APA and other organizations. You can “meet” key people, and get involved in things that might seem more “do-able” in your schedule if you know that you can do it online!

Howard Smith

On January 21, I was sent to Haiti by the American Red Cross (ARC) on a special assignment. Having 17 years of experience as a Disaster Mental Health Volunteer for the ARC I have been deployed to over 25 national disaster relief operations and worked extensively with my local ARC Chapters so I know a bit about disaster relief operations and the mental health impact a disaster has on individuals. However, this was the first time I had been deployed by the ARC International Services Department to a disaster where the relief operation was coordinated by the International Red Cross/Red Crescent organization. There was another mental health worker, a sheltering expert (an engineer) volunteer in our party, and a logistics and two other staffers who were consultants to help manage the financial end of reestablishing the operation of the American Delegation Office that is a permanent office in Port-au-Prince.

We were flown into Santo Domingo, Dominican Republic, since the airport at Port-au-Prince, Haiti, had sustained some damage by the earthquake which occurred on January 12th and was only allowing planes carrying supplies to land there. We were lodged there overnight and then had a 234 mile, 12 hour, bus ride to Port-au-Prince the next day in convoy fashion along with other International Committee of the Red Cross (ICRC) responders from other nations. The bus trip was an education in and of itself. Once we left the four-lane, divided highway, about 20 miles outside of Santo Domingo, every 8 – 10 miles there were speed bumps across the highway and in many instances, vendors, had set up stands along the side of the road selling fresh fruit and local crafts. We had heard that there had been significant delays at the border between Haiti and the Dominican Republic; however it took us only about an hour to be cleared and allowed to enter Haiti.

Once we arrived in Port-au-Prince, due to the damage and debris that literally blanketed the city of 1.75 million residents, it took us over 3 hours to get to the Base Camp that was being set up by the ICRC. In an International Response to a disaster, nations work closely together so that every nation does not have to deliver a full component of services. So in addition to the American Delegation office staff (n = 10) who had been there before, during and after, the earthquake, there were 12 – 15 First Responders from the ARC who were working at Base Camp where supplies were being delivered and dispersed. At the Base Camp, everyone was housed in tents and it became a bit of an International Village with the responders from each respective nation having their tents clustered together in the compound. Those individuals stationed at the Base Camp worked long and hard hours, ate, and slept inside the compound. The extreme heat and humidity added to the discomfort. What few amenities that existed were welcomed. Many different languages were being spoken with efforts to cooperate, collaborate, and communicate with responders from other nations. Each nation had its specific tasks to perform but it was also vitally important that they all work together.

One of the ARC Delegation staff members had not been heard from since the earthquake and was presumed dead. A few more had to move out of their damaged apartments. The ARC staff at Base Camp had been working 18 – 20 hour days in an attempt to get set up for and respond to the huge response that was required in the immediate aftermath. Fatigue, if not exhaustion, was beginning to show. The added stressors of the many languages, the intense heat, the constant drone of the gas and diesel engines used to generate electricity, and the lack of adequate cell phone towers all were beginning to take a toll.

The special assignment for me and the other disaster mental health person was to provide mental health support to the other ARC people and their respective staff members and to assess the need for an on-going mental health presence for these responders. That is very different from a domestic disaster in which mental health responders provide services to the people most directly impacted by the disaster as the primary focus, and to the other responders as a secondary mission. In this case, the language used by the Haitians was primarily Creole and Haitian culture was less open to mental health assistance than most others.

As indicated earlier, many of the streets were still blocked by the buildings that had come cascading down during the earthquake. The concrete blocks strewn out in many areas made the streets impassable. Initially, bulldozers simply drove down the streets pushing the rubble aside so emergency vehicles, cars, and trucks could move about. Not surprisingly, many of the local vehicles had flat tires from driving in the rubble and several cars were literally buried under the concrete that had fallen on them. The difficulty in getting from one place to another was exacerbated by the foot traffic walking in the narrow streets.

