InSession Magazine- April 2022

HOW TO CREATE FINANCIAL FREEDOM IN PRIVATE PRACTICE QUARTERLY LEGISLATIVE UPDATE WITH FMHCA LOBBYIST, CORINNE MIXON

HOW TO SURVIVE A HEALTH INSURANCE AUDIT

DR. AARON NORTON Persevering with Passion & Purpose

THE NEUROSCIENCE OF CODEPENDENCY FOR CLIENT UNDERSTANDING AND TREATMENT

COMPASSION FATIGUEAN EXHAUSTION OF THE FRONTLINE WORKER

Y n o a u e l r C H g a n b i r its p S A reminder from The FMHCA Staff

After two years of the COVID-19 pandemic, many of us have found ourselves in survival mode, living to survive versus living to thrive. What has this done to our daily habits? What has this done to our happiness?

volunteering, signing up for a dance class, or by grabbing a bite with a friend.

Habits to toss: Avoiding the outdoors. Vitamin D plays a big part in controlling the levels of serotonin in your As we all know, happiness has a great deal to do with body. Try to get at least 20 minutes a day our day-to-day habits, so let us pause to spring clean outdoors this Spring (and don't forget your what no longer serves us while we also make room sunblock!). for habits that do.

Holding grudges. Forgive others and yourself for the past to make room for the new that is Habits to keep: coming towards you.

Showing Gratitude. If we are acknowledging Sleeping less than 7 hours per night. Mayo the bad, chaotic, and stressors going on, let us get Clinic studies have shown that getting less than into the habit of acknowledging the pockets of seven hours of sleep a night on a regular basis good and peace as well. has been linked with poor mental and physical Practicing Movement. Stretching, walking, health. running- whatever makes your body feel good, counts.

As you are tossing out old habits and taking on new Plug in. A Harvard study has found that ones, remember to be patient with yourself. Setting embracing community helps us live longer, and small and realistic expectations are both key to be happier. Connect in this season by making these changes last.

INSESSION April 2022

Page 3 Spring Clean Your Habits

Page 9 The Impact of Stigma and the Importance of Being Trauma Informed Page 13 How to Create Financial Freedom in Private Practice Page 17 How to Survive a Health Insurance Audit Page 22 FMHCA's Favorites Page 25 Frontline Mental Health Workers: The Importance of Self-Care During a Pandemic Page 26 Ask AMHCA- FAQs from The American Mental Health Counselors Association's Code of Ethics Page 29 The Neuroscience of Codependency for Client Understanding and Treatment Page 35 Honoring Emotions Page 36 Healthy Oats, 4 Ways!

MAGAZINE

Page 40 Dr. Aaron Norton - Persevering with Passion and Purpose (FMHCA Exclusive Feature Interview) Page 47 Compassion Fatigue An Exhaustion of the Frontline Worker

Page 50 WANTED: Military Cultural Competencies Standards in Counseling Page 52 Quarterly Legislative Update with FMHCA Lobbyist, Corinne Mixon InSession Magazine is created and published quarterly by The Florida Mental Health Counselors Association (FMHCA).

THE FMHCA STAFF:

FMHCA is a 501(c)(3) non for profit organization and chapter of the American Mental Health Counselors Association.

Laura Giraldo, Executive Administrator & CE Coordinator

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 strength-based advocacy, networking, accessible professional development, and legislative efforts.

Madison Borgel, Social Media Coordinator

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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 first-person 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.

The Impact of Stigma and the Importance of Being Trauma-Informed Professional Experience Article

As I reflect on my journey with mental health, both personally and professionally, I am reminded of the impact that casual conversation and language can have on the stigma we work so hard to end. For as long as I can remember, I have heard the names of diagnoses be used to describe everyday things like weather changes or simply an individual who expresses organic emotions that do not need to be defined or labeled, clinically.

When I entered the profession of mental health, I entered with my own history of trauma which contributed to bouts of crippling anxiety and depression. After separating from the Air Force, I encountered some great as well as a few not-so-great providers. I learned what it felt like to feel heard and unfortunately, on some occasions I learned what it felt like to be labeled. Taking the good with the bad, my own experiences led to a deeper level of empathy and understanding for individuals that I later encountered in my professional career. My personal experiences fueled my desire to hold space for people in need as well as advocate for individuals who experience various conditions to be treated fairly while being active members of

society without being labeled and judged. After several years of working in the mental health field, I returned to school to become a therapist. I will never forget the emotions I felt when I wrote my letter of intent to submit with my application. I spoke about a few of my personal experiences and explained how this ignited my desire to become a therapist. Fast forward years later, after continuing to see the impact of stigma and labeling from “the other side”, I have the desire to speak on this topic through the eyes of a clinician.

Addressing the Elephant in the Room: Stigma and Labeling In full transparency, I cringe when I hear anyone in the field speak with stigmatizing language or call consumers by the name of their diagnosis rather than describing them as the human they are at the core. This is the junction in which the importance of being trauma-informed needs to be magnified. To be able to provide trauma-informed care to the individuals and groups that we serve, we must first understand the impact that lived experiences and past traumas can have on someone. This would

not only provide you with the ability to provide adequate treatment, but it also provides you with a better understanding of what could be contributing to certain symptoms from a biopsychosocial perspective. Labeling individuals, whether it be out of frustration or a general lack of understanding, contributes to the stigma that advocates and providers are working so hard to end. In addition to that, it may impede your ability as a provider to provide the care that the individual deserves and needs.

Damaging Effects of Stigma and How to Fight It

It is important to also be aware of the impact that stigmatizing language amongst providers can have. Mental health stigma not only impacts the consumers we serve, but it can also wreak havoc in the workplace. Stigma in the workplace or amongst colleagues can also impact a provider’s willingness to seek help for themselves out of fear of being labeled or judged. Instead of disclosing the need for help with managing difficult emotions or previously diagnosed mental illnesses, providers may attempt to navigate these difficulties themselves.

It goes without saying that there is an ongoing need to continue the fight against stigma and hurtful labels. A few ways of fighting the stigma include but are not limited to: Take the time to learn about mental illness Become an advocate to break barriers Educate others about stigmatizing language Speak openly about mental illness Provide support to those suffering in silence; show that you care

Providers who struggle with mental illness may avoid disclosing the need for help due to the fear of being perceived or labeled as not being competent or “stable” enough to do their job by their counterparts.

Mental health is something that we should be speaking freely about, without the fear of stigma. Let’s focus on the bravery, resilience, and the courage of those who suffer silently out of fear of being judged. Let's focus on wellness. Let’s focus on fighting the stigma.

The effects of stigma are pervasive and can impact various areas of a person’s life. Effects of stigma may include: Social isolation and withdraw Feelings of shame Reluctance to seek treatment Early termination of treatment Low self-esteem Feelings of hopelessness and/or helplessness

Written By: Joshualin Dean, MS, NCC, Registered Mental Health Counselor Intern Joshualin "Jay" Dean is a Therapist in Tampa, Florida. Joshualin specializes in trauma with a population focus of victims of crime. Joshualin is skilled in crisis intervention, trauma-informed care, and mindfulness-based techniques. Joshualin has experience working in inpatient psychiatric units, residential programs, and outpatient settings.

Mind GAMES Fill in the missing numbers

The missing numbers are integers between 0 and 5 The numbers in each row add up to the totals to the right The numbers in each column add up to the totals along the bottom The diagonal lines also add up to the totals to the right Answer Key on Page 45

14 14 7 4 8 2 11 14 7 10 9 4

How to Create Financial Freedom in Private Practice Professional Experience Article

Many therapists and counselors think they need a 9-5 agency job to provide them with financial stability. While an agency job may provide you with a steady paycheck and some vacation time, it can be limiting in terms of how much money you make and how much time you work. If you are craving freedom in your time and money, private practice might be right for you.

Don’t listen to the naysayers out there. You can make money in private practice. You will need to strategically plan to make that money and put in some time and effort but you can do it. Here are five common ways therapists can create financial freedom in private practice.

Create a specialty that commands private pay There are certain niches out there where people will pay cold hard cash to see you. Some of the most popular ones are psychological testing, play therapy, and couple’s counseling. Do some research about your location and what the needs of the community are. If you need training for those services, take the training and start to advertise yourself as a specialist. You are a specialist compared to the general population. And if you have the training, you are a specialist among your peers. Once you are seen as a specialist, as opposed to a generalist, you can command higher pricing, thus making more money in the long run.

Take insurance and focus on volume Again, don’t listen to those people out there that say you can’t make money taking insurance. Taking insurance is about changing your perspective about your private practice. When you accept insurance, it’s going to be more about volume. This does not mean you have to burn yourself out and see 45 clients a week.

If you decide to take insurance and you get half full, bring on another clinician under your practice. Taking insurance is an excellent way to start a group practice.

Offer other services related to counseling Multiple streams of income can help stabilize income in private practice. Workshops are a popular income generator that you can host. Pick a topic and link up with another local business and host the event. It can be a wonderful way to get your name out

and create some revenue. Another popular example of workshops is marriage counseling workshops and boot camps. A lot of couples are in distress and need help. Offer 3 hour marriage boot camps to jumpstart therapy. If you are trained in EFT or Gottman, there are workshops you can be trained to provide to couples.

Start consulting in your area of expertise If you are a whiz at social media or SEO or systems, start consulting other therapists. There are thousands of private practice owners out there that are amazing at therapy but need support in other areas of practice building. You can consult by offering mental health services to local business owners. You can go in and do training on how to implement mental health initiatives in the workplace. Consulting is a great way to move

from getting paid by the hour to getting paid by the project.

