MENTAL HEALTH IN MENTAL HEALTH IN A POLARIZED ERA: A POLARIZED ERA: PRIORITIZING PRIORITIZING WELLNESS AS A WELLNESS AS A FORM OF FORM OF PERSONAL PERSONAL PROTEST PROTEST
PG. 47 PG. 47 OLDER OLDER ADULTS AND ADULTS AND MENTAL MENTAL HEALTH HEALTH
PG. 9 PG. 9
WHY TO USE- OR WHY TO USE- OR AVOID- ARTIFICIAL AVOID- ARTIFICIAL INTELLIGENCE (AI) IN INTELLIGENCE (AI) IN YOUR COUNSELING & YOUR COUNSELING & PSYCHOTHERAPY PSYCHOTHERAPY PRACTICE PRACTICE
PG. 39 PG. 39
WORKING WITH WORKING WITH DUAL DUAL DISORDERED DISORDERED CLIENTS: CLIENTS: UNDERSTANDING UNDERSTANDING THE HIDDEN THE HIDDEN CHALLENGES CHALLENGES
PG. 37 PG. 37
TRANSFORMING TRANSFORMING RELATIONSHIPS RELATIONSHIPS THROUGH THROUGH PSYCHEDELICPSYCHEDELICASSISTED ASSISTED THERAPY THERAPY
Dr. Denny Cecil-Van Den Heuvel
A LIFELONG ADVOCATE FOR MENTAL HEALTH COUNSELING
President’s Column
Uncertainty, distress, frustration and confusion are feelings that may seem to hang around the Counseling Office like stalactites in a cave They come in with our Clients and if we are not careful, those feelings can linger with us That’s where self-care and connection becomes both an inoculation and a soothing balm for Counselors
As part of sharing a needed emotional lift, I have invited Colleagues and recently met Counselors to discover the wealth of learning opportunities in FMHCA’S monthly CE Webinars. Sure earning CE’s is good but the greatest benefit is in discovering creative approaches and hearing fresh views on diagnosis and treatment options Our field is actively developing, it’s not static or boring
One thing I particularly love about the Counseling Profession is that it’s a work in progress. What have you discovered, applied or found effective with your client base? Our FMHCA Members
and Students are “inquiring minds who want to know ” The strength of FMHCA is our dedication and our passion for this work If that sounds like you, then there are upcoming opportunities to share with our member and students by presenting at our 2026 FMHCA Conference or in a Webinar You can also become involved in Committees and Legislative Advocacy.
When lost or in trouble, the late Mr. Rogers wisely advised, “look for the helpers”. We are those helpers. FMHCA is your “Helper” to uplift, encourage, educate and advocate for members and students who make a difference every day in your communities
Respectfully,
Dr Kathie Erwin
MAY 2ND 2025 | 4PM-6PM
Flourish Together
CREATIVITY & CONNECTION FOR THERAPISTS
BROUGHT TO YOU BY BRUCE LAW FIRM
Join us for a fun and creative networking event at Grandview Public Market’s Living and Tea Room in West Palm Beach Therapists are invited to gather and embrace the spirit of spring Come together to build your own beautiful floral bouquet while connecting with fellow counselors in a relaxing and creative atmosphere
Light bites will be provided by Bruce Law Firm, making this a perfect opportunity to unwind, network, and nurture both your creativity and connections
Page 9 Why to Use- or Avoid- Artificial Intelligence (AI) in Your Counseling and Psychotherapy Practice
Page 17 Your Life, Your Terms: Rewriting the Story Imposed on You
28 Mental Health in a Polarized Era: Prioritizing Wellness as a Form of Personal Protest Page 30 Dr. Denny Cecil-Van Den Heuvel: A Lifelong Advocate for Mental Health Counseling
Ask The Expert with President & Managing Partner of The Health Law Firm, George F. Indest, J.D., M.P.A., LL.M.
Page 15 Prioritizing Mental Health for College Success Page 39 Working with Dual Disordered Clients: Understanding the Hidden Challenges
MAGAZINE
Page 47
Older Adults and Mental Health
Page 50
Navigating Confidentiality in Couples Therapy
Page 53
Dealing
with Political Conversations in Sessions
Page 54
Submit for the next issue of InSession!
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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 firstperson pieces about a topic related to their experience as a mental health professional, or an opinion about a trend in the mental health counseling field
Professional Resource Articles are in-depth pieces intended to provide insight 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
FMHCA'sMissionStatement
The Florida Mental Health Counselors Association (FMHCA) is the State Chapter of the American Mental Health Counselors Association (AMHCA) FMHCA is the only organization dedicated exclusively to meeting the professional needs of Florida’s Licensed Mental Health Counselors
The mission of the FMHCA is to advance the profession of clinical mental health counseling through intentional and strengthbased advocacy, networking, professional development, legislative efforts, public education, and the promotion of positive mental health for our communities
Its sole purpose is to promote the profession of mental health counseling and the needs of our members as well as:
Provide a system for the exchange of professional information among mental health counselors through newsletters, journals or other scientific, educational and/or professional materials
Provide professional development programs for mental health counselors to update and enhance clinical competencies
Promote legislation that recognizes and advances the profession of mental health counseling
Provide a public forum for mental health counselors to advocate for the social and emotional welfare of clients
Promote positive relations with mental health counselors and other mental health practitioners in all work settings to enhance the profession of mental health counseling
Contribute to the establishment and maintenance of minimum training standards for mental health counselors
Promote scientific research and inquiry into mental health concerns
Provide liaison on the state level with other professional organizations to promote the advancement of the mental health profession
Provide the public with information concerning the competencies and professional services of mental health counselors
Promote equitable licensure standards for mental health counselors through the state legislature
Professional Resource Article written by Aaron Norton, PhD, LMHC, LMFT
In March 2022, I had the pleasure of serving on AMHCA’s Ethics Committee when AMHCA made history as the first national association representing mental health professionals to revise its code of ethics to explicitly refer to AI (artificial intelligence). Of course, this historic event doesn’t mean that counselors feel ready to open their arms and offices to this ever-evolving technology. When I train counselors on the use of AI in counseling, I flash an image of a human hand reaching out to a robotic hand on a screen, a variation of a detail from Michaelangelo’s “The Creation of Adam” fresco When I ask participants to identify the first thoughts, feelings, and sensations they experience, the counselors commonly use words such as “creepy,” “unreal,” “yuck,” “scary,” or “scared” to describe their initial rection. A minority of counselors instead use words like “interested,” “curious,” or “cool” to describe their reaction.
On one hand, our codes of ethics call on us to expand our awareness of the role of technology in the work we do, considering the use of innovative advances in technology as an adjunct to counseling and psychotherapy On the other, the technophobic attitudes that many of us foster for AI is not entirely unfounded this technology comes with a cost, as well as a slew of legal, ethical, and clinical risks I believe that embedded within human DNA there is a natural suspicion of anything that closely mimics humanity without being human. But we counselors can use our expertise in mental health and leadership to augment the beneficial aspects of AI while reducing the likelihood of harm caused by this rapidly advancing technology.
In this article, I’d like to introduce you to AI, offer examples of how you and your clients can use AI to improve the counseling process, expose you to the potential risks and dangers of AI as an adjunct to therapy, and summarize guidelines for using AI in your counseling practice. I won’t talk about the use of AI in counselor education; that’ll come in a future issue, so keep your eyes on your inbox for that.
What Exactly is AI, Anyway?
There is no single, universally recognized definition of AI, but the definitions offered by authoritative sources are similar. I like the definition offered in a course created by the Innovative Education team at the University of South Florida (USF), which describes AI as “the theory and development of computer systems able to perform tasks that normally require human intelligence, such as visual percepion, speech recognition, decision-making, and translation between languages ”
Using this definition, AI is a much broader concept than most counselors seem to think it is, and most maybe all counselors are already using it in our day-to-day lives. When you wear a smart watch that monitors your heart rate while you exercise, use an app to find the fastest route to work, unlock your phone using a facial scan, interact with a chatbot on a website, or open Google Translate to communicate with someone who speaks a different language, you’re using AI
AI isn’t new. The term was first coined in 1957, but the concept originated decades before the term existed. AI is not even new to counseling. You can still converse with a Rogerian mock therapist chatbot called “Eliza” that was developed in the 1960s
AI-generated image credit: Art of Znerol
by a researcher at MIT Though Eliza’s counseling skills are basic, focusing on open-ended questions, reflections, and empathetic responses, her or should we say, its services are free!
Fear and discomfort with AI are as old as the concept of AI itself. Dismal stories focused on the potential horrors of AI predate any of our entries into the counseling profession. For example, a list on the Internet Movie Database (IMDB) site identifies 113 movies filmed since 1927 with plotlines involving AI, often consisting of dysphoric, post-apocalyptic futures in which humanity struggles to survive
If AI isn’t new, then why do so many people think it is? I think it’s mostly because of ChatGPT, a revolutionary generative AI platform created by a San Francisco-based company called OpenAI. ChatGPT is unique because of its advanced ability for natural language generation.
I should back up here a little and offer some additional definitions, courtesy of USF’s Innovative Education team. We’ve already learned that AI can be defined as “the theory and development of computer systems able to perform tasks that normally require human intelligence.” Natural language processing (NLP) is a subfield of AI that focuses on enabling computers to understand, interpret, and generate human language. Natural language generation (NLG) is, in turn, a subfield of NLP that focuses on generating human-like language from structured data or other inputs.
ChatGPT is unique because it offers NLG that feels more like communicating with a real human than any of its predecessors You can communicate with it similarly to the way that you would converse with any person who exists, except that ChatGPT is, essentially, more knowledgeable than any single human being, as it borrows from a substantially greater pool of data than any single person can possess, and its capacity for analogical reasoning (i.e., identifying similarities between concepts and ideas) is superior to previous generative AI platforms.
So, if ChatGPT is, in a sense, smarter than any single counselor, does that mean it can counsel better than we can?
Will AI Replace Counselors?
