InSession Magazine- July 2022

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JULY 2022




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Claim Y ur Space a letter from the FMHCA office

Are you claiming your space? When we ask this we aren't asking how much space you are claiming physically. Moreover, we are asking: are you living up to your potential, dreams, ambitions, and values? We are now six months into 2022, a perfect check-point to analyze our new years resolutions and how far we've come to reaching them (if they weren't already surpassed!). It is also time to seek out a community of support, live unapologetically, and reflect on your daily self-talk/ languagelet us dive into what that really means. Seeking out a community of support Humans are social creatures, meaning, we must have interpersonal contact to survive. Whether this be an art club, book club, or even FMHCA- ensure that you are locked into a community that can support, encourage, and influence you.

you are right now in order to make the first step forward. Living unapologetically means truly accepting who you are-flaws and all- in order to live your most authentic you. Reflect on your daily self-talk/ language Research shows that positive self-talk can improve stress management, wellbeing, and self-esteem. Self-talk and language are both things that you do naturally throughout your waking hours and they are key to the trajectory of your life. A great example and starting point on changing your self-talk can be found below. "How ridiculous! I can't teach myself how to think more positively." vs "Learning to think more positively can help me in many ways so I am going to try my best."

Live unapologetically

Notice your emotions shift while just reading those- imagine them placed into action!

To claim your space you must stop with the "I will... when.." talk. You do not need to be smarter, prettier, skinnier, or heavier than

We hope that these tips help you claim your space in the remaining 6 months of 2022- we are rooting for you!

Join or Renew your FMHCA membership today! Gain access to member only discounts on NBCC approved CE events, Abenity retailers, and The FMHCA Store Gain access to member exclusive networking events such as "Alliance" Help shape legislature through our Government Relations Committee Get on FMHCA's public directory for individuals seeking services across Florida & more! | InSession- July 2022 | 3


Page 3 Claim Your Space

Page 7 And Along Came Grief Page 11 Counselor Privilege: Awareness and Reduction Page 14 FMHCA's Favorites Page 17 Passionate Kisses Page 19 A Path to Mindfulness: A Lesson from the Ocean Page 22 Ask The Expert with The Health Law Firm Page 25 Blending Personal and Professional Experience to Heal Eating Disorders Page 28 Grow Your Own Way- From NAVY to LMHC with Maria Giuliana Page 33 Ethics: New Technology & Confidentiality Page 34 Ask AMHCA- FAQ's from AMHCA's Code of Ethics Page 37 Trauma in the Black Community: The Pain of Misconnection 4| InSession- July 2022 |

MAGAZINE Page 40 Therapist Burnout

Page 43 We Should Stop Talking About Triggers Page 47 Addressing Cyberbullying, Suicidality, Suicide, and Psychological Distress in Youth Populations: Clinical Implications for Mental Health Counselors Page 53 2022 Elections Now In Full Swing- Quarterly Legislative Update with FMHCA Lobbyist, Corinne Mixon InSession Magazine is created and published quarterly by The Florida Mental Health Counselors Association (FMHCA).


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

Laura Giraldo, Executive Administrator & CE Coordinator

FMHCA is the only organization in the state of Florida that works exclusively towards meeting the needs of Licensed Mental Health Counselors in each season of their profession through intentional and strength-based advocacy, networking, accessible professional development, and legislative efforts.

Madison Borgel, Social Media Coordinator

Let your voice be heard by becoming a FMHCA Member today! Click here to view FMHCA's current Bylaws.

CONTRIBUTE: If you would like to write for InSession magazine or purchase Ad space in the next publication, please email: Naomi Rodriguez at


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

Diana Huambachano, Executive Director Naomi Rodriguez, Marketing & Outreach Coordinator Samantha Samarelli, Administrative Assistant

DISCLAIMER: Information in InSession Magazine does not represent an official FMHCA policy or position and the acceptance of advertising does not constitute endorsement or approval by FMHCA of any advertised service or product. InSession is crafted based on article submissions received. Articles are categorized between Professional Experience Articles & Professional Resource Articles. Professional Experience Articles are writer's first-person pieces about a topic related to their experience as a mental health professional, or an opinion about a trend in the mental health counseling field. Professional Resource Articles are indepth pieces intended to provide insights for the author's clinical colleagues on how to be more effective with a particular type of client or a client with a particular disorder, or tips for running their practice more efficiently. Each article is labeled with their article type. | InSession- July 2022 | 5

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And Along Came Grief Professional Experience Article

A lot of running happens in therapy. Running in circles, from the past, away from emotional turmoil. Deflecting away from the hard stuff, the pain, and the grief that we all encounter at some point in our journeys. Somewhere along the way, some emotions begin to embody the big, bad monster that lurked under our beds as children. Something we more subconsciously than not pull the metaphorical sheets over our heads in feeble attempts to cower from. Perhaps we are so fond of running because we hate the ending of most everything that is “good”. The conclusion of a relationship, the closing of a life chapter, the death of a loved one. Unless the ending is on our terms based on our clocks, we want nothing to do with it. Even the ending of a TV series or the conclusion of a good book can send pings of longing and hints of sadness dancing delicately down our spines. A witty commercial once termed this experience falling into a “show-hole” and I still giggle at the accuracy. I wish I could convince others (and myself) that running from “the end” is only going to leave us exhausted, lost, and with no sense of satisfaction.

