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FLORIDA

The Birthplace of the Clinical Mental Health Counselors Profession



The Final Quarter As I enter the initial phase of my final months as President of Florida Mental Health Counselors Association (FMHCA), I pause to express my appreciation, reflect on our collective accomplishments, and share my vision for the remainder of my term. I thank you for allowing me to represent you as President of FMHCA. I am grateful to work beside our exceptional Executive Staff. Diana Huambachano, Executive Director; Laura Giraldo, Executive Administrator as well as Madison Borgel and Naomi Rodriguez who make up FMHCA’s Media Team. As a result of their innovative ideas, we hosted our inaugural Virtual Summit and leadership retreat and expanded our webinar series to bring you over 25 interactive webinars and On-Demand professional development workshops. Our executive staff increased the following and activity across our social media platforms, transformed our newsletter online magazine that is read in over 10 countries and increased our membership benefits and perks. We actualized a FMHCA student member scholarship fund to cover the total cost of the Registered Mental Health Counselor Interns licensure exam (NCMHCE) application fee which has helped 6 Registered Mental Health Counseling Interns. FMHCA’s staff launched an FMHCA store and a “Donate” link on the website to fund special #FMHCAGivesBack causes (Hardship fund, Legislative Day Fund, Political Action Committee Fund, and the

Registered Mental Health Intern Scholarship Fund). Diana, Laura, and I shared FMHCA’s effective professional development, engagement, and leadership strategies with other state leaders during the American Mental Health Counselor Association’s 2021 Leadership Summit. Also, I am proud to announce that we have welcomed Lastly, FMHCA’s Government an additional 700 members this year. Relations Committee drafted FMHCA’s I am blessed to lead FMHCA and serve legislative agenda to close the gap alongside experts in the profession of between available Clinical Mental Mental Health Counseling. Our Board Health Counselors and the population of directors Dr. Aaron Norton, Laura of those in need of mental health Peddie-Bravo LMHC, NCC, Dr. Kathie counseling and expand the scope of Erwin, Dr. Grace Marin, Joe P. Skelly. practice of CMHCs, eliminate barriers P.A., Jennifer Raymond Ms. LMHC, for Registered Mental Health NCC, Dr. Marin Cortez Wesley, Maria Counselors Interns working in private Giuliana, LMHC, and Mr. Michael practice, and improve access to mental Holler, LMHC supported the agendas health counseling among Floridians of FMHCA’s Regional Chapters (see more on page 78). During the last throughout Florida, provided quarter of my Presidency, I plan to professional development trainings, support the advancement of FMHCA’s attended 491 Board meetings, shared legislative initiatives. I encourage you information about FMHCA with to join FMHCA’s grassroots efforts by students and Professors in the staying informed of the progress of Counselor Education Programs at FMHCA’s Bill and let your voice be Colleges and Universities, launched a heard by contacting your legislators to virtual member discussion forum, encouraging them to support improved relationships between FMHCA’s Bill. regional, state, and national chapters, presented at professional development With Gratitude, sessions, and served on multiple Deirdra Sanders-Burnett, committees. FMHCA’s executive team remained focused on meeting the Ph.D., LMHC Florida Mental Health needs of the members and advancing Counselors Association FMHCA’s vision, mission, and 2021 President annual goals.


INSESSION October 2021

6 The Therapist's Role in Smoking Cessation

11 Grab a Seat, Let's Talk 12 The Power of a Popsicle Stick 14 A Cynic Look into Meditation 16 From Us to You: Lessons Learned from New Private Practice Owners

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18 FMHCAs (Fall) Favorites 20 Is Kindness just a fluff concept? 24 Listening with Both Ears

26 5 Personality Traits for Eating Disorder Clients to Develop

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28 Jungian Resurgence and Applicable Constructs 30 Thinking Like A Business Owner: A philosophy and business plan for survivors of family of origin abuse

34 Florida: The Birthplace of the Clinical Mental Health Counseling Profession 39 Adolescence and Destructive Behaviors 44 Networking During a Pandemic: Tips for Graduate Students and Registered Mental Health Counselor Interns

48 Psychotherapy on the Go 50 I'm a girl, boy, both... neither? 52 Not a Minority- Why Language Matters is ending biases and improving Mental Health

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MAGAZINE 68

56 Case Study: A Comparison of Clinical Mental Health Degree Programs

62 Recovery of Connection: Be of Service 64 Coaching Clients Toward Sexual Intergrity 68 Parting is Such Sweet Sorrow: Saying Goodbye to an Eating Problem 72 Mental Health Awareness 73 2021 Webinar Series Lineup 74 Using Creative Strategies to Explore Career Theories with Counselors in Training 78 State & Federal Legislative Update by FMHCAs Government Relations Committee

87 FMHCA Bylaws

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Created and published by The Florida Mental Health Counselors Association (FMHCA), InSession Magazine is The Magazine Dedicated to Mental Health Providers. Each issue is crafted with our members in mind.

CONTRIBUTE:

If you would like to write for InSession magazine or purchase Ad space in the next publication, please email: naomi@flmhca.org

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. FMHCA reserves the right tp edit or reject all copy.

ANTI-DISCRIMINATION POLICY: There shall be no discrimination against any individual on the basis of ethic group, race, religion, gender, sexual orientation, age, or disability.

FMHCA is a chapter of the American Mental Health Counselors Association and is the only organization working exclusively for LMHC's in Florida


The Therapist’s Role in Smoking Cessation

We all know that smoking has an

insidious and cumulative effect on our physical health throughout years of smoking. What it doesn’t affect directly, it will most definitely complicate and while smoking may be blamed for causing problems that it may not actually cause, the medical problems it does cause will complicate the other problems we get. When the 1st Surgeon General’s warning was put on all of the cigarette packs (1966) with updated warnings in 1970 & 1984 (the latter being more impressive of a warning that in previous years) and the information about the dangers of smoking (inclusive of multiple additives that we had not been aware of before) were released in 2000, it became “uncool” to smoke. Public places no longer allowed

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smoking indoors and/or had “smoking sections” depending in the State you were in (1973-1980s) and even outdoor places (such as amusement parks) sectioned off smoking sections due to the dangers of smoke being released into the air around us. Children’s candy cigarettes were taken off the market in some States but the word cigarettes was taken off the labels and replaced with the word sticks and smoking commercials were banned in 1970, taking effect in 1971; all in an effort to deter people from smoking. So why do we smoke and why don’t we “just stop”? Most likely because we are addicted. According to the articles reviewed, smoking provides temporary good feelings and those good feelings, over time, train your brain to want it even more. Despite the fact that many articles say that smoking does not make people feel better, some articles finally admit the truth. For a smoker, smoking does improve mood and helps with relaxation. If we are going to explore smoking cessation, let’s begin with the truth. We can’t tell someone who smokes that it doesn’t make them feel the way that they feel. Smoking causes our bodies to release Dopamine. Remember our old friend Chocolate?

October 2021 InSession | FMHCA.org

Chocolate stimulates our neurotransmitters to release dopamine (as does sex). Studies have suggested two interesting things. People who gained benefit from smoking may have had lower dopamine in their systems. However, it is possible that their smoking lowered their dopamine production levels. What came first, the chicken or the egg? But it is an interesting concept. The point is that while we are being told that it doesn’t “really” help with anxiety, depression, stress reduction and so on, it “really” does. The reality is that it doesn’t “fix” those feelings, it replaces them temporarily so that we want to smoke more. Sounds like addiction. It is an addiction. And this is indisputable. No matter how many articles are reviewed, smoking is an addiction. Knowing how addictions work, receiving information about the dangers of smoking can only serve to stop others from starting. People who were and are addicted already don’t just stop. We can explain the changes in the brain, the temporary good feelings, the stress reduction and how the pattern is repetitive. Herein lies the problem. On a Pamphlet from one of those State issued free smoking cessation nicotine patches, it


challenged it’s reader to take a test to determine how high they are physiologically addicted, emotionally addicted and psychologically (behaviorally) addicted. The truth is that the longer we have been smoking, the more addicted we are, as with any other drug. NAMI (The National Alliance of Mental Illness) points out that smoking actually worsens a person’s mental health and interferes with the effects of Psychotropic medication. This may not be worded in the most convincing manner but yes, if you are feeling good and smoke 15 to 40 cigarettes a day, and your medication isn’t really working that well anyway, we can see how your mental health issues may worsen. While Web MD states that smoking actually creates anxiety and stress. That has yet to be proven with full certainty. However, it is not something that a smoker is going to buy into because it is not what the smoker experiences and they are likely not to identify this as a reason to stop smoking. People who want to stop smoking typically identify health reasons and increasing life expectancy. Others may identify the cost as a motivator and still others may discuss the smell on their person and clothes as reasons to stop smoking. One of the reasons we, as mental health practitioners (and medical practitioners) fall short with our smoking clients is because many of us fail to recognize that “Even though nicotine’s high isn’t as dramatic as cocaine or heroin’s, it’s

equally as addictive as those illegal drugs” (Felson, MD). Herein lies another problem. The addiction is not given the same credence or potence as any other addiction and so is not addressed as comprehensively as other drug addictions. The physiological, emotional and psychological/behavioral addictions are not validated. Smokers are often told by their doctors to stop smoking and suck on a lozenge or chew on carrots instead. Most smokers are not going to do that. Most smokers are going to substitute with a dopamine producing activity. For instance, tootsie pops. Tootsie pops stay in your mouth a relatively long time, release dopamine, are crunchy; most smokers experience “angst” and taste good. Much more so than carrots. My mother quit smoking by using radishes. But she was an atypical person (more on Nanny’s ways in another article). Most of us would rather tootsie pops. We all have encountered people who were addicted to smoking, managed to stop smoking and gained 30-50 pounds. That can’t be healthy physiologically (being overweight will be discussed in another article). That will ultimately affect their selfimage and add more social stigma into their lives; so it certainly isn’t emotionally healthy and most smokers will immediately tell you they don’t want to give up smoking and gain weight. This is a well-known factor in smoking cessation. So, let’s look at

some of the other symptoms we might have during cessation that are not typically acknowledged by our providers. In the literature, it is acknowledged that there is a fishbowl of physical, mental and emotional symptoms that will last for weeks: Profuse sweating Anxiety Insomnia Depression Nightmares Irritability Strong cravings Increased appetite. Stomach pains Dizziness Headaches Coughing Fatigue Constipation/nausea Mental Fog Feelings of hopelessness Tremors Mood swings Note that these are known withdrawal symptoms for nicotine;


and do not include any withdrawal symptoms for the other products that are put into cigarettes that are also addictive. When we are working with clients who are trying to quit smoking, are we expecting them to carry on their usual daily activities while they are going through these symptoms? Are their doctors preparing them and working toward lessening the withdrawal that they will go through? As Clinicians, we can be aware of the missteps in order to create a more wholistic treatment plan for smoking cessation. First, we would need to understand that a client should be informed of the truth regarding not only the effects of smoking but the effects of quitting. Yes, the benefits of quitting far outweigh the benefits of continuing to smoke but nonetheless, the client needs to be prepared. The CDC informs us that there are

medicines available to assist in the withdrawal process and in fact, do not recommend “Cold Turkey” for everyone as it increases the chances of relapse. It sites the following Nicotine Replacement Therapies (NRT) to help ease some of the withdrawal symptoms: Nicotine patches, Nicotine gum, Nicotine lozenges, Nicotine oral inhaler, Nicotine nasal spray, combining medicines ie: the Patch plus an additional NRT and the two other medications found to be helpful are Varenicline (Chantex) and Bupropion (Wellbutrin). A doctor should be involved with the planning, and it would be preferable if the clinician and the doctor consult with each other during the smoking cessation. E Cigarettes are recommended by some. E cigarettes are not FDA approved however, are felt to be less dangerous to health than smoking and therefore are thought of as beneficial in the cessation stage. Counseling and coaching are highly recommended activities as well. This Clinician feels a “Sponsor” who is available for emergencies the same as they do in AA is a good idea for smoking cessation. Some of the other techniques that are recommended by the Mayo Clinic and The Medical News today are the following: ·Assist the client in writing down what they do like about smoking so that other substitutes can be developed. ·Assist the client in writing down what they do not like about smoking (opposed to what we are told are the

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October 2021 InSession | FMHCA.org

negatives, we have developed out own dislike; what are our reasons?) ·Assisting the client to mentally prepare for the withdrawal symptoms. ·Having the client make a list of the benefits of quitting and reviewing this list in times of struggle (Clinicians can broaden their own knowledge to bring more information to light that may not be known to clients) ·Suggest the client provide opportunity for more physical activities (exercise, walking, swimming, hiking) ·Most recommend the client should tell everyone in order to assert social pressure on their decision to quit but this needs to be explored because this can backfire for clients who are either defiant, have issues with shame and doubt and client’s who have friends who will goat them into giving up. ·Discuss triggers and what actions the client might take to avoid them. Have client list triggers and habits to understand their addiction. ·Discuss working on a new hobby or something that will keep client’s busy (again, this needs to be discussed fully as it shouldn’t be something that will frustrate the client) This is not the time to learn how to knit. ·Stock up on whatever is decided as a substitute for smoking ·Always discuss issues truthfully; don’t push client into doing what they are not ready to do; use relapse as a learning mechanism rather than a failure. ·Help client to identify online tools and apps and support groups; most


recommend choosing a “quit date”. Look at the National Cancer Institute for implementing a quit plan www.smokefree.gov/build-yourquit-plan and Truth initiative at www.becomeanex.org/ which provides chat services, text messaging and apps for mobile devices for support. ·Suggest client schedule a dental cleaning during the cessation.

nicotine from their system expediently. Recommend journaling so that clients can vent their feelings on paper rather than using smoking as a way of placating those feelings. This author recommends helping client to create a determent chart that they can put on their refrigerator reminding them of activities you have discussed to keep them occupied for the stormy times.

Symptom

Type

Action Plan

Comments

Headaches

Physical

Drink water; take Tylenol

Lie down when possible

Mental Fog

Psychological

Keep log on what must be done for the day

Mindfulness

Strong Cravings

Physical & Emotional

Exercise

New Hobby

Need to put another activity into place

Physical

Take cough drop or honey to ease soreness

This is your lungs clearing themselves

Most importantly, work with client on choosing whether client will use vacation time to stop smoking or work through it because while work may keep them busy, the withdrawal symptoms may interfere with their work. The same applies to clients with young children and home responsibilities. The decompensating effects may be worse for some than it is for others. Walk through the symptoms and discuss how client may cope with them. You can encourage your client that although some of what they experience may be extremely difficult to cope with, these symptoms will be temporary. All of the physiological symptoms should take anywhere from 1-3 weeks to rid themselves of the cigarette components from their system. Help the client to prepare for the psychological symptoms and cravings.

Bibliography: _________, Brennan, Dan (Medical Reviewer) “What to know about Tobacco and Your Mental Health”WebMD (Online) March 2020 _________, “Which Quit Smoking Medication Is Right For You?”CDC; Control and Prevention, (Online) June 2021 _________, Felson, Sabrina, MD (Medical Reviewer) “What Is Nicotine Withdrawal?” WebMD (Online) March 2021 Chandler, Adam“Cigarettes Have Officially Been Bad For You For 50 Years” The Atlantic (Online) January 2014 Kandola, Aaron,Westphalen, Dena (Medical Reviewer) “Nicotine Withdrawal Symptoms And How to Cope” Medical News Today, (Online) January 2020 _________, “Smoking” National Alliance On Mental Health (NAMI) (Online) Mayo Clinic Staff“Healthy Lifestyle: Quit Smoking Create A Plan to Cope With The Hurdles You May Face As You Quit Smoking”

Help clients to be mindful of some of the behaviors they incorporate into smoking ie: blowing the smoke out, flicking their cigarette and other details they may not pay attention to as they will want to prepare for the urges to do these behaviors. Suggest clients drink water to wash

Written By: Dawn M. E. Picone, BCTMH, Psy.D, LCSW Dr Dawn Picone is Board Certified in Telemental Health, holds a Psy.D and is licensed as a Clinical Social Worker in six States. She works exclusively online as a Clinical Consultant for Major Medical Venues and provided Clinical Supervision for MHC and CSW in the State of Florida, New York and New Jersey.

Coughing


Must Try Zucchini Bread Ingredients 3 cups all-purpose flour 1 teaspoon salt 1 teaspoon baking soda 1 teaspoon baking powder 4 teaspoons ground cinnamon 3½ cups grated zucchini (you can use as few as 2 cups and as much as 4 cups) 3 eggs ½ cup apple sauce ½ cup vegetable oil 2¼ cups granulated sugar 4 teaspoons vanilla extract 1 cup chopped pecans (optional)

Instructions Preheat oven to 350 degrees F. Generously butter and lightly flour two 8”x4” loaf pans. In a medium bowl, sift together flour, salt, baking soda, baking powder and cinnamon. Stir gently to combine. Shred zucchini, lightly packing it down as you measure it. In the bowl of a stand mixer beat eggs, applesauce, oil, sugar and vanilla extract. Mix very well. Slowly add the dry ingredients (about 1/3 at a time) mixing as you go – then beat well to fully combine. With a rubber scraper or wooden spoon, stir in shredded zucchini and nuts into the batter and mix well. Pour half of the batter into each prepared pan. Bake for 45 to 60 minutes or until a toothpick inserted into the center of the loaf comes out cleanly. (The bake time will vary depending on how much shredded zucchini you add to the batter.) Remove from the pans and cool on wire racks.

Prep Time: 20 Minutes 10

October 2021 InSession | FMHCA.org

Cook Time: 60 Minutes

Makes 2 Loaves


Grab a seat, let's talk.

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t is no secret that many of us were destined to become helpers and healers to those who need that safe space to process the whirlwind of emotions that sometimes smacks you right in the face. We may find that we get a nice lick from those too, from time to time. Other times, we may even find ourselves back in the ring taking body punches from the big T we thought we left in the past- yes, I mean past trauma. You may even catch yourself asking how you can be in the position to help others work through things when you still find yourself standing toe to toe with those same demons. Sound familiar? Ok then, grab a seat and let’s talk. First things first, therapists are human, too. Therapists, like everyone, have experienced things that may not have been so pretty, and they have definitely felt some feelings that were not so pleasant. This is why it is important to practice what we preach: Self-care, self-care, self-care. It is natural for us to walk alongside our clients, meet them where they are, and help them on their path to healing. During that walk, we remind them that healing is not linear and though they will be able to better process and regulate their emotions, they may still experience days that are a little tougher than others. You may have even spoken the words, “give yourself some grace” while meeting with them. So why is it so hard for us to take our own advice? I would be lying to you if I told you that there weren’t days when I have found myself stewing with the frustration of feeling anything other than happy, focused, and invincible. On those days, I have to remind myself that I am not invincible, I am not a stone wall of positivity, but I

am human. No amount of training, coursework, on the job experience, webinars, or certifications are going to fully eliminate days when therapists also need a little pick me up. Being strong is fantastic, yes, but it is important to recognize that at the core, we feel and express some of the same emotions as those we are blessed enough to be in the position to help. Being reflective and aware of things that may influence our day to day is just as important for us to do as therapists as it is for our clients. Sometimes as new, or even experienced therapists, we fail to allow ourselves the grace to feel and express emotions due to belief that we have to be strong and resilient at all times. Being a therapist does not make us any less susceptible to fatigue and unwanted feelings than anyone else. At times we may even find that the unexpected road bumps we encounter may even bring about uncomfortable feelings that relate to things that we thought we had put away in the past. Encountering these road bumps does not make you any less qualified to help people navigate the battles that they struggle with and it is important that you do not allow that to define how you see yourself as a helping professional. One of the most powerful things we can do as therapist is to lead by example. So be kind to yourself, show yourself some compassion, and follow the same guidelines you give your clients because after all, you are human, too. Written By: Joshualin Dean, MS, NCC, Registered Mental Health Counselor Intern Joshualin is a Staff Clinician at the Corbett Trauma Center division of the Crisis Center of Tampa Bay. Joshualin specializes in trauma with a population focus of victims of crime. Joshualin is skilled in crisis intervention, trauma-informed care, and mindfulness based techniques. Joshualin has experience working in inpatient psychiatric units, residential programs, and outpatient settings. After serving on active duty in the United States Air Force, Joshualin received a Bachelor of Arts in Psychology from the University of Alabama followed by a Master of Science in Counseling and Psychology from Troy University.


The Power of a Popsicle Stick

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was working at a Child Development Center as a Youth Behavioral Counselor and the hospital donated several thousand tongue depressors because they could not use them. Basically, when the tongue depressor storage box got wet, they could not use them anymore in the hospital. Being curious I thought decided to try something new. Taking out a few of the big popsicle sticks I began to draw out different expressions of emotion and came up with a pattern that seemed to make sense. On one side of the stick, I drew a happy face, turning it over I drew a sad face; on the side with the happy face on the opposite end I drew an angry face, turning it over I drew a surprised face. As I turned it and twisted it I came up with words and tune for it based on the song “If your happy and you know it.” After creating it I walked around the corner and noticed a mother with her Pre-K child who was having a melt-down. She had been working with him for over ten minutes to calm him down and help him enter the classroom without success. Being curious I asked permission to see if I could help and the mother said yes. The boy had his face buried in his mother’s lap and was crying, so I got down to his level and had the happy side of the stick shown toward his face. I asked, “Are you feeling happy?” And then I quickly flipped the stick to the sad face and asked, “Or sad?” To my pleasant surprise, within 3 seconds the child was engaged and laughing. The mother was glad to see it worked, but also very frustrated with the situation. It is amazing how the simplest tools can be used to connect and redirect. I use the stick and teach to children the song to help them become aware of their emotional experience. I use the stick motion with the song which adds textile element and a focus point. The song is sung to the tune “If You’re Happy and You Know it, Clap Your Hands” the stick action is italicized under the words: 12

October 2021 InSession | FMHCA.org

If you’re happy and you know it don’t be sad, Stick action (rotate Happy side of stick to sad side: rotate back) If you’re happy and you know it don’t be sad, (rotate Happy side of stick to sad side) (flip from sad to angry side of stick) You may be angry or surprised (rotate from angry to surprised) in the moment you decide, (flip stick to happy) If you’re happy and you know it don’t be (rotate stick to sad) ______ (they say/sing “sad”) Expanding the use into elementary school and middle school environment, I was able to add the element of turning it into a guessing game by using a smaller stick that fit into the palm of my hand that could be rotated. They would then select where they believed happy, sad, angry, or surprised was at. Some children were uncanny with their ability to focus and pay attention while others had a more difficult time. By slowing the process down with those who had a hard time focusing they were able to develop better focusing skills. There are several sensory avenues able to be noticed. The visual, the auditory and having the individual hold the stick and learn how to do the motions while singing is an opportunity to notice developmental progress and ability for a child to refocus. It is fun to use and I have used it with children of all ages. Some parents have used the popsicle sticks as an arts and crafts activity to help their children draw faces and express their feelings about challenges at school and in life. Some have even used it as a roleplaying tool to act out different situations. I have also created sticks with dog faced themes and cat faced themes that the children love. Behold, the power of a popsicle stick! Have fun everyone! Written By: David I Copeland, PhD LMHC-S Dr. David Copeland, PhD is an LMHC-S and Licensed Clinical Pastoral Counselor. He is the founder of GHP Theory and GHP Counseling Services. He specializes in working with individuals and families through trauma issues. He is a Veteran of 20 years Active-duty military service with the USAF and understands combat related issues with family dynamics. His work with Combat Veterans using Brainspotting has yielded great results, recognized by SOF Missions and Camaraderie Foundation.