Many counselors fear that they’ll eventually become fully or partly obsolete as the influence of AI in society continues to grow As time progresses, AI bots are becoming increasingly difficult to differentiate from humans. The Turing test, named after Alan Turing, who invented the procedure in 1950, employs what is known as the “imitation game” to determine whether humans can differentiate between responses offered by AI or
other humans In a study published in 2024, humans incorrectly identified text-based responses from ChatGPT 54 percent of the time, which is about the same as random chance
In a 2022 study published in Computers in Human Behavior, 55 percent of the sample of 872 adults preferred AI-based psychotherapy over psychotherapy with a human. At the same time, participants in that study acknowledged that they generally trust human therapists more than AI In a 2023 study published in JAMA Internal Medicine, a panel of healthcare professionals judged human physicians’ answers to patients’ questions as much less empathetic and lower in quality than the answers offered by ChatGPT
Though I know of no such study ever being conducted with mental health counselors (any doctoral student reading this article who is looking for a good dissertation idea should consider replicating that study with counselors instead of physicians), this study highlights how generative AI tools may, in the future, become better sources of mental health-related information than any single counselor
Interestingly, in a 2022 study published in Current Psychology, therapy clients preferred AI bots that disclose or exhibit humanlike emotions over those that provide information only. This is notable, given that AI bots do not truly experience human emotions they can simply be programmed to mimic them. Yet, people would rather communicate with an AI bot that essentially feigns human emotion than one that doesn’t.
I can’t pretend to know what will happen in 100 years, but I don’t believe that in our lifetime we will see mental health counseling dominated by AI bots. But I’ll come back to this issue after exploring both some of the beneficial and potentially detrimental uses of AI in counseling.
Beneficial Uses of AI in Counseling
Let’s talk about examples of how AI could be helpful as an adjunct to counseling and psychotherapy.
Enhanced learning. Both counselors and clients can use generative AI tools to learn more about a concept or idea related to mental health and wellness To test this idea out, I recommend that you obtain a free ChatGPT account and then type questions such as:
According to the DSM-5-TR, what does the specifier “in remission” mean in relation to substance use disorders?
What life experiences influenced Viktor Frankl, MD, PhD, to develop logotherapy?
What are specifiers and subtypes in the DSM-5-TR, and how are they different? Offer examples and cite
sources
What is “parental alienation,” and what are some of the criticisms and defenses of the concept? Provide sources
Brainstorming. Counselors could use generative AI tools to brainstorm ideas for treatment plans and therapeutic interventions. Examples of prompts:
I am a psychotherapist working with a client who was diagnosed with a major depressive episode that is likely connected to “empty-nest syndrome ” What are some examples of treatment plan goals and specific interventions from a cognitive behavioral therapy perspective?
Provide descriptions of evidence-based treatment for antisocial personality disorder. Cite academic/scientific sources.
Proofreading. Counselors can use ChatGPT to offer recommendations for clearer communication in written correspondence, such as emails and reports Prompt examples:
I am a mental health counselor submitting a report recommending accommodations for a client with generalized anxiety disorder and panic disorder
Proofread the following report, and offer suggestions for improving spelling, grammar, word usage, and clarity: [paste report].
Offer suggestions for improving the wording of this professional email: [insert email draft text].
Data analysis. Articles published in journals such as Industrial Psychiatry Journal and Journal of Medical Internet Research have focused on digital phenotyping, which uses data from apps, smart watches, and other devices to predict relapse, identify triggers and early warning signs of disorders or relapses, and offer additional insights that can be helpful to both counselors and their clients. For example, an AI tool may identify a seasonal pattern to a client’s depressive symptoms, or perhaps a pattern that correlates with a client’s menstrual cycle, while a counselor may not have picked up on that correlation.
Psychoeducation and Support Between Sessions. Clients could potentially use AI bots to offer information about mental health, wellness, and therapy homework assignments between sessions, or acting as a counselor’s assistant, an informed life coach, or a support specialist between therapy sessions. For example, several studies have demonstrated that clients using Woebot, an AI-
powered chatbot, have experienced emotional relief between sessions AI bots can also check in with clients and ask them to rate their mood or remind them of their therapy homework.
Differential Diagnosis. Counselors can use AI tools to consider various diagnostic possibilities for client presentations. Prompt example:
I am a mental health professional conducting a mental health evaluation of a client Her symptoms include depressed mood most of the day nearly every day for two weeks, difficulty falling and staying asleep, daytime fatigue, a sense of worthlessness and hopelessness, reduced appetite, and unintentional weight loss. What disorders might be potential diagnoses for her? What questions might I ask during a follow-up interview for further assessment?
The “Dark Side” of AI in Counseling
Despite the numerous, potentially beneficial ways that AI can be used as an adjunct for counseling, there’s no shortage of ways that the use of AI could go horribly wrong in our profession:
Inaccurate Information. AI tools are powerful, but they are also fallible, just like we are AI-generated summaries often include mistakes For example, during a recent session, a client of mine was talking about his wife and then shifted to talking about his daughter While I was able to track this shift, a generative AI tool we were using to take notes for the client during the session missed this shift and falsely attributed some of the client’s statements about his wife to his daughter.
Over-Reliance. Some people have heralded the 2006 comedic movie “Idiocracy” as ironically prophetic. In this movie, a librarian is chosen by the US Army for a suspended animation experiment. He awakens 500 years later to a society that has regressed, partially due to over-reliance on technology. Not knowing what was happening to him or where he was, he wanders into a hospital, where healthcare professionals try to use buttons with simple graphics on them and computer-generated instructions to diagnose him, apparently lacking the capacity to apply their own reasoning to evaluate his condition What if counselors over-rely on AI for evaluation, diagnosis, and treatment planning? What might such a future look like?
Social Isolation and Deterioration. The 2013 movie “Her” depicts a man who falls in love with his AI companion, preferring her over the challenges of navigating relationships with actual humans. In October 2024, the
New York Times reported that a 14-year-old Florida teen developed a romantic relationship with his AI chatbot and then completed suicide after a conversation in which his chatbot suggested that “maybe we can die together and be free together.”
Could relationships with AI bots offer enough companionship that some people especially those who are socially anxious or otherwise vulnerable might further avoid the inherent challenges of navigating relationships with other humans? And how might this affect them?
Privacy Violations. Some AI tools are HIPAA-complaint, and others aren’t. For example, ChatGPT is not HIPAAcompliant and does not offer a business associate agreement for counselors. Inputting sensitive client information could, in addition to violating state and/or federal law, allow a generative AI tool to positively identify a client and then link information offered by a counselor to that individual in its knowledge base And for those platforms that advertise that they are HIPAA-complaint (e g , AutoNotes, Blueprint, Upheal), how secure is stored data? What happens if it is compromised?
Perpetuation of Biases and Stereotypes. Information gleaned from AI tools are only as good as the data that trains them. Articles recently published in Perspectives on Psychological Science and Frontiers in Psychiatry have highlighted the problem of AI tools perpetuating stereotypes and disseminating biased information.
For example, when I was in Ireland in 2019, I noticed an ad campaign called “This Is Not Us” funded by EPIC, the Irish Emigration Museum, that drew attention to inaccurate, biased, and insulting depictions of Irish people offered by generative AI tools. Tech companies have tried to counter such biases in AI-generated outputs. I’m pleased to say that if you type “show me an Irish man” in ChatGPT’s image generator today, you’ll see an image that is nothing like the images reported by EPIC in 2019.
Client Inactivity. Ever watched the 2008 Pixar film “WALL-E?” It depicts a future in which obese humans glide around in electric chairs that offer them entertainment and food with a click of a button, allowing them to live lives that are fully sedentary. In the book “The Anxious Generation,” by social psychologist Jonathan Haidt, PhD, the invention of the smartphone is linked with increases in anxiety, depression, and self-harm among adolescents and young adults.
In addition to offering a more pessimistic depiction of
society by overexposing youth to “bad news” and algorithms that perpetuate negative and polarizing stereotypes about society, the smartphone augmented unrealistic social comparisons and also contributed to a reduction in physical activity, synchronous and unstructured play, and exposure to nature among youth, all of which are believed to negatively impact mental health and well-being. Could AI technology further this trend?
Environmental Impact. As described in a September 2024 article published by the United Nations Environment Programme, AI can positively impact the environment by generating data that can help governments, businesses, and individuals improve efficiency with natural resources and reduce waste, but on the other hand, a tremendous amount of energy, raw materials, and hazardous chemicals are used to power AI technologies.
Guidelines for Using AI in Counseling and Psychotherapy
Thankfully, guidelines offered by AMHCA, the American Counseling Association (ACA), and the National Board for Certified Counselors (NBCC) give counselors ways to augment the beneficial uses of AI in counseling while reducing the potential for negative AI-related impact. Following is a summary of those guidelines:
Stay open, informed, and educated about AI and its application in counseling.
Avoid over-relying on AI. Use it as a tool to learn, not as a substitute for learning.
Recognize that AI tools can be biased, and that overrelying on AI-generated information can perpetuate stereotypes and discrimination
Advocate for transparency on the part of tech companies on the algorithms and data sources used to train AI tools.
Maintain transparency with your counseling clients about your use of AI, and solicit appropriate informed consent if you intend to use AI while working with them (as an example, you can view the informed consent form that I use with clients who want to use my telehealth platform’s AI tools).
Leverage AI for data-driven insights. Consider opportunities for you and your clients to use AI technology to identify trends, patterns, and insights related to their symptoms or to correlations between experiences and behaviors and their symptoms.
Ensure data security and privacy. Use AI tools that are HIPAA-compliant, and make sure you’ve signed a business associate agreement (BAA) with any AI platform in which you are entering protected health information (PHI) If
using an AI tool that is not HIPAA-complaint, ensure that no information is being entered that could potentially identify a client or violate a client’s privacy
Ask clients about how they use AI in ways that are relevant to their counseling. For example, I recently asked a therapy client if he ever uses AI tools between sessions, and he acknowledged that he used ChatGPT to offer recommendations for how to word his text messages to his girlfriend when he wants to politely confront her on some concerns he has with their relationship, which was helpful information for me as his counselor. Understand the limitations of AI in diagnosis, assessment, and treatment planning. When using AI tools to generate ideas, think of those tools as though they are a human consultant Consider what they have to say, do your own research, and then decide what to do with that information The information these tools provide is simply a perspective to be considered, not a directive
A Call to Action
Maybe I’ll be proved wrong someday, but I don’t think that AI will replace counselors I think that no matter how advanced AI technology becomes, many people will always want a true human connection with another person, even if that person uses AI as a tool for quality care.
The role of AI is progressing and advancing in society, regardless of how counselors think and feel about it. We can stand by while others advance this technology, hoping and pretending that AI will somehow disappear, or we can do what we’ve always done serve as an anchoring presence for our clients and for society during a time of change
We can choose a path in which we are not slaves to our emotional impulses but one in which we seek to understand our emotions and then supplement them with reason, reacting from a position of authority, leadership, and resiliency, embodying the adaptive spirit that has always guided our profession. We can help guide clients, tech companies, legislators, and the public on how to ethically use AI for enhanced mental health and wellness.