Amidst all of this chaos, grief, confusion, and difficulty, I found the Haitian people to be very gracious and courteous. They went to great lengths to groom themselves and wear clean clothes when going out and about. At the first aid station that was set up in the compound of the ARC Delegation building that had suffered adequate damage to be declared unsafe itself, people would walk great distances to get the dressing on their wounds changed. They would often stand for hours in line waiting to be helped, in spite of the heat and humidity. If someone came along who had worse wounds than theirs, they would encourage them to go to the front of the line. Amputees were often physically carried in for a change of dressing on their wounds. During the week that I was there I saw only one set of crutches and not a single wheel chair. There were many post-disaster foot wounds where people had stepped on sharp objects as many had either no shoes or merely wore flip-flops.

There were tent cities or shacks strewn all over. The first day we were there a couple of staff members of the ARC Delegation asked if we would like to go for a walk. In this one area close to where the Delegation building had stood, there were over 6,000 individuals living in rows and rows of shacks which they had built out of corrugated tin and scrap lumber they had scavenged from the fallen buildings. A family of 6 would be living in a 10 foot by 10 foot area. They had lost their household goods such as pots, pans, and other necessary utensils but strangely enough, they had obtained food that had been brought down from small mountain farms. There were charcoal grills that had been rigged up to cook stew or broth. Fresh fruit was present and very popular.

Many of the children were finding ways to entertain themselves by making kites from plastic shopping bags and twigs, or playing with some make-shift objects. When ICRC distributed goods, again, the people were generally polite with one another. One truck brought a load of tarps and blankets. These were being distributed as the rainy season was about to begin and the shacks they had constructed were not weather proof. Other things distributed were the household items mentioned above and water.

Overall, the responders were coping very well with the stressors that were ever-present. It enhanced my regard for the volunteers who respond to these hardship disasters. Toward the end of the week, there were a few of those first responders who were getting ready to return home. While going home is part of the experience, in many ways it is the toughest part because they see the need is so great and the job not yet done. And on the other hand there is always the excitement of returning home to family and friends, and a regular job for most.

I left Haiti with some of the same mixed emotions. I wanted to stay and continue to help in whatever way possible at the same time, the magnitude of this disaster for a country that had little to begin with I knew that I was incapable of making a significant difference in their lives. It is a very humbling experience.

My “take-away” message from the experience is this: We, who by accident of birth were, so fortunate to live in this country, to have the benefits of comfort at the level we have them, often times act as if we deserve this good life. After being in Haiti, where the population is so dense and abject poverty reigns supreme, I sincerely hope that I never become so calloused that I either come to think that I deserve what I have in life, or ever become so comfortable that I would not want to do what I can to help those whose accident of birth gave them so little. Even for those of us who cannot “go” to offer assistance, there are many ways we can help through contributing financially or of our time. To be sure, there are areas we can help individuals who are less fortunate right here in our own area. We can read to children, visit the elderly, assist someone who is disabled in some way, or find an agency or an entity that offers assistance and make your contributions through them.

Joan Phillips

“Theories are like toothbrushes….. everyone has one- and nobody wants to use anyone else’s.” This anonymous quote was shared with me during my doctoral study and really stuck, I think because of how very truthful it feels at both an intellectual and gut level. Having been in practice now since 1977 I have gone through many iterations of various theories, as I am sure many of you have. I can actually remember when child abuse was an emerging clinical focus and when there were no personal computers in every family room and marriage. Prevailing theoretical orientations when I began work were Rogerian and Freudian. The emergence of cognitive-behavioral thinking as well as post-modern deconstructionism, narrative therapies, and now positive psychology (just to name a few toothbrushes) all unfolded over the years I have been growing as a counselor, art therapist, and marriage and family therapist.

I have seen raging debates in every professional association i have been honored to be in about “who are we” and “what are we doing” in some form or another. Not only do we not want to share theories or toothbrushes, it appears that we have a very hard time sharing turf- which only hurts clients as there is such a need for caring providers of all our services in so many places in this world.

I too can become enamored of a particular position, theory, idea, approach, you name it…. but essentially this kind of love affair with ideas and labels draws me further away from, rather than closer to, my clients. Maybe a sequel to the toothbrush truism is this- theories are like toothbrushes in another way- they are only valuable to the extent that you use them.