A Cynic Look Into Meditation

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s a graduate student in marriage and family therapy, I have been introduced to meditation practices against my own will. One of the foundational courses in my program was about Milton Erickson and his revolutionary ideas towards the field of marriage and family therapy. However, the course required every student to meditate throughout the semester and journal their experiences as a graded assignment. While I particularly enjoyed learning about an important figure and his contributions to my field, I had conflicting thoughts regarding to my meditation experience. Throughout my training, I have witnessed the importance of mindfulness practices first hand. Yet,

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meditation was everywhere. From that first awkward class demonstration where we all had to close our eyes and meditate in an awkward class room setting, to the one we had to drink tea while meditating in class. Without even a warning the practice of meditating was the pill we all swallowed. And before I could process the value of it, I have seen meditation everywhere in the social media, in television, in radio shows, even the big companies such as apple and google are all incorporating meditation into their practices. The act of meditating can be wonderfully calm and grounding experience. Allowing its practitioners to breathe and stay in

October 2021 InSession | FMHCA.org

the moment. My experience of meditating always left me in a state of just being. Devoid of any feeling or emotion just simply existing. When I asked my colleagues about their experiences, they all agreed into just being and not feeling any particular way. Which led to the burning question of why? Why are we trying to prune ourselves from our fundamental emotions? Why are we trying to escape our right to feel? I remember being employed in a field I despised. However, for the monetary reasons I had to continue working. I vividly remember feeling sick of it and wanting more. The emotion itself was so intense that it made it difficult for me to motivate myself. During those moments of


intense feelings, I often closed my eyes and exhaled deeply. Yet, I did not try to drown myself to be present or stay on my breaths. Just like staring into a chess board, I would think calmly about million different ways to move forward. I channeled that lack of joy into motivating myself. I worked harder, and charted a course. Ultimately, following my plan to switch fields. I utilized and channeled the strong negative emotions into something concrete and constructive.

Throughout my life I have utilized my emotions to achieve different means over and over again. Therefore, I believe that emotions serve an important purpose in our lives. Yet, the act of meditating just gets us out of our state of feeling abruptly pushing us into coming to terms with just being. I believe as future therapists we should acknowledge the value of ourselves and how uniquely we feel each of our emotions. Because, knowing our depths and our capabilities can be a

wonderful tool for our tool box. Written By: Mert Yildiz Mert is an international student in marriage and family therapy Ph.D. program at Nova Southeastern University. Previously working in translation and in foreign trade with a business background. Mert is interested in traveling, psychology, learning different cultures and languages.

Ask AMHCA

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

Q

Part of my practice as a counselor involves providing clinical supervision to people who are seeking licensure. What should I do to protect myself from liability, in case I am sued for the actions of a supervisee? For example, how could I defend myself if a therapist that I was supervising was having a personal relationship with a client—without my knowledge? The best defense against any potential risk in a situation such as this is for the clinical supervisor to have a thorough Clinical

A

Q

When is telehealth not appropriate for a client?

A

When a potential client is in crisis, the person is not appropriate for telehealth. If

Q

Am I required to report another CMHC if I know that the counselor cannot practice competently or if I know of an ethical violation that a professional has committed? The Code addresses this problem in II.A.7, which provides: “When CMHCs have knowledge of the impairment, incompetence, or

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Supervision Contract or Disclosure with the supervisee incompliance with Code section III.A. (See Appendix E, Clinical Supervision Disclosure Template, in “Essentials of the Clinical Mental Health Counseling Profession” for more information). Exploitative relationships, such as an intimate relationship between the supervisee and client are “strictly prohibited” according to Code section I.A.4. Thus, the AMHCA Code of Ethics is an excellent learning device in the clinical supervision process, and the supervisee’s commitment to comply with the Code assures that the clinical supervisor is not responsible if the supervisee crosses boundaries with the client without the supervisor’s knowledge, after the supervisee has promised to comply with the Code of Ethics. the crisis is imminent, such that the individual is imminently suicidal, dangerous to self, or dangerous to others, then the person needs to be referred immediately to a hospital for crisis evaluation and treatment. CMHCs are not required to provide services via TSCC or may decide not to offer services based on appropriateness (B.6.c). unethical conduct of a mental health professional, they are obliged to attempt to rectify the situation. Failing an informal solution, CMHCs should bring such unethical activities to the attention of the appropriate state licensure board and/or the ethics committee of the professional association.” If the information about the unethical conduct of another professional comes from a client and constitutes confidential treatment information, obtain consent in writing in a release by the client before disclosing it.


From Us to You:

Lessons Learned from New Private Practice Owners That's because we, along with most of the world, were going e can’t believe it's been over a year since we opened W through it. our virtual doors. In reflecting on our year, it's been an incredible experience to meet and connect with such inspiring folks with who we have been lucky enough to support, coach, and collaborate. We are so grateful for everyone who has played a role in helping turn our vision of Live LYTE into reality. Throughout this journey, we have learned some valuable lessons that we wanted to share. Don’t sweat the small stuff. Prior to our launch, our perfectionistic tendencies were definitely driving the bus. The fear of failing or making a mistake created monsters in our minds over every detail. (Did you know that you can spend over 40 hours picking colors?) And if we learned anything from this experience, it's that those things don’t matter as much in the long run. What matters more is making a decision that we feel good about, even if we change our minds later. Always make time for each other. It can’t be ALL about business. This year came with many personal challenges and stressors. No matter what was on the agenda to take care of, we prioritized taking care of ourselves and each other. We spent time talking about our worries and finding ways to support one another. This made all the difference. Practice what we preach. Spoiler Alert! The content we put out isn’t just for you. It's for us too. It's a reflection of how we are navigating the world as two female entrepreneurs. There is a reason we talked about selfcare, self-worth, imposter syndrome, and values this year. 16

October 2021 InSession | FMHCA.org

Every relationship needs good communication. Starting a business with your friend can sound really exciting, and it was! But it also meant we had to be ready to have honest and sometimes tough conversations. We practiced setting our own boundaries and learning how to compromise with each other in a way that we both felt heard and understood. For us, living life on our own terms has been exciting, challenging, and rewarding. We are looking forward to our second year together and continuing to empower others to do the same. That is what we came together to do. If you are looking to turn your vision into reality, we are here to help. Live LYTE offers virtual solutions that include individual therapy, clinical supervision, and professional development. All of these services are virtual, making it convenient and personalized. Every truly great accomplishment is at first impossible. - Proverb Written By: Marissa Friedman, MA, LMHC, LPC, NCC Marissa is born and raised in Florida and has dedicated her career to empowering others to achieve their goals in reaching their full potential. Marissa received her Bachelor's Degree in Psychology from the University of Florida and completed her Master's in Marriage and Family Therapy from the University of Central Florida. She has been a licensed LMHC since 2013. For the past 8 years, she has worked with individuals struggling with anxiety, depression, relationship issues, addiction, eating disorders, trauma, selfesteem issues & life changes. In early 2020, she founded Live LYTE Counseling and Services to help professionals bridge the gap between mental wellness and professional fulfillment.



FMHCA's (Fall) Favorites Butternut Squash Soup Recipe

Ingredients 2 tablespoons extra-virgin olive oil 1 large yellow onion, chopped ½ teaspoon sea salt 1 (3-pound) butternut squash, peeled, seeded, and cubed 3 garlic cloves, chopped 1 tablespoon chopped fresh sage ½ tablespoon minced fresh rosemary 1 teaspoon grated fresh ginger 3 to 4 cups vegetable broth Freshly ground black pepper For serving Chopped parsley Toasted pepitas Crusty bread

Instructions Heat the oil in a large pot over medium heat. Add the onion, salt, and several grinds of fresh pepper and sauté until soft, 5 to 8 minutes. Add the squash and cook until it begins to soften, stirring occasionally, for 8 to 10 minutes. Add the garlic, sage, rosemary, and ginger. Stir and cook 30 seconds to 1 minute, until fragrant, then add 3 cups of the broth. Bring to a boil, cover, and reduce heat to a simmer. Cook until the squash is tender, 20 to 30 minutes. Let cool slightly and pour the soup into a blender, working in batches if necessary, and blend until smooth. If your soup is too thick, add up to 1 cup more broth and blend. Season to taste and serve with parsley, pepitas, and crusty bread.

The Body Keeps The Score

Habit Tracker App

The Body Keeps the Score, uses recent scientific advances to show how trauma literally reshapes both body and brain, compromising sufferers’ capacities for pleasure, engagement, self-control, and trust. The author explores innovative treatments—from neurofeedback and meditation to sports, drama, and yoga—that offer new paths to recovery by activating the brain’s natural neuroplasticity. Based on Dr. van der Kolk’s own research and that of other leading specialists, The Body Keeps the Score exposes the tremendous power of our relationships both to hurt and to heal—and offers new hope for reclaiming lives.

Habit is a habit tracker app that helps you to build good habits to reach your goals. Habit tracking is powerful for three reasons. 1. It creates a visual cue that can remind you to act. 2. It is motivating to see the progress you are making. You don't want to break your streak. 3. It feels satisfying to record your success in the moment. 18

October 2021 InSession | FMHCA.org

Lavender Lavender is a flowering plant in the mint family that’s easily identified by its sweet floral scent. In ancient times, lavender was used as a holy herb to aid relaxation and sleep. A study in the National Medicine Journal states that lavender can calm anxiety by relaxing the limbic system (area of our brain that controls emotions). You can purchase lavender oil or dry your own lavender to place around your home and workplace for quick anxiety relief.


Vision Boarding

Are you prepared to end 2021 stronger than you started? Studies show that you are 42% more likely to achieve the goals that you write down! Vision Boarding is a great way to remind you of who you want to be. Whether your goal is to drink more water, pass the NCMHCE, or open up your own private practice- write it down and stick it on a board that you see each day!

Meditation Minis Podcast

Blue Light Glasses As more work and social life revolve around looking at a screen for multiple hours every day consider wearing blue light protection to combat the effects of too much blue light exposure. Benefits of blue light glasses include: better sleep, fewer headaches, & less eye strain.

Meditation Minis Podcast is designed to help you feel better quickly. Designed by Hypnotherapist Chel Hamilton, each episode is meant to help you feel better in about 10 minutes or less. The meditations presented in this podcast The Tapping Solution App are from a wide variety of sources and do not subscribe to Tapping has been recommended by any particular ideology. Click to listen. top doctors, therapists, psychologists, personal development experts, and (Re-useable) Straws mental health experts. This app uses Did you know that you are more likely to EFT (Emotional Freedom Techniques) consume more ounces of water by in 5-20 minute drinking through a straw versus taking a sessions intended sip? Meet that water intake goal by to lower stress sticking a (re-useable) straw into your levels, reduce glass of water or by purchasing a water anxiety, overcome bottle with a straw attachment. fears, and more.

Raw Honey Have you heard the latest buzz on Raw Honey? Experts say it 1. Is A Great Source of Antioxidants- Raw honey contains several plant chemicals that act as antioxidants, some honey types even have as much as veggies and fruits! 2. Aids Digestion- Honey is often used to aid digestive issues since it is a potent prebiotic (this means it nourished the important good bacteria that lives in the intestines) 3. Acts as a Cough Suppressant- According to research, honey is as effective as dextromethorphan, a common ingredient found in overthe counter cough medicine.

UPick Farms Some farms allow visitors to handpick their own fresh fruits and vegetables. This form of direct marketing helps farmers save on labor and shipping costs while offering consumers the freshest produce at lower prices. Find a UPick Farm near you by using this Florida Farm Locater!


Is Kindness just a fluff concept? S

igmund Freud once said, “Out of your vulnerabilities, will come your greatest strength.” Psychology and psychiatry have proven time and time again that empathy, compassion, and kindness, which require us to practice selflessness, have numerous benefits for mental and physical health. From a biological perspective, acts of kindness signal the brain to release serotonin and dopamine, known as “feel good transmitters,” and endorphins which in turn lessen pain, depression, and anxiety. Kindness and compassion have been proven to release Oxytocin, also known as the “love hormone,” which increases self-esteem and optimism. Oxytocin also reduces blood pressure and has been dubbed the “cardioprotective” hormone. Some studies have even indicated that

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energy increases, stress decreases, and the lifespan extends. Research from Emory University has displayed that when an individual is kind to another, the brain’s pleasure and reward centers light up resulting in a “helper’s high.” The mechanism behind being kind is thus selfreinforcing. From a social perspective, kindness towards others results in connection to others and a lessening in feelings of isolation. Small acts of kindness build up compassion in oneself and have the added component of improving mood in others. Research indicates that kindness doesn’t just positively affect the giver and receiver but can also benefit onlookers. According to www.randomactsofkindness.org, those who witness acts of kindness are also more likely to “pay it forward,” resulting in a domino

October 2021 InSession | FMHCA.org

effect. Along these same lines, altruistic people, specifically those who engage in charitable donations expressed higher levels of overall happiness according to a 2010 Harvard Business School survey. “You can’t pour from an empty cup” is a trendy quote that has been making its way around social media as of late. But what does this quote mean? Before we can be kind and compassionate to others, we must first be kind and compassionate to ourselves. In today’s world, productivity and pressure-filled environments consume us daily. We often find ourselves skipping meals, forgetting to connect with loved ones, taking breaks, and even neglecting proper sleep. It is virtually impossible to care for others when we are depleted ourselves. Sometimes not prioritizing ourselves can result in


From a social perspective, kindness towards others results in connection to others and a lessening in feelings of isolation collateral damage. We may become short-tempered, irritable, moody, and overwhelmed. More often than not, these reactions are a direct result of frustration within ourselves. At this point kindness, compassion and empathy towards others are likely to be absent. Once we replenish, whether that means taking a day off, treating ourselves to a nice meal, or exercising, we are more likely to respond as opposed to react, ask others about themselves, and engage in overall positive interactions throughout our day. Overall, the kindness cycle asks of us two principles: being kind to others in order to maintain the cycle and being kind to ourselves to sustain our own well-being. Kindness and empathy are ever present in the field of mental health, medicine, and substance abuse treatment. The very act of caring for another involves kindness, even if it


is implied in one’s profession. How do mental health professionals practice kindness? Let us examine the concept of empathy. Empathy, which some use interchangeably with kindness and compassion, is defined as the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner (Merriam-Webster, 2021). Mental health professionals receive empathy training pretty early on in their schooling-particularly over the last decade. Research has indicated that trusting relationships between providers and patients results in optimal care. How is empathy practiced in mental health? For one, evidence-based communication styles are being widely implemented. This entails using non-judgmental language, open-ended questions, and active listening skills for example. In addition, mental health professions are humans, and all have judgments. If empathy training is provided, these professionals can learn to acknowledge their biases and mitigate them. Lastly, empathy training has been proven to assist with destigmatization, increase in treatment seeking, and overall better outcomes. Substance abuse treatment, which often focuses on cognition and behavior changing, boundaries, and family dynamics also requires support and kindness. Although not 22

an empirically based “treatment,” Alcoholics Anonymous has utilized kindness for decades. The premise behind step 12 encompasses all of the aforementioned concepts. Once an alcoholic is on solid ground with their sobriety, it is encumbered upon them to then help other alcoholics. This process is multi-faceted. Firstly, when an individual is worrying about someone else, they are less focused on themselves. This requires the alcoholic to cease engaging in selfloathing and rumination and “get out of themselves.” Secondly, it allows for the alcoholic to be kind and helpful to an individual who was once in their same situation thereby expressing kindness, compassion, and empathy. Thirdly, it fully displays the concept of “paying it forward,” and produces a domino effect that has withstood the test of time as evidenced by the evergrowing fellowship of Alcoholics Anonymous. It results in an increased social support network and activity. In conclusion, kindness, empathy, and compassion are vital concepts that are not just fluffy theories. They have vast mental, physical, and social benefits.

What are small acts of kindness that can improve your day: 1. Call a family member or friend and ask them how they are doing. Then engage in active listening and refrain from giving advice. 2. Donate to a homeless shelter or volunteer your time at a charity 3. Give a stranger a compliment. 4. Surprise someone with a small gift. 5. Send a loved one a letter instead of a text. 6. Pick up litter 7. Plant a tree. 8. Bring treats to work. 9. Help a neighbor with their groceries. 10. Leave a generous tip.

Written By: Lina Haji, Psy.D. Dr. Lina Haji is a licensed clinical psychologist specializing in psychodiagnostic assessment, forensic assessment, dual diagnosis, serious and persistent mental illness, depression, anxiety, personality disorders, and substance abuse treatment. Dr. Haji completed a master’s degree in forensic psychology at John Jay College of Criminal Justice, a master’s degree in clinical psychology from Albizu University, and a doctorate in clinical psychology with a forensic emphasis from Albizu University. Her training includes inpatient and outpatient settings, private forensic practice, and an APA accredited pre-doctoral internship.

October 2021 InSession | FMHCA.org



Listening with Both Ears

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e really do not give Kindergarten the credit it deserves when it comes to the values it encapsulates. Some wise soul decided to craft a book about the lessons learned in the year prior to jumping both feet into the academic rat race. Its humble wittiness is endearing. Ms. Wahloo was the delightful name of my Kindergarten teacher. Imagine the vivacious teacher from The Magic School Bus and you’ve got an idea of the soul that graced the classroom that year. To grab the attention of 20+ youngsters with the attention spans of hamsters, she would clap out a pattern to signal us to follow suit. Then, she would place a finger over her mouth and poise two fingers with her other hand above her head. The expectation was for us little humans to copy the pose. Years later, I connected the dots and realized the two fingers meant listen with both ears.

had to exercise the art of putting aside my own agenda to sit with the experiences of someone else’s that were different from my own. This was easily one of the most arduous skills to incorporate into my clinical repertoire. What makes putting a pause on our own agendas so difficult? Perhaps it’s the irritating experience of perceived misunderstanding on behalf of the others involved in the dialogue. Defensiveness derives from a place of vulnerability that nobody wants to validate. If we acknowledge the vulnerability in the room, then we must sit with the fact that it’s an impossible feat to fully “get” the differing perspectives circulating within a discussion. Desperate to cover up our humanness, we latch onto the idealistic expectation of convincing others our experiences are the most “correct”. Yet, all this pattern of interaction does is chase one another around the metaphorical bush.

What an underappreciated lesson this is once we exit the Kindergarten classroom.

I work toward normalizing the act of pausing as a clinician. This always throws me back to the stance Ms. Wahloo took I cannot tell you how many people grace my office that only with the two fingers high above her head. As youngsters, we adapted to the mindful nature this simple pose signified. listen with one ear. One ear to capture the dialogue of the We were not focused on the internal dialogue poised to experiences different from their own, and the other ear is attack in response. Instead, we placed our bumbling distracted by the buzz of their own flustered internal agendas to the side and attended with both ears to the dialogue that is busy preparing to rebuttal whatever thoughts and feelings of the bubbly teacher we adored. narrative is shared by the other. Perhaps this is where we get lost. We so often sidestep the So often, we become conditioned to listen to respond, compassion that humans are worthy of and get lost in the forgetting that the true purpose of listening is to shame of vulnerability that is cued by hurt feelings. understand. Something they forget to teach us in grade school is that we must achieve understanding prior to problem solving in Oy, if only people knew the negating nature of that “but”. any vocalized interaction with others. If we jump right into I will admit, I had to complete a master’s program to relearn problem solving, it is as if we begin to build a new house the original intent of listening, including relearning how to before the old one is finished burning. We must first attend properly attend to those I am engaged with. This meant I to the fire prior to beginning new construction. This means My favorite cop-out line is “I hear what you’re saying but…”

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we must first hit the pause button and tune into the worlds of those we are stuck with in a misunderstanding. Validation of the authentic nature of another’s experiences primes each party for adequate problem solving. It’s enormously helpful to muster up compassion while this pause button is hit, so that we can fight the urge to listen to respond and instead focus on empathizing with the other’s perspectives. This does not mean you must agree with their perspective, but to merely exude empathy that this is in fact the other’s stance on the matter. Similar, yet vastly different.

experiences. Yet, if you’d like to sidestep the mundane sprint around the metaphorical bush of disagreements, this practice of listening with both ears will pay off in the long run. Plus, that Kindergarten teacher would be quite proud. Heck, they would probably even give you a sticker. Written By: Katherine Scott, M.Ed/ Ed.S, LMFT

Katherine Scott is a Licensed Marriage and Family Therapist working at a private practice lovingly know as Puzzle Peace Counseling in NE Florida. While working with those in most walks of life, she has Your patience will nag you as you first habituate to the her niche working with neurodiverse children and their engagement of duel-ear listening. It’s difficult to sit with the families. She embraces an experiential approach with her discomfort of misunderstandings and exude compassion clients in their pursuit of healing. when frustrated. All completely and utterly valid

M I N D ggaam me es s Challenge your mind with this quarter's puzzles! Answer Key on Page 38

Start Here!

Fill in the missing numbers The missing values are the whole numbers between 1 and 9. Each number is only used once. Each row is a math equation. Each column is a math equation. Remember that multiplication and division are performed before addition and subtraction.

Escape the maze Do you have what it takes to escape? Start at the dot and end at the flags, see you there!


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Personality Traits for Eating Disorder Clients to Develop

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hen therapists treat clients who regularly diet and overeat, it’s easy to get sucked into talking about their experiences with food for an entire session. As an eating disorders therapist for 30-plus years and fully recovered from binge-eating, chronic dieting and bulimia for half a lifetime, I can tell you that there’s nothing most dysregulated eaters would rather talk about than their eating, even as they’re struggling not to make food the centerpiece of their lives. Therefore, it falls to clinicians to draw clients into territory that to them might seem far afield from their food struggles. Personality traits is one of those territories. Most of our eating disorder clients are so used to the way they act and think that they don’t consider how their personality traits benefit or hinder them. Our job is to help them recognize how specific traits misdirect them around food and how to modify these traits (add some, delete others, strike a better balance) to support “normal” eating. There are five personality traits of dysregulated eaters that stand out as barriers to their having a positive relationship with food and their bodies. It’s no wonder they have eating problems; reliance on these traits is the exact opposite of what would aid them in becoming comfortable around food. 1.All or nothing thinking and feeling Many overeaters embrace an all-or-nothing mindset. Actions are either right or wrong, feelings and people are either good or bad, with little room for nuance or

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gradation. For example, if they stray from their diet, they believe the whole day is blown in terms of healthier eating and so they cease to care about what foods they put into their mouths. 2.Full of judgment about their mistakes Although they’re often forgiving of others, because they can be obsessed about doing things right, they’re very hard on themselves. They push themselves to be accountable and responsible—except when they’re saying the heck with it and “being bad” with food—and berate themselves when they don’t do what they think they should do. 3.Perfectionistic If they take on a task, they’re driven to do it to the nth degree, even if it’s minor or inconsequential. They believe it’s wrong to leave jobs half done (or worse, undone!) or to do them in a mediocre fashion, and the higher the stakes, the stronger perfectionism grows. They relieve their stressing about not being perfect by eating. 4.People-pleasing and approval-seeking They worry about what others think of them more than what they think of themselves, yearning for acceptance and praise. Little makes them happier than compliments about their healthy eating or weight loss and little makes them more miserable than what others might think of their eating or size.


5.Insufficient pleasure, joy and play Because they worry so much about doing well and pleasing others, they don’t seek enough pleasure, joy and playtime for optimal well-being. They often view relaxing as slacking off and pleasure as something they’ll enjoy down the road. In truth, rather than needing more mindfulness in their lives, they could do with more mindlessness. Our job as clinicians is to teach clients that their all-ornothing mindset is a hindrance to growth and to point out when we see them feeling or thinking in black-and-white, not simply around food, but in relationships, work, daily life and self-appraisal. We can help them replace judgment with curiosity about their mistakes and failures and show them how to have self-compassion, accountability and responsibility in equal measure. We can explain their perfectionism as being intertwined with their harsh self-judgment and encourage them to be kinder to themselves and decide when enough is enough, not only in the food arena, but in all aspects of life. Therapists can support clients in developing a stable sense of self which relies on internal rather external

appraisal and focuses on clients’ wants and needs rather than on how others view them. One of the most important jobs we have with dysregulated eaters is to help them learn to let go without food. Teaching them the value of play validates their very real human need for it and encourages them to build a life that finds joy and pleasure everywhere, not simply on the scale or in the refrigerator.

Written By: Karen R. Koenig, LCSW Karen R. Koenig, LCSW, M.Ed., is an eating psychology expert with more than three decades of teaching people how to become “normal” eaters. Recovered from dysregulated eating for half-a-lifetime, she uses her clinical expertise and personal experiences to help clients improve their relationship with food and their bodies. She’s also an 8-book international, award-winning author and a popular blogger. Practicing out of Sarasota, Florida, she can be found online at www.karenrkoenig.com.