Create online courses to reach more people The future is online. People are connecting online. People are finding therapists online. People are learning online. Create an online course and put it out for the world to see. The course can be related to your niche or it can be related to your consulting.

Once the course is developed, this can be a passive stream of income for you.

Being in private practice does not mean you have to struggle financially. It means you have a greater opportunity to create a schedule and income source that works for you. If you are looking for support in building your private practice, join us on Facebook in the “My Private Practice Collective” group.

Written By: Amanda Landry, LMHC, CAP, NCC Amanda Landry is a Licensed Mental Health Counselor, Certified Addictions Professional, National Certified Counselor, and private practice consultant. She’s the owner of a group practice, Caring Therapists with several locations in Florida. She is a private practice consultant at My Private Practice Collective. She is currently Secretary of FMHCA.

How to Survive a Health Insurance Audit Professional Resource Article

The Insurance Vultures are Circling

What is a Clinical Insurance Audit?

Insurance companies have recently been conducting audits, like vultures looking for dinner. Especially Medicare.

A clinical insurance audit is a review of treatment that is meant to root out fraud, abuse, and waste in the health care system.

Unfortunately, it seems that when the new mental health parity laws kicked into effect February 10, 2021, it had an unexpected consequence. Insurance audits jumped. So the new parity law is experienced as (and not without merit) a way to limit services to clients and deny payment to providers to keep healthcare costs down.

Fight, flight, freeze, or fawn! An audit letter from a health insurance company is enough to send shock waves through your body and make your mind go blank. Have you received this letter? The first thing to do when you get one of these letters is take some deep breaths. Then read it. Many therapists have and they have a lot of questions when they do. Lately, I’ve been getting requests from therapists to review paperwork for audits almost daily.

Andy, a 46-year-old therapist from Colorado who works with elders, contacted me when she received an audit letter. Within the first 3 minutes of our conversation, it was obvious her racing thoughts kept her from absorbing the information even though she reread the letter many times. All she could remember was the deadline – “send immediately.” After listening to and validating her fears, my next task was to read the letter and explain the finer points in a way that her muddled brain could hear. She calmed down immediately. Together, we planned her strategy for submitting her notes.

Though most therapists will not be audited, many will. So be prepared.

What Health Insurance Companies are looking for in an Audit The first question is always — what do I send? If you read the letter closely, it tells you exactly what to send. But because of the anxiety audits generate, it’s easy to just stare blankly at the paper or dissociate and eat a bunch of chocolate instead of absorbing the content of the letter.

To start with, it’s easy to confuse psychotherapy notes with progress notes. I call psychotherapy notes, “Memory Notes”

because the name describes their purpose. They are notes we write to trigger our memory from session to session. Insurance companies do not want our memory notes.

The insurance company wants our Progress Notes. I call these notes, the “Medical Record,” because they are written to justify medical necessity. During an audit, insurance companies want our medical record. This includes our intake summary, progress notes (memory notes), treatment plans, and any consultation notes we may have. In other-words, they want all the notes associated with our medical record and they want them between specific dates of service. They often ask for a year’s worth of notes, say for example, between November 1, 2019 to October 30, 2020.

stringent. If you document to Medicare standards, you should be able to pass any audit from a commercial insurance company.

Failing an audit 100% is rare, but it does happen. It’s usually because the therapist doesn’t know what’s required to justify medical necessity — and is too afraid to call the insurance company, worried that anything they say, can and will be used against them.

What to Expect

Crestfallen yet determined to not let that happen again, he took my course and used my forms. I reviewed his treatment plans and session notes so that he was able to complete records quickly and confidently. Two years later, he contacted me again, this time with good news. He passed another extensive audit by 100%.

The insurance company will not swarm your office like a swat team to pillage your files or seize your computer. An audit is usually initiated through a letter from the insurer. They may indicate that you were overpaid for one or more past claims. Or they may simply demand proof of medical necessity by way of submitting the documentation associated with the claims. They will most likely request documentation for a client’s file between specific dates of treatment. This will likely include: the diagnostic assessment (also known as an intake or bio/psycho/social assessment) treatment plans progress notes a discharge summary any communications you may have had with others associated with the client’s case.

They are looking for fulfillment of specific documentation requirements and proof of medical necessity. The only time an insurance company will demand to look at your online program or records is if they suspect fraud. Let’s not give them the opportunity.

Preventing Claw Backs Audits are based on a “pass/fail” scoring system. 80% is passing but if you do go below that magic number, you will incur a “recoupment.” A recoupment, grimly referred to by psychotherapists as a “claw back,” is a demand to repay the insurer prior payments. There are two ways to calculate a claw back. 1) It’s based on the specific claims reviewed or 2) it’s calculated through “sampling and extrapolation.” Sampling and extrapolation mean the insurer reviews a small sample of prior claims and applies your score to all other claims that you submitted over a specific time. You either pay the money back or it’s deducted from future payments.

Most companies follow Medicare standards, which are the most

Nathan, a seasoned therapist in Chicago, sought my help after he submitted two years of notes for five clients. His notes were based on an audit he passed 20 years earlier because he didn’t know the standards had changed. Even the start and stop time of the sessions were missing. He scored 12%, which resulted in an $21,000 claw back that he had to repay over time.

Though the insurer that audited Nathan didn’t allow him to correct his records and resubmit, many companies do. That doesn’t mean you want to submit your notes without first reviewing them. Even though the review process is time consuming, it’s best for your nervous system to “get it right” the first time.

Do's and Don'ts of Health Insurance Audits Don't … … put the letter aside for when it’s convenient to read. Timing will never be convenient. If you don’t respond, the insurance company will assume you don’t have the notes to submit. The result is automatically forfeiting payment for all the sessions under review. … skim the letter because you’re too anxious to read it carefully.

Despite advising Andy to ask for an extension during her initial consultation, a very frightened part of her couldn’t bring herself to call until I read that clause in the letter to her. Had she thoroughly read the letter when she got it, she would have saved herself a lot of heartache. … turn in all your documents without reviewing them first.

Mistakes happen. Period. You’re allowed to amend your notes as long as the amendment is clearly labeled with a date and your initials.

Do remember to... … BREATHE! This too shall pass. Though an audit feels like an attack on your professional dignity and identity, it’s not. The calmer you are, the more clarity you bring to this unfortunate episode in your professional life.

… read the letter thoroughly, if not when you get it, soon after.

Then read it again after you’ve calmed down. … speak with someone at the insurance company. Call and ask for any clarification you need. For example: Find out the purpose of the request for records and ask if participation is mandatory. Some requests for records are not “to root out fraud” but to determine the most prevalent diagnoses being treated. This request is research, not an audit, and not mandatory.

If you don’t get a clear answer by asking about the purpose of the audit, ask about the consequences of not responding to the letter. This answer should indicate if your bank account will be affected by your compliance.

If the letter does not specify, ask which clients you need to send records for. Sometimes, it’s just one client. Other times, it’s several.

What are the dates of service being requested? Is there a date range or specific dates of service? Some insurance companies want specific notes, others want 6 months of records, others want 1 year, while others want 2. I once helped a psychologist prepare for a 4-year retrospective Medicare audit (which she passed 100%). Some states have laws limiting the length of time to one year.

What is the deadline? Some letters state, “… send your records immediately.” Others give a specific date, often two weeks from the date of the letter. However, this date seems somewhat arbitrary. If you need more time, ask for an additional month. Explain your very real-world circumstances. It’s quite likely you didn’t carve out time to deal with an audit when planning your calendar. Are you going on vacation, sick, caring for an ill family member, managing your kids’ online learning while working full time, etc.? Though there’s always a first time, I have not heard of anyone being turned down.

Find out how the insurer is calculating possible recoupments. Is it based on the specific notes being audited or is it based on sampling and extrapolation? This will give you an idea of how much money could be at stake.

Find someone knowledgeable to review your notes so you can correct what might be wrong. Like anything you write, it’s hard to be your own editor because you know your work too well. Even I, the Documentation Wizard, would have my notes reviewed by someone knowledgeable in documentation requirements before submitting them.

Get a free consult with the Risk Retention Specialist provided by your liability insurance. Your liability insurance offers this free service because it’s cheaper to prevent a problem than to defend you if a problem develops. The result of this discussion should help you decide if you need to consult

with an attorney who specializes in working with psychotherapists. Attorneys usually provide a “free 20minute consult.” This discussion is how the attorney decides if there is a reason to take your case. You can get some useful advice during these consults.

Make a decision that supports your well-being. You may decide that preparing your notes for an audit it more trouble than it’s worth.

Marcia, a sandwich generation therapist in California, received the dreaded letter during the Covid-19 pandemic. She was already caring for her ill mother, managing remote learning for her two children, and seeing too many clients due to the increased need for services. After talking to me, she decided that the loss of income was worth her peace of mind. She traded a claw back for less aggravation. Then she resigned from the insurance panel, but still had to repay the amount in question.

Appeal if you incur a claw back that does not explain the reasons or seems arbitrary. This is when you really need an attorney.

Pass Audits, Protect your Income, and Prevent Claw Backs You can’t prevent the flight, fight, freeze, or fawn response to a health insurance audit letter. But perhaps knowing how the process works will help you keep your feet on the floor and your mind clear. This is the way to get through this unwanted experience as quickly and successfully as possible.