I hope this article, which was written without any assistance whatsoever from any AI tools, has helped you to start thinking about your role in this evolving technological landscape
We can stand by while others advance this technology, hoping and pretending that AI will somehow disappear or we can do what we’ve always done: serve as an anchoring presence for our clients and for society during a time of change.
This article is reprinted from AMHCA’s The Advocate Magazine with permission from the author
Dr. Aaron Norton, is a Licensed Mental Health Counselor and Licensed Marriage and Family Therapist who serves as an assistant professor of instruction at the University of South Florida’s Department of Mental Health Law and Policy, executive director of the National Board of Forensi , chair of AMHCA’s International Counseling Task Force and a member of AMHCA’s Ethics Committee. He has 20 years of clinical experience providing psychotherapy, supervision, and clinical and forensic evaluation (www.anorton.com). See Dr. Norton’s article on the use of virtual reality in counseling (https://bit ly/41L9mpE), which appears in the 2023 #2 issue of The Advocate Magazine
PrioritizingMental HealthforCollegeSuccess
Professional Experience Article written by Ariella VanHara, LCSW-QS
College students are faced with immense pressure including areas such as academic course loads, financial concerns, balancing social and family connections, and career and future uncertainty. This occurs all while navigating through their personal and professional identity development This pivotal moment can often contribute to an increase in stress, anxiety, and depression as they navigate through these complex challenges
Students often experience heavy workload related stress by managing multiple courses with assigned readings, papers, and exams, with many overlapping deadlines. The competitive nature of programs for advanced degrees can contribute to an increase in stress and burnout. This may also present in other signs and symptoms such as changes in sleep, appetite, mood, and functioning Many students are facing the rising cost of tuition with loans and taking on part-time or full-time work This presents challenges to maintain a balanced life of academics, work, and social connections The transition to college can often involve meeting new people and creating a social network, as well as balancing other relationships such as family and significant others. Social connections are a key part of our internal needs and neglecting this can contribute to an increase in psychological distress, specifically during this particular stage of development. There may also be an increase in stress related to career and future uncertainty. It is not uncommon for a student to switch their major through course
exploration At a younger age, it can be daunting to choose a “forever career” Students can often grapple with the idea of permanency in their decisions, as well as their identity outside of being a student.
Research cites that college student mental health is declining, with a reported increase in psychological distress. The Healthy Minds Survey which evaluates college student mental health across the nation supports the data trends being discussed The question remains whether college and university campuses are equipped and prepared to handle the increase in acuity related to psychiatric concerns Many colleges and universities offer counseling services, but the demand often exceeds the availability of staff and resources While professors and academic advisors are not mental health professionals, they are often the first point of contact a student has with someone in the campus setting to disclose their mental health concerns. Many campuses may focus on a crisis intervention plan, but the discussion should consider a shift to changes that can be made for prevention and additional support. For example, college campuses may want to consider investing in evidence-based training practices to equip faculty and staff on how to navigate situations where a students may disclose distress to them. This can include basic de-escalation strategies, how to support a student, and how to refer them to the appropriate care. Evidence-based training such as Mental Health First-Aid (MHFA) and Question, Persuade, and Refer (QPR) are forms of training that can support non-mental health professionals in this area
Many campuses provide supportive counseling on-site, but not all students take advantage of this resource. Internally reviewing ways to adjust operations and procedures to help reach and meet the students can be a helpful tool in program review and enhancement. This can be evaluated using external and internal data and collaborating with partners to identify strategies and techniques for prioritizing mental health for college success
Ariella VanHara is a licensed clinical social worker (LCSW) and qualified supervisor (QS) She has experience in various clinical roles, and administrative leadership She is currently a Clinical Assistant Professor at Florida Gulf Coast University (FGCU) in a joint appointment with the Department of Social Work and Counseling and Psychological Services (CAPS). She also serves on the board of directors for a sexual assault agency, Project HELP. Additionally, she serves as co-chair on the Chapter Committee for Nominations and Leadership (CCNLI) for the NASWFL chapter.
Professional Experience Article written by Monik Mossini, LMHC
She walked into my office, and before she could string together two sentences, she broke down in tears. It wasn’t just sadness it was exhaustion, grief, and shame
She was 33. Not married. Not in a career she was proud of “It’s just a job, not a career.” Living with her mother. No hobbies, no close friends. But her pain wasn’t about missed milestones. It was about something deeper: she hated herself.
She didn’t see that she was the top performer at work, that she had held her job for eight years in an industry where people cycle through jobs like seasons All she saw was that it wasn’t the “right” kind of success
She believed she was a failure.
She hadn’t followed the timeline she thought was carved in stone school, degree, career, marriage, children She felt like she had missed her window for all of it
And if you’ve missed your chance at life, what’s left?
There is an invisible script handed to us at birth It tells us when we should graduate, when we should settle down, when we should have children It defines success before we even know who we are.
And we follow it not because we chose to, but because we don’t know another way.
She had tried to keep up, but somewhere along the way, she fell behind. She didn’t go straight to university, didn’t become an architect like her family hoped, didn’t marry by 30.
Instead, she spent years feeling like she was running a race she had already lost. Then came the awakening.
She realized her suffering didn’t come from failing herself. It came from failing to meet expectations that were never hers to begin with. When you spend your life living by someone else’s rules, rewriting your story isn’t just about making new choices it’s about unlearning.
That’s where Cognitive Behavioral Therapy (CBT) became a lifeline CBT helped her dissect the deep-seated beliefs that shaped her identity It challenged the idea that she was a failure simply because life hadn’t followed a timeline It wasn’t easy challenging ingrained thought patterns never is but slowly, she began to see herself differently.
Rewriting her story meant letting go of the idea that her parents “knew better.” It meant refusing to compare herself to where her mother was at 33. It meant redefining success not as a title, a degree, or a timeline, but as something deeply personal. But more than anything, it meant rewriting the way she saw herself
How do you love someone who has let you down so many times?
How do you forgive yourself for failing over and over again?
How do you become your own ally when you’ve spent years being your own worst enemy?
It took her over a month to come up with a list of ten things she liked about herself. Not accomplishments. Not skills. Just ten things that made her her And it was painful Because when you’ve spent years defining yourself by what you lack, seeing your own worth can feel like staring into the sun But that list became a foundation a crack in the armor of self-loathing
From there, she started rewriting everything:
She gave herself permission to change jobs in her 30s. She gave herself permission to go back to school, even though she wasn’t 18 anymore.
She gave herself permission to believe that being single for ten years didn’t mean she would be alone forever.
She gave herself permission to exist on her own terms
It was slow. It was painful. But this time, she was the author of her story. And in her new narrative, she deserved to be happy. Rewriting your life isn’t just about choosing a new path It’s about unlearning old beliefs, forgiving yourself for not meeting someone else’s expectations, and realizing you have always been enough
This is the promise of CBT and the power of self-compassion: You can put down the script handed to you at birth and replace it with one that reflects who you truly are. And that script can begin at any age, on any page you just have to be willing to write it
Monik is a psychotherapist specializing in mood disorders and anxiety, working with both adolescents and adults With extensive experience in Partial Hospitalization (PHP), Intensive Outpatient (IOP), and outpatient settings, she provides comprehensive care tailored t each client's needs. Trained in DBT, CBT, and min combines these evidence-based approaches to help resilience, navigate their challenges, and achieve lasting emotional well-being. Her practice is centered on empathy, empowerment, and fostering meaningful growth.
FMHCA
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Effortless Until Now: Helping High-performing Students Manage Stress and Anxiety
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Navigating Perinatal Mental Health: Clinical Approaches, Strategies, and Support
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Integrating the Neuro-Logical Level Alignment (NLLA) Process in Mental Health Counseling: A Neuroscience-Informed Approach to Transformative Change
02 May 2025 | 2:00 PM-4:00 PM
Presented by: Maria Giuliana, LMHC, BC-THP, RTM Certified Practitioner Register Now
Common, Often Overlooked Ethical Issues in Counseling Practice
02 May 2025 | 2:00 PM-4:00 PM
Presented by: Leslie Delaney, MS, MA, LMHC, NCC Register Now
& More!
P.S. We are seeking presenters for our 2026 Webinar Series until Nov. 1st! Learn more HERE
FMHCA's Favorites
Emotional Support Desk Pets
Another meeting that could’ve been an email? An inbox inching closer to 100 new messages? When all that stress starts to pile up, take a screen-free moment to check in with your emotional support pets They’re low-maintenance no food or water are necessary and small enough to take up residence on your desk. Crafted of reclaimed rubber wood, they’re a little dash of workday whimsy.
Planter Water Alarm
Poking your houseplant's soil is one way to figure out whether it needs watering, but it's not exactly scientific (or tidy). This smart moisture sensor takes the messy guesswork out of watering by lighting up red when your plant is thirsty and green when it’s perfectly hydrated. Designed to blend into your plant’s environment with its cute, succulent-inspired shape, this simple tool makes plant care easier for beginner and experienced plant parents alike
Glass Bee Drinking Orb
This stunning handblown glass oasis will brighten your garden and refresh nature’s busiest pollinators. Handblown with exquisite detail, this stunning sphere creates a refreshing oasis for thirsty pollinators a striking piece of outdoor art that also serves a practical purpose.
Wall Mounted Personal Masseuse
These versatile and effective portable rollers are the next best thing to having an at-home massage therapist. Expertly designed tools lock onto a wall so you can experience a hands-free therapeutic massage anytime.
Classic Fairytale Popup Book
Through critically acclaimed illustrator Robert Sabuda's 3D work, classic tales of imaginary lands come to life for a new generation in pop-up book form Each artful book offers a new way into a classic story, becoming a keepsake for its young reader and a forever reminder of a time when imagination reigned supreme.
Soothing Sensory Journal & Diffuser Pens Set
When your senses are engaged, creativity flows These unique journaling tools transform writing into a fully immersive experience, helping to boost focus, relaxation, and motivation. Whether journaling, brainstorming, or simply unwinding, this set turns everyday writing into a moment of mindfulness.
Need to check the time? Close the book on traditional clocks with a bibliophile-inspired digital innovation. This timepiece showcases literary quotes instead of conventional numbers to indicate the moments of the day Every minute, a new handpicked story excerpt appears on the display, synchronizing with the current time It’s the most cultured and captivating way for avid readers to stay punctual
Couch Caddy
Lose yourself to a good book or movie without losing your cellphone, remote, or water bottle to the couch cushions
Each acacia-wood caddy has a designated spot for your book, cellphone, remote, and even your favorite beve Clever wood paneling lets you adjust the piece to fit the rightside arm of most chairs
Heating and Cooling
Emotional Support Wrap
Cozy up with a handcrafted wrap filled with lavender and organic rice for soothing warmth or cooling relief
Nite Nite & Wake Up Patches
Rainbow Ellipsoid Fidget Toy
Discover endless fidgeting possibilities with this compact wonder that bends, squishes, and extends without making a sound.