Jungian Resurgence and Applicable Constructs D

uring my graduate program I found myself naturally gravitate to the theories of Carl Jung. Which makes sense for me since I also resonated with similar concepts within Transcendentalism such as the collective unconscious and the panentheistic Gaia model. However, in my Theories class, Jung was not deeply covered since his work is often considered too convoluted for clinical application in psychotherapy, outdated, or seen as sub-par to more evidence based treatments which provide measured progress in a shorter time span as opposed to the stereotypical psychoanalytical process which can sometimes span years or even decades. This left me to pursue additional education on the subject after graduation, and since the typical path to becoming a Jungian Analyst can be grueling and expensive, I found the Zur Institute program for Jungian Psychology put together by the host of the popular podcast Shrink Rap Radio to be a happy starting point. The courses have equipped me with an introduction to how to apply the lofty and quixotic concepts within the context of the clinical hour. To my pleasant surprise, I’ve encountered frequent interest from clients into Jungian concepts as well, such as Shadow work, the Hero’s Journey, and the archetypes such as those within the Tarot. In approaching this kind of work with clients, it can be helpful to see a level of interest and insight into the individuation process and consciousness exploration. Once this has been established, the work can begin to delve into the symbolic manifestations of the clients presenting concerns and allow for a more integrated perspective into healing and even spiritual connection or existential excavation of meaning. Understanding the stages of alchemical consciousness development can often provide a guided path along this 28

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journey. In Jung’s understanding these stages can be broken down into four main categories which include: Confession, Elucidation or Illumination, Education, and Transformation. The confession stage often coincides with the client’s acknowledgment of their own suffering and identifying the perpetuating source of this within their own psyche. This can involve discovering the shadow and integrating this knowledge. The elucidation stage allows the client to build conscious awareness into their inner world and how this relates to the outer world through the exploration of dreams and symbolism. The education stage can then lead into developing a framework for understanding dynamics with others through the lens of the Anima and Animus. Lastly, the transformation stage provides the client with the opportunity for individuation and carving out their own path in the world which allows embodiment of their own myth. In facilitating this alchemical process through the therapeutic framework, the client is supported through a safe container which allows for the aforementioned stages to bring forth the natural unfolding of the development of Self.

Written By: Kathryn Post, LMHC Kathryn Post is a Licensed Mental Health Counselor currently in private practice in Jacksonville, Florida. She is a graduate of FSU's Master's of Science and Education Specialist program in Clinical Mental Health Counseling, focusing on chronic mental health conditions and wellness management for adults. Kathryn's work focuses on providing individuals the safe space to explore their inner world and work towards their personal goals.



Thinking Like a Business Owner:

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A philosophy and business plan for survivors of family of origin abuse

am a therapist in private practice for over twenty years. I am also a survivor of Family of Origin Abuse. As I encourage my clients to do when facing a life altering event, I gave my life a deep dive audit. The outcome was a philosophy and a business plan proven beneficial for the survivors of family of origin abuse I’ve worked with in my practice. Custody of Self Like my clients who grew up immersed in chaos and fear, I spent much of my life looking for "home". Home was contingent on a parental- like approval from practically whomever I was interacting with, regardless of age or circumstance. These designated others became like casting directors who could deem survivors for the role of “home-worthy”. For many survivors of early child abuse, every situation can be like a new audition with new casting directors to say yay or nay to their level of worth, intellect and presentation. In my deep dive, I factored in the dynamic of an Identified Patient dealing with abusive relatives, where the IP comes away from the interaction feeling like tangible property. Right then, in mid dive it hit me. What so many survivors 30

October 2021 InSession | FMHCA.org

were giving away to others was custody of self. Because of the patterned frequency of giving others custody of self, Freud’s Repetition Compulsion fit the aspect of striving for a pseudo “second chance” to correct the damage. But exactly what was repeatedly given away became clear. An image of me struggling to respond to a bitchy comment at a party reminded me of the feelings that preempted handing my custody of self over to a “superior”. Holding this image and challenging my then beliefs helped me recognize that I was my full custodian – on a logical level. I didn’t feel like it often, especially when in either abusive environments or modestly mean situations. The goal was to learn what being a full, consistent self-custodian looked like and felt like by practicing acting -as if- I was my full custodian regardless of approval and no matter how frightening the potential rejection of another person felt. In alignment with Dr. Albert Ellis and his REBT, Custody of Self is a philosophy ideal for use as “D” to dispute negative beliefs within the ABC’s of REBT. The specifics of practicing, eye contact, posture, lower, slower speech pitch, direct language emanated from holding Custody of Self as a POV worth working towards, even in a start comprised of tiny moments. Beyond individuation


that was linked to specific interests and traits, I needed and was entitled to custody of myself and that also meant custody of my small business. A Business Owner Modality An adult survivor of child abuse is automatically not only a survivor, but also a business owner. The mission is basic survival and the vision is a life that includes home, hearth, love and purpose. Every successful business needs a president. My clients respond positively to validation from pairing of Custody of Self with conceptualizing their lives as a small business. In alignment with Maslow, the client’s foundation for practical survival- (business) is the starting point for therapy. After the initial intake and the getting acquainted phase of therapy has passed, is the Assembly Line Approach. The assembly line approach begins with creating a timeline. On this timeline, actions that sabotage security and happiness and actions that promote security and happiness are mapped out and linked up with the time, day and circumstances when they occur. Typically, behaviors don’t happen within a vacuum. When a behavior is repeated, there are similarities shared by the various circumstances in which the behavior occurs and predictable thought patterns and beliefs that make up the survivor’s response. By constructing the assembly line and dissecting it within sessions, we incorporate strategic and tactical business development skills as a psychological modality. During this phase of therapy, our emphasis is on the structure of a client’s life in terms of daily schedules, finance, associations and actions/interactions with others. Emotions are tracked showing day, time, circumstances to mark where they fit on the assembly line. Goals are established that include internal goals, such as implementing new beliefs and external goals where the client’s ideal actions are targeted as desired outcomes. Trauma Work Begins Without Trauma Sometimes not working on trauma is working on trauma, and sometimes working on trauma when there is no stable baseline level of housing, employment, social support and schedule is retraumatizing. It is understandable for the client and therapist, both eager to get to the core issues of the presenting problem, to delve into the deeper emotional issues and past traumatic

events without first determining the level of security in the mechanics of the client’s lifestyle. When skipping over the trivial, daily life challenges, even when effective therapy took place, the client becomes more vulnerable to the difficult situations in the present. The energy delving into the mud and muck of therapy is continuously expended as processing takes place in-between appointments. The day-to-day challenges seem insignificant and even a distraction from the client’s memories and complex life events. The risky result is that the client experiences more events that feel too emotional taxing to participate in from a position of strength. Jung’s quote, “If all you have is a hammer, everything looks like a nail” is proven. By validating the merit and meaning of a client’s daily life, the client gets a strong ability to distinguish his life from the “nails” being discussed in therapy. Routine situations are handled. The client gets familiar with mastery over his immediate environment. Meet David David’s mother, Terri, was the social butterfly of New Jersey. Always the best dressed, the most up to date about on goings of the neighborhood’s rich and famous, Terri made a name for herself beginning in the fall of 1966 at their anniversary party when she and Ed and moved away from their suburban home to Queens just in time for her to give birth to David. House parties where like a third roommate. Ed’s hours were never ending. He loved being a firefighter. Though not a fan of his wife’s steady stream of friends at the house, he liked being able to get drunk at will with everyone being preoccupied, intoxicated or both. David described his childhood as a hijacking, recounting being dropped off at his cousin’s whenever the party and his dad’s absence were paramount – which was weekly. He remembered many times when he was told to pack preemptively as his home would not be available. David’s family included the entire fire department of NY state as his father earned a reputation as the best instructor. His oldest uncle was a fire chief. His father provided trainings throughout the northeast region. His mother was credited for writing the most comprehensive training workbook for firefighters. She met David’s father while conducting an interview with him after auditing his classes for a full month. Both of his parents were first generation American, both born and raised in large


apartments in Bay Ridge that housed parents, grandparents, siblings, aunts, uncles and cousins, and, both families were plagued my alcoholism. The pattern continued within the couple’s home and watered down the childhoods of their two children. David and his sister, Lilly looked like miniature adults, worn from pulling allnighters listening to their parents party and fight. David began drinking by sipping the left-over alcohol in the glasses left throughout the house or in the kitchen sink. As a preteen, it was always easy to take shots from any of the collection of bottles left out on display in the dining room China closet. By high school and throughout college, David liked to go to school with a flask in his backpack. Though his evenings and weekends were filled with fights and blackouts, David graduated in the top five percent of his class with a doctorate in mechanical engineering. David’s alcoholism lead to one final arrest for disorderly conduct that he had to face from a hospital bed. That same week, when his on again off again girlfriend became pregnant, David proposed before making a vow that his baby would never see him drunk and as long as he was a father, he would ever drink again. His baby boy marked the break and final end of the family cycle. His son his now sixteen and David is almost seventeen years sober. By the time David began therapy with me, he was already aware that he was the Hero Child in terms of his assigned role within his family. David prided himself on thorough research about the roles children play in alcoholic families, and his personality style of self-reliance and resiliency. He told me all this in his first sentence following my “hello”. It was Sunday and I typically did not answer my work phone, but there it was ringing next to my personal cell and for some reason, I felt an internal directive to pick up. Then David’s voice took on a confidential tone, more like that of a whistle blower revealing secrets to a reporter in a recorder phone call. “I am so angry right now, it’s burning through my veins. I could spit venom.” David’s wife, a celebrity chef and restaurateur was photographed in an intimate kiss with one of her investors. With photo in hand and propelled with pure 32

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adrenalin, David questioned everyone who had access to his wife’s whereabouts. The affair kept getting closer to David’s own personal life, to the point where the cleaning lady revealed knowledge of his wife having the same man over. David was asked to leave the house upon confronting his wife. He admitted to throwing a vase from their engagement party, but denied any threats. “I watched the vase shatter in front of the wall, picked up my gym bag and went into the spare bedroom. Next thing I know my wife is suddenly disheveled with tears and mascara down her face and a cop is telling me to leave.” David spent that night in a hotel room. He said his entire life felt like a robbery where he was the victim. He became aware of the theft three nights ago when it was raining. His tires were low. His car reeked new car plastic. It was this stupid new loaner toy car he drove that seemed to be only inching towards his house. Amanda was there. Good. He was happy to see his wife. He turned down their street, pulled up into the driveway. Amanda tensed as the unfamiliar car pulled into the driveway past their son’s big wheel and seemed to yell. A man walked out. Out of his house. There, right out of his own front door walked Him. This guy he saw before. A month before. At the restaurant. Trillo’s was always their go to place when they wanted a calm, quiet atmosphere and Italian food. “Who’s that?” He had asked. And like so many other times asking so many other questions, he got no answer, only Amanda’s blank stare. Why did that preoccupied look of hers always suffice as an answer? Why did he almost always let her off the hook? He wasn’t sure whether he hated her for her dismissive games more than himself for accepting them. What he did know is that he felt at war with his entire life. The lynchpin had been pulled. Nothing could be put back neatly in its delusional bandaid place. By the time the police left, Amanda and her friend drove away and he was to remain in the house that night with their son. This would be his last night in the house and he was to coordinate with Amanda to eventually get his things. They would divorce. It was now in play. “Tire tracks in the dirt road make the next truck get through faster.” My best go- to metaphor for past abuse paving the way for future abuse.


David started crying. A silent cry, with his face beat red and his hands covering most of it. He took my metaphor without my adding about his marriage being the next truck and his family of origin sounding like the definite first. “Why does it always come back? Why does it always come down to them?” He leaned in further. “I don’t want to scare you, but I feel like I could kill. She knew my family life and promised me we’d always be a team.” We were midsession and a pattern of constantly caretaking for others at his own expense emerging. The resulting damage was compounded by the deeper awareness that he was harmed by his family, by the very people he worked so hard to win over. Soon David saw that regardless of the topic being about the years of cleaning up the totality of his father’s mess from all the black outs all the nights before or about how right from the start of his marriage, he was charged with putting on a performance worthy united front for his wife’s family, his rights were almost always deemed nonexistent. David made the new decision that a life without rights was not livable. The assembly line structured the process of teasing out the specifics of exactly what transpired within his relationships. Moments where his rights were annihilated in past events were now blinking lights of neon transparency.

We looked at the nonverbal, unwritten contracts that he participated in, the reasons behind his choices, and the toll taken. Session time was spent delving into the toll taken and looking at the rewards/consequences lead to the final step of David’s declaration of “no more”. The rewards of connection were not worth the consequences of abuse. He was creating new standards that would be binding and nonnegotiable. Written By: Pamela Garber, LMHC Pamela's background includes over 20 years private practice, providing counseling to individuals, couples and families dealing with depression, anxiety, family and work-related issues. Additionally, she provides debriefing and crisis management to organizations after on-site violence, including assault and theft. She works with management and employees to resolve other work based disruptions. Ms. Garber has experience working in industrial film production and created an awardwinning behavior modification curriculum – “Playing the Tape” which has been used in residential and outpatient treatment programs. Pamela has been published in Counseling and Human Interest magazines.


FLOR DA

The Birthplace of the Clinical Mental Health Counseling Profession

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i, my name is Jim Messina and my story begins in 1973 after I got my PhD in Counselor Education from the State University of New York at Buffalo. 12 days after we got married on August 4, 1973, my wife Connie and I moved to Gainesville Florida for my NIMH Post-Doc Fellowship at the University of Florida’s Health Center. We loved Gainesville, loved being in Florida and near the end of my post-doc, I applied and got a job with the federally funded Escambia County Community Mental Health Center in Pensacola, Florida. I was at the Escambia County CMHC from 1974 through 1978. Eventually a friend and colleague from UF got a position at the center as well. This linking up with Nancy Spisso a 1974 graduate of the UF Counselor education program resulted in the following impactful events. How the Clinical Mental Health Counseling Profession Began in Florida

1973- WEDDING PICTURE OF JIM & CONNIE MESSINA AND THEIR DAUGHTER, MELISSA

The earlier incarnation of the American Counseling Association—the American Personnel and Guidance Association (APGA)—did not include a division for counselors who worked exclusively in the mental health field. The letter that sparked the creation of AMHCA appeared in the February 1976 APGA Guidepost Newsletter suggesting that APGA needed a division 34

dedicated to counselors who worked in mental health centers, marriage and family counseling centers, and other community agencies and mental health settings. The day Nancy Spisso and I read that letter, we were counselors at the Escambia County Mental Health Center in Pensacola, Fla. We talked about it and agreed on the spot to make this possibility a reality. I had served as chair

October 2021 InSession | FMHCA.org

of the National Negotiation Committee of the American School Counselors Association (ASCA) from 1972–75 and already had a working relationship with Thelma Daley, the president of APGA at the time, and Chuck Lewis, APGA’s executive director. After our impetuous decision to create the division, Nancy and I contacted Daley and Lewis, who gave us a list of the steps to take. Before any dust could settle, Nancy and I formally applied for creation of a new division and created the name for

AMHCA on the spot. The March 1976 Guidepost announced APGA’s intention to form a new division called the American Mental Health Counselors Association (AMHCA). Overcoming Hurdles More than 500 respondents to the notice in the Guidepost requested formal development of AMHCA. Unfortunately,


at its spring 1976 board meeting, APGA put a hold on developing new divisions for at least a full year. This moratorium spurred Nancy and me to file in Florida to establish AMHCA as a nonprofit corporation, and my wife, Connie, became our first administrator. When the moratorium was lifted in spring 1977, AMHCA’s board asked its 1,500 members whether to continue as a freestanding organization or become an APGA division. When voting closed Dec. 30, 1977, by the slimmest of majorities—51 percent—voting members chose to become an APGA division. A formal application was submitted to APGA, and APGA welcomed AMHCA as a division at its spring 1978 board meeting. The original leaders of AMHCA also came from Florida specifically from UF they were Bill Wiekel the first editor of the AMHCA Journal and 6th President of AMHCA (Weikel, 1985), Jim Hiett the first editor of the AMHCA Newsletter and Gary Seiler the 3rd President of AMHCA was also instrumental in the formation of the association (Seiler & Messina, 1979; Seiler et al., 1990).

SOME OF AMHCA'S PRESIDENTS & PAST PRESIDENTS

Formation of the Profession of Clinical Mental Health Counselors In 1978 at the time of the first AMHCA National Conference held in Columbia Maryland the AMHCA Board of Directors wrote up a blueprint for the advancement of the clinical mental health counseling profession which included the call for National Certification Standards for CMHC’s, State Licensure, Accreditation for CMHC’s, Code of Ethics, Research in CMHC’s clinical work (Messina et al., 1978). AMHCA Foundational Pillars for the Clinical Mental Health Counseling Profession To expand upon our attempt to create a new profession of Clinical Mental Health Counseling the Blueprint (Messina et al., 1978) identified the need for a strong foundation to build on. AMHCA was tasked to build a solid professional foundation and so, formulated the Six Foundational Pillars for the Clinical Mental Health Counseling Profession. These foundations were re-emphasized in 1979 under the 11th President of AMHCA Nancy McCormick also from Florida along with Jim Messina (McCormick & Messina, 1987). These foundational pillars comprise the following elements: The professional association, the code of ethics, the national certification process, licensure in each of the fifty states of the U.S., competency-based educational accreditation standards, and the promotion of research in the field of clinical mental health counseling. Pillar 1: Professional Association: AMHCA became a division of ACA in 1978. In 1998, AMHCA opened an independent national office in Washington with its own executive director. Pillar 2: Code of Ethics: The first AMHCA Code of Ethics was quickly formulated in 1978 based upon the existing APGA (ACA) code. Since then, additional codes which affect mental health counselors were written and updated for the American Counseling Association, the National Academy of Clinical Mental Health Counselors and the National Board for Certified Counselors.

41 PAST PRESIDENTS WITH AMHCA RETIRING EXECUTIVE DIRECTOR, MARK HAMILTON AT THE 2013 WASHINGTON DC CONFERENCE

Pillar 3: Accreditation & Educational Standards: This element was an area of tension between APGA counselor educators and the young AMHCA leadership from the outset. Counselor educators fought efforts to establish accreditation standards for mental health counseling


programs. In 1994 under the AMHCA presidency of Roberta Driscoll Marowitz (also from Florida and the 17th President), I agreed to spearhead the effort to identify a means to accredit mental health counselor training programs. Robert and I suggested a competency-based model called the Orlando Model which created the National Commission for Mental Health Counseling (Covin,1994). In 1995, this commission published a monograph titled Mental Health Counseling in the 90’s (Altekruse & Sexton, 1995). This publication reported on national research comprised of fifteen hundred CCMHCs to identify the competencies needed to provide mental health counseling and the competencies needed in counselor education programs. In 1995, the AMHCA Board of Directors chose to transfer their funding from the National Commission toward efforts to establish its freestanding office in Washington D.C. The effort to accredit Mental Health Counseling programs diminished until the new Mental Health Counseling Training Standards from CACREP were formed fourteen years later, in 2009. Today, over three hundred CACREP programs are accredited for CMHC training. “Community Counseling” was the politically acceptable term that counselor educators adopted in 2001 which inspired 160 of these courses of study in counselor training programs. This development weakened the growth and recognition of the Mental Health Counseling profession and became a contentious issue in 2009 when CACREP eliminated the Community Counseling Standards and replaced them with Clinical Mental Health Counseling Standards. Finally, after thirty-six years, a unified accreditation standard for the training of Mental Health Counselors existed. New standards for CACREP came in 2016 and did not differ greatly from the 2009 version. There are now over 300 graduate programs accredited by CACREP in Clinical Mental Health Counseling (CACREP, 2009). Pillar 4: Nationally Recognized Certification: As president of AMHCA (1978-1979) under the Blueprint (Messina et al., 1978) my board and I fulfilled the goal of creation of the National Academy of Certified Clinical Mental Health Counselors (NACCMHC) (Messina, 1979). The Academy devised a competency-based assessment model and gained recognition for the first national certification body which required work samples from candidates. The 36

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National Academy then allied with the National Board of Certified Counselors (NBCC) making the CCMHC one of a number of advanced certifications open to the 48,000 Nationally Certified Counselors (NCC) (Messina, 1985). Today AMHCA is now promoting a new designation: the AMHCA Diplomate. The Diplomate and Clinical Mental Health Specialist (DCMHS) credentials are based on graduate training, licensure, work experience and advanced training. The attainment of the CCMHC will be one significant prerequisite for such designations. Pillar 5: State-Recognized Licensure for Independent Practice: In 1980, after the NACCMHC was established, I wrote the legislative language for the first Licensed Mental Health Counselors in Florida. In 1981, this bill passed the state legislature and in 1983 over eighteen-hundred counselors become LMHCs. Today in Florida, over tenthousand LMHCs are practicing along with over elevenhundred MHC residents pursuing full licensure. Only sixteen states currently feature the term “mental health” in the title of their professional counselors. To add to the identity confusion, thirty-four states use the term “licensed professional counselors” as the legal descriptor which weakens the Mental Health Counselor designation. The American Counseling Association (ACA, 2011) documents the existence of 140,000 Licensed Professional Counselors, 54,785 Licensed Marriage & Family Therapists, and 202,924 Licensed Social Workers in the United States. Pillar 6: Research into the Effectiveness of Clinical Mental Health Counselors: The Journal of Mental Health Counseling was established in 1976 featuring Bill Weikel as the first editor. The first edition of the Journal appeared in 1979 after AMHCA was formally recognized as an official division of APGA and has been published regularly since that time. An Unresolved Training & Identity Dilemma The founders of AMHCA entered the field of clinical behavioral medicine without any educational underpinning for this new professional identity. The founders did not realize that by using the term "clinical mental health counselors" that the professional training would need to emerge from the colleges of education and take its place in the field of behavioral medicine. Current training programs based in education departments were not in a political position to support the concept that their


graduates engaged in “clinical mental health work”. This obstacle has, over the last 40 years, hindered the professionalization of the field of mental health counseling. Finally, however, in 2009 CACREP approved accreditation for clinical mental health counselors with a 60-hour graduate program requirement. To date, more than 300 counselor education programs are now accredited under the CMHC standards. Counselor educators had resisted using the term “clinical mental health counselors,” and indeed, during licensure efforts, even presidents of AMHCA who were also leaders in APGA, the American Association for Counseling and Development (AACD), and the American Counseling Association (ACA) supported the term “licensed professional counselors.” This explains why the field of mental health counseling has a bifurcated naming. For its 50 state licenses, 17 states use “licensed mental health counselor” and the rest use “licensed professional counselor.” Unfortunately, no theoretical model of counseling has developed with roots in Mental Health Counseling over the last thirty years. In addition, no significant body of research exists to assess and document the effectiveness of Clinical Mental Health Counselors. This fact has weakened the impact of the Clinical Mental Health Counselors among the other mental health professions and is an issue which needs attention by the professional organizations advocating for Clinical Mental Health Counselors. Since the early 2000’s, AMHCA has focused on working cooperatively with ACA and AAMFT to include CMHCs and MFTs in Medicare Reimbursement. Major legislative initiatives have resulted in Federal recognition of CMHCs for hiring with the Veteran's Administration and the Department of Defense as well as TRICARE reimbursement.

pertaining to the practice of clinical mental health counseling in an era of increasingly complex ethical concerns. FMHCA and AMHCA a 45 Year Working Relationship In 2013-2014 the then President of FMHCA Steven Giunta became president of AMHCA becoming the fifth Florida resident and FMHCA member to become President of AMHCA. He followed the traditions of Nancy Spisso 19771978, Jim Messina 1978-1979, Nancy McCormick 1987-1988, and Roberta Driscoll Marowitz 1993-1994. I(Jim Messina) have been involved with the work of FMHCA since 1979 when I was a lobbyist for Mental Health Counselor Licensure and the drafter of language for the new PL 490 Licensure for Mental Health Counselors from 1978-81. I then took a break from professional organization work and went to work to make a living for my family. I came back to a revitalized 2012 FMHCA Annual Conference to present two programs. I went on to become Chairman of FMHCA’s Higher Education Committee 2012-2015. After which I became a member of the FMHCA Board of Directors 2015-2019 and was FMHCA’s Treasurer 2015-2017 and in 2018-2019. In working with FMHCA I supported the outstanding work of its Administrative Executives: Darlene Silvernail followed by both Diana Huambachano and Laura Giraldo. My wife Connie and I have attended the FMHCA Annual Conference yearly since 2012 and I have made presentations at each of them. I firmly believe that FMHCA is still the vital base for the overall Mental Health Counseling Profession, and they have demonstrated this during the COVID-19 times by initiating a series of online webinars which have been more than well received. I have been and will always be an ever-present advocate in AMHCA for its Florida Chapter FMHCA and I am exceedingly proud of the work and accomplishments of FMHCA.