If you haven’t taken my workshop, Misery or Mastery: Documenting Medical Necessity for Psychotherapists, wrapping your head around all the details of clinical documentation can be overwhelming… especially if you wait to learn this skill until you are being audited. If you need more guidance on how to write treatment plans, document sessions, or manage the administrative side of a private practice, I offer templated forms and online workshops that give you a step-by-step approach to turn your clinical intuition into thorough and effective documentation.

Written By: Beth Rontal, LICSW Beth is an internationally recognized trainer on mental health documentation for private practice clinicians, group practices, and clinics. Her Misery and Mastery TM documentation trainings and accompanying forms have been used all over the world.

She mastered her documentation and teaching skills with thousands of hours supervising and training both seasoned professionals and interns when supervising at an agency for 11 years. She maintains an active private practice in Boston, MA.

FMHCA's Favorites Dr. Mayim Bialik's Breakdown

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Mayim Bialik’s Breakdown is a quirky, informative, and interactive podcast breaking down the myths and misunderstandings about mental health and emotional wellbeing. Neuroscientist Mayim Bialik combines her academic background with vast personal experience to provide listeners with valuable practical advice focusing on removing the stigma surrounding mental health and encouraging an understanding of the mind-body connection. Nothing is off limits as Mayim breaks it down with an amazing collection of guests.

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Children's Book: Beautifully Me From designer, creator, and self-love advocate Nabela Noor (@Nabela) comes a much-needed picture book about loving yourself just as you are.

Meet Zubi: a joyful Bangladeshi girl excited about her first day of school. But when Zubi sees her mother frowning in the mirror and talking about being “too big,” she starts to worry about her own body and how she looks. As her day goes on, she hears more and more people being critical of each other’s and their own bodies, until her outburst over dinner leads her family to see what they’ve been doing wrong—and to help Zubi see that we can all make the world a more beautiful place by being beautifully ourselves.

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Source: MedicalNewsToday

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If you're looking for a way to reduce stress, consider tai chi (TIE-CHEE). Originally developed for self-defense, tai chi has evolved into a graceful form of exercise that's now used for stress reduction and a variety of other health conditions. Often described as meditation in motion, tai chi promotes serenity through gentle, flowing movements.

Source: Mayo Clinic

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Frontline Mental Health Workers: The Importance of Self-Care During a Pandemic Professional Experience Article

Audre Lorde said, “self-care is not self-indulgence, it is selfpreservation.” I remember when I was in graduate school, my professors discussed the importance of self-care and being aware of burn out and fatigue. They would discuss the importance of being mindful and making sure we were taking care of ourselves, especially since we would one day be working with people who were struggling with mental health issues. During the pandemic, this resonated with me so much more since I was working at the local community hospital, and it was non-stop. People were struggling with addiction, depression, anxiety, and so on and the fact places were shut down there was nowhere to go and get the help they needed. We remained open during the entire pandemic and now, we were conducting intensive outpatient treatment via telehealth and groups were 7 days a week. I would notice at times I was getting home and wanting to just get in my bed and go to sleep. I became aware I was burned out. Although the hospital would call frontline workers as superheroes, I felt defeated. I knew I had to take time for myself.

I then recalled a presentation I completed in my doctorate program and discussing the importance of being able to assess for burnout. I remember pulling up the presentation and completing the assessment and realizing I was completely burned out. I stopped and took a moment to think about some of the things I enjoyed doing and how I have been putting things on the back burner do the non-stop work environment due to the pandemic. I have taken for granted all the things I enjoyed doing before the country shut down. I realized how much I missed

those things and I started to take care of myself. I started to work out at least 30 minutes a day and eating healthier. I would read again for fun, and I would just sit on my balcony and practice mindfulness meditation and radically accepting we were in a pandemic, and this would eventually pass, and we can get back to “our new normal” one day.

I started to implement self-care into the group therapy, which I included in my group with pregnant women, who were currently struggling with addiction. By reminding the clients the importance of being able to take care of themselves and how essential it is for their mental health and well-being, it helped them gain a better understanding of the importance of self-care for both them and the baby. I would use myself as an example during the session and explain to them, “if I am not okay, I am not going to be an effective therapist for them.” I would discuss the importance of being aware of when I needed a break and what I would do to take care of myself, which I then included self-care routines during the group. For example, we would bring in essential oils and smell them during the session and we would also do creative activities, like painting and woodwork, which some included in the baby’s nursery when the baby was born.

Participants would then start implanting those things outside of the group and would develop new hobbies, which helped their mental health. In making sure I was practicing self-care for myself, I realized how important is for clients to practice it as well, that we would do self-care together, which also helped because everyone was feeling isolated due to the pandemic. This

practice also allowed for clients to learn how to love themselves, which then helped them establish healthier relationships and boundaries with others.

practice self-care as well. During the pandemic, self-care was one

I feel self-care is one of the most important things to put into practice as not only a therapist but also encouraging patients to

adapt a daily self-care routine so I would check in with myself

of the most essential things that kept me going especially in the hospital environment I was working in and making sure I would and making sure of practicing self-love with myself.

Written By: Melina Rodriguez, LMHC Melina is currently lead therapist and navigator for the Mothers in Recovery Program at Memorial Regional Hospital in Hollywood, Florida, which helps pregnant women struggling with addiction deliver babies born substance-free. She graduated with her Master’s degree from Barry University and a current PhD candidate in Family Therapy at Nova Southeastern University. Melina has been an LMHC since 2017 and is a Qualified Supervisor for MHC and MFT interns. She is also a certified clinical trauma professional (CCTP).

Ask AMHCA

Frequently Asked Questions from The American Mental Health Counselors Association's Code of Ethics

Q

I have been seeing a Mom and her children in counseling to deal with issues concerning parent-adolescent problems and divorce issues.

Mom and Dad are separated. Mom’s attorney wants me to testify in court that Mom should have custody of her children. I have never met the husband, and know little about him, except for information provided by Mom concerning his drug problems and his acts of domestic violence.

Can I testify as an expert witness for Mom in the divorce case?

Q

How do I handle confidentiality in conducting group therapy, and what do I tell group members will be the consequences if confidentiality is breached?

A

The Code provides that “in working with… groups, the right to confidentiality of each member should be safeguarded” according to section I.A.2.l. Inform each group member in the treatment contract or disclosure statement that group counseling is confidential, disclose

Q

I am providing services online through e-mail with clients. Is this practice ethical? Are there any special disclosures that I need to give these clients?

A

Yes, at a minimum, two disclosures are needed regarding the security of email communication. First, in compliance with Code principle I.B.6.h., “unless email and text messages are encrypted or otherwise secured or confidential,

A

No, a CMHC who is serving in a clinical role, providing treatment to a Mom and her children in family counseling, cannot also take on the role of forensic expert. To do so would violate Code principle I.D.4.g which prohibits CMHCs from evaluating for “forensic purposes, individuals whom they are currently counseling or have counseled in the past.” To express an opinion on custody, which Mom’s attorney has requested, would also result in a violation of Code section I.A.3 which prohibits CMHCs from having dual relationships in serving clients. A dual relationship would result if a CMHC served the same client in both a clinical and forensic role. Mom’s attorney should ask the court to appoint an unbiased, objective, forensic evaluator; or the attorney can retain a forensic expert to evaluate custody issues and make recommendations to the court in the best interests of the parties’ children.

the exceptions that apply, and also disclose that what is said in group stays in group, because the information is personal, private and confidential.

Then, at the beginning of each group session, remind the members again that all information shared in sessions is confidential, and stays in group. If a member talks outside of group about what someone else had said in a session, then often the consequences are left up to the group to decide what should be done. However, the CMHC should reserve the right to determine if group counseling should be terminated for the member who violated another’s confidentiality, in order to prevent a repetition of the breach of confidentiality.

the client should be informed of the risks and discouraged from using as a means to disclose personal information”. Section I.A.2.n states; “CMHCs take necessary precautions to ensure client confidentiality of information transmitted electronically through the use of a computer, e-mail, fax, telephone, voicemail, answering machines,” or other media such as video conferencing platforms. The second disclosure that should be made pursuant to I.B.6. concerns “the benefits and risks of entering into distance counseling” including “e-mail contact with a client.” The risk that a breach of confidentiality may occur if unencrypted e-mail is used is well known to most e-mail users, but should still be discussed in making this disclosure.

The Neuroscience of Codependency for Client Understanding and Treatment Professional Resource Article

Abstract: Research on codependency is scant as it is not a formal disorder in Diagnostic and Statistical Manual of the American Psychiatric Association, 5th Edition. There is also not a specific medication to treat it, hence funding may be challenging but is necessary as most of us exhibit codependent behaviors at some time throughout our lifespan. Codependents who seek mental health treatment are likely to be involved with those who have disorders such as substance abuse or Cluster B personality disorders. People who are narcissistic, antisocial or who have borderline personality disorder manipulate and exploit others and codependents are altruistic and enjoy giving to others. This creates a dysfunctional foundation of attraction. The fear of abandonment drives both the codependent and the narcissist or borderline. In this context, codependency will be viewed as narcissism in reverse. Narcissists are hyper-focused on themselves, and codependents derive physiological pleasure focusing on others. Assisting the client with psychoeducation will help them to understand their maladaptive physiological reactivity. Nonjudgmental mentoring of why and how they give

to be of benefit to others and a detriment to themselves expedites the therapeutic process. Helping a codependent understand the neuroscience of their behaviors will cause them to feel less embarrassment or shame that impairs positive outcomes in therapy.