Grief is apart of the human condition. I feel like someone left this out of the “How to be Human” handbook. It’s the balance that is necessary for a full life. Just as joy and the full extent of enjoyable emotion is inherently ours to experience, grief is just as required. We forget to acknowledge the beauty of grief and the purpose of this heartbreaking sensation. Perhaps this is due to the breath being knocked from our lungs and the punch in the gut that follows. Can anyone guess why grief is a side effect of humanness? Anyone? Grief exists because love ensues. Personally, I think the most courageous act a person can do is to love deeply following the experience of grief. We begin our lives with innocence enveloping love. Innocence serving as a protective barrier away from the existence of conclusions. Love only means connection, security, snuggles, and togetherness. As we grow, the harshness of reality chips away at this barrier, some quicker than others. However, there is typically enough innocence left over for our “first loves”. I believe we can all | InSession- July 2022 | 7

envision a memory of either experiencing or witnessing a “first break-up”. The dramatics of it may make you cringe, so sorry if it did. I’d like to fill in the blank in your “How to be Human” handbook. Grief will come, and the wave of its entirety will knock you senseless. For a moment, or perhaps a block of time, you may not know what is up or down. The sensation of emptiness and longing will leave you gasping for air. You may clutch at your sides in a futile attempt to hold your broken heart together. Grief will come because love transpires. This the beauty in the chaos. This is the rainbow after the storm. What a privilege it is to love deeply and to be a part of a story that exceeds our wildest dreams. I wish we could have a say over the conclusions that we care most about, but these conclusions are simply not meant for us. The extent of our power as humans only reaches so far.

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Let yourself feel it. Let yourself cry. Allow yourself to crumble amongst those whom you cherish. Validate your gamut of emotions that will wax and wane, for these are yours and they are meaningful. “For what is grief but love persevering.” Written By: Katherine Scott, M.Ed/ Ed.S, LMFT Katherine Scott is the assistant clinical director and lead Licensed Marriage and Family Therapist at a practice known as Puzzle Peace Counseling located in NE Florida. While she works with people in most walks of life, her niche is working with children and young adults on the Autism Spectrum and their families, as well as broad Neurodiversity. She utilizes an experiential approach with clients in the pursuit of healing. | InSession- July 2022 | 9

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Counselor Privilege: Awareness and Reduction Professional Experience Article

Full disclosure: I am a white, middle-class male who grew up in a middle-class suburbia family with divorced parents and the youngest sibling of 5. I imagine all kinds of conclusions can be drawn from that information and would most likely be considered counselor privilege. And this is precisely the reason this topic has interested me for so long. But it hadn’t touched me so deeply until this year's FMHCA conference when a presenter talked about diversity in counseling services. I was struck (again) by the lack of diversity in therapy and therapists and how that could affect counselor privilege. Definitions could help to level the understanding field of these two words before moving forward: Counselor- a reoccurring theme that came from research about a definition included listening and giving advice or advices. I was struck by the listening part as it relates to counselor privilege and how that might reduce it if I am to listen. Instead of interrupt, evaluate, or even advise. Privilege- one explanation that struck me was how it was described as the opposite of privilege, “disadvantage, disbenefit, handicap (a word used less these days), and drawback”. I wondered if these words could describe sometimes how the client might feel if I am imposing counselor privilege, unknowingly of course. For our purposes here to combine with the definition of counselor privilege is, “a special right or advantage granted only to a particular person or group” (Merriam Dict) So, combining these definitions into a working model going forward in my own words it could be; a person who listens/advises others from a place of privilege or advantage that appears to exclude others. While there are many understood, and not so understood, types of privilege I want to narrow that down to some of the areas that apply to counseling; race, color, gender, culture, identity, education, and spirituality. Many others include visible and invisible privilege but for the purpose of our time here I am interested in awareness and reduction. What do I mean by that? Awareness is how I respond to my surroundings, both physically and humanly. This is a skill that constantly needs attention and | InSession- July 2022 | 11

fine-tuning and unfortunately with social media and phones this has become a lost art but so vital to healthy interactions. As therapists, we typically have mastered this trait with client gestures, mannerisms, and how the client is responding to their surroundings and sometimes pointing out when this may need to change. This quote from an article speaks to some of my intent, “As counselor educators and students in counseling training programs, we have observed that conversations about privilege and oppression are common in training but that they generally occur in two ways. First, the conversations typically use a lens that looks outward into societal structures while neglecting to use a lens that looks inward and focuses on how our own educational and professional structures create disparities. Second, such conversations most frequently center on advantages given to a person on the basis of sex, race, gender identity, ethnicity, sexual orientation, religion or age, while ignoring socio-economic class”. (Counseling Today, Feb 2021). This inward scope is how I want to approach privilege in the counseling field so that we can be more aware of, and reduce, this in our field.

Also a warning, that is possible that I may step on emotional toes related to privilege due to a blind spot or disagreement from your own lens of life. I too carry these and ask that we be less dismissive of perspective, and maybe even facts, about privilege and how those influences my practice along with present/future clients. They deserve the best version of us as a therapist and as a human. Future topics related to this include: Education privilege Social privilege Socioeconomic privilege or economic capital Gender privilege Race privilege Immigration status Religious privilege An interesting fact about educational privilege that I will discuss in the next article is the nine students that crossed the stage of Harvard in 1642 not by grades buy by rank their families held in society. More about that next time.

Written By: Scott Jones, LMHC Scott has a private practice in Orlando since 2015 and has recently taught the Qualified Supervisor course at the FMHCA 2022 conference where some of this article was adapted from. He relies on interaction and uses questions along with group scenarios to guide and train and looks for input from the class. He recently is certified as a Florida Supreme Court Mediator/Arbitrator and is currently supervising 10 interns and has a 100% passing rate of the LMHC exam due to training during the internship.


Join us for webinars all year long with knowledgeable speakers on topics including: Addiction, Play Therapy, Therapeutic Journaling, Decision Fatigue, & more! Don't miss out! Register Now

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FMHCA's Favorites "Why are you so sad?" Children's Book

Therapy Thoughts with Tiffany Roe Tiffany is a Licensed Clinical Mental Health Counselor, psychology teacher, host of Therapy Thoughts Podcast, speaker, Therapy is Cool merch creator, and owner of Mindful Counseling in Utah.

When a parent has depression, children often feel sad and confused themselves. This interactive children's book can help by: Explaining depression and its treatment in kid terms Reassuring children that their parents can get better Exploring the many feelings children usually have Helping children understand and express their feelings Providing practical tips for coping with a parent's depression Showing children how they can feel better too Why Are You So Sad? contains a comprehensive and authoritative note to parents by therapists from the disciplines of clinical social work and clinical psychology.

Therapy Thoughts Podcast is meant to share quick and accessible therapy lessons. The show explores tools and tips to provide mental health education. Check it out.