CMHCs now make up over one fifth of the available psychotherapists who are licensed in the United States (approximately 140,000 of the total number of 502,000 psychotherapists). AMHCA continued to update the AMHCA Code of Ethics with the latest revision in 2021. The code of ethics was developed specifically to address issues specifically

2013- WHEN FMHCA RECIEVED OUTSTANDING STATE CHAPTER AWARD, ACCEPTED BY DARLENE SILVERNAIL


References Altekruse, M. K. & Sexton, T.L. (1995), Mental Health Counseling in the 90's: A Research Report for Training and Practice. Tampa, FL: National Commission for Mental Health Counseling - An Orlando Model Monograph Series Monograph. AMHCA Certification Committee. (1979). The Board of Certified Counselors procedures. American Mental Health Counselors Association Journal, 1, 23-28. AMHCA/NACCMHC Blue Ribbon Task Force. (1980). Standards and procedures for competency based mental health counselor training programs.Unpublished Text. Washington, DC: AMHCA Council for the Accreditation of Counseling and Related Education Programs (CACREP). (2009), CACREP 2009 Standards, Washington, DC. CACREP Covin, T. M. (1994). Credentialing - an Orlando model project report. Unpublished Text, Washington, D. C. AMHCA. McCormick, N. J. & Messina, J. J. (Eds.). (1987). Professionalization - the next agenda for the mental health counseling profession: The proceedings of the 1987 AMHCA think tank. Washington, DC: AMHCA Messina, J. J., Breasure, J., Jacobson, S., Leymaster, R., Lindenberg, S. & Scelsa, J. (1978). Blueprint for the advancement of the counseling profession. Unpublished text. Washington, DC: AMHCA Messina, J. J. (1979). Why establish a certification system for professional counselors? A rationale. American Mental Health Counselors Association Journal, 1, 9-22. Messina, J. J. (1985). The National Academy of Certified Clinical Mental Health Counselors: Creating a new professional identity. Journal of Counseling and Development, 63, 607-608. Seiler, G. & Messina, J. J. (1979). Toward professional identity: The dimensions of mental health counseling in perspective. American Mental Health Counselors Association Journal, 1, 3-8. Seiler, G. Brooks, D. K. & Beck, E. S. (1990). Training standards of the American Mental Health Counselors Association: History, rationale and implication. In G. Seiler (Ed.) The mental health counselor’s sourcebook (pp. 61-77), New York: Human Sciences Press, Inc. Weikel, W. J. (1985). American Mental Health Counselors Association. Personnel and Guidance Journal, 63, 457-60.

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Answer Key

Start Here!


Adolescence and Destructive Behaviors

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arenting children through adolescents is, to say the least, challenging. It is a natural part of growing into an adult to rebel, to seemingly abandon family values, experiment with new behaviors and test limits. According to Eric Ericson the adolescent must throw out the values the family has instilled in them as a child and create their own set of values. They must first empty the proverbial tea cup before filling it up again. This process allows them to become an individual with a unique identity who is able to function in the world and be autonomous from the family of origin. Still it can be quite worrisome and at times downright scary to be a parent of an adolescent. When are adolescent behaviors natural and adaptive vs. problematic and indicative of more serious underlying causes? This is a difficult question as many adolescents experiment with dangerous behaviors. They may drink and use drugs, have unprotected sex, drag race with the family car, shoplift or any number of activities that will make a parents hair stand on end. Still “experimenting,” with such behaviors is a natural part of going out into the world, trying on different values and forming a functioning sense of self. This article will help parents identify when their adolescents behavior may be indicative of a larger problem. Also I will introduce some strategies to help deal with these behaviors. What is destructive behavior? Good question. Let’s take alcohol or drug use. Although I am not suggesting you tolerate any chemical use, I am suggesting that some experimental use may not qualify as necessarily

destructive. If the use is occasional, experimental and/or not interfering with the adolescents general functioning or development I would label this as inappropriate but not destructive behavior. If the use becomes chronic, serves to self-medicate, interferes with functioning and/or impedes development then I would label the behavior destructive. Chronic use of marijuana that causes decreased motivation, increased anxiety and a lack of attention given to schoolwork and other developmental tasks such as dating, I would label destructive. A teen might engage in a dangerous behavior while driving a car. There is a road near where I grew up that has a large bump in it, for decades young people have driven fast over the bump to become airborne. Usually the most damage done was to the cars suspension. Although not a recommended activity I would not consider this behavior destructive. I would consider it risk taking behavior. About eight years ago a group of teenagers did this on a very cold night; the car slid on an ice patch going onto the bump and skidded into a tree killing one of the passengers. So yes, risk taking can be very dangerous but not necessarily destructive as defined here. Conversely, driving recklessly at high speeds frequently, and flirting with causing an accident may be a symptom of depression and suicidal thoughts. This is a destructive behavior. We used to have a list of about sixty adolescent behaviors that are earmarks of substance abuse. They included,


change of dress, isolation from family, change of friends, and selling possessions. These behaviors may also be signs of normal adolescent development. Additionally they may be signs that the adolescent is suffering from an underlying mental health disorder. We look for underlying issues and causes when the behavior is destructive rather than simply breaking a rule or risk taking. The fifteen year old girl losses her virginity to her new boyfriend only to realize he has been cheating on her and sleeping with other girls. She is regretful, angry and embarrassed. We would say she should not have been promiscuous and took a risk. She will learn and adjust her values as a result. Yet this was not destructive behavior. Another fifteen year old girl begins sleeping around and becomes quite promiscuous to the point of contracting an STD and developing a negative reputation. I would label this destructive behavior that very well may be an indication of an underlying problem. It is not uncommon to see promiscuous behavior like these in adolescents who have been sexually abused or abandoned in some way. With non-destructive but inappropriate behaviors it is important to give corrective guidance and consequences for the behavior. With destructive behaviors it is also 40

October 2021 InSession | FMHCA.org

important to do this but we also must address the underlying behavior. Let’s look at some underlying issues that can drive destructive behaviors in adolescents and outline some signs and symptoms. Psychiatric disorders: Depression in adolescents can present differently than it does in adults. In adolescents depression manifests as irritability, aggressive angry behaviors, sleeping too much, difficulty sleeping, isolating, problems concentrating, substance misuse, or promiscuity. Anxiety may manifest in quite the same way. Bi-polar disorder may manifest as bouts of depression interspersed with times of high energy that may cause the adolescent to sneak out at night, engage in at risk behaviors and act erratically. Early experiences of psychosis may trigger substance use, and cause a decreased ability to concentrate and isolation. The child may have undiagnosed Oppositional Defiant Disorder which can create much turmoil for a family. Certain types of personality disorders that may cause much destructive behaviors may be forming.


Systemic issues: The adolescent may be, “acting out,” problems at home. If a parent is abusing drugs, or there has been a difficult divorce or a form of abuse. Poor behaviors may be the result of attention seeking, as negative attention is better than no attention. Shop lifting, bulling and drug use may be the result. Systemic issues originating from outside the family can cause destructive behaviors as well. The child may be the victim of bullying or lack basic resources like food are appropriate opportunities to socialize, leading to destructive behaviors. Additionally, the family system may actually reinforce destructive behavior. A few years ago the father of a 16 year old client called and reported that the previous evening his son had punched him. The father was complaining how inappropriate this behavior was. I then spoke with the son and he told me what had occurred. He had asked his father for $20 to buy something on line, his father said no and that he was busy and not to bother him. A while later the father came to the sons room and, according to the son, began to lecture him about disturbing him when he’s working and the value of money and so forth. Then the son swung at his father striking him on the shoulder. The father then abruptly left his son’s room and left his son alone. When I asked the father what the consequences were for his son striking him he said there were none. I also heard from the son that the next morning his father handed him $20. Yes this is inappropriate behavior and ultimately destructive behavior. But look at the function of the behavior; the father stopped lecturing and the son received the $20, the son had no consequences but in fact was rewarded with being left alone and $20. Yes, this behavior was inappropriate, but it worked. Sometimes families must ask if they in fact are reinforcing negative or destructive behavior. In the substance abuse world they call this enabling, but he word applies here also. Substance use disorders: Some individuals suffer from chemical dependency. This disease often begins to rear its head in adolescents. Addiction itself is a base study in destructive behavior. The child lies, steals from parents, stays out all night and presents with some pretty nefarious behaviors. They seem caught in a destructive pattern and they in fact are. Other

adolescents may be self-medicating an underlying issue. The key in differentiating between self-medicating abuse of drugs and addiction is this; does the use decrease or stop once the underlying problem is addressed. If so we are most likely seeing self-medication if not we are most likely seeing addiction? We may treat young Johnny for depression as he says; I’m so depressed I drink.” Six months later after engaging in therapy, taking antidepressant medication and addressing issues in family therapy, Johnny reports no signs of depression but continues to drink. When we ask him if you’re not depressed why do you drink today, he replies, “its Tuesday.” When I was the clinical director of an outpatient center that treated adolescents we provided both IOP and an EIP substance use treatment programs. Ok, what are those? IOP stands for intensive outpatient program. This type of program generally treats people with primary addiction. EIP or Early intervention programs were designed to treat people who may be abusing substances or selfmedicating. One purpose of separating the two populations is to combat the “cross pollination” effect of exposing less indoctrinated youth to others that may be using harder drugs and suffer from addiction. A third or less of the admissions to EIP had difficulty discontinuing substance use to the point of needing to be referred to IOP. For the remaining kids admitted to EIP, a portion were diagnosed with an underlying psychiatric disorder, received appropriate treatment and were able to discontinue or ’control,” their substance use. Another portion was able to exercise better judgement around substance use, gain an awareness of the negative impact on their lives and control or stop their use also. The point here is, it is important to rule out chemical dependency and substance use as the cause of destructive behaviors. Co-occurring Disorders: Some individuals and a majority of adolescents admitted to both substance and psychiatric programs suffer from Co-occurring disorders. Having a co-occurring disorder means the individual suffers from substance use disorder and a mental health issue. It can also mean a substance co exists with another, systemic or environmental problem or stressor.


To summarize, destructive behaviors may be indicative of an underlying problem. Destructive behaviors tend to be chronic, cause much stress in the family and cause ongoing harm to the adolescent. Conversely, inappropriate behaviors can be an adaptive and natural part of the adolescent’s journey to adulthood. What to do about it: First, always seek professional help if you have an adolescent engaging in destructive behaviors. Always rule out underlying medical causes, substance abuse causes and psychiatric causes as well as systemic problems that may be influencing the adolescent. Take care to find an objective professional versed in all these areas. Try to avoid professionals with an investment in a certain type of treatment. If I work at a psychiatric facility I will tend to identify psychiatric problems. Conversely If I work at a substance use treatment facility I will tend to identify substance use as the primary problem. Ask for referrals from friends, school personal and relatives. DO NOT go online, surf websites and start dialing the phone. I am adamant about this as many practices and facilities are ethical and truly are there to help where others are unscrupulous and out to benefit financially with no consideration for the person’s needs. Next, learn about setting appropriate limits, the use of contracting and what has been called mindful parenting. Often times I find parents can benefit from seeking treatment and guidance from an appropriate professional. A common mistake I see parents make is believing they can convince the adolescent their behavior is inappropriate. Another mistake I see is when the parent works hard to convince their teen just how scared, angry or uncomfortable their child’s behavior makes them. They become invested in these tactics and continue to use them even though they are not working. Here is a classic scenario from family therapy with adolescents. Mom begins to berate the adolescent with arguments as to why they should study, “you will never get anywhere in life, look at cousin Bob who didn’t study, it’s a family value to be successful at school, how are you going to be a pilot without studying……….. “ Dad then becomes a bit agitated, and tells the teen he is upsetting his mother and is sick of this, he will study or else. Mom then tells the 42

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father he should calm down and the father turns to his wife and yells, I am calm!” (example of splitting) Notice the focus has now moved from the child’s behavior to the father’s behavior. I intervene and say,” boy, you guys really put a lot of energy in convincing your son to study. Seems you really care about his getting somewhere in life. I the ask, “how long has your son struggled with grades?” They all respond about five years since eighth grade. Me, “Oh wow that long, tell me how long have you engaged in this type of exchange.” About five years they reply. Me, “really and how is that working for you?” They ask, what do you mean?” Me, “well, engaging in this behavior what’s the success rate for you, for every twenty minutes of convincing, (nagging) what’s the grade point improvement?” Hopefully I cause an ah ha moment for the parents as I have pointed that this tactic is not working, has not worked in the past and probably won’t work in the future. Then I can ask, as they see this is not working, do they want to try something different. If they say yes, I usually get the adolescent to say they will try something different as well. I then will start to introduce the concepts of contracting, limit setting and Mindful parenting. Contracting involves setting limits on problematic behavior and enacting consequences when the contract is broken as well as building in rewards when the contract is followed. Usually part of the contract includes the parents agreeing not to discuss grades with their teen. Rather to enact the consequences and rewards. Here is an example: For a couple years the teenage daughter and her mom have had a rough time with the daughter getting up on time and getting in moms car to get to school on time. They yell, argue, curse, water has been thrown and often times the result is the daughter being late for school and mom being late for work. “How is that working for you?”They say not well and agree to contract around the behavior. The daughter agrees to try to get up on time. Mom (and dad) agree that the daughter will be left alone in the morning and left to her own resources to be on time without any prompting. All agree that if the daughter is not in the car by the specified time mom will leave her


home, not excuse her from school and she will not have the use of electronic devices that evening. Most of the time this backfires, at least at first. Mom can’t seem to get in the car alone and decides to remind her daughter of the contract. Daughter screams,” you see you promised and now you’re yelling at me” and the old behavior pattern returns. Giving up that old behavior is hard to do. It usually takes a session or two to help the parents grieve the loss of the belief that the old behavior can work and adapt to a new pattern. Ultimately the contract usually proves quite effective. Mindful parenting, in a nutshell, is being mindful of emotions and the functions of our behaviors. It involves having supports and outlets for frustration. Mindful parenting is centered on the fact that we cannot control others (even our children’s) behaviors but we can control our own. It involves processing the loss of old beliefs that gave us a false sense of security. Ultimately Mindful parenting creates a calmer, nontoxic and nurturing environment in the household.

In summary, the answer is not to give up but rather to accept that some of these inappropriate and/or destructive behaviors may occur, to be prepared and have a plan. Being a good parent IS NOT measured by the child’s behavior it is measured by your reaction. How you respond is the key. Written By: Nelson L. Hadler, LCSW, CAC, ICCS Nelson L. Hadler has been providing clinical services to adolescents, adults and families for over twenty-five years. Nelson holds an MSW from Rutgers University. He is a NJ and FL LCSW, a NJ LCADC and a FL CAC, as well as a Certified Clinical Supervisor in NJ and Fl. Nelson’s focus has been substance abuse disorders and co-occurring psychiatric disorders. His years of experience allow him to offer comprehensive treatment to adults and adolescent’s suffering from mental health, substance use and co-occurring disorders. Nelson is in Private practice in Ft Myers Fl. He offers Telehealth in both Florida and NJ


Networking During A Pandemic: Tips for Graduate Students and Registered Mental Health Counselor Interns

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etworking and making professional connections are important in just about every career. Graduate Student and Registered Mental Health Counselor Interns are no exception. Networking with Licensed professionals may seem out of reach or a bit intimidating, however, it is a critical aspect of one’s career. While busy with taking classes or accruing the necessary hours for graduation or internship, adding something else to one’s plate might seem a little overwhelming, especially during a pandemic. Rest assured, there are plenty of ways to network and connect with your colleagues, even from the comfort of your own home. Remember the interview most of us had to do with a Licensed Mental Health Counselor at the beginning of our Graduate program? The person you connected with to do that interview is still a good resource. Having been interviewed about 30 times, I would appreciate a follow up from anyone who has ever interviewed me. You could reach out to that professional in order to follow up and share where you currently are on your professional journey. Perhaps that professional could recommend other professionals you could connect with in the specialty in which you are interested? Instead of having to search for connections on your own, this established connection could be very helpful to you. Your professors are another valuable resource. Develop a relationship with your professors. Even if their office hours are virtual, you can go with questions or simply to get to know them better. Professors can be a terrific resource to you beyond just teaching your classes. Additionally, some colleges and universities offer mentoring programs. Joining 44

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a mentoring program can be a great way to network. Your local FMHCA chapter may offer mentoring as well. Feel free to share both on-line or at an in-person meeting that you are seeking a mentor. If you are currently or recently in a study group you set up for the state exam, your group could continue to meet even after the exam. Many of us start peer groups for supervision, education, collaboration, and/or simply connecting. Your study group could transition into a networking or peer supervision group or the like. Another way to network is by connecting with your local inpatient mental health hospitals. The inpatient treatment programs in my area, Central Florida, offer networking, programming, and even meet & greets and tours both virtually and in-person. Inpatient programs are often looking for new therapists and referrals. It can be mutually beneficial to take them up on their marketing opportunities. If you have these programs in your area, I highly recommend taking advantage of


implemented new ways to connect during the pandemic. For example, the local chapter in my area, The Mental Health Counselors of Central Florida, (MHCCF), added random breakout rooms for the purpose of networking as a part of their regular monthly virtual meetings. Chapters may currently be meeting entirely online, like the Central Florida chapter; or may have gone back to meeting in-person; or may be offering a combination of on-line and in-person. You can choose whichever you are most comfortable with.

these as you can network with the inpatient facility sponsoring the programs, the therapists there, as well as the other attendees. Many of us miss the in-person social and networking piece of our professional associations, and plenty members have given feedback to that effect. Our organizations have responded by creating new ways to connect with each other. As you may already know, FMHCA is a state chapter of our national organization, The American Mental Health Counselors Association (AMHCA). Both AMHCA and FMHCA have created virtual ways to connect with each other. (For those of you reading this who are outside of Florida, you can find a list of AMHCA’s chapters here. For example, AMCHA has a Forum where any member can post questions, quandaries, or information for other members. FMHCA also has a Forum where members can post these as well. Your local FMHCA chapter can be a great resource to you. You can locate your local chapters here. Local chapters of FMHCA throughout the state have also

AMHCA, FMHCA and its chapters have been very creative during the pandemic, and they have come up with and implemented other ways to create opportunities for networking and connecting with our colleagues virtually. FMHCA regularly offers a free online networking event for all members called “Alliance.” The purpose of “Alliance” meetings is to help us connect with each other. Additionally, some chapters are offering in – person meetings, and if you feel comfortable, you can go there to meet people. Students and Interns are always welcome. Arriving early and staying late, whether on-line or in-person, can help you maximize opportunities of networking time. You also can take advantage of any networking events your National or Local Chapter may be offering. Another member resource available to you is the FMHCA Graduate Student and Registered Mental Health Counselor Intern Committee. As the Chair of the committee, I can attest that there are plenty of Licensed Mental Health Counselors who love to mentor students! The FMHCA office sends out a Doodle poll to all who have expressed interest in the committee, and the committee members decide what days and times the meetings will occur. FMHCA also has an online Forum on the website which is available to all committee members. Committee members can post questions, resources, and information important to students and registered interns. It is never too late to join the committee! If you would like to join the committee, please email our administrative office at Office@FLMHCA.org. FMHCA’s annual conference will be held February 4th & 5th 2022. (Pre-Conference workshops will be held February 3rd.) FMHCA will be offering a hybrid conference: in-person and online. Students and Interns are encouraged to attend, volunteer, and network along with the licensed professionals. Even though I did not need the credit, I


enjoyed attending conferences as a student, because it was both educational and a great networking opportunity. Conferences and workshops may still be primarily online, but there are many ways participation will benefit your career. If you attend a workshop or conference breakout session you particularly enjoy, I suggest initiating a connection with the presenter by requesting a connection on LinkedIn within a day or two of the training. Presenters appreciate hearing participants enjoyed their presentation.

questions, and so much more! In addition to connecting with FMHCA on these platforms, your local chapter may also have a presence on social media as well giving you even more professionals to connect.

Let’s not forget online platforms and social media for connecting. You likely already have a LinkedIn profile. If not, know that LinkedIn is a free professional networking platform. Are you new to LinkedIn and don’t have any connections? FMHCA has a presence on LinkedIn, and you can get connected there and end up with plenty of professionals with whom to connect. Additionally, FMHCA also has a presence on Facebook, Instagram, Twitter, LinkedIn, Tik Tok, and Pinterest. You can connect on any of those platforms. Different platforms attract different professionals. As for FMHCA’s social media, as a student or Intern, you can submit posts or comments and check for others responses to your post – perhaps you’ll start a conversation? Additionally, through social media sites, you can learn about networking opportunities, educational opportunities, office space for rent, new therapy tools, learn from others’ ethical dilemmas and

If you have any other ideas about how to network during a pandemic, please feel free to share them on our FMHCA Member Forum. Please also consider joining and sharing your ideas with our Graduate Student and Registered Mental Health Counselor Intern Committee either by attending a virtual meeting or submitting to the Graduate Student and Intern committee page on FMHCA’s website. Simply visit FMHCA’s website, go to the “home” button in the upper left-hand corner and a drop-down menu will appear. Scroll down to “committees” and the Graduate Student and Registered Mental Health Counselor Intern Committee. Then you will be taken to the committee’s forum page and will be able to read existing posts or create new a new post.

One last tip – if you feel concerned about sharing possible germs while networking, whether you are a Graduate Student or Registered Intern, I recommend you have some business cards printed. Business cards can help keep your hands germ free by avoiding entering your Volunteering in our professional associations is another contact information directly into a colleague’s smart great way to network. There are plenty of roles for both phone and also helps by avoiding the sharing of pens. graduate students and registered interns to fill at the local, There are plenty of low-cost printers to be found online. I state and national level. You could network on a national, recommend flat stock, as opposed to glossy, and leave the state and local level. When I was a registered intern, I back blank so others can write notes on them. If they write volunteered with my local chapter and got to really know notes on them, your colleagues are more likely to hold my local colleagues. I also ended up with multiple job onto them. All of us started from the beginning, so please offers! Volunteering, “forces” one to get know one’s know as a student, it is okay to simply list your name, colleagues personally. I find that when I am an attendee, I preferred means of contact (i.e., phone number and/or do not get to know, or remember, as many people as when I email, and/or social media links) and “Graduate Student” volunteer. There are opportunities to serve in elected board or “Registered Mental Health Counselor Intern.” The positions, and/or serve on committees. You can contribute cards do not need to be expensive, and simple designs articles on a topic you are passionate about or an issue which area easy to read, are best. If you do not want to important to you for the FMHCA In Session magazine. You order business cards, I recommend jotting down could even write about the challenges you and your peers colleagues’ names right after you meet them and later are facing having been a Graduate Student or Intern during that day or next day, send a connection request to them the pandemic. via LinkedIn.

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Remember- FMHCA is here to serve you! AMHCA www.amhca.org/home FMHCA www.fmhca.org LinkedIn www.LinkedIn.com


Written By: Laura Peddie-Bravo, LMHC, NCC Laura Peddie-Bravo, LMHC, NCC is the current President Elect of the Florida Mental Health Counselors Association, FMHCA. Laura graduated from The University of Central Florida’s CACREP accredited Counselor Education program in 1998. She obtained her NCC credential in 1999 and obtained her license in 2001. Laura owns a private practice, The Bravo Counseling Group, LLC, in Winter Park, Florida. She is married and the mother of three young adult children, one of whom has Autism Spectrum Disorder. Among her specialties are Depression, Anxiety, PTSD, Bi-Polar, OCD, Domestic Violence, and Personality Disorders. Working with clients and families with Autism Spectrum Disorder is a special passion for her. Laura also enjoys serving the profession of counseling, and she has been a member of and volunteered for professional associations since she was a graduate student.

Let's Get Connected! Resources FMHCA has in place for all to get connected to the community.

Follow Us On Socials Tips on growing your social media presence, daily interactive posts, and more can be found by following @fmhca on all major platforms. FMHCA Member Forum Never miss a beat by subscribing to The FMHCA Member Forum. Simply log into your FMHCA account on our site, navigate to the member forum tab and hit subscribe!