Help your client with neuroscience education: Codependent clients can be resistant to treatment because they believe they are being selfless and kind, but they are relieving their anxiety by people pleasing and approval seeking. Teaching a client about the neuroscience of this issue can be a turning point in codependent recovery. Imparting the complex cause and effect of how a codependent brain maladapts can help the clinician guide the client to healthier relationships and selfcompassion.

Early development, attachment, and trauma bonds The brain develops early in the womb, beginning with the neural plate and the neurons we have from birth remain through life.

Newborns have instincts and reflexes to guide them to receive love and nurturing and are fundamental for safety. We are born to reach and grasp for love by innate reflexes to seek security and a sense of belonging. In receiving attention, a clinging infant trusts the person who loves and cares for them. If you gently touch a baby’s cheek, they turn their head and begin sucking to get nourishment. It is the root reflex, but infants need more than food.

Proper nurturing is needed in all stages of early development. If a child does not experience nurturing, the brain can develop maladaptive attachment styles. Codependents are often called, “clingy and “needy” and suffer from anxious-preoccupied attachment. They may have experienced trauma bonding through intermittent reinforcement with an early caregiver. As an adult, a person gets hooked by feeling the chemical sensations of love, but when kindness is intermittently or abruptly withdrawn, intense anxiety occurs. If this was a pattern in childhood, it can wreak havoc in adult relationships.

At Harvard University, Dr. Edward Tronick, performed “still-face mother” experiments. A baby is fully engaged with an attentive mother. The infant smiles, reaches, and appears safely connected. When the mother is cued to have a blank expression, within moments, the baby is agitated, and attempts to re-engage her with anxious smiles and distress sounds. The child frantically flaps his fingers to get a response. When the mother pays attention to her infant again, the child is soothed.

Mirror neurons We learn by mirroring our caregivers and people subliminally “read” each other. Mirror neurons helped humans successfully evolve as an intelligent species. Affection and proper attention are necessary to develop into confident adults. A sense of belonging in a dysfunctional family is restored if an anxious child performs in ways that result in everyone being happy or “fixed”, even if temporarily. They morph into imposed gender roles such as “the little man of the house” or the “the good little girl”. They can become the family clown, hoping that entertaining the family will help them maintain connectivity.

When a parent and baby bond properly, oxytocin, the trust hormone, is released, and the child feels safe, and adulthood is navigated with secure attachment. Brains develop in sequence, so it is vital for a child to receive proper affection in the developmental order needed. Erik Erickson, Abraham Maslow, Carl Jung, Sigmund Freud, and John Bowlby were pioneers in this field of human development and concur, what happens to a child from birth to age six is crucial for healthy development.

Attentive parenting is how we learn to trust and become autonomous adults. In 2012, Viladarga and Hayes did extensive

research on developmental codependency.

“Codependence can be viewed as a dysfunctional empathic response, a displaced mutual aid endeavor in which the main defect is an inability to tolerate negative affect in the important other…Evidence is pointing to the newborn human entering the world already innately primed to engage. There is reason to believe that prosocial skills develop early, in tandem with other capacities, such as conscience and empathy…Very likely, there are evolutionarily early neurological systems or pathways for emotional empathy…Empathy is clearly an advantageous facet of human cognition. Where the codependent individual may stray is in the modulation of the affect it generates in the observer.”

It can be deduced, if the child experiences a dysfunctional frame of reference, codependency is fostered. Abandonment, abuse, neglect, parental addiction, death of a parent or any childhood trauma can result in a lifetime of grasping for love like a frantic infant or to become submissive to a narcissistic or demanding partner.

When a child detaches from their family in adolescence, they may develop relationship reenactment. It is a subconscious compulsion to gain mastery over the past and is seldom successful. Trauma bonds may have been established early and repeated later in life by more intermittent reinforcement. Cycles of giving and withholding affection or approval is a tool of manipulation that traps a codependent and keeps them biochemically addicted. When treated well, dopamine, serotonin and oxytocin create a sense of wellbeing. When they are treated poorly, cortisol and adrenaline flood the codependent with feeling of intense anxiety. This makes it feel impossible to leave a perpetrator. Without recognition of this chemical exchange in therapy, clients may continue to seek safety from the same people who hurt them or are like them as the brain seeks the familiar.

When we develop, memory centers of the brain including the hippocampus, amygdala (fight/flight/frozen) and limbic system work together to form consciousness. Suppressed wounds from childhood may result in crossed circuitry and can damage the hypothalamus and adrenal system and cause brain synapses to malfunction.

We have biological needs to receive dopamine, oxytocin, vasopressin, serotonin and other hormones and peptides for proper attachment. The same attachment hormones that made us fall in love go awry when a person is devalued or discarded.

Trauma can cause shrinkage of the hippocampus and create false signals of safety. What feels “right” or “love at first sight” may be a trauma triggered reaction. Codependency and trauma are closely related. Making connections between the past and present are crucial to help a client enjoy a better future.

We can, in a sense, “watch” what we say by understanding mirror neurons. Reaction shots in films are a way to understand this principle. The reaction of the listening actor is showing the audience how to feel. This same theory applies to codependents and the characters in their life. Subliminal messages are processed in the brain and emotions can be negatively manipulated if the codependent is unaware. Their fixated awareness of others and a lack of it for themselves makes them a vulnerable target.

Empathy and codependency People who are born highly empathetic, have more capacity to sense the needs of others through mirror neurons and other brain connections. Mirror neurons are essential for empathy to enhance the greater good of society. There is a correlation that the greater someone experiences empathy, the more they will be inclined to help others and receive pleasure in return. Empathy and heightened conscience reside in the most evolved part of our brain, which primarily is in the prefrontal cortex. Conscience and empathy display significant activity in PET scans.

In “The Empathic Brain: How the discovery of mirror neurons changes our understanding of human nature” neuroscientist Christian Keysers, PhD states: “By charting the detailed machinery of empathy…shared circuits have started to reveal, we might be in a position to…prevent atrocities.”

Keysers diagramed the empathic brain and noted authentic, altruistic giving is good for humankind, but can be misused by predatory people. Keysers warns overly empathic codependents.

“We all suffer from an egocentric bias. Shared circuits are not magic; they make us interpret other individuals in the light of our own actions, solutions, and emotions. If your life is fundamentally different from that of the person in front of you, shared circuits will make you feel something the other person is not feeling. In these cases, in the mirror of shared circuits lies to us.”

Teaching a codependent to be aware of their mirror neurons they project to others will help them see what may be what attracted those who exploit them.

Viladarga and Hayes developed these key concepts of the biological connections in codependency.

Codependency is an inability to tolerate a perceived negative affect in others that leads to a dysfunctional empathic response.

Codependency likely shares roots with pathological altruism.

There are evolutionary, genetic, and neurobiological components to the expression and propagation to codependent behaviors.

Giving feels good Feel good chemicals such as dopamine, serotonin, oxytocin (the trust hormone) and endorphins elevate when we give.

Generosity is more than a learned trait and is healthy if the motives are based on fear or guilt.

In May 2018, The John Templeton Society at UC Berkeley presented, “The Science of Generosity”.

“There is growing evidence the human brain is wired for generosity…

Acting generously appears to stimulate neural circuits involved in reward, the same circuits that are activated when we eat food or have sex, which helps to explain why giving feels good…This neural response is also a sign that generosity is important for survival. When an act feels good, we’re more likely to do it again and…thanks to evolution, the behaviors that are most fundamental to our survival also tend to make us feel good…the mesolimbic reward system, which are activated by stimuli like sex, drugs, food, and receiving money, are also engaged when people make charitable donations….brains showed activity in reward-processing areas even when they were forced to give to others…

Generosity also triggers a part of the brain called the orbitofrontal cortex, which not only activates when we receive rewards but is thought to be involved in assessing the subjective value of our decisions…some of the anatomical and functional differences seen in extreme altruists are the opposite of those seen in psychopaths…

Oxytocin also has wide-ranging effects on social behavior, from supporting maternal care to encouraging pair bonding.”

Not giving feels bad to the client Guilt and empathy are closely related in the brain and neural responses. If you are in a park, about to take a bite out of a sandwich and see someone sorting through rubbish to find a morsel, you feel empathy and give them your meal. That is not coerced guilt; it is empathic kindness. Kindness helps both giver and receiver to feel good.

“Neural Systems for Guilt from Actions Affecting Self, Versus Others”, a 2018 study by R.A. Morey et al, reported how guilt and social connection are symbiotic. In a codependent, this could be catastrophic.

“Guilt is a core emotion governing social behavior by promoting compliance with social norms or self-imposed standards…actions with social consequences are hypothesized to yield greater guilt…Our results suggest these regions intensify guilt where harm to others may incur a greater social cost.”

Clients can become angry when it is proposed it is a form of selfharm to allow people to use or abuse them. Helping them to understand their subconsciously driven need for connection enhances self-awareness, acceptance, and redirection.

Intermittently reinforced conditioning can be reconditioned with

positive methods to forge new neural pathways.

Healing physiological reactivity Donald Hebb, PhD said, “neurons that fire together, wire together”. This Hebbian principle is related to the term “neuroplasticity”. It was once thought that if you were born thinking a certain way, you couldn’t change it but now we know differently. Cognitive behavioral therapy promotes changing perspectives, beliefs, and thoughts so the brain will change in a positive way.

Codependent recovery can also be expedited by what we know about how our emotions affect our autonomic nervous system (ANS) of fight/flight/freeze reactions. This involves our limbic system and amygdala and our reactions and emotions set the vagus nerve into motion. This parasympathetic nervous system (PNS) comes out of the brain stem and begins at the space outside the forehead. It travels down through the face, throat, heart, lungs, vital organs and abdomen and lower back.