Handmade Wooden Foot Massager
These all-natural patches are designed to help with energy during the day and sleep at night. Easy to use, simply peel, stick on your wrist or any venous area. Patch may be worn up to 12 hours, and then just peel off and discard.
Mental Health
Embroidery Kit
When overwhelming feelings take hold, sometimes you need to take things day by day, step by step or stitch by stitch.
The Couples Game
Questions are inclusive for all kinds of couples and range from the silly (“What would our DJ-duo name be?”) to the sweet (“What pet name do we call each other most often?”)
Endlessly Reusable Art Book
These reusable art pads featuring a built-in chalk holder and charming cover illustration are small enough for onthe-go doodling and cut down on paper waste.
Nap Anywhere Pillow
Wooden ridges and knobs will knead foot muscles, tendons and ligaments until they purr.
A rejuvenating nap can help prevent fatigue by guiding you through the crucial stages of sleep. As you move from light rest to deep recovery and REM, any siesta can revitalize both the mind and body. Escape into a cozy cocoon that transforms any moment into a restful retreat.
Fam Gabs Kids Cards
These cards are meant for all families, caretakers, extended family, teachers and counselors to really get to know the kid you love and get closer Games/play are the language of a child and a card game is FUN to use. The back of each card has 1 of 5 finger mazes to use for fun, relaxation and focus!
Heated Full Back & Shoulder Wrap
Bliss out as shoulder and back pain fade, thanks to the gentle weight and thermal therapy of this handmade recovery wrap. Heat in the microwave or oven or chill in the freezer to bring it to the therapeutic temperature you need.
Mindful Breathing Necklace
This necklace helps you slow your heart, calm your brain, and become mindful of the present moment. Inhale normally, exhale through the breathing straw pendant, and float to a mini meditation while stress melts away.
A Question A Day for Self-Care: A 3 Year Journal
Prioritize your mental health every day with this multiyear diary dedicated to emotional well-being.
The Committee had a fantastic in-person meeting at the 2025 FMHCA conference! A group of Graduate Students, Registered Mental Health Counselor Interns, and Qualified Supervisors all gathered to learn about and support this committee. Ideas were generated and you will notice the first implementation of a new idea this month! Starting in March, we will have a regular meeting time! We will meet on the fourth Thursday of every month from 11:00 am – 12 noon. The meeting link will stay the same each month, so you will be able to plug these meetings and the meeting link into your calendar for the rest of 2025. Here are all the dates for the entire year:
Thursday, March 27 11:00 am – 12 Noon th
Thursday, April24 11:00 am – 12 Noon th
Thursday, May 22 11:00 am – 12 Noon nd
Thursday, June 26 11:00 am – 12 Noon th
Thursday, July 24 11:00 am – 12 Noon (during FMHCA’s Annual Summer Bash) th
Thursday, August 28 11:00 – 12 Noon th
Thursday, September 25 11:00 am – 12 Noon th
Thursday, October 23 11:00 am – 12 Noon rd
Another new change we are implementing, members may bring a friend to the meeting for free! New attendees are welcome to attend up to two meetings without officially becoming a member to try it out and see what we have to offer. Additionally, this year we will introduce guest speakers to meetings. Please share with your peers!
Government Relations Committee
Committee Chair: Aaron Norton, PhD, LMHC, LMFT
“Legislative Days” Event and SB 122
FMHCA’s Government Relations Committee (GRC) is sending a delegation of six members to Tallahassee on 3/26 and 3/28 to meet with legislators in support of SB 122 and its companion bill, HB 361 If passed, this bill would rename registered mental health counselor interns as "registered associate mental health counselors" as well as remove a line in the statute that requires registered interns in private practice settings to have licensed mental health professionals on the premises when while providing clinical services. Florida is one of the few states that uses the term “intern” to describe individuals who have already
graduated with a master’s degree in mental health counseling and are practicing under supervision until they can apply for a license to practice independently. This title change is important because (a) the public often perceives that an “intern” is a college student, and (b) using terms that are common in other states is helpful in a Counseling Compact era The bill is also needed because many practices that could be considered “private practice” allow therapists, whether licensed or registered interns, to provide telehealth from a home office, and the current statute unfairly singles out private practices as the only setting in which this practice would not be permissible unless a licensed mental health professional were in the intern’s home while they were providing telehealth.
Summary of Disciplinary Actions at 491 Board Meeting
What are licensed mental health professionals in Florida getting into trouble for?
At the most recent 491 board meeting on 2/6/25, some of the violations related to disciplinary hearings included:
Failure to keep appropriate records in client files (e.g., treatment plan, progress notes, consent form, etc )
Billing for sessions that did not occur
Failing to report sanctions from other state licensure boards or certain criminal convictions to the 491 Board within 30 days
Non-compliance with PRN program monitoring
Inappropriate communications and boundary-crossing with clients (e.g., asking clients for money for personal reasons).
Want to learn more about these (or other) disciplinary cases (or even use “real cases” to educate students, interns, and coworkers?) Here are some steps for accessing additional information:
Download “Full Board Minutes” for the meeting of your choice. Here, you’ll find the case numbers and some facts about each disciplinary case.
To listen to the audio for a particular disciplinary case, download “Meeting Audio” and then forward to the timestamp for that case.
To get some background information on the case, click on “Lookup: Verify a License” and then click “Discipline & Admin Actions ” Use the case number to locate and download the “administrative complaint,” which will document the background behind the case, the statutes or rules that are alleged to have been violated, and the outcome of the case (when available).
MHCs and Educational and Disability-Related
Evaluations
A GRC subcommittee is exploring potential action related to adding counselors to a list of professionals who can offer ESE evaluations for the schools. That subcommittee is also exploring potential action related to recommending that Florida’s Division of Vocational Rehabilitation revise a policy that prohibits its employees from using a diagnosis provided by a LMHC, LCSW, or LMFT who is not supervised by a psychologist or physician.
Advocating for a Testing Rule
Two members of the GRC addressed the 491 Board during its meetings on 12/4 and 2/6 to read FMHCA’s recommendation to create a rule for 491 Board licensees that is similar to a rule for psychologists about the release of testing materials, answered questions from board members and legal counsel, and offered follow-up information about fair and equal access to tests The Board is still considering this recommendation
Advocating for MHCs who Provide Forensic Evaluation and Expert Witness Testimony
SMHCA's partner, the National Board of Forensic Evaluators (NBFE), is collecting data to support judicial circuits that are trying to reduce wait times for certain types of forensic evaluations by appointing qualified MHCs for those evaluations FMHCA's GRC is searching for a criminal justice bill that might be amended to revise a statute that fails to list 491 licensees as professionals who the court can appoint to conduct certain types of evaluations. More info coming soon.
Military Committee Committee Chair: Maria Giuliana, LMHC
2025 Policy Updates Affecting Military Personnel and Veterans:
Key Information for Mental Health Counselors
As mental health professionals serving military personnel, veterans, and their families, staying informed about policy changes is essential. Legislative and administrative shifts at both the federal and state levels can directly impact the wellbeing, healthcare access, and mental health outcomes of service members and veterans
Since the start of President Donald Trump’s administration in
January 2025, several enacted and proposed measures have influenced military pay and benefits, Department of Veterans Affairs (VA) operations, veteran healthcare opportunities, and diversity, equity, and inclusion (DEI) initiatives. This article provides a neutral and factual overview of these developments to help mental health providers understand how these policies may affect their clients.
Enacted Federal Policies Impacting Military Personnel and Veterans
Federal Hiring Freeze and Workforce Reductions
Implemented on January 20, 2025, affecting multiple federal agencies, including the VA
While military personnel were exempt, some VA administrative positions were cut, potentially impacting service delivery.
National Defense Authorization Act (NDAA) for Fiscal Year 2025
Signed into law in December 2024, approving an $895 billion defense budget.
Military Pay Increases:
A 4.5% pay raise for all service members.
A 14.5% pay increase for junior enlisted troops to improve recruitment.
TRICARE Adjustments:
Restricted TRICARE coverage for gender-affirming care for minors in military families.
Executive Order 14183 – “Prioritizing Military Excellence and Readiness”
Issued on January 27, 2025, reinstating a ban on transgender individuals serving in the military
Cited concerns over unit cohesion and operational effectiveness.
Proposed Federal Legislation Affecting Veterans Protect Veteran Jobs Act
Introduced by Senator Tammy Duckworth to rehire veterans terminated due to federal workforce reductions. Mandates reporting and justification for veteran dismissals Putting Veterans First Act
Introduced by Senator Richard Blumenthal to reverse workforce reductions that impacted VA services
Aims to protect VA employees and improve healthcare delivery
Veterans’ ACCESS Act of 2025 (H.R.740)
Proposes expanding and streamlining VA healthcare services, caregiver benefits, and support for homeless veterans.
Veterans 2nd Amendment Protection Act of 2025 (H.R.1041)
Establishes due process protections before veterans’ names are added to the National Instant Criminal Background Check System (NICS) for firearm restrictions.
Department of Veterans Affairs (VA) Updates
Leadership and Workforce Changes
Doug Collins confirmed as VA Secretary on February 4, 2025.
Planned workforce reduction of 72,000 jobs, announced in March 2025, sparking concerns about VA service availability.
Paused $2 billion in VA contract cuts after concerns emerged over impacts on critical healthcare services, such as cancer treatment and toxic exposure assessments.
Veteran Medical and Mental Health Care Updates
Expansion of Telehealth Services to improve access to mental health care, particularly for veterans in rural areas. Community Care Scheduling Platform (EPS) introduced to expedite non-VA provider appointments, with 2,700+ providers enrolled by early 2025
Disability Compensation Rate Increase of 2 5%, effective January 1, 2025
Faster VA Disability Claim Processing:
Over one million disability claims processed at an accelerated rate.
$62 billion in benefits distributed by early 2025.
Florida-Specific Military and Veteran Updates
Legislative Actions
Florida Veterans’ Benefits Guide (2025 Edition) released by the Florida Department of Veterans' Affairs (FDVA).
Senate Bill 116 proposes expanding a Veteran Suicide Prevention Training Pilot Program to provide specialized mental health training for veteran service officers.