Tea Subscription Box Are you a tea lover? Consider this Sips by subscription box! Sips by is the #1 rated tea club. Each month they will deliver 4 personalized teas chosen based on your unique preferences. Get your box

Weekly Self-Care Checklist The Self Care checklist serves as a daily reminder to take time for yourself. Caring for your physical and mental helps build resilience and manage stress. This 50-page notepad has over 15 self-care activities ranging from Basic, Physical, and Mental/ Emotional well being. Get Yours here.

Mediterranean Diet The Mediterranean diet is a healthyeating plan. It's plant based and incorporates the traditional flavors and cooking methods of the region. Interest in the diet began in the 1950s when it was noted that heart disease was not as common in Mediterranean countries as it was in the U.S. Since then, numerous studies have confirmed that the Mediterranean diet helps prevent heart disease and stroke.

Gua Sha

Therapy Dough

Learn Facial Gua Sha from a Chinese Medical skincare professional

Today’s high-impact lifestyles can take a toll on our precious systems especially when trying to figure out how to relieve stress, naturally. Replenish, rejuvenate, and get back to center with Pinch Me Therapy Dough; a professionally developed, soft, pliable dough infused with calming aromatherapy.

You’ve probably seen people rubbing gua sha stones across their faces on social media and wondered what was going on. Gua sha has been proven to help relieve tension in the face, reduce puffiness and inflammation, and it can even help reduce sinus pressure.

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The Anti-Anxiety Notebook Reduce your anxiety, manage stress, and become more aware of your thought patterns through this easy-to-use, guided notebook created by therapists. This notebook utilizes Cognitive Behavioral Therapy (SBT), a rigorouslytested & widely-used treatment modality for anxiety, to help you develop the skills to identify, challenge, and change unhelpful thought patterns for the better.

The Couples Game It is an interactive game of fun questions meant to make you laugh with your partner. It is not a 'get to know you' game or overly mushy gushy... just fun! Whether you're taking your relationship to the next level, just moved in together, or been married for a decade, we can't wait for you to play.

Emotional Support Animal Cards

Fidget Strips Discreet Anti Stress Textured and Satin Soft Strips for Anxiety. Stick them on anything!

Plastic Free Pens

Each card of positive affirmations offers you a daily moment of joy to escape from the problems so many of us face in this hectic, modern world.

These pens are a must have for a successful transition to a low-waste lifestyle. The barrel and lid are made of kraft paper while the inkchamber is made of stainless steel. Order a pack of 50

Mango Salsa Ingredients: 1/4 cup Cilantro 1/4 Jalapeno 1/2 tbsp Lemon 2 cups Mango

3/4 cup Red onion 1 cup Tomato 1 tsp Salt

Combine & serve with your favorite chips!

Weighted Eye Pillow The weighted blanket for your eyes! Four equally weighted pods Hollow ends for head-resting comfort Strap and Velcro free Pull through slit for 360* head-hugging comfort One side jersey cotton, other side microfiber fleece Pods filled with BPA-free polyethylene (PE) beads Scent-free / machine washable Order Yours

(Reef Safe) Sunscreen Our skin works to protect us from harmful ultraviolet radiation, which is why we should use sunscreen to protect us from damaging UV rays. Even on cloudy days, our skin is susceptible to the sun's rays which can lead to skin cancer, discoloration, and wrinkles over time. To keep ocean life happy, the key is to find an SPF that uses physical UVA and UVB filters (as opposed to the chemical ones that have been connected to coral reef deterioration). | InSession- July 2022 | 15

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Passionate Kisses Professional Experience Article

Getting the Love You Want: The Sweetness of Long Lasting Love “Passionate Kisses” is a Grammy-winning song penned by the Country performer Lucinda Williams and made famous by the 1993 single version by Mary Chapin Carpenter. In it she cries “Shouldn’t I have this? Shouldn’t I have all of this…. and passionate kisses?” She shouts: “Is it too much to ask? I want a comfortable bed that won’t hurt my back, food to fill me up and warm clothes and all that stuff.” “Shouldn’t I have all of this, and passionate kisses from you?” One of my favorites for many years, her words are tucked gently into my mind and surface often in my counseling with couples seeking better, stronger, more resilient marriages. It is especially rewarding with marriages that have stood the test of many years, and life’s adversities, maturing into delicious, sustainable partnerships giving back ever increasing gifts. Raising children, building estates, discovering what matters most…it is in mature relationship that we know ourselves most fully and deeply. We discover what inspires us, but we also learn what may scare and defeat us. How We Lose It It’s deceptively easy to leave out the “passionate kisses” over time. We make routine at home and work. We forget to touch and linger. We assume our partner will “be there” for us when we turn toward them…sometimes for any number of reasons, some subconscious, we fear kissing with force and feeling and, instead, get by on “cheek pecks” and “air hugs”. Evenings spent checking social media. Too much time at the gym. Rarely alone with our beloved. This isn’t enough for healthy sexuality to flourish. The real thing is called “making love” for a reason. In our intimate, wet, hot, passionate sexual contact, we create an extraordinary experience that has staying power and a quality that can nourish our lives and give them meaning. It is an experience of magic and delight when we get it right, especially when it’s with someone who’s known us for a long time. How do we keep “passionate kisses” in our marriages? How do we keep “finding” our partner and friend and lover? How We Get it Back Internationally renowned couples therapist Hedi Schleifer refers to the “space” between couples as “sacred” and teaches that this “sacred space” requires maintenance, not unlike a garden. She warns that, if not “maintained”, the space will “self-pollute”. Vigilance is essential. Frequent tender dialogue critical. Without passionate, intimate physical contact, without our willingness to

take risks and be vulnerable by revealing thoughts and feelings to our partners…the space will falter and become stale and produce stress. Hedy defines “intimacy” as “into-me-I-willallow-you-to-see”. I ask couples seeking help if they’ve arranged their lives to promote the intimacy they say they seek. So many of life’s central concerns, if poorly managed can deaden us to our partner’s needs. Excess work, excess focus on children at the expense of “mommy and daddy time”, failure to take good care of ourselves physically, mentally and emotionally, substance abuse and dependency. Dr. David Schnarch, author of the excellent book “Passionate Marriage” cautions that sometimes below our awareness, undercurrents of hostility and sadness may run through our marriages and keep us fearful, angry and distant. We grow afraid to try repairing our partnership. Unwittingly, we treat each other carelessly. Struggles over money and control can flatten desire and build resentment that undermine authentic, passionate connection. (And create fertile ground for extra-marital affairs.) Mature relationships require constant tending. Slowing down and spending quiet time is essential. Listening carefully and lovingly. Sometimes brief periods of marriage therapy can create healthy patterns that last a lifetime. The myth of “automatic erotic arousal” is an adolescent fantasy. If lucky, and mindful, we know more and want more as adults, and it takes effort to get it. Mary Chapin Carpenter asks: “Do I want too much? Am I going overboard to want that touch? I shout it out to the night: Give me what I deserve, ’cause it’s my right!”