The vagus nerve is partially responsible for facial expression which is how mirror neurons are cued. This physiologic exchange is what gives us, “gut feelings” and codependents often ignore these feelings. They have faulty interoception from traumatic conditioning. Price and Hooven explored this in 2018.

“Individual ability to detect interoceptive signals may be influenced by stress and adverse life experiences that negatively affect willingness, tolerance, interest, and practice with attending to the language of the body. People who have experienced undue stress or trauma may have ceased to trust or listen to their bodily cues, making it difficult for them to predict their emotional responses and to regulate them…Mindful attention to inner body awareness, or interoceptive experience, reconnects the individual to deep bodily states of equilibrium, helping to override and rescript maladaptive stress responses and automatic patterns…Interoceptive awareness skills facilitate optimal emotional responding and the individual’s ability to process and interpret feelings, or to plan ahead and strategize at the onset of small cues before becoming overwhelmed or entering an unmanageable situation, thus…providing clients with self-care skills critical for emotion regulation.”

Codependents who care more for others than they do themselves often misinterpret their own physical and emotional signals.

Without mindful self-awareness, a codependent may believe the best of the worst of people.

Sigmund Freud believed a person has an “optimal homeostatic level of psychic energy” called the “comfort level”. The mind and body perpetually seek the comfort level of “homeostasis”.

Holistic tools such as polyvagal exercises and meditation can assist the client reach homeostasis more quickly. By guiding your codependent client to understand their brain, he or she can

become more proactive than reactive. Choosing therapeutic interventions combined with neuroscientific evidence will be an addition to other cognitive behavioral or eclectic modalities of therapy.

References 1. Tronick, Ed. The Neurobehavioral and Social-Emotional Developments of Infants and Children. New York: W.W. Norton & Company, 2007.

2. Bowlby, John. Separation: Anxiety and Anger Attachment and Loss. Basic Books, 1976.

3. Vilardaga, Roger & Steven Hayes, “A Contextual Behavioral Approach to Pathological Altruism,” Pathological Altruism (December 2011): 25-37, 10.1093 /acprof:oso/9780199738571.003.0033.

4. Hebb, D. O. The Organization of Behavior. New York: John Wiley and Sons, 1949.

5. https://ggsc.berkeley.edu/images/uploads/GGSCJTF_White_Paper-Generosity-FINAL.pdf Greater Good Science Center, May 2018 6. Keysers, C. (2011). The Empathic Brain. Chicago: University of Chicago Press.

7. Price, C. J., & C. Hooven. “Interoceptive Awareness Skills for Emotion Regula- tion: Theory and Approach of Mindful Awareness in Body-Oriented Therapy (MABT).” Frontiers in Psychology, 9 (2018): 798. doi:10.3389/fpsyg.2018.00798.

8. Morey RA, McCarthy G, Selgrade ES, Seth S, Nasser JD, LaBar KS. Neural systems for guilt from actions affecting self versus others. Neuroimage. 2012 Mar;60(1):683-92. doi: 10.1016/j.neuroimage.2011.12.069. Epub 2012 Jan 2. PMID: 22230947; PMCID: PMC3288150.

Written By: Mary Joye, LMHC Mary Joye is a Licensed Mental Health Counselor, Life Coach and Florida Supreme Court Certified Family Mediator. Her recent book, “Codependent Discovery and Recovery 2.0: A Holistic Guide to Healing and Freeing Yourself on HCI/Simon and Schuster has been well received. Her transformative journey was featured in "O" Magazine.

She is a best-selling writer for DailyOM.com and her most popular course, "From Codependent to Independent" has sold tens of thousands of copies.

She contributes as a guest author and interviewer to OpentoHope.com, Huffington Post, Prevention, ThriveGlobal, UpJourney, Psychology Today, PsychCentral, Central Florida Health News and many other publications.

Honoring Emotions Professional Experience Article

It was early morning, and I was preparing my smoothie to take to work. I opened the meal replacement powder and began to pour it into the smoothie jar filled with strawberries, blueberries, and almond milk. As I put the scoop back into the container my elbow knocked it off the countertop. It was a big, powdery mess. This is going to take a lot of energy to clean up. As I reached for the broom I began thinking about the mess before me. It was perfectly contained before I accidentally spilled it all over the kitchen. It reminded me of conversations with my clients as they try to figure out what causes their outbursts of anger, or what is behind their anxious feelings. Many of them believe they need to contain their emotions and even push them down.

Their disappointment, hurt, and rejection was not addressed in their families growing up. So, they learned to keep them compartmentalized and it gave the appearance of being in control, contained. But they discovered when a situation “bumped” them, emotions poured out of them causing people around them to be the recipient of their wrath. When their tirade was over, they admitted there was a mess that needed to be addressed.

explains that naming our feelings (utilizing our left brain) allows the frontal cortex to calm the amygdala (our “Uh-Oh” center of our brain). It connects thoughts and feelings. When clients come into my office for counseling, one tool I talk with them about is identifying emotions. We talk about how anger is a secondary e motion which means when they express “I’m angry” I teach them to take a step backward and recognize what feelings are underneath the anger.

Maybe they are feeling disconnected, embarrassed, rejected, hurt, or misunderstood. Many times, there can be 10-15 feelings underneath the emotion of anger. If emotions are not identified and felt, then negative emotions begin to accumulate.

Anger can begin to occupy a place inside of each of us, if not dealt with, it can stay there for a long time. We begin to recognize that time by itself does NOT heal anger. What heals the negative emotions is to honor them when they show up. Instead of containing them, give the emotions permission to be present and say something like this:

Many reported coming into counseling for either outbursts of anger or feeling numb with no emotions at all. What they thought of as disciplining their emotions was ignoring and pushing them down, thus causing a numbing of emotions. Brene’ Brown states “We cannot selectively numb emotions, when we numb the painful emotions, we also numb the positive emotions.” And numbing emotions will eventually cause them to gush out when someone or something triggers them, similar to an activated geyser. How can we help our clients when they have lost all feeling except anger or rage?

I choose to honor this hurt. I give myself permission to cry and to feel the pain of the feelings of inadequacy and discouragement.”

Dr. Dan Siegle teaches the principle of “Name it to Tame it”. He

“I’m feeling hurt and disappointed that I did not get the promotion and it was given to my coworker. It hurts me deeply.

When ready, allow the pain to be released. I utilize the phrase “Feel it to release it.” Some hurts or actions take longer than others to be let go. But they will wane, and happiness will show up in its place. I believe learning how to navigate our emotions is a path to lessening anxiety and rage. Emotions are energy in our bodies when they are contained. Hard emotions need a voice and the ability to be discharged. Positive emotions need to be nurtured and embraced. They are the bridge to connect us with ourselves and others.

References: Brown Brené. (2022). The gifts of imperfection: Let go of who you think you're supposed to be and embrace who you are. Hazelden Publishing.

Thalla, L. (n.d.). "Name it to Tame it": How Naming Our Emotions Soothes the Brain. "Name it to Tame it": How Naming Our Emotions Soothes the Brain. Retrieved from www.lindsaythalla.com Siegel, D. J., & Bryson, T. P. (2012). The whole-brain child. Constable & Robinson.

Written By: Sandra B. Stanford, LMHC Sandra B. Stanford, MA works as a Licensed Mental Health Counselor at Charis Counseling Center’s satellite office in Titusville, FL. Sandra earned her master’s degree in Psychological Counseling from Palm Beach Atlantic University. Sandra is Certified in EMDR Therapy. Additionally, Sandra enjoys working with couples with a niche in Affair Healing. Sandra is an active member of the Florida Mental Health Counselors Association and the American Association of Christian Counselors.

Healthy Oats, 4 ways!

For every portion of oats, you need double the amount of liquid. For a single serving with 1/2 cup of oats, that means you’ll need 1 cup of liquid.

Apple Cinnamon 1. Boil water. In a small pot, bring the water or milk and salt to a boil over medium-high heat.

2. Cook the oats. Stir in the oats then reduce the heat to medium-low. Let it simmer for about 5 minutes to let the liquid absorb, while stirring occasionally.

3. Top and serve. Add diced apples, chopped pecans, a sprinkle of cinnamon, and a drizzle of maple syrup.

Raspberry Chia Jam 1. Boil water. In a small pot, bring the water or milk and salt to a boil over medium-high heat.

2. Cook the oats. Stir in the oats then reduce the heat to medium-low. Let it simmer for about 5 minutes to let the liquid absorb, while stirring occasionally.

3. Top and serve. Add a spoonful of chia seed jam, coconut flakes, sliced almonds, and extra milk on top.

Banana Blueberry 1. Boil water. In a small pot, bring the water or milk and salt to a boil over medium-high heat.

2. Cook the oats. Stir in the oats then reduce the heat to medium-low. Let it simmer for about 5 minutes to let the liquid absorb, while stirring occasionally.

3. Top and serve. Add sliced bananas, blueberries, a drizzle of almond butter, and a sprinkle of chia seeds.

Strawberries and Cream 1. Boil water. In a small pot, bring the water or milk and salt to a boil over medium-high heat.

2. Cook the oats. Stir in the oats then reduce the heat to medium-low. Let it simmer for about 5 minutes to let the liquid absorb, while stirring occasionally.