Statewide Plan for Veteran Adult Day Health Care Facilities to be submitted to the Florida Legislature by November 1, 2025
Veteran Advocacy and Community Actions
March 14, 2025: Florida veterans protested VA job cuts at the state capitol, expressing concerns about reduced healthcare access
Military and Veteran DEI Initiatives and Mental Health
Implications
Policy Changes to DEI Programs
February 2025 directive for the Department of Defense (DoD) to reassess DEI initiatives in training, recruitment, and leadership programs.
Restrictions on gender-affirming care under TRICARE may impact the mental health of LGBTQ+ military families.
Veteran-Specific DEI Efforts
The VA’s 2025 Health Equity Action Plan addresses racial disparities in veteran healthcare access
Increased funding for mental health services for women veterans, including those affected by military sexual
trauma (MST)
Mental Health Considerations
Potential Increase in Mental Health Struggles: LGBTQ+ service members may experience heightened stress and anxiety due to policy shifts.
Minority veterans may encounter barriers to accessing care.
Changes in Support Systems:
DEI-related mentorship programs and advocacy networks may be reduced or restructured. Alternative sources of mental health support may be needed for affected service members.
Implications for Mental Health Counselors
Mental health professionals serving military and veteran populations should anticipate potential shifts in their clients’ experiences due to these policy changes Key considerations include:
Access to Care:
VA staffing reductions and workforce cuts may lead to longer wait times for services.
Expansion of telehealth may help mitigate some access challenges.
Insurance and Benefits Adjustments:
Changes in TRICARE coverage for gender-affirming care may lead to increased stress for affected families. Disability compensation and benefit adjustments may positively impact financial stability for some veterans.
Mental Health Impact of Policy Shifts:
Service members affected by DEI policy changes may experience increased distress related to identity, workplace belonging, and healthcare access
Mental health providers should be prepared to offer guidance on alternative care options and advocacy resources
By staying informed about legislative and administrative updates, mental health counselors can provide more comprehensive, informed, and empathetic care to service members and veterans navigating these changes. For further information, visit:
VA.gov
Congress.gov
Military.com
Florida Department of Veterans’ Affairs
Join Us for the FMHCA Military Committee Monthly Meeting – Peer Collaboration and Competency Building
As mental health professionals committed to supporting military personnel, veterans, and their families, we recognize the unique complexities and challenges that come with this
vital work From navigating military culture and trauma to working within the VA community care system, maintaining and expanding our competency in military mental health is essential.
We invite you to join the FMHCA Military Committee’s Monthly Meeting, a dedicated space for peer collaboration, professional growth, and discussion of emerging issues impacting the military and veteran community This forum provides an opportunity to:
✔ Seek clinical guidance on complex cases.
✔ Share best practices and resources.
✔ Stay informed about policy updates and systemic changes.
✔ Network with fellow clinicians who share your passion for military mental health.
Meeting Details
Date: Last Thursday of each month
Time: 12:00 PM - 1:00 PM Eastern Time
Platform: Zoom
Meeting ID: 985 3109 7501
Passcode: FMHCA
Whether you’re looking for case consultation, policy updates, or a supportive community of like-minded professionals, this is your space to engage, learn, and collaborate Together, we can enhance our skills and ensure that the military community receives the highest quality mental health care.
We look forward to connecting with you your voice and expertise matter!
Get Involved!
Joining a committee is a great way to participate in FMHCA and increase your presence in our community We have several committees that we would love you to participate in! Below is a list of all our committees and their chairperson.
We invite you to contribute your efforts as there are numerous opportunities for you to get involved and make a difference For more information on how to participate right away, please contact the chair committee or fill out this form.
Professional Experience Article written by Jessica Straughn, LMHC, LPC, CCTP, NCC, Founder of Supportive Counseling, LLC
In today's politically polarized environment, mental health professionals have observed an increasing trend: clients intentionally prioritizing emotional wellness and self-care as acts of personal protest. Serving clients virtually in Florida and Colorado at Supportive Counseling, LLC, I've witnessed how professional women, trauma survivors, and members of the LGBTQ+ community are actively redefining self-care as a powerful means of reclaiming personal agency amid societal stress
Many clients describe feeling overwhelmed by political conversations at work, among family members, or within their social circles. For trauma survivors, the stress associated with societal polarization can intensify existing anxiety, hypervigilance, or feelings of powerlessness Professional women often report experiencing emotional exhaustion from balancing personal convictions with professional expectations in environments where political discussions are inevitable
Members of the LGBTQ+ community frequently express concerns related to safety, acceptance, and inclusivity amidst divisive political rhetoric. In all these scenarios, clients have reported heightened anxiety, depressive symptoms, and increased emotional fatigue.
Recognizing these experiences, many clients have started viewing their mental wellness routines as deliberate acts of resistance. Choosing to disengage from overwhelming political discourse or actively prioritizing rest, mindfulness, and boundaries are increasingly seen as forms of self-advocacy and empowerment. Clients express a sense of liberation in deciding to protect their emotional health as a statement against societal pressures that threaten their well-being.
As a professional counselor and practice owner, supporting clients through this transformative shift has required intentional adaptations in my therapeutic approach. At Supportive Counseling, LLC, sessions emphasize validating
clients' experiences and feelings, helping them understand that emotional fatigue in politically tense environments is a valid and common reaction Our practice supports clients through individualized strategies such as grounding exercises, mindfulness practices, boundary-setting techniques, and selfcompassion training. These tools are critical in helping clients regain a sense of calm and clarity amidst societal turmoil. Additionally, our feminist and trauma-informed approach has reinforced the importance of autonomy and empowerment in therapeutic work Clients are encouraged to recognize their own agency and strength in making wellness a priority This perspective helps clients view their emotional self-care not just as personal health maintenance, but as a meaningful form of advocacy and empowerment.
From my professional perspective, creating a compassionate and affirming virtual environment has been crucial. By offering a supportive space where clients feel validated and understood, we help them cultivate the resilience needed to cope with external societal pressures Clients frequently report that having their emotional well-being supported and validated
empowers them to maintain their health and self-care routines consistently, even in stressful times
This emerging trend underscores a profound shift in how individuals are responding to political polarization. Prioritizing mental health and emotional wellness has evolved from simple self-care practices into intentional acts of resilience and personal protest, reshaping the conversation around mental wellness in our polarized society
Jessica Straughn is a Licensed Mental Health Counselor and founder of Supportive Counseling, LLC, providing virtual therapy in Florida and Colorado. Specializing in anxiety, depression, trauma recovery, and LGBTQ+ affirmative counseling, Jessica emphasizes femi and trauma-informed approaches. Her extensiv roles with Harbor House, 26Health, and victim Pulse tragedy Jessica is an active member of the Florida Counseling Association, dedicated to inclusive, empowering mental health care
Dr. Denny Cecil-Van Den Heuvel
A LIFELONG ADVOCATE FOR MENTAL HEALTH COUNSELING
Dr. Denny Cecil-Van Den Heuvel (also known as Dr. Denny) received her Masters of Education from the University of North Carolina at Greensboro in 1991. She attained her licensed in North Carolina and continues to hold that license. She received her Ph.D. in Counselor Education with a minor in Psychology at North Carolina State University. During this time, Dr. Cecil-Van Den Heuvel also founded a state association, License Professional Counselors Association of North Carolina, along with her colleagues, and promoted legislative ground work for Licensed Professional Counselors in the 1990s. Currently, this association is under the umbrella of the American Mental Health Counselors Association. Dr. Denny was the Director of the Clinical Mental Health Counseling Master Program at South University in West Palm Beach, FL. Dr. Denny was hired to set up this Master Program in 2003 at South University where it has successfully graduated students and attained CACREP accreditation in 2014. She retired from academia in 2019 and currently has a part time private practice where she enjoys direct client interaction. She specializes in treatment of trauma, depression, anxiety with individuals and also works with couples and families. She is trained in EMDR and certified in NARM. Dr. Denny is a Licensed Mental Health Counselor and a Licensed Marriage and Family Therapist in the state of Florida. She is also a Licensed Clinical Mental Health Counselor in North Carolina. Dr. Denny has served as President of the Mental Health Counseling Association of Palm Beach County for two years, President of the Florida Mental Health Association for one year, and President of the Licensed Professional Counselors Association of North Carolina for two years. She was a member of the 491 Licensure Board in the State of Florida for 11 years.
For more than three decades, Dr. Denny Cecil-Van Den Heuvel known to many as simply Dr. Denny has dedicated herself to strengthening the mental health profession. From cofounding the Licensed Professional Counselors Association of North Carolina (LPCANC) to serving on Florida’s 491 Licensure Board for 11 years, her career has been marked by leadership, advocacy, and a deep commitment to ethical practice. Now semi-retired with a part-time private practice, she continues to leave a lasting impact on the field she helped shape.
A Calling That Found Her
Dr. Denny’s journey into counseling began in an unexpected place working as a financial aid director at a university. While her educational background was in economics and business, she found that students weren’t just coming to her for financial guidance; they were seeking support for their personal struggles This realization sparked a desire to shift from numbers to people, leading her to pursue a Master of Education in Counseling from the University of North Carolina at Greensboro
She received her counseling license in 1991, on her birthday, and quickly became aware of how young and unrecognized the
profession was. Rather than accept the status quo, she took action. Alongside her colleagues, she founded LPCANC to establish Licensed Professional Counselors (LPCs) as vital mental health providers. Over the years, she worked directly with legislators to lay the groundwork for the profession’s growth.
Her commitment to professional development didn’t stop there Just two years after earning her master’s, she pursued a Ph D in Counselor Education with a minor in Psychology at North Carolina State University She later played a crucial role in academia, founding and directing the Clinical Mental Health Counseling Master’s Program at South University in West Palm Beach, Florida, securing CACREP accreditation for the program.
Overcoming Challenges and Finding Purpose
Starting out as an LPC wasn’t easy Dr Denny recalls the struggle to be recognized as a legitimate mental health provider, particularly in North Carolina, where state funding was heavily focused on family and youth services. When she later moved to Florida, she encountered a different kind of challenge a system that, at the time, lacked a clear mission to support clients effectively. These experiences motivated her to
transition into private practice, where she could maintain a direct impact on the lives of those she served
Through it all, one thing has kept her passionate after 34 years in the field: the ripple effect of change. “The betterment of lives and community everybody wins,” she says. She sees her work not just as helping individual clients, but as creating positive change that extends to families and entire communities
The Power of Professional Community
When Dr. Denny arrived in Florida, she was alarmed to find that FMHCA had lost momentum. Understanding the critical role of professional organizations in licensing, advocacy, and practice rights, she took action. Under her leadership, FMHCA was revitalized, and its first major conference was held with over 300 attendees.