Networking Facebook Group With over 700 members and growing, our Facebook networking group is the place to be as an upcoming (or seasoned) professional. Click here to join. Volunteer at our 2022 Annual Conference We are searching for reliable volunteers to help us bring back our 2022 Annual Conference in February at Lake Mary, FL. Members can apply here

FMHCA Member Feature Program We love bragging about you. Complete this form to take part in our FMHCA Member Feature Program. Members selected get a feature on our social platforms on who they are, what they offer, and who they are trying to connect with.


Psychotherapy on the Go S ince 1998 all my therapy sessions have been on the telephone. Everyone told me it couldn’t be done. They insisted, that to be effective, therapy had to be done face to face in the office. I too, once believed that “conventional wisdom,” but today I know it isn’t true. I know that the work I do with people over the phone is not only as effective as the face to face consolations I did for years, it is often more effective. Here’s how it happened.

In 1994, I moved from Los Angeles to Florida and, believing that therapy had to be done face to face, I referred all my clients to local therapists. Shortly after I moved I got a phone call from an advertising executive who was dealing with a mid-life crisis. After talking to him for a while I offered to refer him to therapists in Los Angeles. He asked me to treat him on the phone. I declined. He said that he’d gotten so much from our brief conversation and his travel schedule made it impossible for him to visit any of these therapists. I agreed to four trial sessions, but said that if I didn’t think it was being effective I wouldn’t continue. It quickly became evident that he was not only struggling with mid-life crisis issues, but with a terror of intimacy which made it impossible for him to say what he needed to say when facing another person. He needed the anonymity of the phone to benefit from therapy. Intrigued by this result. I wrote to my Los Angeles clients telling them I’d be available for phone sessions. An artist, who’d been a previous client called. He remarked that talking on the phone was “better than in person.” He said that, as a visual person, he was distracted by everything he saw, including “the way your earrings moved.” On the phone however, it was as though we were connecting “mind to mind.” I assumed I’d only hear from previous clients, and then, only for emergencies or an occasional “tune-up.” I was surprised when I began to get referrals from people I’d never seen, and might never see. I was further surprised to discover unexpected benefits from 48

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working on the phone. In the office, although not necessarily intending to, clients were on good behaviour. When talking from home they behaved more naturally, offering me additional valuable information. Many people, like the advertising executive and the artist, are simply more comfortable on the phone, and others can’t, or don’t want to, go to an office. That is no longer an obstacle. Working on the phone opens offers many other advantages not present in an office-based practice. Obviously scheduling is much easier. No one has to get dressed or go anywhere; I’ve done sessions when the clients, and I, were in hotel rooms, friends’ homes, moving trains, and airport lounges. I’ve treated couples when each was in a different room, home, or country. One client interrupted a session to go through security at an airport, calling me back when he’d collected his bag and put on his shoes. I can, of course, only speak from my own experience. I’m an auditory learner, receiving most of my information from what I hear. Subtle changes in the pitch, tone and the volume of the voice, breathing, hesitations and use of language, all have meaning for me, and make working on the phone perfect for me. I don’t depend on, and am therefore not as hampered by, the loss of visual cues as a visual learner, to whom facial expressions, and body language are essential. The pandemic has forced many therapists to leave their comfort zone, and for visual learners Face time and Zoom can free them from the office and offer the visual cues they need.

Written By: Lynne Bernfield MA, LMFT Lynne Bernfield MA., MFTC has been in private practice for over 40 years. She is the author of When You Can You Will, why you can’t always do what you want to do and what to do about it. She has recently made available the When You Can You Will audio book and Workbook. She can be reached at the whenyoucanyouwill.com website.



I’m a girl, boy, both...neither? The impact of feeling invisible.

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hroughout school I was taunted by other students’ questions of “are you a boy or a girl?” I hated the

question as I knew it didn’t come from a place of mere interest or curiosity. It highlighted my already uneasy feeling that I was different than other girls. Shop attendants would ask my mum, “what does your son want?” It hurt because I knew I was “supposed to be a girl.” Born into a female body, which meant I was a girl, right? Maybe. Maybe not. I loved all the “boy things.” I hated dresses. I was a “tomboy” through and through. Eventually my mum got the message and stopped giving me dresses for birthdays. Our school decided to require uniforms, and girls had to wear skirts. I refused. I was distressed at the thought of it. Thankfully my mum spoke up for me and made me my favorite pair of trousers ever! I didn’t question everything about myself. I was competitive and challenged the boys to races, arm wrestling competitions and I also got into some fist fights. That’s just how I was. I loved that part of me. Early on, I recall only having boys as friends.

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As I got a little older, into high school, my being different was not ok. I could see that. Neither was it ok to just have boys as friends. I didn’t fit anywhere, and at a time in my development when I wanted so much to belong, the impact was detrimental. Not only were the people my age around me, not like me, but the adults seemed different too. I didn’t see people like me on tv or in the news either. It wasn’t a conscious questioning but more of a visceral and environmental awareness that I didn’t fit anywhere. My conclusion at the time: I am inherently wrong. I didn’t date in high school and ended up marrying the first person I dated, towards the end of college. A year into my marriage, I started to question my affectional orientation as that was the only thing that seemed to make sense about my “difference.” I silenced the questions to raise my children and yet my discomfort only grew stronger. It is interesting in looking back, as I tried so very hard to fit into the female mold. I tried because I was unaware of other options. Years later I broke down in my masters group therapy class, and although the words out of my mouth were that I was gay, what I was really feeling however, was that I was male, or at least not really female. I avoided that thought. I silenced it by keeping busy. With alcohol. With food. During my internship a client asked if I was androgynous. I smiled and said maybe even though, at the time, I had no idea what that meant. Then the true inquiry began. Now at 45years old, I know I am not inherently wrong, and I know that I am not alone and there are many others who


feel their bodies don’t match how they feel inside. Today I am comfortable presenting in a non-binary fashion, and yet it has taken years and years of trying to fit in to get to this point. I have struggled with depression, anxiety, an eating disorder, disordered drinking, excessive exercise habits in the desperate attempt to hide from who I am. Thankfully, I am now comfortable with being non-binary yet there is part of me that questions whether this is yet another step in the direction of true full self-acceptance. Being invisible growing up certainly impacted how I viewed and experienced myself, and the world around me. This very likely contributed to my mental health challenges. We need to do better, so that others can find a comfortable place within themselves sooner in their life. Imagine, if from an early age children saw and heard about “all genders.” It was the norm. There would be

no societally constructed gender-binary and each person could see themselves somewhere. In seeing themselves, they could then express what feels true to them rather than trying to fit into a mold that wasn’t made for them. Written by Krissy Moses, LMHC Krissy is a Florida Licensed Mental Health Counselor & level 2 yoga instructor. Krissy works within a school district offering various self-care practices to staff and students and is passionate about helping support LGBTQ+ youth feel included and safe at school. Krissy mostly helps LGBTQ+ clients within their evening private practice and is constantly increasing their knowledge and skills to better support the varying needs of the LGBTQ+ population.

Serving The Community One FMHCA Member at a Time The Mental Health Association of Okaloosa & Walton Counties proudly announced the establishment of the Joe P. Skelly Children's Therapy Scholarship in the amount of $50,000.00. The scholarship, created and funded by a donor who wishes to remain anonymous, is a tribute to honor the professional career of Joe P. Skelly, LMHC, Lic. Clinical Psychotherapist.

The Scholarship will be used to provide for the mental health needs of children whose situations require intensive levels of treatment and care, including Intensive Outpatient (IOP), psychiatric services and more.

When we spoke with Skelly, he shared how grateful and excited he was to offer hope to pre and early teen families who can't afford full spectrum services. Skelly worked in impoverished areas during his internship providing mobile psychotherapy. This experience taught him the importance of early intervention, stating that this scholarship's purpose is to "contribute to the mental health of people who will likely be my patient as adults." Skelly, an award winning area mental health therapist, is the CEO of Joseph P. Skelly, PA, operating as Lórien Counseling in Mary Esther, FL. Skelly is also the President of the Emerald Coast Mental Health Counselors Association and is a Regional Director of the Florida Mental Health Counselors Association. He is a previous winner of the MHAOW Treatment Professional Of The Year award and has been a leading activist for the mental health community and the mentally ill since the 1980’s. If you would like to make a donation to the Joe P. Skelly Children's Therapy Scholarship, please click here


Not a Minority

Why Language Matters in ending biases and improving Mental Health

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s a Licensed Clinical Social Worker serving children, individuals, and families in the private and public sector for over 15 years I understand what the intended purpose is when using the word Minority when referring to certain populations. When used appropriately the word really refers to a group that is not part of a majority. It is not intended to be negative, harmful or biased when used in this way. Unfortunately, the word Minority however is used quite often in negative forms to refer to certain groups through many platforms such as the social media. The way the word is used now in many instances has completely changed the meaning and purpose, making the use of it feel harmful and negative. The use of the word in this negative form has created an opportunity for the word to really hold a bias. I personally have supported many children, and adults who experienced the harmful effects of the word when used inappropriately. Why then have we been referring to certain groups using this word and how does this action affect their mental health? While we examine the use of this word let us also reflect on the use of other words such as Immigrant, Alien, and Hispanic. Words have power, they can break people, thus language should be respectful. In an effort to improve our own mental health and that of those around us, we should lead efforts aimed at identifying & replacing words that encourage oppression and victimization. Now more than ever our society is being called on to become active participants in the work to address the generational abuse and trauma faced by oppressed communities. As we fight for the rights of all oppressed and vulnerable groups our duty is to ensure we use strategies that change the way we discuss culture. Why I refuse to use the word Minority One of the definitions for the word minority is “a group in society distinguished from, and less dominant than, the

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more numerous majority, a racial, ethnic, religious, or social subdivision of a society that is subordinate to the dominant group...” according to Dictionary.com. As a child I felt this word was used to refer to my community as being less than. As an adult I experienced the word being manipulated to define & confine my community, and now as a social worker I often supported students and families who have been experienced negative biases as a result of the use of this word, as well as others such as illegal alien. The media is doing an excellent example of using language and/or terminology to portray the stereotypes associated with belonging to a minority group, rather than demonstrating all aspects including the positives of being a part of that minority group. In an article titled, “On Race: The Relevance of Saying ‘Minority’”, Edward Schumacher Matos referenced the following quote:"… "minority" is part of a media language "mired in euphemisms and the tortured, convoluted syntax that betray America's pathological avoidance of straight talk about race relations. .. minority status is insulting to blacks, Latinos and Asians and ignores their cultural influence on the mainstream. …the emphasis encourages victimization.” As a Licensed Clinical Social Worker working in the education field, I have had to listen to endless accounts from my students on how this word has negatively impacted the way they view themselves. They do not understand why this word is used to reference their community, or ethnicity. I have had to process with my students the implications of this word as well as others such as "immigrant", and "alien." Many of my students shared the way the use of this word made them feel: "ashamed, sorry, less than, and inadequate". These experiences will

forever stay with me. I myself have endured many harsh experiences of racism and discrimination while growing up as an immigrant in the south Bronx. Even this word “immigrant” is just another example of an attempt to refer to a certain group in a derogatory, and inferior form. As a young teenager I was once forced out of a NYC Yellow Cab, by a driver who insisted I could not afford to pay him; and while I screamed and fought against his hands which he used to drag me out of his car, he insisted no Latino "minority" living in the Bronx could not afford to pay his fare, as I lay in the ground on which he threw me; I was once again reminded of a word that was used to encourage victimization, hate, and violence. Do we even realize the implications of such actions, the re- traumatization, and re victimization that occurs in moments like these? Many of my students shared how these words always had a cruel way of reminding them that certain words were part of a vocabulary that was not only accepted but used to put them in their place, perpetuating again stigmas, and reinforcing the biases made by using this word. The impact of negative words/ affirmations/ language Negative words, affirmations, and language can have a detrimental impact on our mental, spiritual, and physical health. We all have negative thoughts about ourselves at some point in time in our lives. But our thoughts and feelings about ourselves may unfortunately become our reality. To avoid this from occurring we must identify the negative language that can perpetuate negative thoughts and decide to replace our vocabulary with words that develop strong and healthy human beings. I invite you to think about what it would be like explaining


to someone else; that they are considered to be less than someone else based on one simple word. Now reflect on how this might affect their self-esteem, and self-worth. Think about the feelings of sadness, fear, isolation, anger, and difficulties with understanding & acceptance of their own identity they will experience. The constant use of certain words in a derogatory context or, and the language they hear, and read being used to refer to them will affect the way they view themselves, and the world. The implications of positive affirmations/ words/ language What if, as soon as students awoke, they heard & visualized positive words and language? These words would become positive affirmations & transpire into positive thinking. The development of Language that has the potential to develop feelings of strength, love, value, and acceptance within our students. Words to emphasize the power of our own individualism of our “minority” groups. A reminder that no two people are alike therefore our contributions to this world are just as valuable as those of any other group. The use of positive words and affirmations in our daily lives, can improve our selfesteem, feelings of self -worth, physical being, and our overall mental and emotional state. While we examine these implications, let’s examine our self-care, how do the words we use to refer to each other affect our overall being & that of others? Part of our toolbox or care plan should include removing words that we use to reinforce biases or may be associated with stigmas. How to move forward Our experiences and those of our students need to be validated, and not minimized or compared to those had by others. My experiences are my own, and It is not my intention to equate what I lived through with that of others. It is my intention however to shed light on the pain that is felt when we use language in a derogatory form. Many of my students have suggest educating others on what the use of the meaning of these words are and the damaged that can be inflicted if we use them inappropriately! This communication and education suggested by students involved transparency, honesty, a judgement free zone. Students also shared holding those 54

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accountable for using words out of context and with intent to harm, because of you remain silent and do not act or have a consequence, it implies compliance. These practices shared by students can ignite the healing process, from the wounds left by these senseless acts. Allowing students, and adults alike to re-examine and magnify the beauty of our differences and be intentional with the portrayal of all aspects of “Minority” groups. Ideally, we must be able to process our grief, pain, loss, and trauma by examining our own biases and reflecting on our beliefs through open supportive conversations. Keeping in mind, we must also set aside time to process our discussion, and work through any unresolved feelings that may arise as well as any unresolved traumas. We must not continue to remain silent about this!! Sharing our painful experiences may provide us with an opportunity to connect with others who may have experienced similar pain. In sharing these traumatic experiences, we may also gain a sense of support and hope from others. We can help do our part to help end the generational trauma that is experienced by using words such as “minority” “alien”, “illegal”, to refer to certain groups. Our new administration will also play a key role in addressing language and exploring the use of these words and terms as examining these biases, and the impact of these used to refer to certain vulnerable communities will certainly help us to improve our mental health, become better educators, and professionals. Sources On Race: The Relevance of Saying 'Minority' Edward Schumacher-Matos Minority. Dictionary.com

Written By: Martha Rodriguez, LCSW Martha received her MSW from the Wurzweiler School of Social Work at Yeshiva University. Rodriguez has more than 15 years of experience in both private and public sectors. She previously served as the Service Manager in Recovery at Marjory Stoneman Douglas High School, facilitating the delivery of mental health services. Currently, her role is Mental Health and Social Work Consultant for the Student Services Project at the University of South Florida.



Case Study: A Comparison of Clinical Mental Health Degree Programs: Clinical Mental Health Counseling, Marriage & Family Therapy, Social Work, and Psychology Republished with permission of AMHCA’s The Advocate Magazine and the author.

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o compare clinical mental health degree programs, Dr. Aaron Norton compared the curricula of the four main mental health professions that do clinical work— counseling, psychology, marriage and family therapy, and psychology. Using the University of South Florida as a case example, Dr. Norton looked at three aspects of preparation for graduate mental health professional degrees in those four main mental health professions that do clinical work. Dr. Norton’s findings appear on the following five pages, presented in three tables: Table 1 compares the content requirements set by the accreditation and standards bodies for each of the four professions. Table 2 lists the required coursework for graduate mental health professional degrees in each of the four professions. See also the Key following Table 2. Table 3 compares the required coursework domains for graduate mental health professional degrees in each of the four professions. His analysis concludes that: The Clinical Mental Health Counseling program requires more coursework on counseling and psychotherapy and career assessment and counseling than the other programs. The Marriage and Family Therapy program requires more coursework on marriage and family therapy than the other programs. The Social Work program requires more coursework on policy development and analysis, and social and cultural issues, than the other programs. The Clinical Psychology program requires more coursework in cognitive and physiological psychology and research than the other programs. 56

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After reviewing a side-by-side comparison of the graduate level training of the four mental health professions,” Dr. Norton said, "I must say that clinical mental health counseling pretty clearly provides the most relevant and robust coursework in terms of clinical utility."

TABLE 1. COMPARISON OF CONTENT REQUIRE CLINICAL MENTAL HEALTH COUNSELOR CONTENT DOMAINS

Council for Accreditation of Counseling and Related Educational Programs (CACREP) 2016 Standards

ASSESSMENT, DIAGNOSIS, EVALUATION, AND TESTING

1e. Psychological tests and assessments specific to clinical mental health counseling

COUNSELING, PSYCHOTHERAPY, TREATMENT, AND INTERVENTION

1b. Theories and Models Related to Clinical Mental Health Counseling

3a. Intake interview, mental status evaluation, biopsychosocial history, mental health history, and psychological assessment for treatment planning and caseload management

1c. Principles, Models, and Documentation Formats of Biopsychosocial Case Conceptualization and Treatment Planning 2c. Mental Health service delivery modalities within the continuum of care, such as inpatient, outpatient, partial treatment and aftercare, and the mental health counseling services networks 2h. Classifications, indications, and contraindications of commonly prescribed psychopharmacological medications for appropriate medical referral and consultation 2m. Record keeping, third party reimbursement, and other practice and management issues in clinical mental health counseling 3b. Techniques and interventions for prevention and treatment of a broad range of mental health issues

ETHICAL AND LEGAL ISSUES

2l. Legal and ethical considerations specific to clinical mental health counseling 3c. Strategies for interfacing with the legal system regarding court-referred clients


Case Example: Comparison of Curriculum for Licensed Mental Health Professions at University of South Florida

EMENTS: CACREP, COAMFTE, CSWE, AND APA MARRIAGE & FAMILY THERAPIST

SOCIAL WORKER

CLINICAL PSYCHOLOGIST

Council on Accreditation for Marriage and Family Therapy Education (COAMFTE) 2018 Standards

Council of Social Work Education (CSWE) 2015 Standards

American Psychological Association (APA) 2015 Standards

FCA7: Systemic/Relational Assessment & Mental Health Diagnosis and Treatment

Competency 7: Assess Individuals, Families, Groups, Organizations, and Communities; Competency 9: Evaluate Practice with Individuals, Families, Groups, Organizations, and Communities

Assessment

FCA2: Clinical Treatment with Individuals, Couples and Families

Competency 8: Intervene with Individuals, Families, Groups, Organizations, and Communities

Communication and Interpersonal Skills; Intervention

FCA 5: Professional Identity, Law, Ethics & Social Responsibility

Competency 1: Demonstrate Ethical and Professional Behavior

Ethical and Legal Issues

Written By: Aaron Norton, PhD, LMHC, LMFT, MCAP, CCMHC, CRC, CFMHE

Dr. Norton is a Licensed Mental Health Counselor and Licensed Marriage and Family Therapist who serves as executive director of the National Board of Forensic Evaluators, Southern Region director for AMHCA, pastpresident of the Florida Mental Health Counselors Association, and adjunct instructor at the University of South Florida. He has 20 years of clinical experience providing psychotherapy and clinical and forensic evaluation (www.anorton.com). The research comparing the curricula for four mental health professions on the following pages complements the article "Let’s Be Fair! Comparing Social Work and Counseling Degrees," that appears on page 9 in the 2021 Spring Issue of AMHCA’s quarterly magazine, The Advocate Magazine. AMHCA members can download the issue free at connections.amhca.org/ publications/advocatemag


Case Example: Comparison of Curriculum for Licensed Mental Health Professions at University of South Florida

CLINICAL MENTAL HEALTH COUNSELOR FOUNDATIONS/ INTRODUCTION TO PROFESSION

1a. History and Development of Clinical Mental Health Counseling 2a. Roles and Settings of Clinical Mental Health Counselors 2k. Professional organizations, preparation standards, and credentials relevant to the practice of clinical mental health counseling 3d. Strategies for interfacing with integrated behavioral health care professionals

HUMAN GROWTH AND DEVELOPMENT

2g. Impact of biological and neurological mechanisms on mental health

POLICY DEVELOPMENT AND ANALYSIS PSYCHOPATHOLOGY

2i. Legislation and government policy relevant to clinical mental health counseling

MARRIAGE & FAMILY THERAPIST FCA1: Foundations of Relational/Systemic Practice, Theories & Models; FCA9: Community Intersections & Collaboration FCA 6: Biopsychosocial Health & Development Across the Life Span

SOCIAL WORKER Competency 6: Engage with Individuals, Families, Groups, Organizations, and Communities

CLINICAL PSYCHOLOGIST Professional Values, Attitudes, and Behaviors; Consultation and Interprofessional/ Interdisciplinary Skills

Competency 5: Engage in Policy Practice

2b. Etiology, nomenclature, treatment, referral, and prevention of mental and emotional disorders 2d. Diagnostic process, including differential diagnosis and the use of current diagnostic classification systems, including the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) 2f. Impact of crisis and trauma on individuals with mental health diagnoses

RESEARCH

SOCIAL AND CULTURAL ISSUES

2j. Cultural factors relevant to clinical mental health counseling; 3e. Strategies to advocate for persons with mental health issues

SUBSTANCE ABUSE

1d. Neurobiological and Medical Foundation and Etiology of Addiction and Co-Occurring Disorders 2e. Potential for substance use disorders to mimic and/or co-occur with a variety of neurological, medical, and psychological disorders

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FCA 4: Research & Evaluation

Competency 4: Engage In Practice-informed Research and Researchinformed Practice

Research

FCA 3: Diverse, Multicultural and/or Underserved Communities; FCA 8: Contemporary Issues

Competency 2: Engage Diversity and Difference in Practice; Competency 3: Advance Human Rights and Social, Economic, and Environmental Justice

Individual and Cultural Diversity


TABLE 2. LIST OF REQUIRED COURSEWORK FOR GRADUATE MENTAL HEALTH PROFESSIONAL DEGRESS AT UNIVERSITY OF SOUTH FLORIDA

DEGREE PROGRAM

CREDIT HOURS ACCREDITATION

COURSEWORK

CLINICAL MENTAL HEALTH COUNSELOR

MARRIAGE & FAMILY THERAPIST

SOCIAL WORKER

Master of Arts (MA) in Rehabilitation and Mental Health Counseling

Master of Science (MS) in Marriage and Family Therapy

Master of Social Work (MSW)

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CLINICAL PSYCHOLOGIST Doctor of Philosophy (Ph.D.) in Psychology, Concentration in Clinical Psychology 80

Council for Accreditation of Council on Accreditation for Council of Social Work Counseling and Related Marriage and Family Therapy Education (CSWE) Educational Programs (CACREP) Education (COAMFTE) (pending)

American Psychological Association (APA)

Foundations of Mental Health Counseling

Foundations of Mental Health Counseling

Foundations in Human Behavior

Physiological Psychology

Rehabilitation Counseling: Concepts and Applications

Legal and Ethical Issues in Marriage and Family Therapy

Foundations of Social Work Macro Practice

Typical and Atypical Development

Legal, Ethical, Professional Standards and Issues in Counseling

Introduction to Systems Theory

Foundations of Social Welfare Policy

Cognitive Psychology (x2)

Medical Aspects of Disability

Dynamics of Family Therapy

Foundations of Social Work Micro Practice

Graduate Research Methods

Fundamentals of Substance Abuse Counseling

Assessment in Marital and Family Therapy

Diversity and Social Justice

Research Methods and Measurement (MA component)

Individual Evaluation and Assessment

Family Therapy Theories and Techniques

Foundations of Social Work Research and Statistics

4 electives (MA component)

Human Sexuality Counseling

Contemporary and Community Issues in Marriage and Family Therapy

Psychopathology

Personality and Social Psychology

Human Growth and Development Social and Cultural Foundations of Counseling

Health, Illness, and Disability

Graduate Seminar in Experimental Psychology OR Clinical-Community Psychology

Research and Program Evaluation Diagnosis and Treatment of Psychopathology

Social Work Practice with Individuals

Statistical Analysis for Educational Research III OR Multivariate Statistical Analysis for Aging Research