3. Top and serve. : Add diced strawberries, a dollop of yogurt, and a sprinkle of flaxseeds.

Photo: Madison Borgel Interview: Naomi Rodriguez

DR. AARON NORTON Persevering with Passion and Purpose Feature Interview Article

Aaron Norton, Ph.D., LMHC, LMFT is a Licensed Mental Health Counselor and Licensed Marriage and Family Therapist serving as Executive Director of the National Board of Forensic Evaluators, Adjunct Instructor at the University of South Florida, Southern Regional Director for the American Mental Health Counselors Association, and PastPresident of the Florida Mental Health Counselors Association. He has nearly 20 years of clinical and forensic experience at Integrity Counseling, Inc., was awarded Mental Health Counselor of the Year by the American Mental Health Counselors Association and Counselor Educator of the Year by the Florida Mental Health Counselors Association in 2016, Researcher of the Year by Florida Mental Health Counselors Association in 2020, and he has been published in several social science journals and professional magazines in clinical mental health counseling.

Tell us about your background and where you are today in your career.

I got an early start in the counseling profession at the age of 20. Because of that, I’ve had the pleasure of working in very diverse settings for the past 20 years, including a facility where juveniles are assessed after an arrest, a long-term, intensive, residential Department of Corrections program, a public health clinic, a public vocational rehabilitation program, a not-for-profit outpatient center on a hospital campus, a private for-profit dual diagnosis residential program, and an outpatient group private practice. I got to experience a lot of roles

in our profession, working from the ground up as a behavioral health technician, community liaison, outreach worker/case manager, substance abuse counselor, vocational rehabilitation counselor, rehabilitation supervisor, behavioral health therapist, and now a clinical mental health counselor in a group private practice.

In my first job as a Licensed Mental Health Counselor, I walked into the lobby one afternoon and called out the first name of a new client. I introduced myself to him and shook his hand. I welcomed him to come back to the therapy room with me. A woman got out of her chair and started walking with us. I asked if she was coming back with us, and they told me that they were coming in for couples therapy. I asked them to have a seat and went back to talk to my supervisor. I told her that I don’t provide couples therapy.

In truth, I had some training on couples therapy, but I did not feel qualified to provide couples therapy because up to that point in my life I had never been successful with a long-term relationship, so I felt like a fraud.

My supervisor looked at me and said, “Well I guess you do now.”

I should pause here and acknowledge that I do not think that it was okay for my supervisor to respond this way, and I don’t think it was wise for me to accept that response, but, in truth, it’s what happened.

I started working with the couple, and to my surprise it went very well. They went from the verge of divorce after an affair to feeling like they were on their “second

honeymoon.” They worked very hard.

After a few months of therapy, we terminated our sessions. Though I was pleased that my first couples therapy experience went well, I knew that I was very inexperienced and that I lacked confidence in my approach, so I decided to spend a couple years immersing myself in training on marriage and family therapy in hopes that I would feel more comfortable working with couples. I eventually obtained dual licensure as a marriage and family therapist.

In 2014, I learned that the National Board of Forensic Evaluators (NBFE), a not-forprofit organization that partners with AMHCA and FMHCA to provide quality training and certification for counselors (and other mental health professionals) seeking specialization in evaluation and expert testimony for the courts, was providing a forensic certification workshop as a pre-conference workshop at FMHCA. I had been providing evaluations (mostly substance abuse evaluations) for the courts for several years, but I lacked formal training and wanted to know if what I was doing was consistent with good practice, so I went to the workshop. With great discomfort, I learned that there was a lot that I was doing wrong in the forensic arena. I was so pleased that the training provided by NBFE and FMHCA could help set me straight, so I studied and trained more, and eventually forensic evaluation became an important focus of specialization for me.

In 2015, I applied to return to school for a PhD in Counselor Education and

My First Counselor Position Operation PAR, 23 years old Supervision. I wanted an opportunity to become a faculty member at the university (which required a doctorate), and I wanted to appease people who take master’s-level professionals less seriously in the forensic arena. I also knew that I wanted to be a father and felt that if I didn’t go back soon, I’d miss my chance.

So I went back and earned my doctorate.

It took me twice as long as I thought it would, but it’s done. In that program, I met Dr. Deirdra Sanders-Burnett, who I have come to admire, appreciate, and respect. She is now Past-President of FMHCA. Today, in my private practice, I provide individual therapy, family and couples therapy, clinical supervision, and forensic mental health evaluations for courts and government agencies. Though I have a wide range of interests, I find it particularly rewarding to work with adolescent clients, college students, and LGBT clients. I believe that has a lot to do with my personal background. I also teach as an adjunct instructor at the

Trip to Ireland, 2019 University of South Florida’s Rehabilitation and Mental Health Counseling program, and I serve as the Executive Director of NBFE. Was the Mental Health field your first career choice?

No, it wasn’t. Starting in middle school, I wanted to work in law enforcement, and I eventually wanted to become a criminal profiler for the FBI. Because I was very focused on this goal, I went to a Criminal Justice Academy magnet program for my high school experience, and I also spent six years with the Police Explorers, a branch of Boy Scouts of American that prepared teens and young adults for career in law enforcement.

After high school, I was working as a service clerk at the heavy machinery company my Dad worked for while also attending undergrad coursework in Psychology, which I hoped would help me prepare for criminal profiling. After 9/11, the machining industry suffered, and the business was closing down. My

Receiving AMHCA’s Mental Health Counselor of the Year award in 2016 boss gave me permission to use any spare time I had calling or faxing companies that might have a job for me until our closing date. I decided to fax bomb a cover letter and resume to every criminal justice-related agency I could find that might have a civilian job for a college student.

One of the faxes I sent went to the Pinellas Juvenile Assessment Center, a multi-agency facility where juveniles are taken when they are arrested. Instead of someone from the Dept. of Juvenile Justice reading my letter, a program director at Operation PAR, a substance abuse agency that took the lead role at the center, intercepted my fax. They needed someone to fill-in for a community liaison who was on pregnancy leave. Someone like a college student—someone like me! My fax came through at just the right time, and they called me for an interview. I was hired, and I didn’t even realize that I was working for a community substance abuse treatment agency until my first day

on the job. I loved that job, which involved linking juvenile and their families to treatment services in the community with the hopes of reducing recidivism. That’s how I got into the field.

asking my therapist something like, “What am I going to do now?” He replied, “You’ll probably end up being a therapist.” I decided that I should be a counselor and not a criminal investigator.

I still planned on working in investigative law enforcement, but I also struggled with depression and anxiety. After high school, I got worse. It eventually reached a point where I was experiencing depersonalization and derealization. I was finding it harder and harder to hold myself together. Part of my problem was that I was a closeted gay man. I didn’t want to be gay, and I often thought that I’d rather be dead than gay. I believed that I was deeply flawed and that it was sinful and immoral for me to be gay. I couldn’t understand why I was inflicted with homosexuality, and I couldn’t reconcile my beliefs with my sexual orientation. I could accept and love others who were gay, but not myself.

I started seeing a Christian therapist. He referred me to my doctor for antidepressant medication, which I took daily during my first year of therapy. I was improving. It was so helpful for me to have someone to talk to about what I was experiencing. I could tell that my therapist really cared, but I couldn’t understand why he was giving me books on sexual addiction to read. I thought the books were interesting, but I didn’t relate to them. I eventually learned that my therapist viewed homosexuality as a form of sexual addiction. I joined an “ex-gay” support group. I tried very hard to “recover,” but I wasn’t getting any better, and it didn’t seem like anyone in my group was, either.

I saw a new therapist—one who didn’t think homosexuality was a disease. I started getting better. I went to grad school, and I eventually came out (quietly) to my classmates in my mental health counseling program. I still felt ashamed, but I started accepting myself.

I’m very grateful today that I found a home in the counseling profession.

Eventually, with the help of some very supportive people who came into my life, I started accepting who I was. I lost some friends. I disappointed some family members. A few things happened that, in my mind, meant that I would never be “good enough” for the FBI. I remember

How do your passions shape your current leadership roles?

I have a love for learning. I try to keep the wide-eyed and curious inner child within me alive, and the acquisition of

"I have a love for learning. I try to keep the wide-eyed and curious inner child within me alive, and the acquisition of knowledge is one way to do that." knowledge is one way to do that. On a slightly darker note, my internal perfectionism, which I continue to work on, also seems to motivate me to learn more. This desire to learn probably influenced me taking on the role of FMHCA’s Chair of the Education, Training Standards, and Continuing Education Committee.

Since obtaining licensure, I have had several experiences that informed an observation that some people do not take counselors as seriously as other mental health professionals. For example, in an agency I worked at, I watched some very qualified LMHCs get turned down for a job opening because we needed a LCSW who could bill Medicare (but who wasn’t

very qualified for that particular position). I’ve had an attorney thank me for what he thought was the best forensic evaluation report he’d ever seen, but then he discovered that I was a LMHC, and he said, “You and I both know that you can write as good a report as anyone, but around here, if you’re not a psychologist, it doesn’t mean much.” I was turned down for a position as a therapist in the U.S. Air Force Reserves because I wasn’t a social worker or a psychologist. I was turned down for my judicial circuit’s list of approved evaluators because I’m a counselor and not a psychologist or a psychiatrist. I have testified for a legislative hearing that a psychological association was incorrect when it tried to block counselors from having fair and equal access to tests because testing “is not typically part of [counselors’] Masters’ level training.” These experiences, and many like them, have taught me that counselors do not have the luxury of showing up for work each day, providing our sessions, and going home. We have to advocate for ourselves.

We have to protect our scope of practice.