She firmly believes that engagement in professional organizations isn’t just beneficial it’s a responsibility “If you are not at the table, you are on the table legislatively,” she warns FMHCA has since become a platform for advocacy, networking, and education, providing opportunities that have shaped her own career and strengthened the profession statewide.
To those hesitant to join, she offers a challenge: “Recognize that you have a responsibility to your profession. If you’re relying on others to advocate for you, you’re missing an opportunity to be part of the solution.”
Ethical Leadership and the 491 Board
Dr. Denny’s commitment to ethical practice led her to serve on Florida’s 491 Licensure Board for over a decade. This board plays a vital role in maintaining professional standards and ensuring client safety She highlights real cases that have had major consequences, such as professionals improperly issuing emotional support animal letters, which led to professional penalties
She emphasizes the importance of staying informed on licensure rules, particularly regarding issues that many professionals overlook. For example, in Florida, Registered interns in a “private practice” setting cannot provide telehealth services from home or any location that does not have another licensed mental health clinician on site at the time the clinical services are being rendered something some clinicians unknowingly violate “You have to keep your ear to the ground because regulations evolve from real situations,” she advises Attending 491 Board meetings, she says, is an eye-opening experience that underscores the seriousness of the profession.
“We deal with very vulnerable humans There’s good and bad in every field, and the board’s job is to protect the public from unethical and illegal practices that violate laws/rules and state statutes relative to the mental health field.”
The Importance of Lifelong Learning
Even after decades in the field, Dr Denny remains committed to learning She sees continuing education as an essential tool for self-improvement, ensuring that both counselors and their clients benefit. “Education allows me to hear, ‘You’re doing okay,’ or ‘Here’s where you can improve,’” she explains.
As an educator, she encouraged her students to embrace lifelong learning, emphasizing that growth doesn’t stop at graduation Today, she sees emerging challenges in the field, particularly the long-term effects of social media on youth and the increasing use of “dumping ground” diagnoses “That’s where workshops come in handy,” she notes, stressing the importance of staying informed through professional development.
A Legacy of Leadership and Service
Throughout her career, Dr Denny has worn many hats counselor, educator, advocate, and leader She has served as president of FMHCA, the Licensed Professional Counselors Association of North Carolina, and the Mental Health Counseling Association of Palm Beach County. Though she officially retired from academia in 2019, she continues to shape the profession through her private practice and ongoing advocacy efforts.
Her advice to new counselors? “Know thyself before you practice Don’t make assumptions Always be open to learning more You never know it all ”
Whether through her work with FMHCA, the 491 Board, or the countless students and professionals she has mentored, Dr. Denny’s career serves as a testament to the power of dedication, ethical practice, and lifelong learning. She remains a steadfast advocate for mental health professionals, ensuring that the field continues to evolve and thrive.
The FMHCA team would like to sincerely thank Dr. Denny for her willingness to be our feature this quarter in InSession magazine. We appreciate the time and effort she dedicated to sharing her insights and expertise with you, our readers.
Dr. Denny, your contribution will undoubtedly have a lasting impact on the FMHCA community.
Ask the Expert
FMHCA Member Questions Answered by President and Managing Partner of The Health Law Firm, George F. Indest, J.D., M.P.A., LL.M.
Mr. Indest is board certified by The Florida Bar in the legal specialty of health law. He is the President and Managing Partner of The Health Law Firm, based in Orlando, Florida. The information provided in this article is for educational and informational purposes only and does not constitute the provision of legal advice.
Qlengthy telephone discussions about things such as what foods the client likes, a book the client is writing, the type of clothes the client likes and other similar non-therapy subjects. Is this appropriate?
AWithout knowing all the details, it is probably not appropriate Mental health therapists must be very careful to maintain only a professional relationship with their therapy clients. Part of this requires you to avoid any
I am a licensed mental health counselor. I have a counseling client for whom I am providing therapy who is roughly my age. Lately I have found myself exchanging texts a lot with the client and even having several conversations or interactions that may cross that professional boundary and stray into a social or "friendship" type of relationship. Your interactions may easily be misinterpreted by the client. You must avoid any such "dual relationships" or crossing of professional boundaries. Unfortunately, you should probably carefully and gently transition this client to a different therapist
AQAre there any "rules" about what I can or cannot say, text or write to a client for whom I am providing ongoing therapy? What guidance is there?
You should review the American Counseling Association (ACA) Code of Ethics. Additionally, I would highly encourage you to purchase a copy of the ACA Ethical Standards Casebook which is available online from
Amazon and from a number of other sources. It contains some great case studies, some of which are "eye openers." You should also search for and take some of the many online short courses and seminars on maintaining appropriate boundaries and relationships with clients. There are also YouTube videos available in which other psychotherapists discuss problems and provide case studies
My "rules of thumb" (and mine only) include:
Never give your client your personal cell phone number nor your home address
If your client attempts to contact you outside of a therapy session and strike up a personal relationship of any kind, terminate the client and refer the client to a different psychotherapist
Avoid any type of communication with the client outside of a therapy session (other than directly relating to cancelling or rescheduling appointments, of course), except what is strictly related to the treatment, such as referrals, information for health insurers or employers, information for disability claims purposes, and other similar professional communications.
Hint: If you are not getting paid for the communication, then it most probably is not a professional one; avoid it If it is a professional communication, then you should be getting paid for it
Never use emojis, cartoons and unprofessional images in your communications with a client Responding to a communication with a client and including emoji's such as a heart, smirking face, heart-eyed face, or any other image can be completely misunderstood. You are a professional, make sure your communications are professional.
If you "bump into" a client at a social function, keep your distance and maintain your professionalism Consider that you may be being stalked by the client
Never meet a client outside a session for food or drinks This can be misconstrued by the client and by your licensing board Remember at all times that you are the client's psychotherapist and not the client's friend
As a licensed marriage and family therapist, I have witnessed incredible changes in my clients who have worked with psychedelics in the context of ketamine-assisted therapy
Psychedelics show promise as being a catalyst for relational therapy when used in conjunction with psychedelic integration through psychotherapy. Ketamine is legally being used clinically throughout the country for the purpose of meaningful healing. In order to best enhance the therapeutic gains from this treatment, it is essential that the client integrate their psychedelic experiences with a licensed therapist who has specialized training in psychedelic integration.
Psychedelic integration allows clients to gain insight on their psychedelic experiences and apply the lessons learned during their trips into their day-to-day life. The process of psychedelic integration often leads to profound changes in how clients relate to themselves, others, as well as the world around them.
The prosocial effects of psychedelics have been well documented (Hess et al , 2024) and I can concur with such findings as I have seen clients cultivate more empathy for themselves as well as others The enhanced empathy clients experience can even extend to include those who have hurt them as they realize that everyone is doing the best that they can do. Forgiveness is incredibly healing not only for individuals but also for the greater collective. The enhanced empathy that one experiences from ketamine-assisted therapy leads me to believe that this therapeutic treatment has the potential to be powerful when applied in the relational context of couples therapy.
As a clinician I have heard numerous reports of clients experiencing increased connectedness to self, others, as well as the universe during and following their psychedelic experience The deeper connection clients feel with themselves can translate into meaningful change as they cultivate self-love and honor their own existence.
Ketamine accelerates neuroplasticity, meaning that it allows clients to make healthy changes in their life and create new patterns and ways of being When applied to couples therapy, these neuroplastic gains could help clients see their partners in a more empathetic light and learn to communicate more effectively
Although the research is limited, it has been found that couples who took part in 4 weeks of group ketamine-assisted couples therapy had significant improvements on how satisfied they were in their relationship (Cornfield et. al, 2024). These couples reported being able to be more vulnerable with each other and cultivated more empathy and compassion for one another. Their communication also improved as they felt less defensive and more connected to each other These findings indicate that ketamine-assisted therapy has holds great promise as a therapeutic catalyst when used with couples Future research should be devoted to exploring the relational implications of ketamine-assisted therapy as this treatment shows promise as being powerful tool when used in conjunction with therapy for profound, relational healing.
References
Hess, E M , Greenstein, D K , Hutchinson, O L , Zarate, C A , & Gould, T. D. (2024). Entactogen Effects of Ketamine: A Reverse-Translational Study. The American Journal of Psychiatry, 181(9), 815–823 https://doi org/10 1176/appi ajp 20230980
Cornfield, M., McBride, S., La Torre, J. T., Zalewa, D., Gallo, J., Mahammadli, M., & Williams, M. T. (2024). Exploring effects and experiences of ketamine in group couples therapy. Journal of Psychedelic Studies.
Dr Cahill is a compassionate, extensively trained psychotherapist devoted to helping individuals and couples thrive She believes that profound healing comes from cultivating self-love and creating meaningful relationships. With a Ph.D. in Family Therapy, a Master’s in Family Therapy, and an MBA, she integrates her diverse expertise with somatic and spiritual practices, including yoga, breathwork, meditation, and psychedelic integration. Learn more about her work at https://www.drjencahill.com/
Working with Dual Disordered Clients: Understanding the Hidden Challenges
Professional Resource Article written by Dr. Nicole Kratimenos, LMHC, NCC, QS, C-DBT, BC-TMH
Working with clients that face both mental health and substance abuse struggles involves challenges that make the counseling process trickier for mental health therapists. To better understand the roadblocks, it is important to understand the concept behind dual diagnosis and the treatment associated with co-occurring disorders. Dual disordered diagnosis refers to a diagnosis of both mental health and substance abuse struggles This clientele can often benefit from treatment that focuses on both issues concurrently This article discusses the assessment and treatment for this population and how to properly build an alliance to promote effective counseling practices
When working with dual disorders, it is imperative that providers have a solid understanding of how they interconnect Research shows that about half of individuals with mental health conditions also deal with addiction (National Institute on Drug Abuse [NIDA], 2021). Some examples of the most
common mental health struggles that professionals encounteris Post-Traumatic Stress Disorder, anxiety disorders, and bipolar disorder. Though stigma can exist for all therapy clients, individuals with dual disorders face additional stigma due to the frequent instability of their symptoms and behavioral patterns. Part of the stigma that these clients deal with stems directly from the clinicians Research reveals that counselors can exhibit stigmatization towards their dual disordered clients solely based on the substance they are struggling with For example, clinicians in a study by Francis, Manning & Cheetham (2020) revealed that they demonstrated greater judgmental beliefs toward clients abusing methamphetamines over a substance such as alcohol. Specifically, they were viewed as more dangerous and unpredictable and clinicians expressed a greater desire for more social distance from them. Dual disordered clients may also face additional challenges with accessing care due to the nature of their living situations and needs.