Diagnosis and Treatment of Psychopathology

Research and Program Evaluation

Social Work Practice with Couples and Families

Research Methods and Measurement OR Advanced Educational Measurement

Social and Cultural Foundations of Counseling

Counseling Approaches for Substance Abusers

Social Work Practice with Groups

3 electives (Ph.D. component)

Group Theories and Practice

Human Growth and Development

Social Welfare Policy Development & Analysis

External Internship (one year, full-time)

Career & Lifestyle Assessment

Human Sexuality Counseling

Evaluation of Clinical Practice in Diverse Setting

Dissertation

Counseling Theories and Practice

Practicum I-IV

Field Instruction I-IV

Practicum in Counseling I-II; Internship

2 electives or thesis courses

2 electives (BSW), 3 electives (non-BSW)

2 electives

Updated 5/5/21


Case Example: Comparison of Curriculum for Licensed Mental Health Professions at University of South Florida Key: MA = Master of Arts in Rehabilitation and Mental Health Counseling MS = Master of Science in Marriage and Family Therapy MSW = Master of Social Work Ph.D. = Doctor of Philosophy in Psychology, Concentration in Clinical Psychology • Assessment, Evaluation, and Testing: All four programs require at least one course in assessment/testing. • Career Assessment/Counseling: The MA program requires a course in this content area, but the MS, MSW, and Ph.D. programs do not. • Cognitive and Physiological Psychology: The Ph.D. program is the only program that requires coursework in this area. • Counseling/Psychotherapy: The MA and MS programs include courses exclusively focused on theories and techniques of counseling and psychotherapy. The MSW and Ph.D. programs do not, though counseling/therapy theories may be included as part of the content of some courses. • Disability: The MSW and MA programs both have courses exclusively focused on disability (i.e., Medical Aspects of Disability and Health, Illness, and Disability), but the Ph.D. and MS programs do not, although the Ph.D. program includes a disability-related course as an elective option. • Ethical and Legal Issues: The MA and MS programs require a course exclusively dedicated to legal and ethical standards. The Ph.D. program does not, though such a course is available as an elective. The MSW program also does not. • Group Counseling/Therapy/Work: The MA and MSW programs require coursework on group therapy, but the MS and Ph.D. programs do not. • Human Growth and Development: All four programs require coursework in this area. • Human Sexuality: The MA and MS programs require coursework exclusively focused on human sexuality. The MSW and Ph.D. programs do not, though human sexuality may be included as part of the content of some courses. • Marriage and Family Counseling/Therapy/Work: The MSW and MS programs both require at least one course in this area, but the MS program requires the most. The MA and Ph.D. programs do not require coursework in this area. • Policy Development and Analysis: The MSW program is the only program requiring coursework in this area. • Practicum and Internship: All four programs require coursework in this area. • Psychopathology: A course exclusively focused on psychopathology is required for all programs except the Ph.D. program. • Research: All programs require at least 1 course in research, though the Ph.D. program requires more courses in comparison to the others. • Social and Cultural Issues: All four programs include at least one course focused on social and cultural issues. • Substance Abuse: The MA and MS programs require coursework exclusively focused on substance abuse. The MSW and Ph.D. programs do not. Analysis: The Clinical Mental Health Counseling program requires more coursework on counseling and psychotherapy and career assessment and counseling than the other programs, the Marriage and Family Therapy program requires more coursework on marriage and family therapy than the other programs, the Social Work program requires more coursework on policy development and analysis and social and cultural issues than the other programs, and the Clinical Psychology program requires more coursework in cognitive and physiological psychology and research than the other programs. Updated 5/5/21

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TABLE 3. COMPARISON OF REQUIRED COURSEWORK DOMAINS FOR GRADUATE MENTAL HEALTH PROFESSIONAL DEGRESS AT UNIVERSITY OF SOUTH FLORIDA

CLINICAL MENTAL HEALTH COUNSELOR

MARRIAGE & FAMILY THERAPIST

Master of Arts (MA) in Rehabilitation and Mental Health Counseling

Master of Science (MS) in Marriage and Family Therapy

Master of Social Work (MSW)

Doctor of Philosophy (PhD) in Clinical Psychology

ASSESSMENT, EVALUATION, AND TESTING

Individual Evaluation and Assessment; Career and Lifestyle Assessment

Assessment in Marital and Family Therapy

Evaluation of Clinical Practice in Diverse Setting

Not Required*

CAREER ASSESSMENT/ COUNSELING

Career & Lifestyle Assessment

Not Required*

Not Required*

Not Required*

COGNITIVE AND PHYSIOLOGICAL PSYCHOLOGY

Not Required*

Not Required*

Not Required*

Physiological Psychology; Cognitive Psychology (x2)

COUNSELING/PSYCHO THERAPY (GENERAL/ INDIVIDUAL)

Foundations of Mental Health Counseling; Rehabilitation Counseling: Concepts and Applications; Counseling Theories and Practice

Foundations of Mental Health Counseling

Not Required*

Not Required*

DISABILITY

Medical Aspects of Disability

Not Required*

Health, Illness, and Disability

Not Required*

ETHICAL AND LEGAL ISSUES

Legal, Ethical, Professional Standards and Issues in Counseling

Legal and Ethical Issues in Marriage and Family Therapy

Not Required*

Not Required*

GROUP COUNSELING/ THERAPY/ WORK

Group Theories and Practice

Not Required*

Social Work Practice with Groups

HUMAN GROWTH AND DEVELOPMENT

Human Growth & Development

HUMAN SEXUALITY

Human Sexuality Counseling

Human Sexuality Counseling

Not Required*

Not Required*

MARRIAGE AND FAMILY COUNSELING/ THERAPY/ WORK

Not Required*

Introduction to Systems Theory; Dynamics of Family Therapy; Family Therapy Theories and Techniques; Contemporary and Community Issues in Marriage and Family Therapy

Social Work Practice with Couples and Families

Not Required*

POLICY DEVELOPMENT AND ANALYSIS

Not Required*

Not Required*

Foundations of Social Welfare Policy; Social Welfare Policy Development & Analysis

Not Required*

PRACTICUM AND INTERNSHIP

Practicum I; Practicum II; Internship

Practicum I-IV

Field Instruction I-IV

External Internship (one year, full-time)

PSYCHOPATHOLOGY

Diagnosis and Treatment of Psychopathology

Diagnosis and Treatment of Psychopathology

Psychopathology

Not Required*

RESEARCH

Research and Program Evaluation

Research and Program Evaluation

Foundations of Social Work Research and Statistics

Graduate Research Methods; Research Methods and Measurement (MA component); Statistical Analysis for Educational Research III OR Multivariate Statistical Analysis for Aging Research; Research Methods and Measurement OR Advanced Educational Measurement; Dissertation

CURRENT DOMAIN

SOCIAL AND CULTURAL ISSUES SUBSTANCE ABUSE

Human Growth & Development Foundations in Human Behavior

Social and Cultural Foundations Social and Cultural Foundations of Counseling of Counseling Fundamentals of Substance Abuse Counseling

SOCIAL WORKER

Counseling Approaches for Substance Abusers

CLINICAL PSYCHOLOGIST

Not Required* Typical and Atypical Development

Foundations of Social Work Macro Practice; Diversity & Social Justice

Personality and Social Psychology

Not Required*

Not Required*

*Content may be available as an elective or included in courses with broader content, but there does not appear to be a required course that is exclusively devoted to the content domain.


Recovery of Connection: Be of Service What is Recovery?

Volunteer, do work that helps others, or even find a creative pursuit that contributes something of beauty to It is recovering that state of oneness with the Universal life the Universe. force that is our natural state. It is recovering the

awareness of that Connection - whether we call it God, the Do NOT confuse service with sacrifice. Sacrifice takes away Higgs Field, or Nature – that is innate in our beings. We all from ourselves in an attempt to control another’s suffering. sprang from the Source of Creation. We breathe air that Service enhances others’ lives and yes, may certainly every living thing on the planet has breathed since the relieve suffering, while enhancing our own lives through dawn of time. We drink water that has been recycled awareness of Connection. Sacrifice denies Connection through every living being that lived on earth. Our DNA since it implies suffering on the part of the giver and then contains the codes of more than one species. Our genes the receiver, if Connected, would suffer from that.

carry the memories of our ancestors. Here is a simple example: My husband and Recovery is awareness of this Connection and I like very different foods. If we discuss recovering from the loss of it. going to a restaurant with something he likes and I don’t, then there is the For many people, the word “Recovery” possibility of either service or sacrifice. signifies recovery from addiction. If we Service means that I can choose to go to look at addiction as a state of his restaurant of choice and enjoy the disconnection, as I do in my book, experience of being with him and Addict America: The Lost Connection, of him enjoying his meal and the two then Recovery is living in a state of of us being in Connection. Sacrifice Connection and recovering from the would mean that I am going to suffer losses we experienced in our lives that by going to his chosen restaurant and led us to a fear Connection. I’m only doing it to “make” him happy How do we live in Recovery? With (think Serenity Prayer). He will either be awareness of Connection, we can let disconnected and enjoy his meal in spite go of our egos and recognize that of my suffering or, more likely, he will not giving our physical and emotional enjoy the meal because I am not happy.

energy to others and our creative energy Make a decision each day: Addiction or Recovery? to the Universe is an evolutionary step to wholeness and Disconnection or Connection? health. When we are focused on others, we are not aware of our selves and the imperfections we attribute to ourselves. Written By: Dr. Carol Clark, LMHC When we are focused on relieving our own pain, making Dr. Carol Clark is a practicing sex and ourselves feel good, or even giving ourselves positive addiction therapist. She is the founder and affirmations, we are turning our energy inwards and that is director of a PhD program in Clinical Sexology not recovery. and of several training institutes where therapists and other healthcare professionals receive advanced Service in recovery means that you turn your energy training in a variety of fields. Her books, Addict America: outwards and experience the awareness of being in The Lost Connection and My Pocket Therapist: 12 Tools Connection. Service can take many forms and all you need for Living in Connection, will help everyone to live in do is open yourself to it. The opportunities are there. connection with themselves, others, and the universe.

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Coaching Clients Toward Sexual Integrity W

hen I began my career as a therapist, I never intended to specialize in sex therapy. It just seemed to organically evolve. The more I worked with individuals and couples on matters related to sex, the more I realized I was not prepared to effectively navigate these cases. Unfortunately, at that time and place, there were few viable options for these clients. At least I could be empathetic and nonjudgmental. Eventually, I pursued certification as a sex therapist and a Ph.D. in clinical sexology. It has been over thirty years since I began my career as a therapist. I have seen clients in both inpatient and outpatient treatment settings. Half that time I have spent in private practice specializing in clinical sexology, the science of sex. I have discovered that compromised sexual integrity is the common thread through every sex therapy case I have had. Integrity is the virtue of honesty and transparency. Sexual integrity is the experience of knowing who you are as a sexual being and allowing others to know you as a sexual being as well. Until we fully own our sexual truth, we will never be able to achieve a relationship that is both emotionally intimate and sexually fulfilling. I help clients accept the reality of who they are as sexual beings. I coach them to lean toward their instincts and desires. For sexual relationships to flourish there must be sexual authenticity. A relationship where you cannot be yourself is a relationship built on lies and deception. Hypocrisy is the opposite of integrity. While "The Sexual Integrity Coach®" is my registered trademark, the concept of sexual integrity is not new, 64

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and I am not the first to use that term. Others have written and spoken on the subject. "Sexual Integrity" is the title of several books, including my own, Sexual Integrity: Finding the Courage to be Yourself. We authors don't all approach the subject from the same perspective. Some write from a religious opinion and as you can expect, take a very different approach than I. While some books coach the reader to repress their sexual truth, I coach my readers to embrace it. Sexual oppression is imposed from external forces that seek to control the sexual thoughts and behaviors of others. It can occur overtly through laws that punish those who do not conform. It can occur covertly by denying people access to other options or even the knowledge that other options exist. Sexual repression is internally imposed as a result of living in a sexually oppressive environment. It is how the individual attempts to control themselves to comply with the demands of the oppressor. Both are barriers to sexual integrity. Both are a product of a sex-negative culture. From early childhood we are taught to dissociate our sexuality as if it is alien to our true self. We compartmentalize it in our mind like an alter ego. Instead of embracing our sexuality as a healthy expression of our unique individuality, we regard it as a mere activity that can only occur under certain prescribed circumstances. We spend our lives trying to live inside the tiny box we have been given. We are a nation obsessed with sex, yet we are sexual illiterates. Most states in the US do not offer science-based sex education in public schools or even universities. Where attempts at sex education exists, it can be so censured that it is un-relatable for the average person. Sexual myths prevail over facts. This is a consequence of living in a sexnegative society.


those states If you are licensed in any of the psychotherapy disciplines, you are considered qualified to practice sex therapy. Unfortunately, healthcare providers, including therapists, receive little or no training in clinical sexology. When it comes to matters of sex, the average consumer has no clue that their therapist has no clue. Many therapists are relying on their own personal experience to help clients with sexual problems.

Individually, each of us are sexually unique. Our sexuality is influenced by our biology and our environment. Our date of birth, where in the world we grow up, the religion we are born into, our parent's socioeconomic status, and their level of education will influence what we learn about sex and how we view ourselves as sexual beings. Biology is our best chance for predicting sexual behavior without the influence of time or culture. When we see the same patterns of sexual behavior across time and cultures, we can establish a good baseline for determining what is typical. Things like masturbation, same sex attraction, nonmonogamy, and non-binary gender identification have been documented in all cultures across history. This lets us know that we have an innate potential to sexually think and behave in ways that are unlimited by time, religion, or politics. Political and religious institutions can attempt to regulate sexual behavior, but they are powerless over sexual thoughts and desires. The authentic self will find its way out. Most states have no special licensing requirements for sex therapists. In

Additionally, therapists are trained to measure the success of couples therapy based on keeping the relationship together, not based on the happiness of the individuals involved. When taking this approach with a couple who are obviously sexually incompatible, one or both will have to shut down their erotic self to keep the relationship intact. Most couples are unsuccessful at this, and the relationship will continue to be a source of pain for all involved. The therapist has good intentions and wants to help the couple save the relationship. Most therapists don't know they don't have all the tools they need to help couples navigate sex. The fault lies with the health boards of the states they practice in and the educational institutions that trained them. Across time mental health providers have become more scientific and less judgmental in our opinions about sex. Mental health professionals are raised in the same society as our clients. We share some of the same wounding and this wounding is often a factor that attracts us to the profession. Mental health providers are increasingly sensitive to the changing sexual norms in the US. Every credible mental health professional organization now includes in its code of ethics statements prohibiting discrimination based on matters of sex, sexual orientation, and gender identity. However, that sensitivity does not equate to understanding the dynamics that influence sexual behavior and gender expression. A basic understanding of sexology is not only important when working with sexual minorities, but also with the mainstream clients as well. Some of the most challenging sex therapy cases I have had were with heterosexuals who identified as monogamous. Sexual minorities generally realize they are unique very early in life. They see the heteronormative, cisgender models and realize they don't fit. They take the hero's journey through the repression and oppression to come out on the other side with a greater clarity about their authentic sexual self. Heterosexuals grow up in a world that gives them full permission to be straight. They believe the map given to them will lead to a happily ever after life. They feel tremendous deception and betrayal when the story does not unfold as promised. Therapists must reconsider how we coach our clients about relationships and sex. We must accept that our culture has changed. How younger adults think, feel, and behave sexually is different from the expectations of their parents and definitely their grandparents. We must stop measuring relational success on the duration of time the couple has been together and start measuring it on the


degree of happiness of those involved. Time is a good measure of endurance and tenacity but tells us nothing about the couple's degree of emotional intimacy or sexual fulfillment.

and wants change over time. However, once the client understands they have a right to individuation and sexual freedom, they will likely self-navigate the rest of journey. Coaching couples to tolerate and value truth prepares them for effective communication about sex for the lifespan of Coaching clients toward sexual integrity requires that the therapist have a good understanding and acceptance of their the relationship. own sexuality. The therapist needs to work from a scienceTruth does not always lead to the intended outcome of based model that is free of judgment. Many sex therapy greater intimacy and sexual fulfillment with the chosen clients have been repeatedly shamed about their sexuality partner. Some relationships will not tolerate transparency. throughout their life. Though they may not identify as Denial and deception is what holds it all together. It is religious abuse survivors, religion is often at the root of their ironic that when one partner finally gets honest or sober, sexual shaming. the other one decides this is the time to leave. The In the therapeutic relationship the therapist provides a safe relationship ends when the prospect of real intimacy and transparency is finally in sight. space for the client to be known authentically. The therapist mirrors back this truer image, validating the client and helping them integrate the hidden (repressed) parts of their sexuality. Coaching clients toward sexual integrity requires the client to be rigorously honest with themselves and others. Some clients can't go there, even with their therapist.

Sexual wounds go to the core of our psyche. The trauma that happens with overt and covert sexual wounding can take years to resolve, if ever. The process of walking clients out of their personal closets can be slow and diligent. Especially if they are trying to bring their unwilling spouse Clients routinely apologize to me for talking about sex in our or family along on the journey. Getting more honest with themselves may require that they severe relationships with sessions. They feel embarrassed for sharing their thoughts those who don't want to know the truth. Intimacy cannot and desires and they worry I will feel repulsed or offended exist where honesty will not be tolerated. by listening to them or even being in the room with them. This is directly proportionate to the amount of shame they Specializing in sex therapy has been the most rewarding have experienced in their life. Reassuring the client and part of my career. I enjoy being part of a small demographic normalizing their sexual fantasies and behaviors is of mental health professionals that identify as sex important. therapists and clinical sexologists. I know this is not a chosen specialization for most clinicians, but I do hope you In couple's counseling the client may worry there is even will take opportunities to increase your knowledge about more to lose. They have spent the entire relationship hiding human sexuality and use it in a way that helps your own parts of themselves from their partner or spouse. clients find the courage to be themselves. Even if they trust the therapist to validate and accept them, they may not trust their partner. They often come to therapy because a piece of reality has been exposed. This is the crisis. For many clients the goal is to quickly get everything swept back under the rug. I generally recommend throwing out the rug and exposing what has been in hiding all along. Transparency is an important aspect of integrity. Sexual integrity is more of an evolving journey than a destination. We are always discovering new things about ourselves. The mind and the body continue to evolve. Needs

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Written By: Steven Davidson, PhD, LCSW Steven Davidson is a licensed clinical social worker and a certified sex therapist in private practice in Fort Lauderdale, FL. He is the author of Sexual Integrity: Finding the Courage to be Yourself. Clients and colleagues know him as The Sexual Integrity Coach®.



Parting is Such Sweet Sorrow: Saying goodbye to an eating problem. How to change your relationship with food.

he following article deals with the impact of loss as it T pertains to changing one’s relationship with food. As a psychotherapist and eating disorder specialist this is a subject that I believe needs more understanding and validation.

loss of living a healthy life physically, psychologically, emotionally and spiritually.

For many people their relationship with food needs to change from the habitual dysfunctional one to a healthy functional one. This is a process that needs to be In addition, I will address the topic of food and its addressed on a continuum in order to embrace a healthy connection to the holiday. This is one example, albeit a relationship. If this change is not adequately accepted, major one, that exemplifies one of the many trials and the return to the problem is likely to be imminent, thus tribulations experienced by individuals. leading to the original imprisonment, shame, anger and hopelessness. Know this is the first step to resolving and How one approaches loss in its many forms is a major dealing with this issue. This reduces the likelihood of component in the goal of ending an eating disorder or returning to the eating disorder or problem. However, it eating problem. The emptiness one experiences is eventually filled through the courage to say goodbye to this necessitates living through bereavement, grief and negative coping mechanism. My purpose is to call attention to the necessity of loss and grief in order to permanently change eating disorders and/or problems. Although the relationship with food holds different meanings for people, it can become all-encompassing for those suffering with anorexia nervosa, bulimia nervosa, binge eating, overeating or obesity. These are a few quotes from people I have worked with; perhaps you have heard similar remarks. “I don’t eat that much.” “Why can’t I be normal?” “I am so ashamed of myself.” “Will I be able to accept the insecurity I feel?” “I accept my newfound sanity; I want to hold onto it.” In order to grow out of an eating disorder or problem and grow into a life without it, one must give up dependencies, expectations, illusions and attachments to this negative connection. Eating disorders or problems often represent an attachment representative of a parent or best friend. Unfortunately, this may segue into a dependency on them. Some things that may have felt uncomfortable at times become comfortable. One literally wears her/his eating disorder/problem. The ultimate result of this is the 68

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change. The grieving process is necessary in order to shift the energy from grieving to living. Judith Voist (1998) states, “losing is the price we pay for living.” Loss is a fact of life that we experience from birth through death. This begins at birth with the loss of the mother’s protective womb and continues through childhood, adolescence, and the multiple phases of adulthood, culminating in old age with the ultimate loss. Those changing their relationship with food have unique losses to contend with. A major theme of these losses is becoming comfortable with healthy changes in one’s weight and appearance. In addition, we need to understand if food and weight are connected to a sense of security. Do unrealistic expectations of weight and body size exist? These unrealistic beliefs need to be explored, worked through, and grieved. As one journeys down this road to healthy eating, unexpected losses, such as death, divorce, work changes, etc. may also occur. How do these losses impact one’s relationship with food? Learning how to grieve and cope with life’s losses without returning to the dysfunctional eating relationship is paramount. In my practice I suggest and use a six-step template which acts as a roadmap to a healthy relationship with food. The steps are as follows: Step 1: Acknowledgement of the Problem Step 2: Shame Step 3: Anger Step 4: Fear & Anxiety Step 5: Inner Voices Step 6: Belief & Acceptance In each step of this template for change, the grieving process continues and becomes clearer. By laying out the template and referring to it during treatment, patients feel more in control. It helps them to recognize and focus on the pitfalls and resistances that surface. The awareness of each step leads to the realization that life can exist without the eating disorder or eating problem. This acceptance is necessary in order to recover from the loss of the old negative relationship with food. This begins the healing process

along with the belief in, and adaptation to, a new reality. There is duality in each step. They also represent areas that may have, originally and currently, contributed to the eating problem as well. Holidays As one journeys along this road, specific memories and experiences will put my theory to the test. One is the interaction of the holidays. What do the holidays mean to you? For some the holidays represent a time of loneliness and memories of times gone bye or memories never experienced. If food has been and continues to be used to fill the void, deny feelings of anger, anxiety, losses, fears, etc., perhaps this practice will continue and intensify. Do you truly want that? For some the holidays represent a time of joy, fond memories and experiences. Perhaps a time for gathering with family and friends and spiritual awakenings reminiscent of life past and present. If food has been connected to the above, the question becomes how do you move on? Whatever the holidays represent to you, if excessive food was always part of them please read the following. It is imperative to understand that changing your relationship with food develops in increments. These increments differ from one individual to another and often depend on your life situation. Changing how and why you use food is not an all or nothing situation. As stated above, once you begin to work on this, the issues of loss become real. Most likely the holiday eating and the desire to change your relationship with the food will be questioned and doubted. You do not have to “throw in the towel”, you do not have to feel as though you can never eat or enjoy food. Utilizing the Loss/Grief theme you can still eat foods but the way or how much you eat is the goal. It never means that you can no longer eat or enjoy food. Eating and its connection to the holidays, good or bad, need to be understood. Once this understanding begins so does the reality of what eating represents. Yes, eating for 12 hours at the holiday table needs to change but only you can change it. Once you incorporate the treatment elaborated above a positive change can begin,


one that isn’t fleeting but one that puts you in control of the ongoing representation of food. Yes it demands a commitment to your inner self, one that can lead to a relationship that is positive and not abusive. Allow yourself to acknowledge the loss and to grieve the negative eating patterns, enjoy the positive changes and sustain the ongoing outcome. Good Luck and Happy Holidays!

Written By: Louise Parente, PhD, LCSW, CEDS Dr. Parente is a certified eating disorder specialist, psychotherapist, supervisor, educator and coach. She has presented at a variety of symposiums, conferences, and hospitals; has worked as an adjunct professor at New York University School of Social Work; and is the recipient of the Marquis Who’s Who Lifetime Achievement Award-2020. She has authored Parting Is Such Sweet Sorrow, Saying Goodbye to and Eating Problem. She is in private practice and licensed in Florida, New Jersey and New York. She is a member of International Association of Eating Disorder Professionals, NASW and the NLAPW.