We have to show others that we are “good enough.” I think is the primary reason that I serve as the Chair of FMHCA’s Government Relations Committee. My desire to help our national chapter address issues such as Medicare parity, fair and equal access to tests, and representation in the armed services and to improve chapter relations between the state and national level, along with the recommendation of my friend and mentor Dr. Norman Hoffman, the President of NBFE, led me to my position as Southern Regional Director of AMHCA. Another area I’m passionate about involves the relationship between political ideology and the counseling profession. Throughout my life, I have had heroes, friends, and loved ones

whose political and religious ideologies span a full spectrum. Through these experiences, as well as my area of research connected to my doctoral program, I have developed an optimistic viewpoint that most people are trying to do the right thing most of the time, and that even when two people strongly disagree, they are reasoning in very similar ways. I have observed (and researched) political bias and polarization within the counseling profession, and I have heard my colleagues demonize conservative clients, colleagues, and students and mischaracterize their positions and beliefs. I am passionate about helping counselors develop more reasonable and balanced viewpoints about political ideology and learning how to influence those we disagree with through understanding and relationship rather than through criticism. I also believe that we have to make it safer for students to talk about their true beliefs without as much fear of judgment or reprisal from their professors and classmates, and I think we have to learn how to speak to the hearts and minds of both conservative and liberal legislators in order to accomplish our legislative goals.

In the summer of 2019, I traveled to Ireland with a group of counselors and students to learn more about counseling

in Ireland for two weeks. I loved this experience. Shortly thereafter, I helped AMHCA create a membership category for international members and started chairing AMHCA’s International Counseling Task Force in partnership with the International Association for Counselling. Interacting with counselors from other countries and collaborating together on projects has been an absolute joy.

How were you introduced to FMHCA? I first entered the AMHCA and FMHCA arena through my regional chapter, the Suncoast Mental Health Counselors Association (SMHCA). SMHCA was an amazing place. I loved meeting my colleagues, learning from them, and experiencing unfamiliar faces becoming familiar. I heard some things about FMHCA through SMHCA, but I didn’t know much about FMHCA. Then, my friend and former co-worker Dr. Miguel Messina told me about FMHCA’s Qualified Supervisors Training (QST).I attended it in 2013, and I think that was my first FMHCA event. I’m very grateful that Dr. Messina told me about FMHCA’s QST training.

What made you stay with FMHCA after introduction?

Honestly, when I saw the 2013 FMHCA annual conference lineup, I was not very

With Past-President Dr. Carlos Zalaquett and AMHCA Founder Dr. Jim Messina

impressed with the topics and descriptions. I liked the QST training, though, and I was glad that FMHCA provided it. I think that what really drew me in was FMHCA’s 2014 annual conference. I came for the certification workshop with NBFE, and I decided to attend the whole conference and not just the certification workshop. The trainings seemed more interesting and relevant to me than the 2013 lineup. More importantly, I met Dr. Norman Hoffman, Michael Holler, Dr. Darlene Silvernail, Frank Hannah, Dr. Kathie Erwin, and Joe Skelly. I also got to spend more time with Dr. Jim Messina, Dr. Stephen Guinta, and Dr. Carlos Zalaquett (who I already knew through SMHCA) and others that year. In 2016, my boyfriend, Valentino Travieso, went with me to the conference. He has gone with me every year since then, and now he’s my husband, Valentino Norton.

There are so many others who I enjoyed spending time with—Dwight Bain, Dr. Tania Diaz, Erica Whitfield, our amazing lobbyist, Corinne Mixon…the list goes on and on. I came for the learning, but I stayed for the relationships.

What made you run for FMHCA President?

I wanted to see the counseling profession elevated in Florida. I wanted to see if I could make some small contribution towards better parity for counselors. I

Lobbying in the state capitol at FMHCA’s Legislative Days event

decided that it doesn’t make sense for me complain about things—it’s better to see if I can do something about those things.

the clients we serve.

Was the role what you expected when you took position?

When I became President of FMHCA in 2019, my goals were to increase individual membership by 15%, agency membership by 40%, improve our social media presence, pass a licensure portability bill, pass a bill revising F.S. 916.115 to specifically include 491 Board licensees in the list of mental health professionals that can be appointed by the court, support AMHCA in its efforts to accomplish Medicare parity for counselors, increase webinar attendance by 15% or more, institute a social media campaign both on the state and regional chapter level aimed at increasing annual conference attendance, expand our regional training program, improve relations with the national and regional chapters, improve relations with the 491 Board, reduce board meeting length (but not productivity), and improve communication from departing board members to incoming board members. I identified some very specific objectives connected to these goals and created a “Presidential scorecard” for my term.

Yes and no. I didn’t expect us to accomplish everything that I set as a goal, and we didn’t. I expected to work with a wonderful group of people who I’d learn to love even more, and I did. I thought I’d be impressed by FMHCA’s administrative staff, but I did not expect them to be as incredibly awesome as they were. I have never had the experience of being able to hand things off to an administrative team as efficient, professional, good-natured, and impactful as FMHCA’s team. I learned that I could let go of things after I passed them on, and I am not used to that. Frankly, it was therapeutic. I also did not anticipate a few of the challenges I encountered in liaison work with regional chapters. Some of those issues worked out much better than I guessed they would, and others the opposite.

Overall, though, I have found leaders in our profession to be good-natured and willing to work as a team for the growth of our profession and for the wellness of

Our pets Boousch (left) and Jewels (right) sleeping

Tell us about your development projects while FMHCA President

Through the combined efforts of FMHCA’s amazing administrative team, very active and dedicated board members, committee chairs, committee members, and FMHCA members who helped spread the word at so many important junctures, we accomplished most (but not all) of those goals.

The Presidents who came after me have done better than me. When I was President, our membership increased by 33%, but the growth that happened under Dr. Deidra Sanders-Burnett’s leadership dwarfs that increase, and we continue to grow under Laura PeddieBravo’s presidency. FMHCA’s membership has doubled since the beginning of my presidency and it keeps climbing! I have seen this number grow in Florida when in other states our numbers decreased. It's truly an amazing thing to see.

Still, I don’t think it’s enough. As of this writing, there are 15,236 active LMHCs and 7,136 active registered mental health counselor interns in Florida, totaling 22,372 counselors in the state (not including our counseling students, who are also quite numerous in Florida). This

Enjoying a roller coaster with my husband (Valentino), niece (Marissa), and nephew (Dylan)

means that only 7% of these counselors are members. I do not think we can achieve important goals such as Medicare parity unless more counselors join our associations. The larger the number of constituents we present, the more legislators listen.

We were also unable to revise F.S. 916.115, and our regional training program did not expand under my presidency. I feel very optimistic that FMHCA will accomplish these goals in the future.

Lastly, please close the interview out by giving readers a little bit about yourself outside the therapy room I own the world’s cutest dog (though everyone thinks they own the world’s

cutest dog). His name is Boousch, and he’s a chihuahua and dachshund mix. I’m obsessed with dogs. We also have an outdoor cat named Jewels.

I exercise every single day. It grounds me. There is so much in life that I have no control over, but I can control whether I exercise. It started in the Summer of 2006 in grad school when I attended a course with Dr. Gary Dudell in which I had to implement research on what makes people sustain healthy behavioral changes long-term with a personal project. My personal project was regular exercise, and I’ve kept the plan I created in that class going all these years. I love bikrim yoga, which I have practiced for several years. I love nature parks and

hiking. I find water very therapeutic and enjoy swimming (though I’m not good at it) and kayaking. I like to sing (though rarely in public) and play the keyboard. I enjoy reading. I love watching sci-fi, fantasy, horror, and historical movies and shows. I love theme parks. Valentino and I have annual passes for Universal Studios and Busch Gardens. I was terrified of roller coasters as a child, but now I find them strangely relaxing. My heart rate actually lowers on roller coasters instead of climbing. I think cruises make great vacations. I love haunted houses and ghost tours. I like to travel (though I don’t do it enough), visiting historic sites, and I enjoy learning about how people once.

Thank you Dr. Norton for your time, expertise, knowledge, and vulnerability throughout this interview. We appreciate your contribution to our organization and profession.

The FMHCA Staff Diana, Laura, Naomi, & Madison

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Mind GAMES Fill in the missing numbers- Answer Key The missing numbers are integers between 0 and 5 The numbers in each row add up to the totals to the right The numbers in each column add up to the totals along the bottom The diagonal lines also add up to the totals to the right

8

4 2 4 4 14

2 0 3 2 7

3 2 0 5 10

5 3 1 0 9

14 14 7 8 11 4

Compassion Fatigue An exhaustion of the Frontline Worker Professional Experience Article

As a licensed professional counselor (LPC), I hear the struggles and tragedies of others on a weekly bases. I have done this work for 20+ years and the increase in mental health services has seen a sharp increase in the year 2020 and has carried into 2021/2022.

Clinicians are having to create waitlist and increase their caseloads at the same time they are juggling changes in their own personal lives due to the pandemic. I write this article for my fellow colleagues in the mental health profession as the need for services continues to increase and compassion fatigue becomes a possible reality. I am reminded of this quote “The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.”

Dr. Naomi Rachel Remen It is no surprise that under the current stressors created during the pandemic the CDC (Center for Disease Control) reports elevated levels of symptoms of anxiety & depressive disorders, substance use and suicidal ideation. Identified populations that are at increased risk include caregivers and essential workers.

As our world experiences an increase in mental health needs, hence the demands on helping professionals increases. Frontline workers in the mental health crisis are not just limited to

licensed counselors, this group includes teachers, medical personnel, law enforcement, paramedics, social workers and other 1st responders.