Finding the Right Assessment
Conducting a thorough assessment at the beginning of the treatment process is imperative to create a treatment plan that addresses both disorders. These assessments focus on mental health symptoms, history of substance use, and trauma background. Collaborating with medical professionals might also be needed to rule out medical reasons for some of the symptoms, as well as to decrease gaps in the treatment process Assessment Tools for Providers
There are various assessment tools that could assist the process of working with dualdisordered clients. Starting with the substance abuse portion, some notable assessment tools are CAGE-AID to screen for alcohol and drug use, AUDIT which is the Alcohol Use Disorders Identification Test, and the DAST to screen for drug use The Substance Abuse Subtle Screening Inventory (SASSI), specifically deals with revealing struggles with substance abuse despite client denial To address mental health disorders, some assessments that clinicians could include in the treatment process are the Patient Health Questionnair-9 (PHQ-9) and Beck Depression Inventory (BDI) that screen for symptoms of depression and the Generalized Anxiety Disorder 7 (GAD-7) and Beck Anxiety Inventory (BAI) which identify symptoms of anxiety. When screening for more severe mental health conditions, such as personality disorders, clinicians can use the Minnesota Multiphasic Personality Inventory (MMPI-2) and the Millon Clinical Multiaxial Inventory (MCMI-IV). Finally, with dual disordered clients, there is frequently a history of trauma that could be affecting their mental health and substance abuse behavior It is significant to screen for that as well Standard assessments used are the PCL-5 which assesses Post-Traumatic Stress Disorder, the Adverse Childhood Experiences (ACE) Questionnaire and the Depression, Anxiety and Stress Scale (DASS-21) which assess for general emotional distress Treatment Approaches
When working with dual disordered clients, the goal is to use treatment modalities that integrate various approaches targeting both mental health and substance abuse symptoms at the same time. The following treatment approaches are research-based effective treatments for dual disorders:
Motivational Interviewing (MI) Motivational Interviewing allows the clinician to promote the client’s exploration of goals and values and better understand how their behavior is helping or hindering the process (Miller & Rollnick, 2013)
Cognitive-Behavioral Therapy (CBT) Cognitive
Behavioral Therapeutic techniques, assist the clients in identifying negative thought patterns, replacing them with rational thoughts and developing healthy coping mechanisms. CBT has been known to help reduce thoughts that can serve as triggers to substance abuse and poor mental health (Hofmann et al., 2012).
Dialectical Behavior Therapy (DBT) Dialectical Behavioral Therapy often serves in conjunction with CBT and teaches the client healthy ways to deal with emotional disturbances, coping with stressors and improving the quality of their relationships with their loved ones. It is particularly used for disorders involving self-destructive behaviors such as substance abuse and borderline personality disorder (Linehan, 1993)
Eye Movement Desensitization and Reprocessing (EMDR) EMDR is specifically used to treat clients with a history of trauma It assists the clients to process past traumatic experiences that if left untreated may continue impacting their mental health and use of substances for coping (Shapiro, 2001).
Medication-Assisted Treatment (MAT) MedicationAssisted Treatment (MAT) combines the use of medication management with counseling services. It is often used to treat opioid, alcohol, and nicotine addiction (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023). Examples of medications used for these purposes are Buprenorphine and Methadone.
Why Use Integrative Care?
Research shows that 50% of individuals with mental health struggles, also suffer from substance abuse issues (Torrey et.al., 2002). When incorporating integrative care into the counselor’s approach, it ensures a holistic model of treatment for the clients that includes their physical, mental, emotional, and spiritual being. Integrative care may involve traditional methods of counseling such as Cognitive-Behavioral Therapy, along with nontraditional methods such as reiki and acupuncture
Incorporating integrative care into one’s practice is not always an easy feat. Providers can encounter some obstacles that they may need to overcome. Diagnostic challenges can occur when dealing with overlapping symptoms. Proper provider training could assist in overcoming those obstacles through specialized education and continued learning. This training could involve specialized substance abuse certifications, cultural competency training and specializations in working with dual-disordered clients Additionally, systemic barriers such as lack of adequate programs could pose a threat to dual disordered clients receiving the care they need Providers gaining knowledge of
community resources and helping the clients bridge the gaps in treatment, could mitigate these challenges Partnering with other providers and organizations could also assist clients with receiving well-rounded services.
Collaborating with a Network of Professionals
Receiving adequate support is a struggle that many clients go through, especially dual disordered clients Counselors can collaborate with a variety of professionals to coordinate care. Counselors can communicate with psychiatrists for medication management, social workers for housing needs, and rehabilitation counselors for employment assistance. Assisting the clients to become productive members of the community can safeguard them from issues such as relapse and suicide.
Examples of barriers to collaborating with other professionals that clinicians may encounter include first and foremost, accessibility HIPAA compliance restricts open communication without the client’s signed consent As such, collaboration would require the client’s willingness for it. Furthermore, lack of interdisciplinary training could restrict providers from being open to collaborate with other professionals out of fear that they would be practicing outside of their scope of practice. Lastly, differing backgrounds in training and treatment approaches could lead to professionals being at odds with each other regarding the collaborative approach that would work for that client.
Overcoming those barriers would involve providers of all types receiving some form of integrative treatment training, making case consultations and meetings with supervisors and colleagues part of their routine work and maintaining electronic health records (EHRs) up to date as part of their note keeping and charts to make the communication between the team seamless. Finally, advocating for clients on a micro-level through psychoeducation and reducing counselor bias, and at a macro level through community and legislative advocacy could help the clients receive the support they require.
The Importance of Building Strong Rapport
In the area of counseling, a key factor to the success of the client is building a trusting relationship between the counselor and client. There are many methods therapists can implement to accomplish that goal. Some of those key factors include:
Addressing the clients with empathy and understanding. Remaining steady with appointments and responsiveness to build consistency and avoid gaps in their care
Avoiding the implementation of personal bias in the counselor’s work to promote maintaining a nonjudgmental
stance
Reinforcing multicultural practices in the work itself to allow the clinicians to better understand their clients’ backgrounds that could be influencing their mental health.
How to Handle Resistance
When including addiction treatment models into the counseling platform, it is common to encounter resistant clients Working with them in moving through the stages of change can assist when using strategies such as Motivational Interviewing Additionally, encountering slips and relapses during their treatment is another common occurrence Relapse prevention would be a necessary strategy to implement in these cases Part of this prevention includes early detection of signs of relapse, providing clients with individualized care and harmreduction strategies when needed. Lastly, reinforcing a positive support system and providing the family with psychoeducation is an integral part of this therapeutic process.
Self-Care for the Clinician
Just like in other areas of counseling work, providing the client with the support they require means being open to prioritizing one’s own wellbeing first A burned-out clinician will not be capable of properly supporting their clientele To achieve positive self-care, it is recommended that counselors seek routine supervision and consultation with colleagues, practice positive behaviors such as guided imagery, yoga, meditation, and exercise and maintain the boundaries needed with their clients.
Conclusion
The mental health counseling field involves the clinicians having a profound sense of compassion and care for their clients. When working with dual-disordered clients, it is important to be able to look at all aspects of the client’s symptoms, to accurately diagnose them and use evidence-based treatment to build rapport and therapeutic alliance with the clients and the collaborative team. Working with dual disorders requires the willingness to explore the clients’ life in a nonbiased manner and provide them with the necessary resources to fight their battles.
References
Drake, R. E., Mueser, K. T., Brunette, M. R., & McHugo, G. J. (2004) A review of treatments for people with severe mental illness and co-occurring substance use disorders Psychiatric Rehabilitation Journal, 27(4), 360–374 https://doi org/10 2975/27 2004 360 374
Felitti, V J , Anda, R F , Nordenberg, D , et al (1998)
Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.
First, M. B., Williams, J. B. W., Karg, R. S., & Spitzer, R. L. (2015). Structured Clinical Interview for DSM-5 Disorders (SCID-5)
American Psychiatric Association
Francis, M , Manning, V , & Cheetham, A (2020) Exploring Stigmatizing Attitudes Among Community Mental Health Clinicians Working with Clients Who Have a Dual Diagnosis. International Journal of Mental Health and Addiction, 18(5), 1437–1445. https://doi.org/10.1007/s11469-019-00171-5
Hofmann, S G , Asnaani, A , Vonk, I J J , et al (2012) The efficacy of cognitive behavioral therapy: A review of meta-analyses
Cognitive Therapy and Research, 36, 427-440
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. The Guilford Press.
McLellan, A. T., Kushner, H., Metzger, D., et al. (1992). The fifth edition of the Addiction Severity Index Journal of Substance Abuse Treatment, 9(3), 199-213
Miller, W R , & Rollnick, S (2013) Motivational Interviewing: Helping People Change (3rd ed.). The Guilford Press
National Institute on Drug Abuse. (2021). Common Comorbidities with Substance Use Disorders Research Report. Retrieved from https://nida nih gov
Ridley, J , Newbigging, K , & Street, C (2018) Mental health advocacy outcomes from service user perspectives Mental Health Review Journal, 23(4), 241–252
https://doi org/10 1108/MHRJ-11-2017-0050
Shapiro, F (2001) Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures The Guilford Press
Substance Abuse and Mental Health Services Administration. (2023). Medication-Assisted Treatment (MAT). Retrieved from https://www.samhsa.gov
Torrey, W. C., Drake, R. E., Cohen, M., Fox, L. B., & al, e. (2002). The challenge of implementing and sustaining integrated dual disorders treatment programs Community Mental Health Journal, 38(6), 507-21 doi:https://doi org/10 1023/A:1020888403586
Weller, P , Alvarez-Vasquez, S , Dale, M , Hill, N , & Johnson, B (2020) The need for independent advocacy for people subject to mental health community treatment orders. International Journal of Law and Psychiatry, 68, 101533. https://doi.org/10.1016/j.ijlp.2019.101533
Dr. Nicole Kratimenos joined the Counseling program at Barry University in 2023 and is a Co-Advisor for Barry University's Chi Sigma Iota. Dr. Kratimenos holds an Ed.D. in Counselor Education & Supervision from National Louis University. She is a Licensed Mental Health Counselor and a Qualified Supervisor for the State of Florida. Dr. Kratimenos is certified in Cognitive Behavioral and Dialectical Behavioral Therapy, is Board Certified in TeleMental Health Counseling and is a National Certified Counselor
Older Adults and Mental Health
Professional Experience Article written by
Nichole Jones, EdD, LMHC
Hi, my name is Nichole and I am a part of the “Sandwich Generation”. No, it does not mean I am addicted to eating sandwiches but rather I am a part of a generation of adults that faces some challenges that are not typically experienced by other adults The Pew Research Center (2013) describes adults that are part of the sandwich generation as middle age adults aged 40-59 that have a living parent age 65 or older as well as minor children under the age of 18 Being a sandwich adult obviously comes with its own set of stressors such as financial strain, managing family responsibilities and providing care and emotional support to both our parents and young children.