#FMHCAGivesBack

Because of the generosity of our members, we were able to cover the cost of the NCMHCE licensure exam of 2 Registered Mental Health Counselor Interns. FMHCA matched this amount, allowing for a a total of 4 winners!

Jodi Coleman | Jodi is a Registered Mental Health Counselor Intern with a private practice in Jacksonville, FL. Much of her work involves those overcoming complex trauma and struggling with depression, anxiety, and dissociation. She also contracts with local nonprofits to offer group and individual counseling services for survivors of human trafficking, as well as families in the adoption and the foster care systems. With her Professional Counseling master’s degree from Liberty University, she works from an integrated approach to wellness, emphasizing attunement to mind, body, and spirit. Jodi is passionate about personal and professional growth and is trained, and working toward certification, in Eye Movement Desensitization and Reprocessing Therapy (EMDR) & Neuro Emotional Technique (NET). Melissa Sandino | Melissa is a Registered Mental Health Counselor Intern working towards her licensure. Melissa connects mental health with mindfulness as she is a yoga teacher as well. Melissa prides herself in being nonjudgmental, empathetic, and a teacher in her therapy sessions. Melissa works with all populations, but primarily works with children of all ages. Melissa continues to grow her educational background with becoming Trauma Focused Cognitive Behavioral Therapy certified. Melissa has been trained and certified in Parenting Skills, Youth Mental Health First Aid, and Trauma Focused Therapy. Melissa hopes to continue working with children and bringing awareness to mental health importance for all. 70

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Dahana Emile | Dahana completed her Master of Science degree in Counseling from Nova Southeastern University. She is a Registered Mental Health Counselor Intern in the state of Florida. She has completed supervised training and internship with Pax Recovery Center helping adults with substance use disorders and mental health disorders. Dahana has experience working with substance use disorders, co-occurring disorders, and mental health issues. She utilizes a variety of techniques. Dahana also provides psychoeducation, providing a faith-based approach that guides individuals through themes of compassion, confidence, identity, inspiration, and purpose. She is passionate about helping others achieve wellness. Her professional affiliates are with the American Counseling Association, Florida Mental Health Counselor’s Association, and South Florida Association of Christian Counselors Kelly Gomez | Kelly is a Mental Health Counselor Intern in Miami, FL with a demonstrated history of working in the mental health care industry. She graduated from Nova Southeastern University with a Master of Science in Clinical Mental Health Counseling. She is currently working in a trauma informed agency and hopes to foster growth and experience to open her own private practice one day. Support The Registered Mental Health Intern Scholarship for Licensure Exam Fund here



Mental Health Awareness

s a licensed clinical social worker, I am pleased to A hear that many influential individuals have come

forward to recognize and discuss the importance of mental health issues. This can lead to an increased focus on those issues and what needs exist in the community. The overall impact could lead to funding programs and continuous awareness. Simultaneously, I believe it is important that we, as mental health professionals, become involved in these discussions to ensure that the issues are being evaluated in terms of clinical knowledge and concepts. This can add to an accurate understanding of these concepts in order that we can continue these discussions and, hopefully, add clarity to help reduce stigmas surrounding mental health issues. If we do not manage this evaluation correctly, individuals who are less aware might identify too highly with influential individuals and, without much further evaluation of their individual circumstances, suspend their responsibilities or goals in place of the need for self care. This could potentially result in consequences that could impact their ability to function at a basic level in other areas of their lives. In clinical social work, we 72

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study the impact of the social and environmental factors on mental health. Therefore, if an individual with low income and limited social support decides to not go to work in order to engage in self care, he or she could potentially be putting his or her job at risk. If this individual ends up losing his or her job, there is a possibility that he or she could not pay rent, for instance, and lose housing. This social and environmental consequence could result in a negative impact on his or her health due to the level of worry and anxiety involved in this decision. This decision and potential resulting impact looks a little different than a world athlete deciding to not compete in an event as this latter decision might not impact his or her basic level of functioning to such a high degree when thinking of Maslow’s hierarchy of needs. This does not minimize that the athlete still had a difficult decision to make but the consequences of this decision are different, while still significant to that individual, than the earlier scenario presented. Within this discussion, it is my professional opinion that it is realistic to look at the risk factors (those that put an individual at greater “risk” during times of crisis) and protective factors (those that could “protect” an individual in a time of crisis) in an individual’s life when evaluating the need for self care in place of the individuals’ responsibilities. Again, while this is not meant to minimize the experience of the influential individuals who recently disclosed their need for self care and concerns for their mental health in place of participating in athletic competition, these individuals could possibly have a high level of protective factors, such as financial security, social support and the attainment of a high level in their career that could give them the opportunity to choose the option of self care in a safer manner than others who are not as fortunate to have these protective factors. In my career as a clinical social worker and working with individuals who often have limited protective factors and a higher level of risk factors I would want to ensure they have fully evaluated the realistic implications of not going to work in order to engage in self care. How would this impact their finances and their ability to keep their job, for instance? Would the consequences of suspending their


responsibility of work be greater and have a residual impact on their mental health functioning? Or, would it be more important for this individual to engage in self care if the other alternative would result in such a decline in their mental functioning if they did not take a pause? And, what would the potential psychological ramifications of this decision be? These are tough decisions but imminent to discuss with clients who might be in a more vulnerable place. Therefore, as clinical social workers and counselors, I believe we have the responsibility to help our clients to evaluate ways to engage in self care without suspending their responsibilities, whenever possible, and especially if they do not have as many protective factors as the individuals portrayed in the media. This could be done in ways such as identifying activities that do not take a long time but result in a high level of calmness and stress reduction. It can be a fine balance and each situation should be evaluated closely to understand which decision would be potentially more detrimental and which decision would be the most appropriate and beneficial for his/her individual situation.

I would like to close by reiterating that this does not negate the fact that I am grateful for the bravery of the influential individuals to openly discuss their mental health concerns. Hopefully, their disclosure will result in meaningful and productive conversations about the seriousness of paying attention to mental health symptoms and their impact on individual functioning. Ultimately, prevention is the best line of defense and individuals will not be faced as often with these decisions regarding suspending their responsibilities or not if they are engaging in continual self awareness and preventative measures. Written By: Heather Burroughs, LCSW Heather Burroughs is a Licensed Clinical Social Worker in the state of Florida. She has over 25 years of professional social work experience, mainly in the healthcare arena. Additionally, she has over 10 years of teaching experience in Clinical Social Work and Professional Counseling programs. She is committed to raising awareness of and reducing stigmas surrounding mental health issues.

2021

Webinar Series Lineup Understanding Adverse Childhood Experiences (ACEs) and Client Trauma Presenter: Alicia M. Homrich, Ph.D., LPY, LMFT Friday, October 8th, 2021 2PM-4PM EST 2 General CE Credits | CE Broker #: 20-771449

Click Here to Register Early Recollections and Life Task Assignments: Applying Adlerian Concepts within the Clinical Setting Presenter: Karla L. Sapp, EdD, LPC, LMHC, NCC, CCMHC, CPCS, ACS, CMHFE Friday, October 22nd, 2021 2PM-4PM EST 2 General CE Credits | CE Broker #: 20-820548

Click Here to Register I AM MORE THAN ENOUGH: Lessons of Transformation from Adult Children of Alcoholics Presenter: Daniella Jackson, Ph.D., LMHC Friday, November 5th, 2021 2PM-4PM EST 2 General CE Credits | CE Broker #: 20-839936

Click Here to Register

Intimate Partner Violence: Hidden Victims of Sexual, Gender, and Relationship Minorities and Special Populations Presenter: Patsy Evans Ph.D., L.M.H.C., D.O.M. P.H.D. and Nicki Line L.M.H.C., CKAP Friday, November 12th, 2021 2PM-4PM EST 2 Domestic Violence CE Credits CE Broker #: 20-839940

Click Here to Register Integrating Transpersonal Theory and Energy Therapies for Spiritual Clients Presenter: Paty Hernandez, LCSW Friday, December 13th, 2021 2PM-4PM EST 2 General CE Credits | CE Broker #: 20-840196

Click Here to Register

That's not all! View Available On-demand Workshops


Using Creative Strategies to Explore Career Theories with Counselors-inTraining U

nderstanding how people make career decisions is rooted in career theories and is an essential step for counselors-in-training (CIT) to establish a knowledge base of the career counseling process (Osborn, 2009).The study of theories can oftentimes be dry and lead to boredom and, for counselor educators, finding a way to bridge theory with practice can be challenging. According to Oberman and Studer (2009), “the use of creative strategies facilitates students’ learning and further comprehension of career development” (p. 1). CIT’s may develop a greater appreciation for the influence that career philosophies have through a counselor educator’s ability to formulate exceptional collaborative strategies that are relevant and pertinent to counseling theories (Oberman & Studer, 2009). If the CIT can connect with the material on a personal and professional level, the more meaningful the theories become, and increases the likelihood to utilize this learning in their future practice. This article explores some best practices counselor educators may use when teaching career theory to CIT’s. Theory Collage Oberman and Studer (2009) created a collaborative teaching strategy known as the

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theory collage. This activity would take up to 60 minutes to complete the assignment. Students are randomly placed into small groups that are each assigned a specific career counseling theory, then directed to create a collage that represents the concepts of their assigned theory. The trainees may use available classroom resources to research their career theory and are required to include no more than ten pictures that would best describe the key strategies of their assigned career counseling theory. The students would then create a brief slide presentation, carefully arranging the photos that concisely summarize the assigned career counseling theory. Upon completion of the task, the collages would be posted to the class website with each group presenting their assigned theory to the rest of the students (Oberman and Studer, 2009) This in-class assignment allows students to work together in groups of two or three to formulate a visual understanding of career theories. The Theory Collage is an interactive method that would result in a brief overview of the key concepts of each of the theories and provides a sense of ownership to the students who illustrated them. This type of method may appeal to various learning styles. Flipped Class Design Common core curricular areas such as career counseling that require some explanation of the subject, however profit from application-based activity and practice in the classroom, are the best choices for a flipped class design. When learning about career theory, Merlin (2016) proports that the flipped class design helps to avoid student negative expectations such as dry content material and boredom, and instead affords learners increased class


the Table 1. Considering that the medium for instruction in higher learning institutions continues to advance towards distance, blended, and online learning formats, with limited live classroom time (and more so since the onset of the COVID-19 Pandemic), the flipped classroom design may be a valuable tool for counselor educators to maximize the time allotted for experiential classroom exercises.

time for activities and discussion while enhancing student engagement. Career Theory subject matter can be taught to learners via pre-recorded video lectures while still meeting CACREP National Standards (2016). Merlin (2016) created an outline that demonstrates the relevant standards that can be presented via a flipped class design (p.19). as illustrated in

Role Plays “Savickas (2002) in the spirit of Julian Jaynes, asserted that the history of vocational psychology and vocational psychology itself are inseparable” (Briddick & Sensoy-Briddick, 2009, p. 36). Role plays are a tried-and-true method of engaging students in the learning process and is an effective way of connecting theory with process. One creative method of role playing that is simple to accommodate in career counseling courses begins with formulating smaller groups of students with each team member selecting a notable individual associated with a career theory. A brief position paper is written by each team member on their assigned individual and then the group works together in creating a play, scene, or debate involving all the prominent persons they selected. (Briddick & Sensoy-Briddick, 2009, p. 38) Whatever method the teams select to present their findings, it will be interesting enough to capture the attention of the counseling students, while

Table 1 Career Theories CACREP Standards and a Flipped Classroom Example Area CACREP National Standards (2016) addressed in prerecorded video lecture *Theories and models of career development, counseling, and decision making

Flipped Classroom Design Homework: * Watch 20minute pre-recorded video lecture *Read book chapters about career resources and career assessments

*Processes for identifying and using career, avocational, educational, occupational, and labor market information Classroom: *Question and answer about the video lecture resources, technology, and information systems and readings (15 minutes) *Strategies for assessing abilities, interests, values, *Practice administering career counseling assessments personality, and other factors that contribute to career with partners (45 minutes) development *Exploration of career counseling resources and application to case study (45 minutes) Note: Adapted from Merlin, C. c. (2016). Flipping the Counseling Classroom to Enhance Application-Based Learning Activities. Journal of Counselor Preparation & Supervision, 8(3), 44-71. doi:10.7729/83.1127

*Role playing with partners applying career counseling theory (30 minutes


developing an enhanced comprehension of our career counseling forefathers and their schools of thought. This article explored a few best practices that counselor educators may use when teaching career theory to counseling students. Although the best practices examples noted here are limited, they do demonstrate that implementing some creativity into the classroom can be a positive experience for learning even the drier course contents. For future counselor educators, finding meaningful ways to personally connect career counseling theories with the process of counseling can serve to assist in the development of the practical skills needed to guide counselors-in-training and can also serve as a valuable tool to assist clients.

Written By: Maria Giuliana, LMHC Maria Giuliana, LMHC, Qualified Supervisor, is a 20-year Navy Veteran and founder of Beyond The Matter Counseling and Consulting Services in Jacksonville, Florida. She holds positions as the Regional Director Northeast of the Florida Mental Health Counselors Association and Military Services Committee Chairperson. Currently a doctoral candidate at National Louis University in the CES Program, her research focus is on Military Cultural Competency with an emphasis on LGBT Veterans. Her Leadership and Advocacy experience includes presenting at professional conferences on a variety of clinical topics, including military cultural competency, trauma and other issues related to Military, Veterans, and their families, and addressing unique issues related to the LGBTQIA+ community.

References Briddick, W. C., & Sensoy-Briddick, H. (2009). Dabbling toward our future's Past: Teaching the history of career counseling. Career Planning and Adult Development Journal, 25(1), 36-45. Retrieved from https://login.libproxy.edmc.edu/login? url=http://search.proquest.com.libproxy.edmc.edu/docvie w/204144088?accountid=34899 Merlin, C. (2016). Flipping the counseling classroom to enhance application-based learning activities. The Journal of Counselor Preparation and Supervision. https://doi.org/10.7729/83.1127 Oberman, A. H., & Studer, J. R. (2009, March). Strategies for effectively teaching career counseling. Paper based on a program presented at the American Counseling Association Annual Conference and Exposition, Charlotte, NC. Retrieved from https://www.counseling.org/Resources/Library/VISTAS/2 009-V-pt.2/Oberman-Studer.pdf Osborn, D. S. (2009). Teaching career theories, career assessments, and care information. Career Planning and Adult Development Journal, 25(1), 4657. Retrieved from https://login.libproxy.edmc.edu/login? url=http://search.proquest.com.libproxy.edmc. edu/ docview/204094838?accountid=34899 76

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SUBMIT HERE



State & Federal Legislative Update Provided by FMHCA's Government Relations Committee State Legislative Update The Government Relations Committee (GRC) of FMHCA recently prepared a report recommending that FMHCA attempt to secure legislative sponsors for a mental health counseling bill for this legislative session that, if passed, would have a substantial impact on advancing our profession in Florida.

As of 9/27/21, 55 FMHCA members have participated in the survey, and most of them expressed a high level of support as depicted in the chart below:

The GRC’s full report can be read on pages 79-85 On 9/14/21, the FMHCA Board of Directors voted to authorize the GRC and FMHCA's lobbyist to seek legislative sponsors for the bill pending favorable feedback from the FMHCA membership. The bill would accomplish four things: 1. Add Florida to the interstate counseling compact, enabling LMHCs to practice (in-person or via telehealth) in states that are members of the compact without obtaining an additional license. 2. Revise F.S. 916.115 to include LMHCs, LMFTs, and LCSWs in the list of mental health professionals courts can appoint as expert witnesses. 3. Revise F.S. 491.005(1)(c) to remove the requirement that registered interns have a licensed mental health professional on the premises when providing clinical services (including telehealth). 4. Replace the terms "registered mental health counselor intern," "registered marriage and family therapy intern," and "registered clinical social work intern" with "licensed associate mental health counselor," "licensed associate marriage and family therapist," and "licensed associate clinical social worker" consistent with most states.

We at FMHCA are not the only ones who think that Florida needs to join the counseling compact. On 9/27/21, Senator Ana Maria Rodriguez (R) filed Senate Bill 358, the Professional Counselors Licensure Compact. Click here to read the bill. FMHCA will continue providing updates on legislation aimed at Florida’s participation in the counseling compact. Federal Legislative Update

Our national parent chapter, the American Mental Health Counselors Association (AMHCA), as well as the National Board for Certified Counselors (NBCC), put out calls to action for counselors across the country to participate in Virtual Advocacy Day in support of the Mental Health Access Improvement Act, which would finally give counselors and marriage and family therapists the right to FMHCA is now collecting feedback from its members on this bill Medicare. If you haven't already, please visit proposed bill. If you haven’t already done so, please click https://www.amhca.org/advocacy/takeaction and learn here to provide your feedback. how to contact your legislators in support of the bill. 78

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Proposal: Mental Health Counseling Bill for 2021-2022 Legislative Session

Section 1: Summary of Proposed Legislative Action Florida Mental Health Counselors Association 2101 Vista Parkway Ste. 233 West Palm Beach, FL 33411 Phone: 561-228-6129 www.FMHCA.org

Deirdra Sanders-Burnett President Aaron Norton Past-President Laura Peddie-Bravo President-Elect Kathie Erwin Secretary Grace Marin Treasurer Maria Giuliana Regional Director NE Joe P. Skelly Regional Director NW Jennifer Raymond Regional Director SE Martin Cortez Wesley Regional Director SW Michael Holler Parliamentarian Diana Huambachano Executive Director Laura Giraldo Executive Administrator

FMHCA Chapters Broward County Central Florida Emerald Coast Gulf Coast Miami-Dade Palm Beach County Space Coast Suncoast

FMHCA is a chapter of the American Mental Health Counselors Association, the largest association in the U.S. exclusively representing clinical mental health counselors (www.amhca.org)

Purpose of Bill: The bill seeks to (1) improve access to mental health counseling among Floridians, and (2) modernize the clinical mental health counseling profession by (1) revising two statutes that negatively impact the accessibility of mental health counseling for Florida's citizens during the COVID-19 pandemic, and (2) updating verbiage used to refer to associate counselors to be more accurately descriptive to the public as well as to be consistent with the verbiage used in other states. Issue #1: Florida’s Lack of Participation in the Interstate Counseling Compact Currently, Florida statutes provide two pathways for counselors licensed in other states to be licensed in Florida (i.e., licensure by examination and licensure by endorsement), and Florida is not part of the interstate counseling compact. Implications and COVID-19 Connection In November 2016, the U.S. Dept of Health and Human Services (HHS) released a report concluding that there was a shortage of mental health providers available in Florida to address the demand for behavioral healthcare among Floridians. HHS projected a shortage of 6,720 mental health counselors in Florida by the year 2030 (HRS, 2018). Given the increased demand posed by the COVID-19 pandemic since the release of this report, the shortage of mental health counselors is likely much greater than originally projected. An interstate counseling compact managed by the National Center for Interstate Compacts has been developed with two founding states (i.e., Georgia and Maryland) and pending legislation in four additional states (i.e., Nebraska, North Carolina, Ohio, and Tennessee). The compact allows counselors licensed and residing in a compact member state to practice in other compact member states without need for multiple licenses and covers both in-person and telehealth services (NCIC, 2021). Florida’s lack of participation in the interstate compact means that (1) Florida will not be one of the first 10 states to join the compact and will therefore have no influence in the administrative development of the compact, (2) counselors licensed outside of Florida must undergo a more cumbersome process to obtain licensure in Florida than would be available through the compact, discouraging counselors from relocating to Florida to address Florida’s shortage of mental health professionals and absorbing administrative costs of Florida’s licensure board related to processing licensure applications, and (3) licensed counselors in Florida oftentimes must unethically abandon their clients who are temporarily traveling outside of Florida rather than provide telehealth due to lack of licensure reciprocity in other states. This is particularly problematic given the unprecedented mental health crisis in


Florida related to the COVID-19 pandemic. There has been a more than three-fold increase in reported symptoms of anxiety and depressive disorders among adults and college students (Ettman et al., 2020; Evans et al., 2021; Horigian et al., 2021; McGinty et al., 2020) as well as teens, whose academic performance has also suffered (Cooper et al., 2021; Racine et al., 2021). Additionally, the pandemic has been correlated with increases in stress and financial strain (Ferreira et al., 2020), substance use rates (Castaldelli-Maia et al., 2021; Zaami et al., 2020), interpersonal violence (Cannon et al., 2021; Evans et al., 2020; Parrott et al., 2021), grief related to COVID-related deaths (Hillis et al., 2021; Kidman et al., 2021), the teen suicide rate (Yard et al., 2021), OCD-related behaviors (Jellinek, et al., 2021), and unhealthy eating behaviors (Simone et al., 2021). The pandemic has been linked to poor sleep habits and decreased sleep quality (Smit et al., 2021; Tsang et al., 2021) and reduced exercise due to anxiety, stress, and depression (Huckins et al., 2020; Marashi et al., 2021). The Tampa Bay Times reported that the number of people reporting worsened mental health has tripled in connection with the current COVID-19 pandemic, and many of them are struggling to access treatment (Reeves, 2020). Given that the COVID-19 pandemic is projected by experts to cause an increased demand for mental healthcare for years to come (Loades et al., 2021; Rogers et al., 2020), greater access to mental health counselors to address these problems is vital. Solution: Amend F.S. Chapter 491 to include a new statute (F.S. 491.0047) denoting Florida’s participation in the interstate counseling compact, much like legislators have already done for the nursing profession (Florida Board of Nursing, n.d.). Issue #2: Exclusion of Mental Health Counselors, Marriage and Family Therapists, and Clinical Social Workers from Verbiage in Statutes Referring to Court-Appointed Forensic Evaluations F.S. 916.115 reads, "To the extent possible, the appointed experts shall have completed forensic evaluator training approved by the department, and each shall be a psychiatrist, licensed psychologist, or physician." Implications: This statute does not list 491 Board licensees (i.e., Licensed Mental Health Counselors, Licensed Marriage and Family Therapists, and Licensed Clinical Social Workers). Consequently, some jurisdictions do not permit LMHCs, LMFTs, and LCSWs to be appointed to conduct evaluations for the courts, regardless of their individual levels of expertise and training and despite that assessment, diagnosis, and treatment of mental disorders is within the scope of practice of all 491 board licensees per F.S. 491.003(7), 491.003(8), and 491.003(9). Attorneys sometimes attempt to disqualify 491 board licensees as expert witnesses for not being psychologists. For example, on 5/6/19 an attorney in St. Augustine filed a motion to disqualify an evaluator who was dually licensed as a LMHC and LMFT in Case No. DR 19-0106, asserting that the evaluator was “not a clinical psychologist…he is licensed in Florida as a mental health counselor and marriage and family therapist…[He] is not qualified to conduct psychological testing because he is not licensed as a clinical psychologist…he does not have the expertise.” Additionally, due process rights of defendants and inmates are sometimes violated with lengthy waits for a forensic evaluation due to a shortage of qualified psychologists/psychiatrists available to conduct such evaluations. F.S. 916.115 was written in 1985, just one year after mental health counselors were first licensed in the State of Florida (1984) and simply needs to be updated. Failure to update the statute fuels the myth that 491 board licensees are somehow inadequate as compared to 3 psychologists, psychiatrists, and physicians, despite that the clinical training of LMHCs is comparable to that of psychologists (Norton, 2021b). COVID-19 Connection: Evaluations are even harder to conduct during the pandemic, with some jails restricting access by evaluators, and some evaluators no longer conducting in-person evaluations. As of 9/7/21, there were 13,099 LCSWs, 2,598 LMFTs, and 14,419 LMHCs in Florida, for a total of 30,116 491 Board licensees, whereas there 80

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are only 6,173 licensed psychologists. Therefore, revising this statute to include 491 Board licensees will likely remedy this problem. Solution: Revise F.S. 916.115 to read "To the extent possible, the appointed experts shall have completed forensic evaluator training approved by the department, and each shall be a psychiatrist, mental health professional licensed under F.S. 490 or F.S. 491, or physician." Issue #3: Requirement that Registered Mental Health Counselor, Marriage and Family Therapy, and Clinical Social Work Interns Working in Private Practice Settings Have a Licensed Mental Health Professional on the Premises When Providing Clinical Services (Even if Services are Provided Via Telehealth) F.S. 491.005(1)(c) indicates that for registered interns, "a licensed mental health professional must be on the premises when clinical services are provided by a registered intern in a private practice setting." Implications and COVID-19 Connection: Even prior to the COVID-19 pandemic, this provision singled out only one practice setting (i.e., private practice) and did not apply to counselors working in agencies, hospitals, government settings, universities, etc., which are the most popular settings for interns to work in. The pandemic has made appropriate access to mental health counseling even more vital. Because of the pandemic, 95% of licensed counselors now provide telehealth and 70% of all therapy sessions nationwide are conducted via telehealth, whereas prior to the pandemic only 35% of licensed counselors provided telehealth (according to data collected by the American Mental Health Counselors Association from a sample of 654 licensed counselors, 222 or 34% of whom were licensed in Florida, in October 2020 (Norton, 2021a). Many private practices have closed their doors and are providing services via telehealth only, often from their own home offices. Registered interns in private practice settings who are providing telehealth services are forced to choose between the ethical prerogative of not abandoning their clients (and their own livelihood) on one hand and adhering to social distancing precautions during a pandemic on the other. Just like interns in agency settings, interns in private practice settings are already required to be under appropriate supervision when practicing, and their supervisors can be access by phone, webcam, email, or means other than in-person contact. This statute was clearly not written with telehealth in mind and is particularly problematic given the unprecedented mental health crisis in Florida related to the COVID-19 pandemic coupled with the shortage of mental health professionals in Florida (HRS, 2018). Solution: Strike the following sentence from the statute: "A licensed mental health professional must be on the premises when clinical services are provided by a registered intern in a private practice setting." Issue #4: Florida’s use of the title “Registered Mental Health Counselor Intern” for Associate Counselors Seeking Independent Licensure Florida is one of only eight states in the nation that refers to associate counselors (i.e., counselors who have already completed university-sponsored practicum and internship, have already earned a graduate degree in counseling, are practicing mental health counseling under the supervision of a qualified supervisor, and are seeking independent licensure status) as “interns” (ACA, 2016) Implications and Connection to COVID-19 Pandemic Use of the title “registered intern” creates confusion among the public, healthcare professionals, third party payers, and legislators (both state and federal) who are accustomed to “internship” as a term that denotes a


professional’s status as a college student rather than a graduate. Because of this, clients are sometimes hesitant to work with “interns” who think are college students, healthcare professionals are sometimes hesitant to refer to registered interns, and some insurance companies do not credential registered interns in Florida for provider panels (thereby further reducing the number of counselors Floridians can access affordably through insurance). Last year, FMHCA’s Legislative Days delegation experienced barriers to passing legislation because some state legislators did not understand that registered interns were not college students. These implications are particularly problematic given the unprecedented mental health crisis in Florida related to the COVID-19 pandemic coupled with the shortage of mental health professionals in Florida (HRS, 2018). Solution: Replace all references to “registered mental health counselor intern(s),” “registered clinical social work intern(s),” and “registered marriage and family therapy intern(s)” in F.S. Chapter 491 with the terms “licensed associate mental health counselor(s)” (i.e., LAMHC), “licensed associate clinical social worker(s)” (i.e., LACSW), and “licensed associate marriage and family therapist(s)” (i.e., LAMFT).