Written By: John Davis, LMHC John is a marriage, family & relationship therapist with skill and credentials in addiction and recovery. He is renowned for his couples counseling work, getting successful outcomes in most difficult families. He is currently President of Mental Health Counselor’s Association Palm Beach and a member of FMHCA. He maintains a private practice in Delray Beach. Clients come for help with: couples, family and relationship difficulties, mood disturbances, including anxiety and panic, depression and grief, chronic impulse control issues. John is skilled in trauma resolution including PTSD, questions of spirituality and life meaning. John has extensive experience with ADD/ADHD, narcissistic and other personality problems. Reach him here. | InSession- July 2022 | 17

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A Path to Mindfulness: A Lesson from the Ocean Professional Experience Article

My recognition of the value of present moment awareness began in the Ocean. Surfing became my gateway experience to embracing mindfulness. The lessons I continue to learn from surfing and mindfulness help to orient me as a person and a counselor. I draw from my experience to inspire others to find their unique path to living a mindful life. I learned to surf as a college student, during a period of personal struggle. At the time, I was using excessive exercise as a way to manage my feelings. My Dad gave me something positive to focus my time and energy on when he taught me how to surf. I soon learned that moment-to-moment awareness is essential to skillfully and safely navigate the waves. Being present in the Ocean helped me to fully inhabit my body in a nonjudgmental way. Gradually, my relationship with my body started to heal as I rediscovered the joy in movement. I came to appreciate my body as an instrument, not an ornament. Surfing helped me to taste the joy of fully dwelling in the present moment. In graduate school, I learned that moment-to-moment awareness of one’s experience without judgment has a name; Mindfulness. I wanted to learn how to create this state of being outside of the Ocean, so I began a period of independent study and practice. Surfers train themselves to respond to the everchanging nature of the Ocean. In a similar way, mindfulness practitioners learn to grow the quality of equanimity: the ability to let one’s experience be what it is without struggling against it. Being held under by a wave can be a frightening experience and fighting to surface is instinctual. After multiple wipe outs, I learned that relaxing into the experience is a better way. Consistently practicing present moment awareness with my uncomfortable emotions helped me to embrace them like waves, allowing them to crest and fall. Bringing awareness to my inner environment helped me improve my relationship with my thoughts and emotions. Training myself to tune into

the present allowed me to notice conditions for happiness in the here and now. Training is one of the keys to growing any skill. I found this was just as true when it came to mindfulness as it was with surfing. To progress as a surfer, I committed to paddling out, even on days when the conditions were rough and unfavorable. To become more mindful, I consistently trained my attention through developing a regular meditation practice. As challenges arose, I realized that I could only progress so far on my own. My mindset could get in the way of enjoying and regularly engaging in surfing and mindfulness. Fear and doubt could keep me from going for bigger waves or surfing near others. I allowed the busyness of life and distractions to disrupt my meditation practice. The mental habits of worry and overthinking often pulled my attention away from the present. The discouragement I felt over these obstacles led to selfcriticism. I was relieved to discover how normal my challenges were when I connected with other people. Seeing myself reflected in them allowed me to give myself permission to be human and move forward despite my doubts. Like surfing, meditation is often thought of as a solo pursuit. In my experience, finding a supportive community is the most important external factor for growth. Being part of surfing and mindfulness communities helped me step outside of the ego and expand my awareness to include others. Happiness is multiplied when it is shared. The “Party Wave” is a perfect illustration of this, when surfers agree to share a wave versus keeping it to themselves. Seeing the joy I feel in riding a wave mirrored on the faces of my friends is the ultimate present moment experience. Generating the energy of mindfulness in a group helps me feel connected to something bigger than myself. Witnessing how mindfulness meditation helps people generate stillness and happiness inspires me to maintain my | InSession- July 2022 | 19

own practice. The smallest community is the community of two. When we teach our clients about mindfulness in our therapy office, we are creating an intimate and safe community environment. Teaching others how to be mindful begins with finding our unique path to mindfulness and following it, so we can embody the practice. Consider what inspires you to live a life of present moment awareness. What is your gateway experience to mindfulness, something that makes you feel fully alive in the present moment?

Written By: Erinn F. Beck, MS, LMHC Erinn F. Beck, M.S., LMHC is a mindfulness -oriented therapist in West Palm Beach, specializing in working with adolescents. She is part of the group practice, Restoring Hope of the Palm Beaches. Erinn earned her 200-hour Mindfulness Teacher Training certificate with The Way Mindfulness Education. She is passionate about bringing mindfulness training to her community. She especially enjoys helping young people learn how to incorporate mindfulness into their lives.


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Ask the Expert FMHCA Member Questions answered by President and Managing Partner of The Health Law Firm, George F. Indest, J.D., M.P.A., LL.M.


What role should counselors play regarding the recent issuance of "guidelines" for treatment of transgender clients from the Florida Department of Health that go against best practices recommended by organizations such as WPATH There are three important points to remember in approaching these issues. First, if the client or patient is an adult, the adult's and counselor's communications and treatment are covered by the Florida Constitution's article guaranteeing privacy. Unlike the U.S. Constitution, the Florida Constitution does have a specific provision granting a right of privacy to all Florida citizens. The counselor's advice to the client will be covered by this right to privacy. However, the right belongs primarily to the client, not the counselor. Second, if the "guidelines" are not mandatory, then there should be no consequences for failure to follow them. If there are conflicting "guidelines" or schools of thought on the subject, then the counselor is free to follow those that represent the standard of care or which the counselor believes are the more appropriate ones under the circumstances. Third, counselors must realize that state and national politics are motivating these actions to have competing "guidelines," not scientific ones, and must decide what, if any, role they are going to play or encourage their professional associations to play. All counseling practices and treatments should be grounded in research and accepted practice.