Following my mothers’ stroke at the age of 67, and my fathers kidney transplant at the age of 73, I found myself in a situation of juggling the responsibilities of raising an elementary school aged child as well as managing the affairs of my parents such as doctors’ appointments, medication management and pharmacy visits, meal preparation and emotional support While supporting my father emotionally as he processed and worked through the aftermath of my mothers’ stroke, which left her with early onset dementia, I saw first hand the emotional and mental toll aging can have on a person. As a result of this experience, I began to research the mental health of older adults in efforts to better understand my father’s perspective. Not only have I been able to help him but I also found a population of mental health that I am extremely passionate about working
with which ultimately lead me to a career shift.
According to the US Census Bureau (2021), 21% of the population in Florida is 65 years old or older, that is approximately 4.5 million older adults. In the SAMHSA (2022) Behavioral Health Among Older Adults Survey, results highlight several concerns among older adults such as: 1 in 8 adults age 60 and over had a mental illness in the past year, 1 in 8 older adults 60 and over used illicit drugs in the last year, 1 in 11 adults 60 and over had a substance abuse disorder in the last year, and 1 in 50 older adults had serious thoughts of suicide in the past year.
While there is clearly a need for behavioral health services for older adults, many older adults receive either inadequate or no healthcare. Only 28% of older adults with substance abuse disorders received treatment (SAMHSAA, 2022). Older adults have many contributing factors and stressors that challenge their mental health such as finances, food and housing insecurities, isolation, lost relationships and grief, loss of independence, reduced mobility, and declining health of themselves or their partner. Having access to quality mental health treatment would not only improve mental health and behavioral outcomes but overall health outcomes such as diabetes, high blood pressure, stroke and heart attacks.
As a caregiver, it is also important to monitor personal mental
health and take steps toward mental wellness Participation in caregiver support groups, education, utilization of respite services, and attending individual therapy are just some of the ways to ensure caregivers are mentally prepared to offer care and support to the older adults in their lives.
As the national and state demographics continue to increase in population of older adults, I hope this has encouraged clinicians to consider adding geriatric counseling and caregiver support to their list of available services
Nichole has a Doctorate of Education in Counseling Psychology, a Masers of Scie Counseling & Psychology, and a Bachelo Science in Psychology. Nichole is a Licen Mental Health Counselor and Qualified with experience ranging from military m academia as a program chair and assist and gerontological counseling. Nichole c Health Program Manager for Volusia County Council on Aging.
NavigatingConfidentiality inCouplesTherapy
Professional Experience Article written by
William Carmody, M.Ed., Ed.S., MBA, LMHC, NCC
Couples and marriage counseling is the bread and butter of many counseling practices. Couples don’t always come in together from the start. Sometimes you are seeing one, and they are able to convince their partner to come in, OR, you are seeing the couple, but one or both decide to see you on their own. Now when you see them together, you have the responsibility of protecting the confidentiality of the sessions you have with them individually. What can you share between them? What if you make a comment around something covered in an individual session, thinking it is ambiguous, but now you have broken the trust of the individual and they are scared to share things for fear it will come up in the couples session?
It’s tricky. This is where understanding confidentiality in couples therapy becomes crucial.
HIPAA
You can’t just wing it. Therapists must follow legal and ethical guidelines. It’s like a roadmap for doing what's right.
HIPAA is a big deal. If you are not sure how HIPAA relates to mental health, read this article from the Department of Health and Human Services
Confidentiality
As a therapist, you know that information shared in a
counseling session is confidential There are laws as well as ethical standards to consider There are limits to what is private when you have multiple people involved- this applies to couples as well as families who are being seen together and individually
You know that you can’t make progress with your couple (or family) if the others don’t know the whole story. But what you know is confidential. You can encourage the individual to bring whatever the issue is into session with their partner so it can be addressed, but that is all you can do
No matter the situation, it is always best practice to err on the side of caution when it comes to sharing information discussed outside of the session you are in.
Scenarios Where Disclosure Becomes Complex
Some situations make the decision on what you should or should not share very difficult. Infidelity is one; safety concerns another. Therapists must tread carefully
Infidelity and Secrets
If a client discloses infidelity, or is harboring a secret that they share with you in their individual session but is not addressing it in the couples session, or in a family session, you know this is doing more harm than good, but you are prohibited from sharing this information.
What can you do?
Clearly communicate the importance of honesty in the relationship.
Explain to the client the reason their partner needs to know the secret.
Discuss the benefits, and the likely consequences of disclosing.
Outline how you will work through the issue. Assure the client that you are not going to blurt out something shared in confidence, but encourage them to disclose whatever it is
If a client is simply unwilling to disclose infidelity, secrets, or lies, you have to consider how much you will be able to help the situation. There are a few things I know that will lead a therapist to terminate a therapeutic relationship, this is one of those things.
Risk of Harm to Self or Others
Therapists have a "duty to warn " meaning they must do what they can to protect someone from harming themselves or someone else - which might involve breaking confidentiality. In Florida a professional can use their discretion to decide the level of risk and if information can be legally disclosed if there is any potential risk of harm. Additionally, the professional might be
protected from being held liable for failing to report a potential threat if they did not consider the risk inevitable What can you do? If you are an Intern or employed by an agency or private practice, discuss with your supervisor. If you are a lone practitioner, use your best judgement to determine if the situation requires reporting.
Subpoenas and Confidentiality
Psychotherapy notes can be subpoenaed, but it’s extremely rare, especially since there are special protections under privacy laws for psychotherapy notes. There would rarely be a subpoena explicitly issued for psychotherapy notes.
Progress notes, treatment summaries, or other aspects of the client’s official record are often subject to being subpoenaed, but not usually psychotherapy notes Not all mental health professionals even keep psychotherapy notes, and they are intended to be private
In Florida, mental health therapists are required to maintain records related to their clients, but there is no specific requirement for them to keep psychotherapy notes. This means that while therapists/practices must keep some records, they are not obligated to maintain detailed psychotherapy notes.
What can you do? Different practices and agencies have different policies around record-keeping If you are an intern, be sure you are familiar with these policies and discuss with your supervisor. If you are a practice owner or individual practitioner, be consistent in your record-keeping practices.
Conclusion
Confidentiality in couples therapy is complex It’s about balancing ethics, laws, and client needs. Keep learning, stay informed, and always put client well-being first. By prioritizing clear communication and ethical standards, therapists can create a safe environment for couples to work through their challenges.
Bill Carmody is the founder of Counseling Hope, a private practice with locations in Maitland and Windermere. Bill earned his Master’s degree and Specialist Degree in Mental Health Counseling from the University of Florida. He completed post-graduate training at Harvard Medical School and is a nationally certified counse helping new grads learn how to navigate the business-side of working in a private practice.
DealingwithPolitical ConversationsinSessions
Professional Experience Article written by Heather Burroughs, LCSW
As a clinical social worker, I am reminded at this time of heavy political conflict that mental health can be impacted by environmental, social, culture and spiritual factors. Events that occur politically may, for some, be impactful because of how one’s environment is affected, how the events intertwine with their social or spiritual life and/or implications that influence their culture. Because of this, politics may surface in sessions with clients.
So, how do we navigate such a touchy topic when it comes up in session? First, it is essential that we direct the conversation away from the content of political opinion to the psychological process occurring in the client. Additionally, we can help them evaluate their associated thoughts and feelings, whether any past trauma is being triggered and to what degree these issues impacting their functioning.
Remembering fundamental frameworks of therapy can be helpful when clients bring up politics as a topic These include but are not limited to the following: validation of thoughts and feelings is essential, even if the viewpoints our clients are expressing are not congruent with our own viewpoints and beliefs; helping clients explore their coping mechanisms and how they can minimize the impact of the situation on their functioning; assisting clients in recognizing what they can control and what they cannot; and supporting clients in recognizing any possible ways they can increase their sense of agency over what is occurring.
While not inclusive, ideas I have heard clients say about finding empowerment and agency in terms of politics are as follows: talk to friends and family to help them understand their
viewpoint, volunteer for an organization whose values align with their political stance, extend kindness to individuals in the community to lead toward less division in the society as a whole, and limit the amount of input from social media In doing these things, clients can gain a sense of control, which can be an important aspect of one’s psychological functioning, especially if the individual has been a victim of a traumatic event in which they lacked agency
As clinicians, we are trained to separate our own beliefs and opinions from those of our clients to provide for a safe and nonjudgmental space and minimize the potential for transference and/or countertransference. Because of this, I take the time to explain the therapeutic purpose of boundaries and refrain from talking about my own political opinions Some clients are comfortable with this and some may feel a bit shut out If we are challenged with this or asked directly about our own political views, we can reiterate our policy as it relates to the therapeutic process and/or we can ask the client the reason they are asking Often, the client’s question can be less about what we, as therapists believe, and more about a psychological process of theirs. Also, a client may respond to this question indicating that it is important that they are seeing a therapist who has similar political beliefs as theirs. At this point, if our viewpoints differ, we can give the client the opportunity to seek another therapist who has similar beliefs and values, as we would do if there were a difference in religious beliefs and the client felt it essential to have a therapist whose beliefs aligned with theirs.
Lastly, we need to have self awareness and identify if a political opinion expressed by a client is triggering one of our issues. If we’re triggered, we have to know how to regulate our own central nervous system in session and remember this is about the client’s psychological process and not necessarily about the particular content the client is discussing. If needed, we can seek supervision or our own therapy to understand what was surfacing in us during these sessions and work through it. Ultimately, it is about remembering and applying our Code of Ethics and bringing it back to the client as these conversations surface.
Heather Burroughs is a Licensed Clinical Social Worker with over 25 years of experience. Her background is in medical social work, community mental health and private practice She is trained in Accelerated Resolutions Therapy and is a Certified Clinical Trauma Professional - Level II She is the owner of Deeper Insights Therapy and is dedicated to helping to reduce the stigma of mental health