All the ideas in the world don’t help our clients if we can’t apply them, live them, understand more through them. Without application- a theory is pretty useless. So I manage the proliferation of theory and thought by seeing what works…. and I suspect this is true for most counselors. We are nothing if not a pragmatic group. The more I continue to study and learn the many theories of counseling, therapy, creativity, systems, and human change, the more overhwhelmed I sometimes feel. I felt that way as a graduate student, and still feel that way sometimes now. But then I think of another good quote that has also guided my thinking. The poet Robert Frost said: I can sum up everything I have learned about life in three words: “it goes on.” These are words from a poetic genius, one that could sum up so much in one image or stroke of the pen. When I feel overwhelmed by what I don’t know, or theories I have not learned or mastered, or even by the myriad moments in counseling that confound all theory and toothbrushing… I just remind myself that life goes on. And it helps.

Joan Phillips is a counselor, art therapist, and marriage and family therapist. She maintains a private practice and teaches at the University of Oklahoma.

Marianela Medrano-Marra

Hear blessings dropping their blossoms around you.
-Rumi
As a new director of counseling at the community college level, I am greeted by a pressing need to think creatively and proactively to counterbalance the myriad students’ needs on the rise while the resources to address those needs decline. The severity of psychological and academic problems among college students disrupts the balance they need to achieve academic success. Counselors in community colleges need to wield kaleidoscopes with ample lenses that embrace the multiplicity of issues.

Since its beginning in the 1950s, community college counseling has been characterized by ever-changing currents. With currently decreasing financial support for community colleges, a more general economic recession, increasing campus violence, the pressing need to ensure retention, and other common occurrences in collegiate life (test anxiety, depression, alcohol and substance abuse, etc.) we are called to redefine the models we use to address these needs.

Ordinarily, community college students are conceptualized as ethnic minorities, adult female learners, part-time students and displaced workers. In reality though, the typical community college student has become difficult to stereotype, and radical changes in the community college population is noteworthy in the last ten years. More parents are sending their youngsters to receive the benefits of a more affordable community college education for their first two years, drastically changing the demographics of the student population. Community colleges are thriving, multifaceted entities, calling for a reassessment of what counseling is all about.

In the same sense, counseling in the community college arena is very difficult to stereotype. We now know that it goes beyond reduction of student attrition, advocacy, or academic guidance. In the beginning, the main focus of community college counseling was primarily testing and placement, probation and suspension policies, general education requirements, and transfer programs. The changing nature of the population calls for a focus on an expanded, integrative design where counselors can address the different dimensions that impact students’ lives.

In addition to a developmental perspective, the kind of counseling that is needed now should leave no angle of a student’s life untouched. The priority now is the creation of contextual means to honor the diversity of the growing population. It is imperative that we create sustainable means to track the changes and to identify best practices before we venture to give birth to any initiative. It is imperative that when designing appropriate programs we keep in mind how students exist within a series of overlapping contexts of influence, such as economics, culture, demographics, etc. and that such overlaps should inform the scope of service.

While I am still at the stage of contemplation, and won’t force my way into action until I feel that I truly understand the complexity of the population for which I will recreate a counseling center, I remain open to the wisdom of colleagues who are invested in the community college philosophy. What I am saying is that I am embracing my new responsibilities with a beginner’s mind, a mind that is willing to stop and listen to the blessings dropping their blossoms around me. Each of us is a petal of the blossom, and I invite you to dialogue with me about the future of community college counseling.

Marianela Medrano-Marra is a counselor and Dominican writer living and practicing in Naugatuck, CT. She writes poetry, essays, and creative non-fiction; with publications including essays and four books of poetry.

The study was commissioned by Congress to provide guidance on whether or not to remove the physician referral and supervision requirement for counselors’ services within TRICARE, the health care program serving members of the armed forces and their dependents.

We attended Friday’s briefing with some trepidation. This was ACA’s third visit to the IOM panel. At the first meeting, I testified on behalf of ACA along with Dr. Carol Bobby from CACREP and Dr. Tom Clawson from NBCC. We came away from our testimony somewhat discouraged and feeling that many on the panel – especially the psychiatrists – didn’t get it. The second meeting was better. The panel had done their homework (and maybe heard us more than we thought) and seemed to have a better grasp of professional counseling and our qualifications. So we approached the release of the final report with cautious optimism but not really knowing what to expect.