As a corollary, what are my legal and ethical obligations when it comes to treating transgender youth below age 18, considering the Florida DOH guidelines regarding treatment of gender dysphoria in children and adolescents? The counselor should not be treating any youth (below the age of 18 years) without the full and informed consent of the client's parents or guardian. This should be in writing and signed. That informed consent should, to be on the safe side, provide the information and "guidelines" from the Florida Department of Health, as well as those form differing national organizations such as WPATH, the AMA, the American Academy of Pediatrics and the U.S. Department of Health and Human Services. The fact that such information and guidelines were provided should be documented in the informed consent form. Counselors are not required to take on every client. Counselors must be cognizant of client’s culture, values, and beliefs. If the services desired by the client are outside of the counselor's scope of experience or the counselor has a conflict in providing the services, the counselor should decline to take on the client and refer them to another qualified counselor.


What are the limitations of licensed clinicians in schools? (can licensed clinicians serve as other roles in school settings without parental consent?) First, the licensed clinician must be aware of their scope of practice as established by law. This is set forth in Sections 491.003 or 490.003(5), Florida Statutes. Second, the licensed clinician must function within their job description. Licensed clinicians should only be providing services to students in compliance with an informed consent form that is signed by the parent or guardian. This document should outline any services or treatment that will be performed by the counselor.


May licensed clinicians de-escalate non-crisis/non-suicidal behaviors/ thoughts and feelings in school settings without parental consent? To the extent that any other school employee is allowed to do so, the counselor should not be prohibited from doing the same. For example, the counselor should not be prohibited from attempting to resolve an argument between two students in a hallway, just as a teacher, coach, or administrator could. It bears emphasizing that licensed clinicians must always be aware of professional boundaries and take measures to make sure they do not cross them. With young students, this is especially so.

Mr. Indest is board certified by The Florida Bar in the legal specialty of health law. He is the President and Managing Partner of The Health Law Firm, based in Orlando, Florida. The information provided in this article is for educational and informational purposes only and does not constitute the provision of legal advice. 22 | InSession- July 2022 |

The mission of the Florida Mental Health Counselors Association (FMHCA) is to advance the profession of clinical mental health counseling through intentional and strength-based advocacy, networking, professional development, legislative efforts, public education, and the promotion of positive mental health for our communities. CLICK HERE to view FMHCA's Official Response to the Florida Department of Health (DOH) issued press release regarding Social Gender Transition for Minors. We consider this response to be an example of strengthbased advocacy (i.e., advocating both for the welfare of our clients and for the ability of counselors to conduct themselves in accordance with best practices). This statement was drafted by FMHCA's Government Relations Committee in Collaboration with FMHCA's Ethics Committee and then reviewed and approved by FMHCA's Board of Directors on June 14th 2022. FMHCA members offered an 82% approval rating for adopting this statement. | InSession- July 2022 | 23

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Blending Personal and Professional Experience to Heal Eating Disorders Professional Experience Article

There was a time, in the first half of my life, that I didn’t recognize I had an eating disorder. I knew I craved food beyond its ability to nourish me and that it had a psychic hold on me that seemed unbreakable. The only solace I had as a child and adolescent was that my father also seemed to have a similar affinity for food. My mother, a normal eater, was the odd person out in our small family. She berated my father for overeating and me for sneaking food that was hands off, for company only. In my teenage years I binged and dieted, dieted and binged. In my twenties, I spent about 18 months perfecting bulimia. Then British psychotherapist, Susie Orbach’s book, Fat Is A Feminist Issue, transformed my life with its wisdom, teaching me that I could eat according to appetite and stop worrying about my weight. From there, I read every book I could find (not many back in the early 1980s) on what was eventually called intuitive eating and I was finally on the road to recovery. Half a lifetime later at 75, I enjoy being a “normal” eater at a comfortable weight without dieting. I entered social work school knowing I wanted to treat people

with eating disorders, to teach them what I’d learned and maybe save them from making some of the mistakes I’d made. Of course, as I now know, that was never a possibility because missteps are part of the zig-zag road of recovery and every individual’s journey is unique. What I can offer clients is a blend of what I personally learned the hard way and more than thirty years of clinical observations about what is needed to recover from an eating disorder. I share these insights with clients and colleagues through my books and blogs and let them know at the get-go the pre-requisites for getting them across the finish line. Here’s what I tell them: Persistence Recovery requires a passion to heal oneself and a deep certainty that you won’t stop trying until you are healed. I knew in my heart that failure wasn’t an option and that if other people could become “normal” eaters, I could too. I had no ambivalence about that possibility as so many clients do. I definitely had unconscious reasons for not wanting to stop bingeing—because then I’d have to deal | InSession- July 2022 | 25

with uncomfortable feelings—but I felt undeterrable in reaching my eating goals. Patience Although patience might seem the antithesis of persistence, it is actually its sister trait: you know you’re going to get where you want to go, but that it’s going to take a while and that’s perfectly alright. Having patience means you understand there are no quick fixes and you’re not going to avoid any of the pitfalls that others (like me) have encountered. You fall and pick yourself up; you head off in the wrong direction and circle back and start again— and again and again—and you’re all the wiser for it. Curiosity It’s crucial to wonder why you do what you do, especially if it’s hurting you. Curiosity involves no judgment. It’s mere observation and reflection which hopefully leads to insight: Oh, I ate only salad for dinner because my friends did, Now I understand that I stuffed myself at the party because I starved myself all day, or I finished off the cookies because I didn’t want to feel how sad I was. Ah-ha moments are what drive recovery forward and you can’t have them without curiosity. Self-compassion Dysregulated eaters are notoriously hard on themselves.