Individuals that gravitate towards “helping professions” often posses an extra dose of empathy for those that are hurting and struggling. In addition, many of these professions undergo a great deal of clinical training in the area of empathetic engagement. Even with these added skills and training the weight and increased demand of emotional support needed over this past year can take a toll on even the most highly trained professionals.

This toll can be seen as compassion fatigue. After years of research in early 1990’s this term was coined by Charles Figley, Ph.D. His term, compassion fatigue (CF) is different then burnout. Compassion fatigue is defined as profound emotional and physical erosion that takes place when helpers are unable to refuel or regenerate. In contrast to burnout, compassion fatigue can come on more suddenly verses over a long period of time.

Another important distinction is that CF occurs with strong levels of job satisfaction verses low job satisfaction like burnout.

The key difference for those experiencing CF is being overwhelmed with job demands.

Common symptoms of Compassion Fatigue are: Chronic physical and emotional exhaustion Depersonalization seen in reduced empathy and ability to connect with loved ones Numbness of emotions/indifference Irritability Feelings of self contempt seen as increased feelings of hopelessness or discontent about the world In this past 12 months I can honestly share that I have had moments when compassion fatigue has been present in my life.

It takes a conscious effort on my part to not allow the fatigue to get the best of me. Below are suggested tips to help navigate through a challenging time in our world.

Tips to Overcome Compassion Fatigue Create a work-life balance Invest in strong social supports professionally and personally. Consider supervision or a professional support group Self-care with a focus on mental and emotional decompression. Find the activity that works for

you….physical exercise, time outdoors, complete a puzzle, or get lost in a book Practice “micro self care” use a timer or Apple Watch and deep breathe for 1 minute focusing on inhale and exhaling.

Science proves this practice provides health benefits We as trained helping professionals are at a high calling in our current climate, combined with our own need to personally managing the challenges from the pandemic within our own homes and our day to day routines. The current mental health demands will not come to an end simply with widespread vaccinations, in fact as restrictions ease up and folks are able to move forward in their lives the impact of the emotional drain during this time may surface more readily. Frontline workers, caregivers, teachers and mental health professionals will benefit from a practice of self care and awareness of compassion fatigue in their lives. To my fellow “helping professionals” and all those that are hurting and struggling emotionally I leave you with this final thought: “Taking care of myself doesn't mean ‘me first’ it means me too.”

L.R. Knost

Written By: Christy Billings, MS, LPC Christy Billings, MS, LPC is a licensed counselor in the North Texas area. She has 25+ years of experience working with adult individuals and couples addressing issues of relationship conflict, anxiety, depression and grief. In addition to her clinical background, Christy has experience as an author, group practice owner, and college teacher.

WANTED: Military Cultural Competencies Standards in Counseling Professional Experience Article

Military cultural competence in mental health counseling continues to gain national attention. Professionals have theorized that limited outcomes in the treatment of posttraumatic stress disorder and depression in the military may be related to limited familiarity with the military. National surveys have shown low military cultural competence among providers and limited educational efforts on military culture or pertinent military pathology in counselor training programs.

Military families, with their own unique military cultural identity, have been recognized as a population with heightened risks associated with deployment. In response to these findings, military counseling psychology organizations have researched the value of implementing Military Cultural Competence education geared towards community and organizational mental health care providers and the results have been widely distributed. Assessments of military cultural competence have also been developed. The clinical impact of enhanced cultural competence in general to date has been limited. The military, however, with its highly prescribed cultural identity, may be a model culture for developing a military cultural competency curriculum within an institution of higher education.

The ACA Code of Ethics (2014) advises counselors to take an active role in recognizing diverse cultural histories of the clients they serve. Counselor education programs and clinical supervisors have the responsibility of developing professional counselors while inculcating multiculturalism and diversity into

course curriculums and supervision plans with the goal of increasing awareness, knowledge, and skills that will foster competencies in this area (ACA, 2014) However, counselor education agendas are limited around military-cultural awareness and competencies and do not address specific counseling approaches tailored to this unique population. With the increasing need for clinicians to provide services to military personnel, it is compulsory for providers within the community to possess the necessary culturally competent knowledge and skills to respectfully address the mental health needs of servicemembers. Counselor educators and supervisors also have an obligation to incorporate culturally specific awareness and competencies into the training of novices in the counseling field.

Additionally, with the growing number of military, veterans and their families needing mental health services and support, seeking treatment outside of the overburdened VA and DOD health care systems is becoming more common. To competently meet the needs of this community and establish an effective working relationship that will minimize attrition, it is imperative that counseling professionals possess the requisite knowledge, skills, and evidence-based treatment methods in the context of military culture.

To learn more about this topic, join FMHCA’s Military Services Committee as we move towards advocacy and increased training to better meet the needs of this distinct population.

Written By: Maria Giuliana, LMHC Maria Giuliana, LMHC, Qualified Supervisor, is FMHCA's Regional Director Northeast and Chair of the Military Services Committee. She is the founder of Beyond The Matter Counseling and Consulting Services in Jacksonville, Florida. Her Clinical, Leadership, and Advocacy experience include presenting at professional conferences on a variety of clinical topics including cultural and ethical competencies related to military and LGBTQ+ clientele.

FMHCA Emerges Victorious from the 2022 Florida Legislative Session Legislative Update from FMHCA Lobbyist, Corinne Mixon

Session concluded – several days late due to disagreements over Florida’s $112 billion budget – on Monday, March 14th.

A significant accomplishment – Early in the final week of session, Sen. Ana Maria Rodriguez, (R-Miami), presented HB 1521, a bill titled Mental Health Counseling Compacts, for the final time. It passed with unanimous approval through the Senate chamber. The bill, which was brought to its sponsor in the House of Representatives, Tracy Koster (R-Tampa) and Sen. Rodriguez, by FMHCA and key constituents, surfaced as one of the only bills to pass dealing with licensed health care professionals – an abnormal occurrence during any given legislative session. In fact, the bill was among the 285 bills to pass this legislative session even though an astonishing 3685 were filed by the 150 members of the House and Senate!

FMHCA’s leadership and government relations committee, coupled with our lobbying efforts, were integral in ensuring this success.

Rationale for the bill – There is currently a health care provider shortage in the U.S. This shortage is predicted to continue into the foreseeable future and will likely worsen with the aging and growth of the U.S. population. According to the U.S. Health Resources and Services Administration (HRSA), the U.S. will experience a 7% increase in demand for mental health counselors by 2030, producing a shortage of approximately 6,870 mental health counselors nationwide. In Florida, HRSA estimates a shortage of 3,400 mental health counselors by 2030.

Exacerbated by the COVID-19 pandemic, the American Academy of Pediatrics declared a national state of emergency in children’s mental health, creating a need for more mental health professionals and increased access to such. Interstate compacts are a proven solution.

The compact – An interstate compact is agreement between states to enact legislation and enter into a contract for a specific, limited purpose. In 2020, the National Center for Interstate Compacts adopted model legislation for the Professional Counselors Licensure Compact (PCLC or compact) which

authorizes both telehealth and in-person practice across state lines in compact states. The compact establishes the Counseling Compact Commission (Commission), made up of a representative of each party state’s licensing board. The Commission is responsible for administering the compact. The compact becomes effective on the date of enactment by the tenth state and currently has two member states.

HB 1521 enacts the PCLC and authorizes Florida to enter into the compact. The Department of Health (DOH) must notify the Division of Law Revision when the compact is enacted into law by ten states. Professional counselors licensed in compact states may apply to other compact states for the privilege to practice through either telehealth or in-person. Thus, under the compact a Florida licensed clinical social worker, marriage and family therapist, or mental health counselor is eligible to provide services to out-of-state patients through either telehealth or inperson.

The compact requires all participating states to report certain licensure information to a data system, including identifying information, licensure data, and adverse actions taken against a professional counselor’s license or practice privileges in a compact state. Such information is public under the compact unless a compact state designates the information it contributes to the data system as confidential, prohibiting disclosure to the public without express permission of the reporting state.

Challenges and opportunities – Florida has become only the third state to pass the compact. The compact will not be enacted until 10 states have joined. FMHCA’s House and Senate sponsors will need to take further action next session to ensure the State’s compliance with the rules of the national compact association.

Due to a constitutional amendment passed by Florida voters on the 2020 ballot, the legislature must hold a separate vote (bill) for any legislation that requires or authorizes a new fee or tax.

Since the national compact group requires that a fee be authorized, Florida will have to pass a “fee bill” in the 2023 legislative session to be in compliance with their requirements.

Florida hopes to be one of the first 10 states admitted to the compact! FMHCA will keep its members apprised as the ability of mental health counseling licensees to enter the compact becomes a reality.

Thank you – FMHCA and its lobbyist extend our sincere gratitude to Rep. Traci Koster and Sen. Ana Maria Rodriguez for prioritizing this incredible legislation.

Other great news in BUDGET form – Florida’s proposed budget, which is scheduled for a vote on Monday, includes an unprecedented $101 million in recurring annual funds for community mental health and substance-abuse services.

Lawmakers included the allotment in the Health and Human Services budget.

Written By: Corinne Mixon, FMHCA Lobbyist Corrine is a registered professional lobbyist with more than twelve years of experience representing clients' state governmental interests. At Rutledge Ecenia, Corinne represents a broad client base with a particular emphasis on health care practitioners, education, and regulated industries and professions. She has been instrumental in passing myriad legislation and killing or containing bills that would have negatively impacted her clients.

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