We were therefore pleased when David Butler, the administrator of the report, announced that the study unequivocally recommends independent practice authority for professional counselors.

ACA commends the Congressional commissioned panel for endorsing TRICARE counselor independent practice, but we also note that the report contains some challenges. The report recommends that only those counselors graduating from a CACREP-accredited, 60-credit program and having passed the National Clinical Mental Health Counseling Examination (NCMHCE) be recognized for independent practice. ACA recognizes the hardship this would cause for many qualified counselors, and will be working with Congress to address these barriers in the course of removing the physician referral and supervision requirement from current statute.

ACA would like to thank the two representatives from professional counseling, Dr. Vilia Tarvydas and Dr. Ted Remley, for their work on the panel. Vilia and Ted clearly made a difference in helping panel members understand that the scope of practice, credentials and standards of professional counseling meets or exceeds those of our sister helping professions. In addition, I would like to personally thank Scott Barstow, ACA Director of Public Policy and Legislation, for his extensive and effective efforts on behalf of the association and our members.

The full TRICARE study is available on the IOM website at http://www.iom.edu/Reports/2010/Provision-of-Mental-Health-Counseling-Services-Under-TRICARE.aspx. ACA public policy staff will be analyzing the report in greater detail in the coming days at http://www.counseling.org/publicpolicy.

For more information, contact Scott Barstow at ACA’s public policy office: 800-347-6647 x234, email: sbarstow@counseling.org.

Guest blogger, David Kaplan, is the Chief Professional Officer of ACA.

Bob Stahn

Sinister and Dexter? It is actually a name that I have given a cognitive exercise that I have found very useful in my clinical practice. It helps my client to be able to better dispute faulty beliefs. The exercise starts by drawing a line from the top of a page to the bottom. At the top of right side I label “Right” and above the left side I write “Left.” I review with my client that there are several synonyms for the word “right” and then I write a few of them near the column heading of “Right” (i.e., correct, true, etc.). I then write the opposites of the synonyms near the “Left” heading (i.e., wrong, false, etc.).

Next I inquire if my client is familiar with the word for “right” in Latin. In big lettering I write the word “Dexter” on the right side. Then I ask about the word for “left” in Latin. After the client’s response, I write the word “Sinister” in large letters above the left column. Most clients are surprised to learn that “Sinister” means what it does. (The inference is that if something is not accurate, then it is sinister.)

I ask my client for a faulty belief he or she has been struggling with lately then I write it in the “Sinister” column under the heading. For example, “Other people control how I feel.” Then I ask for thoughts that will dispute that faulty belief. For example, “Others cannot control what I feel.” Then I ask for another and my client may say, “I get to choose for myself” and “Others may influence what I think, but I control what I think.” “What I feel is the direct result of what I think. It is not the result of what others say or do.” We continue to add accurate declarations to the Dexter side until we run out of true statements we can think of.

I then give the paper to my client with a homework assignment to keep this paper in an obvious place and add to the Dexter side as often as any appropriate thoughts come to mind. (Some of the papers return to me with an additional paper attached because my client has done his or her homework very well and has run out of writing space on the first one.) Also, I ask my client to review the Dexter thoughts several times each day.

I also give my client a little spiral notebook inviting him or her to “write the ‘right’ on the right” and “have the ‘left’ left on the left.” One of the benefits of a pocket-sized notebook is that the Dexter thoughts can carried in a pocket or purse and it can be easily accessed and reviewed while standing in a line or waiting at a stoplight.

By often reviewing the Dexter thoughts, the Sinister thoughts will gradually lose convincing power. Before long the Dexter thoughts will have taken root so well that the client will look at the Sinister thought and say, “I can’t believe that I used to believe that thought to be true!”

This exercise can be used with any faulty belief. I work with my clients to identify their issues and then their associated faulty beliefs. After this introduction my client can dispute unlimited Sinister thoughts without my help. By giving my client this tool, I help him or her become more independent. He or she will progress as much as he or she devotes energy to using the exercise. He or she gets to choose which gets more credibility in his or her life—Sinister or Dexter?

Bob Stahn has a general counseling practice. He specializes in relationship counseling and most recently PTSD and trauma.