26 | InSession- July 2022 |

They’re judgy and focus more on their mistakes and failures than their progress and successes. Selfcompassion means making a sharp one-eighty and looking for and putting attention on what you did well. It doesn’t mean you ignore or don’t hold yourself accountable for your missteps. You simply accept them with grace as part of the learning process and shift your gaze towards small steps you made in the right direction. These are, of course, only the basics for recovery, but without them, our clients will not succeed. It also helps for therapists to practice persistence, patience, curiosity and self-compassion, both to model these traits for success and to take care of themselves as they accompany their eating disordered clients on their long road to recovery. Written By: Karen R. Koenig, LCSW Karen 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. Practicing out of Sarasota, Florida, she can be found online here. | InSession- July 2022 | 27

Grow Your

from NAVY

MARIA G First Generation Sicilian American I was born and raised in Trenton, NJ to two Sicilian immigrants whose story in the U.S. began when they arrived at Elis Island NY in the hopes for a better life for the family they planned to have. It was a humble household, my father a WW2 Italian Army Veteran and a barber by trade and my mother a tailor, our measure of wealth came down to my parent’s ability to keep a roof over our heads, food on the table and clothes on our backs. They sent me and my two older siblings to a private Catholic School from K-12, making that monetary sacrifice to ensure we had a good education. We were raised Catholic and received all the milestone sacraments. I was the youngest of the three and fit the perfect title of the Sesame Street song, One of These Things Is Not Like the Others. I began to come to terms with my sexual orientation in high school and being in a traditional Sicilian catholic family, it wasn’t something I could talk about openly with anyone. Throughout my childhood, my career aspirations leaned towards very non-traditional career-fields. I watched a lot of police shows, played with the neighborhood boys, and annoyingly followed my older brother around, always wanting to be his little helper. If I was cajoled to play Barbies with my sister and her friends, that only meant that a very masculinized Ken and GI Joe were coming to the party in full military regalia. When I was in the 2nd Grade, we were tasked with drawing a picture of what we wanted to be when we grew up for show and tell. I drew a picture of a police officer and proudly showed my mom the finished product. Her reaction was “Why don’t you draw something nicer like a doctor?!” With my head bowed low, I returned to my desk and redrew the picture. I don’t even remember presenting it to the class because I was so crushed that I couldn’t share my picture of a police officer. 28 | InSession- July 2022 |

In the early 80’s I was captivated when I watched the movies, Private Benjamin starring Goldy Hawn and She’s In The Army Now with Jamie Lee Curtis. I would run into the kitchen with excitement after getting all pumped up with the possibility of me joining the service, declaring, “I’m going to join the Army!,” only to be met with a firm “Get out of here, forget about it!” from my mom. By the time I hit the 12th grade, I had to decide what my future held. The unspoken expectation in my family was that you don’t leave the home until you’re married. That seemed like a grim prospect for me, and the military was off limits, so I followed in the footsteps of my older siblings and applied to colleges. Early college days I started off at the local community college, majoring in Humanities and Social Sciences. I attended for one year, then transferred to Rowen University (formerly Glassboro State College) in South Jersey, enrolling as a Health and Physical Education Major. My parents were not thrilled with the idea that the school was 90 minutes away and I’d have to live on campus, but alas, the local state college where my sister attended didn’t accept me. After three years of college, I managed to earn a whopping 45 credits and an embarrassing GPA. I majored more in social experiences than the curriculum. I dropped my classes at the end of my last semester and withdrew from school. Even though I was working, the pay was terrible, and I now had student loans and grants to repay. Working for peanuts was for the birds and I knew I needed to get back into college, though there was no easy path to affordably get back into school. I had passed the NJ State Police Exam at the time, but was denied entry during the interview, with the interviewing officer telling me to go back and finish school, then try again. By this point it’s 1985, and the Navy had

Own Way to LMHC,

IULIANA cool commercials with the tagline: It’s not just a job. It’s an adventure. Plus, Sailors have more fun, right? I decided the only way to get out of the house without getting married, earn a decent wage, and give myself another shot at continuing my education was to join the Navy that offered the GI Bill. I signed up for the delayed entry program, giving myself six months to muster up the courage to tell my parents of my decision. My recruiter called my house one day when I wasn’t there, and my mom answered the phone. He did nothing more than leave his name. When I got home, she burst into tears asking me what I had done. My dad gave me the silent treatment for months. I was still going as planned. I was able to enter the Navy as an E-3 because of my college credits and I selected the job rating of Hull Maintenance Technician because it sounded the most interesting to me and it offered the most variety of skills: welding, plumbing, pipefitting, sheet metal work, firefighting, and damage control. US Navy I joined the Navy in 1986 before “Don’t Ask Don’t Tell” came into effect. On 16 January 1981, Department of Defense Directive 1332.14 established a policy of mandatory discharge for service members who attempt to engage in a same-sex act. Part of the medical processing prior to boot camp included being directly asked “Are you a homosexual?” I wanted to serve, so I said “No.” In the article The Navy Once Tried to Hunt Down Dorothy Gale’s Secret Gay Army by R.S. Bennet (2016), he wrote, “According to Randy Shilts’ book Conduct Unbecoming: Gays and Lesbians in the U.S. Military, the United States Naval Investigative Service ran an investigation into homosexual activity among service members in the Chicago area during the 1980s. Investigators learned that gay men sometimes called themselves “friends of Dorothy”,