Potential Benefits:

Section 2: Potential Benefits and Drawbacks of Proposed Bill

1. 491 Board professions, including clinical mental health counseling, will be further highlighted as “on par” with the allied profession of clinical psychology (if added to the list of professionals that courts can appoint as mental health experts). LMHCs may find themselves with additional work opportunities in the forensic setting. 2. Legal stakeholders will likely benefit from the added expertise of 491 board licensees in the forensic arena. 3. It may be easier to advocate for counselors to provide evaluations if state statutes recognize the expertise of counselors in the forensic arena. For example, the Division of Vocational Rehabilitation may be more amenable to referring its clients for evaluations with 491 Board licensees vs. psychologists only, and the insurance companies that exclude LMHCs from psychological testing in fee schedules (e.g., New Directions Behavioral Health/Florida Blue) may be more amenable to adding these services to LMHC provider contracts. 4. Due process violations due to shortages of qualified forensic mental health experts will be reduced and/or prevented. 5. Floridians will have greater access to mental healthcare, as it will be easier for counselors licensed in other states that are part of the interstate compact to practice in Florida, insurance companies will more readily contract with associate counselors (currently referred to as registered interns), healthcare professionals will feel more confident referring to “associate counselors” as opposed to “interns,” and clients may feel more comfortable being treated by “associate counselors” as opposed to “interns” and interns working in private practice settings will be able to provide services (including telehealth) in the same manner and with the same supervisory requirements as those working in agency settings. 6. It may be easier to pass legislation removing the requirement for interns in private practice settings to have licensed mental health professionals on the premises when providing clinical services if it is clear to legislators that the professionals in question are not college interns. 7. Replacing “intern” verbiage with “associate counselor” verbiage may make it easier to pass federal legislation (e.g., Medicare) given increased uniformity of titles state-to-state. 8. If Florida is one of the first 10 states to join the counseling compact, Florida will have greater influence in the way the interstate compact will be administratively designed. 82

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8. If Florida is one of the first 10 states to join the counseling compact, Florida will have greater influence in the way the interstate compact will be administratively designed. 9. LMHCs in Florida will find it dramatically easier to practice telehealth when clients are located in other states that join the interstate compact. 10. LMHCs in Florida will find it much easier to relocate and obtain licensure in any state that joins the counseling compact. 11. The 491 Board will experience reductions in resources (i.e., time, personnel, expense) related to facilitating the licensure by endorsement for cases in which counselors who are already part of the counseling compact seek to practice in Florida. 12. The GRC met with the Janet Hartman, the Executive Director of the 491 Board, and although Janet cannot speak on the behalf of the Board nor can endorse any bills, the GRC interpreted the interaction as evidence that the 491 Board would not oppose the actions detailed in this bill. Possible Drawbacks: 1. Members of the public could confuse “licensed associate mental health counselors” with “licensed mental health counselors.” 2. Perhaps there could be an increase in unsavory practices of registered mental health counselor interns in private practice settings if they do not have to have a licensed professional on the premises when providing clinical services. 3. Inclusion of the forensic component could “draw fire” and potential opposition from groups representing psychologists and psychiatrists. 4. Inclusion of all four issues in one bill could potentially increase the probability of opposition to the bill. 5. Increased ability of counselors licensed in other states that join the counseling compact to practice in Florida could reduce business available to LMHCs in Florida, though it would also bring new telehealth business from other states participating in the compact. 6. The 491 Board will likely incur an expense associated with the change in titles related to interns. 7. Registered interns may incur the expense of updating their promotional materials to include their new titles. Section 3: Concerns Related to the Bill The GRC identifies no concerns about the proposed bill other than those identified in the “potential drawbacks” section above. Section 4: Connection to AMHCA Code of Ethics

The AMHCA Code of Ethics affirms the ability of clinical mental health counselors to provide forensic evaluations but also clarifies that they must be competent to perform those evaluations and must adhere to ethical principles when doing so (see section D.4 on pages 10 and 11) (AMHCA, 2020). The AMHCA Code of Ethics affirms the importance of provision of distance counseling (see Section B6 on pages 6 and 7 (AMHCA, 2020). The AMHCA Code of Ethics calls upon counselors to accurately and adequately portray their credentials as part of the informed choice process for counseling (see pg. 4) (AMHCA, 2020). Additionally, the code calls upon counselors to ensure that their training and credentials are adequately presented to the public (see V.A. on page 16 (AMHCA, 2020). Finally, the code calls upon supervisors to ensure that supervisees adequately portray their credentials (see A5 and A6 on pg. 14 (AMHCA, 2020). Florida’s participation in the interstate compact is consistent with AMHCA’s Counselor Licensure interstate Portability Endorsement and Reciprocity Plan (CLIPER) (Miller et al., 2021)


Section 5: Connection to FMHCA’s Mission and Purpose FMHCA’s bylaws list several purposes that appear to fit the rationale for this bill: Promote the profession of mental health counseling Promote legislation that recognizes and advances the profession of mental health counseling 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 Address institutional and social barriers that impede access, equity and success for clients through ongoing advocacy efforts. Section 6: Recommendation of GRC to FMHCA Board of Directors The GRC hereby recommends that FMHCA’s Board of Directors approve a motion conditionally authorizing the GRC and FMHCA’s lobbyist to develop, support, promote, and lobby for the proposed bill pending supportive member survey feedback. References Ahmad, F. B., & Anderson, R. N. (2021). The leading causes of death in the US for 2020. JAMA, 325(18), 1829-1830. https://doi.org/10.1001/jama.2021.5469 American Counseling Association [ACA] (2016). Practice act/title act. https://www.counseling.org/docs/defaultsource/licensure/appendix f.pdf?sfvrsn=2e78562c_2 Cannon, C. E., Ferreira, R., Buttell, F., & First, J. (2021). COVID-19, Intimate partner violence, and communication ecologies. American Behavioral Scientist, 65(7), 992-1013. https://doi.org/10.1177%2F0002764221992826 Castaldelli-Maia, J. M., Segura, L. E., & Martins, S. S. (2021). The concerning increasing trend of alcohol beverage sales in the US during the COVID-19 pandemic. Alcohol. https://doi.org/10.1016/j.alcohol.2021.06.004 Cooper, K., Hards, E., Moltrecht, B., Reynolds, S., Shum, A., McElroy, E., & Loades, M. (2021). Loneliness, social relationships, and mental health in adolescents during the COVID-19 pandemic. Journal of Affective Disorders, 289, 98-104. https://doi.org/10.1016/j.jad.2021.04.016 Ettman, C.K.,, Abdalla, S.M., Cohen, G.H., Sampson, L., Vivier, P.M., & Galea, S.. (2020). Prevalence of depression symptoms in US adults Before and during the COVID-19 pandemic. JAMA Network Open; 3 (9): e2019686. https://doi.org/10.1001/jamanetworkopen.2020.19686 Evans, M. L., Lindauer, M., & Farrell, M. E. (2020). A pandemic within a pandemic—intimate partner violence during Covid-19. New England Journal of Medicine, 383(24), 2302-2304. https://doi.org/10.1056/NEJMp2024046 Ferreira, R. J., Buttell, F., & Cannon, C. (2020). COVID-19: Immediate predictors of individual resilience. Sustainability, 12(16), 6495. https://doi.org/10.3390/su12166495 Florida Board of Nursing (n.d.). Nurse compact FAQs. https://floridasnursing.gov/enhanced-nurse-licensure-compact-faqs/ Hillis, S. D., Unwin, H. J. T., Chen, Y., Cluver, L., Sherr, L., Goldman, P. S., Ratmann, O., Donnelly, C.A., Bhatt, S., Villaveces, A., Butchart, A., Bachman, G., Rawlings, L., Green, P., Nelson, C.A., & Flaxman, S. (2021). Global minimum estimates of children affected by COVID 19-associated orphanhood and deaths of caregivers: a modelling study. The Lancet, 398. 391-402. https://doi.org/10.1016/S0140- 6736(21)01253-8 Horigian, V.E., Schmidt, R.D., & Feaster, D.J. (2021). Loneliness, mental health, and substance use among US young adults during COVID-19. Journal of Psychoactive Drugs, 53(1), 1-9. https://doi.org/10.1080/02791072.2020.1836435 Huckins, J.F., daSilva, A.W., Wang, W., Hedlund, E., Rogers, C., Nepal, S.K., Wu, J., Obuchi, M., Murphy, E.I., Meyer, M.L., Wagner, D.D., Holtzheimer, P.E., & Campbell, A.T. (2020). Mental health and behavior of college students during the early phases of the COVID-19 pandemic: Longitudinal smartphone and ecological momentary assessment study. Journal of Medical Internet Research, 22(6), e20185. https://doi.org/10.2196/20185 Jelinek, L., Moritz, S., Miegel, F., & Voderholzer, U. (2021). Obsessive-compulsive disorder during COVID-19: Turning a problem into an opportunity?. Journal of Anxiety Disorders, 77, 102329. https://dx.doi.org/10.1016%2Fj.janxdis.2020.102329 84

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Kidman, R., Margolis, R., Smith-Greenaway, E., & Verdery, A. M. (2021). Estimates and Projections of COVID-19 and Parental Death in the US. JAMA pediatrics. https://doi.org/10.1001/jamapediatrics.2021.0161 Loades, M.E., Chatburn, E., Higson-Sweeney, N., Reynolds, S., Shafran, R., Brigden, A., Linney, C., McManus, M.N., Borwick, C., & Crawley, E. (2020). Rapid systematic review: The impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19. Journal of the American Academy of Child & Adolescent Psychiatry, 59(11), 12181293. https://doi.org/10.1016/j.jaac.2020.05.009 Marashi, M. Y., Nicholson, E., Ogrodnik, M., Fenesi, B., & Heisz, J. J. (2021). A mental health paradox: Mental health was both a motivator and barrier to physical activity during the COVID-19 pandemic. Plos one, 16(4), e0239244. McGinty E.E., Presskreischer, R., Han, H., & Barry ,CL.(2020). Psychological distress and loneliness reported by US adults in 2018 and April 2020. JAMA, 324(1), 93–94. https://doi.org/10.1001/jama.2020.9740 Miller, J.E., Moss-Baker, A., & Otis, H.G. (2021). Counselor Licensure Interstate Portability Endorsement and Reciprocity Plan. https://www.amhca.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=87e738c6-22b4-a81f7d6c cf82a05751a6&forceDialog=0 National Center for Interstate Compacts [NCIC] (2021). What is the counseling compact? https://counselingcompact.org Norton, A.L. (2021a, Winter). Counseling during a pandemic. The Advocate Magazine, 10-13. http://www.anorton.com/userfiles/688392/file/Counseling During a Pandemic 2021.pdf Norton, A.L. (2021b, Spring). Case study: A comparison of clinical mental health degree programs. The Advocate Magazine. http://www.anorton.com/userfiles/688392/file/Advocate_SPRING2021-SUPP-Comparison%20of%20MH%20Programs.pdf Parrott, D. J., Halmos, M. B., Stappenbeck, C. A., & Moino, K. (2021). Intimate partner aggression during the COVID-19 pandemic: Associations with stress and heavy drinking. Psychology of Violence. http://dx.doi.org/10.1037/vio0000395 Racine, N., McArthur, B. A., Cooke, J. E., Eirich, R., Zhu, J., & Madigan, S. (2021). Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatrics. https://10.1001/jamapediatrics.2021.2482 Reeves, M. (2020, October 12). Coronavirus crisis brings a surge of depression, anxiety to Tampa Bay. https://www.tampabay.com/news/health/2020/10/12/coronavirus-crisis-brings-a-surge-of-depression-anxiety-to-tampabay/ Rogers, A.H., Shepherd, J.M., Garey, L., & Zvolensky, M.J. (2020). Psychological factors associated with substance use initiation during the COVID-19 pandemic. Psychiatry Research, 293. https://doi.org/10.1016/j.psychres.2020.113407 Simone, M., Emery, R. L., Hazzard, V. M., Eisenberg, M. E., Larson, N., & Neumark‐Sztainer, D. (2021). Disordered eating in a population‐ based sample of young adults during the COVID‐19 outbreak. International Journal of Eating Disorders, 54, 11891201. https://doi.org/10.1002/eat.23505 Smit, A. N., Juda, M., Livingstone, A., U, S. R., & Mistlberger, R. E. (2021). Impact of COVID-19 social-distancing on sleep timing and duration during a university semester. Plos one, 16(4), e0250793. https://doi.org/10.1371/journal.pone.0250793 Tsang, S., Avery, A. R., Seto, E. Y., & Duncan, G. E. (2021). Is COVID-19 keeping us up at night? Stress, anxiety, and sleep among adult twins. Frontiers in Neuroscience, 15, 479. https://doi.org/10.3389/fnins.2021.665777 U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis [HHS] (2019). State-level projections of supply and demand for behavioral health occupations: 20162030. https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/state-level-estimates-report2018.pdf Yard, E., Radhakrishnan, L., Ballesteros, M. F., Sheppard, M., Gates, A., Stein, Z., Hartnett, K., Kite-Powell, A., Rodgers, L., Adjemian, J., Ehlman, D.C., Holland, K., Idaikkadar, N., Ivey-Stephenson, A., Martinez, P., Law, R., & Stone, D. M. (2021). Emergency department visits for suspected suicide attempts among persons aged 12–25 years before and during the COVID19 pandemic—United States, January 2019–May 2021. Morbidity and Mortality Weekly Report, 70(24), 888-894. https://www.cdc.gov/mmwr/volumes/70/wr/mm7024e1.htm Zaami, S., Marinelli, E., & Varí, M.R. (2020). New trends of substance abuse during COVID-19 pandemic: An international perspective. Frontiers in Psychiatry,11(700). https://doi.org/10.3389/fpsyt.2020.0070



BYLAWS, 2020 (8-10) of the Florida Mental Health Counselors Association A Florida Not-For Profit Corporation Adopted: July 18, 1998 Revised January 29th, 2004; January 1, 2009; February 10, 2012; January 8, 2014; May 17, 2014; September 10, 2014; June 8, 2015 ARTICLE V: EXECUTIVE DIRECTOR Section 1. Position The Executive Director will be hired by FMHCA as an Independent Contractor reporting to the Board of Directors. The Executive Director is responsible for the organizations’ administrative functions in the pursuit of its mission and financial objectives. Section 2. Duties and responsibilities The duties and responsibilities of the Executive Director are detailed in the Board of Directors manual and in the Executive Director’s job description. ARTICLE VI: BOARD OF DIRECTORS Section 1. Composition Voting members of the Board of Directors of FMHCA will be composed of the President, President-elect, Past President, Secretary, Treasurer, and four (4) At-Large Members. Nonvoting members of the Board will include all members of the Advisory Board and the Parliamentarian. Section 2. Duties and Responsibilities The Board of Directors will be the agency through which the general administrative, policy, and executive functions of the Association are affected. The Board will be responsible for developing and implementing policies in accordance with these Bylaws. The Board of Directors will conduct, manage and control the business of the Association in accordance with these Bylaws. The Board of Directors may, at its discretion, contract with an outside organization for administrative services to be determined. Such contract services will be on the basis of a written description of the services to be provided. No policy decisions may be delegated to a paid employee or any other entity. Employees of and other entities contracting with FMHCA will report to the President. The Board of Directors approves charters submitted by Local Chapters. The Board of Directors approves the formation of Special Interest Groups (SIGs).The Board of Directors identifies issues and establishes priorities in the areas of mental health counseling. Section 3. Meetings The Board of Directors meets at least quarterly. Meetings may be held in person, telephonically or via the Internet. At least one "in person" meeting must be held annually. The President or a majority of the Board of Directors may call additional meetings. Each member or of the Board of Directors has one vote. A majority of the voting members of the Board of Directors constitutes a quorum. All regular meetings of the Board of Directors will be open to members of the Association. The Board may meet in Executive Session (during which all nonvoting participants will be excluded) for 1) the purpose of considering personnel matters relating to hired employees, 2) when considering disciplinary action of a member or 3) for such other purposes as the board may determine by majority vote. Section 4. Expenses


The President, President Elect and Executive Director are reimbursed for travel, lodging, food and registration at the FMHCA Annual Conference. The President, President Elect and Executive Director are reimbursed for travel, lodging, food and registration at the AMHCA Leadership/Annual Conference. Board members are reimbursed for travel expenses to the August Retreat. Receipts are required to receive reimbursement if paid for separate from the master account. (Other Retreat expenses are paid from the master account.) Board members are reimbursed for expenses that have been pre-approved by the President or Executive Director when engaging in activities directly related to their respective board roles. ARTICLE VII: ADVISORY BOARD Section 1. Composition The Advisory Board will be composed of the Chairperson of each Standing committee, the Chair and Co-chair of each Special Committee, the President of each local FMHCA chapter and the Parliamentarian. The chair and co-chairs of all Standing and Special Committees will serve as direct communication/liaison links between their Committee and the Board and they will be members of the Membership Committee. Local Chapter Presidents will serve as direct communication/liaison links between their Chapter membership and the Board. They will also serve as consultants to promote the purpose and work of FMHCA at the local level, and they will be members of the Membership Committee. The Parliamentarian will serve as a member of the Advisory Board. 1) Qualifications: Has been an active member of FMHCA for at least one year, is knowledgeable concerning parliamentary procedure and is available to attend FMHCA Board meetings. The Parliamentarian may also serve in any Standing or Advisory Board position. 2) Term: Appointed by the President subject to approval by the Board. Serves at the pleasure of the President by whom appointed. May be re-appointed by succeeding Presidents. 3) Duties: Serves as an advisor to the President and the Board of Directors regarding parliamentary procedure and is responsible for ensuring that meetings follow the process outlined by Robert’s Rules of Order, 10th edition, as published by the Robert’s Rules Association, or by subsequent editions published by that association. 4) The position of Parliamentarian is a nonvoting position on the Board of Directors. Section 2. Duties and responsibilities It is the duty and responsibility of Advisory Board members to proactively provide information and advice to the President and Board of Directors. Advisory board members should take advantage of any communication means available to convey their advice to the President and Board. Section 3. Meetings The Advisory Board will meet together with the Board of Directors when invited by the President. They will actively participate in discussing matters under consideration but they will not have a vote nor will their presence count toward the quorum required to conduct Board business. ARTICLE VIII: STANDING and SPECIAL COMMITTEES Section 1. Standing Committees Standing Committees are established to facilitate the organizational structure and well-being of the Association. Standing Committee members will serve for a period of one (1) year following their appointment or until the beginning of the next fiscal year, whichever comes first. Each committee will report to the Board of Directors, in 88

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writing, the salient activities, financial information and progress of the committee. All Standing Committee Chairpersons will be non-voting members of the Board of Directors as well as members of the Advisory Board. The following will be Standing Committees of FMHCA: 1) The Nominations and Elections Committee will be responsible for carrying out nominations and elections procedures. The committee members will be appointed by the President and consist of 1) the Past President who serves automatically as the Chairperson of the Nominations and Elections Committee; 2) one other member of the Board of Directors; and 3) one clinical member of FMHCA in good standing who is not a member of the Board. 2) The Finance Committee will be appointed by the President prior to the beginning of the fiscal year, the Chair of which will be the Treasurer. The Committee will prepare a budget for the upcoming fiscal year and present it to Board of Directors for approval at the first meeting of the fiscal year. The finance Committee may submit revisions to the approved budget as it may become necessary or expedient. 3) The Ethics Committee will receive and review requests from Association members relating to the ethical conduct of Association members or officers, ethics consults and any other issue of an ethical nature that may come before the Association. It will make any recommendation for action to the Board of Directors. The policy and procedure for the reception and review of requests from Association members relating to the ethical conduct of Association members or officers, ethics consults and any other issue of an ethical nature is set forth in the FMHCA Ethics policy. Any and all grievance processes are set forth in the FMHCA Ethics policy. 4) The Bylaws Committee will receive and review proposals for amending the Bylaws and resolutions submitted by members and various components of the Association. The committee will make recommendations to the Board for revising the Bylaws as deemed appropriate. The committee will cause the Bylaws to be published and distributed to the membership every four years. Section 2. Special Committees The Bylaws establish Special Committees in these Bylaws in order to facilitate the professional development and best interest of Association members as well as other goals and purposes of the Association in the mental health counseling profession. Each committee will report to the Board of Directors, in writing, the salient activities, financial information and progress of the committee. All Special Committee Chairpersons will be members of the Advisory Board. The following will be Special Committees of FMHCA: 1) The Governmental Relations Committee will be responsible for advocating and implementing the FMHCA legislative platform. Issues impacting the profession of mental health counseling at the state level will be addressed by FMHCA, including issues involving legislation, agency regulation and encroachment by other entities on the practice of mental health counseling. FMHCA will be represented regularly at 491 Board meetings. The committee will inform and enlist support from members as to pertinent legislative issues and positions beneficial to the membership. Advocacy for legislation that recognizes and advances the profession of mental health counseling will be a priority. The committee will identify and support laws, programs and practices affecting the practice of mental health counseling. The committee, at the request of the Board of Directors, will provide liaison on the state level with other professional organizations to promote the advancement of the mental health profession.

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