and instead of putting two and two together they concluded that there must be a real-life woman named Dorothy commanding an underground gay army right in the center of the Windy City. Of course. The Naval Investigative Service searched far and wide for this shadowy woman to put an end to her mysterious LGBT legion. But alas, there was no one behind the curtain. Maybe they should have just clicked their heels together.” During my first tour of service while stationed at Submarine Base, Pearl Harbor, I witnessed “witch hunts” where gay and lesbian servicemembers were aggressively pursued to be discharged from the Navy. There were also those who willingly disclosed their sexuality just to get discharged to not complete their contract. One Friday night a couple of male sailors from my shop walked into the gay bar we used to hang out at in Honolulu, and we all quickly bailed, escaping out the back door before getting spotted. It was narrow escape. My first interest in counseling After advancing to the rank of E-5 and being selected for Sailor of the Quarter for Submarine Base Pearl Harbor during my first enlistment, I decided to reenlist and reported for sea duty onboard the USS SYLVANIA (AFS-2) homeported in Norfolk, VA. My first deployment was in support of Desert Shield/Desert Storm and by the end of my 4 years onboard I was ranked number one among my peers and selected as Sailor of the Year 1993. From there, I reported aboard the floating drydock SUSTAIN (AFDM-7) and shortly thereafter received the news I was selected to Chief Petty Officer. During that time, I was given the collateral duty of Command DAPA (Drug and Alcohol Program Advisor) which was the command’s primary advisor for drug and alcohol matters. I didn’t know the first thing about alcoholism or addiction, so I began going to Navy training | InSession- July 2022 | 29

courses to prepare for the job and became increasingly interested in the field. I also became aware that the Navy had a special program for Navy Drug and Alcohol Counselors. I applied for the program, went to NDAC School in San Diego, and became certified. I spent four years working as a drug and alcohol counselor at the 28-day residential facility located at Naval Base, Norfolk. VA. It was known as the Navy’s best kept secret. During that time, I also spear-headed the Navy’s Weight Management Program, creating a two-week program for activeduty members who were at risk of being discharged for not meeting Navy weight standards for two consecutive cycles.

evidence. It was a very dark and challenging time in my life.

Throughout my time in the Navy, I took advantage of the Navy’s Tuition Assistance Program and would take college courses whenever possible, slowly chipping away towards a bachelor’s degree.

My Twilight Tour and Graduate School

On the Radar – Career at risk During my Naval career, there was only one major instance where my sexual orientation came into question when an exgirlfriend decided to out me to my command. I was on sea duty assigned as the Repair and Damage Control Chief for Carrier Airwing 17 stationed out of Naval Air Station Oceana, Virginia Beach, VA. This was close to deployment time, and I was very depressed. When I finally admitted I was struggling emotionally and sought help, I remember the female Navy Psychiatrist saying, “You’re a tough woman, you’ll get through it” as she wrote a script for an anti-depressant and sent me back to my command. Because of that accusation, I was subjected to an investigation by the Naval Investigative Service while deployed. I was 12 years in with my career on the line. I had no one I could confide in because of the nature of the “offense.” There was a Navy Psychologist onboard that I would meet with regularly, however, there was no real benefit to the therapy, as I couldn’t be honest. Of course, I denied all accounts as a measure of selfpreservation, and the investigation was eventually dropped because it was considered hearsay with no factual

First Re-enlistment. 1989 30 | InSession- July 2022 |

Despite the extreme stress I experienced during that last deployment, I managed to finally confer a Bachelor of Science Degree with two depth areas, Psychology and Religion, through Excelsior College of New York (formerly Regent College). From start to finish, it took me 18 years to complete. I had a year left at CVW-17 after we returned from that deployment and was sitting at my desk on 9/11/2000 when we got the news about the twin towers getting hit. I transferred from that command in November 2000, attending Navy Instructor Training School in preparation for my next and final tour.

I spent the last few years in the Navy as a Navy Shipboard Fire Fighting Instructor, training and qualifying the fleet through classroom instruction and live firefighting evolutions. During that time, I began graduate school at Webster University in March of 2001, in the Mental Health Counseling Program. Compared to the length of time it took to complete my BS, I conferred my Master of Arts in Counseling by November 2004, a year before I retired from the Navy. Post-Navy Three weeks before my retirement ceremony, I got a call from one of the counselors I worked with during my masters’ counseling practicum and internship, asking if I had retired yet because they were looking for a counselor. I took my first official post-Navy job at Clay Behavioral Health Center in the Substance Abuse Department. I spent 7-years at CBHC and didn’t begin accruing supervision hours towards licensure until my last few years. By 2012, I decided I needed a break since I never gave myself one after my 20-years Navy career. I was considering pursuing a doctorate at the time, but imposter syndrome got the best of me, and I decided to earn two additional master’s degrees, Human Resources Management and HR Training and Development. The two-years offered me a well-deserved break

Three of my pups!

and I finally applied for my LMHC. After the self-proclaimed sabbatical, I was ready to get back to work and got hired as a School-based Military and Family Life Counselor (MFLC) in 2014. I was assigned to two elementary schools and absolutely loved establishing the program at both of those schools. During my first summer break, I continued to work as an MFLC at the Navy Child Development Center, and the following summer I was assigned to Moody Air Force Base in Valdosta, Georgia. There had been an increase in suicides and MFLC’s assigned directly to security forces and combat squadrons were part of the AF’s response to build resiliency. My experiences as an MFLC broadened my experience with military mental health. Private Practice and Continuing Education By late 2016 I began taking steps towards starting my private practice and took my first client early 2017, offering evening hours a couple of days per week. By 2019 I took the leap and opened my practice full-time. That same year, I was also certified as a Florida Qualified Supervisor for both Mental Health and Marriage and Family Interns. In 2017, I enrolled in a Counselor Education and Supervision Doctoral Program, and after two Argosy University school closures and their bankruptcy debacle, I was able to transfer to National Louis University. I’m a member of the NLU Student Veterans of America Chapter, am wrapping up a year as VicePresident of NLU’s First Generation College Students and am a member of Chi Sigma Iota-Nu Lambda Upsilon Chapter. I’m hoping to finally defend my dissertation and confer my doctorate by the end of this 2022. Professional Associations I enjoy attending professional training events as an attendee and as a presenter. I first presented at a professional conference in 2018 and have either presented or co-presented on the National, State, and local levels on twenty-two occasions to

Mom & I , retirement

date. It’s my way of contributing to our field and advocating for the populations I’m passionate about, primary the military and LGBTQIA+ communities. I’ve been a member of FMHCA since 2018 and began attending their conferences at that time. I always loved the energy and opportunity to co-mingle with other professionals while increasing my knowledge and expanding my skill set. Since becoming the NE Region Director in 2021, I’m grateful for the opportunity I was given to serve as part of the board. I’ve learned so much in such a brief period. There’s still much work ahead to fortify our professional mental health community and foster local connections in the NE Region. The Central Florida Chapters continue to grow and thrive. We also have seventeen counties between North Central Florida and the First Coast with no active Chapters and we are ready to support the creation of new chapters in these areas. I’m also looking forward to the 2023 FMHCA Conference, being able to attend in person has made a huge difference this year. Personal I’ve been doing telehealth since the start of COVID-19. I do plan to branch out again to incorporate in-person sessions, workshops, and trainings sometime in the future; but, for now, my focus is putting my energy into completing my doctorate. In the meantime, my five dogs have enjoyed my company full time and can been seen lounging in the background of my telehealth sessions on any given day. I also have several outdoor cats that have taken over my garage and will share their food with the occasional opossum or duck that sneaks in through the cat door. I rescued an injured baby squirrel last year and nurtured him back to health until he ran back into trees on his own. Since then, I’ve felt obligated to keep a feeder stocked out in the yard for all the squirrels to graze. As for what I do in my spare time when I’m not counseling, tending to a small farm, or working on my dissertation, I’m a member of the South Tampa Psychodrama Training Group. I first attended their summer intensive in Clearwater, FL in 2017 and returned in 2021. I decided to join their yearlong training group, where we meet one Saturday a month for a full day of training, which we just wrapped up in June. It’s been both a professionally and personally rewarding experience. The unique aspect of this training is learning and practicing a new skillset while working on one’s own issues. The monthly training also gives me the opportunity to unplug from my busy schedule away from home one weekend a month to connect socially, explore Tampa, and enjoy a variety of great cuisine. It’s been a major part of my self-care in the past year and long overdue after breaking out of COVID isolation. I’m looking forward this year’s summer intensive at the end of July and will begin the next yearlong in September. | InSession- July 2022 | 31

32 | InSession- July 2022 |

Ethics: New Technology & Confidentiality Professional Experience Article

As I have mentioned in previous articles, as part of our ethics-inaction policy, I have been fielding phone calls referred by the 491 Board regarding ethics questions that they could not answer. An interesting one came in today that I think needs to be mentioned. There are a whole lot of new technological devices coming out on the market, some of which have the potential for creating traps or holes into which we, as a profession, could fall if we are not careful. Today I had a licensed mental counselor ask about smart watches. As you probably know, this is a device that looks like a wristwatch, such as the Apple in the form of a wristwatch. It was explained to me that it tells the time, and is a device over which one can text, make phone calls, and perhaps other functions. Many have a GPS in it that allows parents to see where their children are on a map. But one other somewhat frightening function it has is that the parent or other person can dial up the device like a phone, but it does not ring, it only opens a line that allows the parent to listen in on what is happening in the child's environment outside of the child’s awareness. While this can be a great safety device on one hand, it also serves to invade other people's privacy on the other hand. This counselor stated that she works with children, both individually and in group therapy. The concern was as to whether or not this device could compromise the confidentiality of sessions, both individual and group. We, as a profession, need to think about these issues. Obviously, we have the responsibility of maintaining the confidentiality of our sessions, regardless of the modality of the sessions. But the client or patient owns the privilege of releasing the information or not. It is our job to maintain the integrity of that privilege. In speaking to this mental health counselor, I asked if there was a policy in place regarding the confidentiality of the individual sessions with the children. She stated that she worked for an agency, and that they did, indeed, have such a policy. She also stated that this was in the informed consent form, signed by the parents. We all need to make sure that we have signed informed consent forms. The key word here is, “informed.” In order to protect ourselves we need that signed form. In order for informed consent to occur, the patient must be “informed.”

Consequently, the first thing we need to do is make sure we have that signed informed consent, and that it contains the policy of our practice, be it private or agency, that speaks to issues, like these devices. Thus, we may have some protection for ourselves, should these rights be given verbally violated without our knowledge. But, we must make best practice to ensure due diligence with regard to making sure that these devices are not in our sessions. This is both for our protection, and the protection of the patient’s confidentiality. In the instance of the individual session, there is a gray area. Having worked in an agency in the past, I am aware that many or most agencies have policies that what is said in the individual session stays in an individual session, even if the patient is a child — even if the parent demands to know what the child said. Obviously, if the child reveals something that triggers mandated reporting or duty to warn, we must do something. But the other problem is the question, “How do we achieve informed consent when the patient is a child?” Also, in tandem with this, “Who owns the privilege when the patient is a minor?” The parent? The child? Some variation thereof? These are ethical gray areas that we are going to have to negotiate, and possibly, to clarify is when we move forward as a profession. In the instance of the individual session, it is the opinion of this licensed mental health counselor, (with the caveat that I am not representing FMHCA here), that there is a good likelihood that this device is violating HIPAA and various codes of ethics, if the parent listens in without the knowledge or permission of the patient or counselor. It seems even clearer, however, that, in the case of group therapy, there are multiple patients whose civil rights must be maintained in the integrity of a confidential environment. If one parent listens in, (not to mention multiple parents), on one or more of these devices, it seems clear to this licensed mental health counselor that HIPAA is being violated. Again, I use the caveat that I am not speaking for FMHCA. This is a discussion that we need to have as a profession. The opinions expressed here are certainly not the “be-all & end-all,” but merely points at which to begin this discussion. Ethical food for thought. | InSession- July 2022 | 33

Written By: Michael G Holler Michael Holler is the Past President, Ethics Committee Chair, & Parliamentarian of FMHCA, he is a Licensed Mental Health Counselor, a National Certified Counselor, a Certified Clinical Mental Heath Counselor, a Certified Forensic Mental Health Evaluator, a Certified Child Custody Evaluator, a Qualified Parenting Coordinator, a Qualified Clinical Supervisor and a Florida Supreme Court Certified Family and County Mediator and a Certifies Kink AwareTherapist & Educator. Michael has a private practice in Tavernier in the Florida Keys. Michael has been working with individuals, families, couples and organizations for over 25 years. Michael is also a Neurofeedback provider. Michael has worked in inpatient psychiatric, community mental health and private practice settings; Michael has worked as an adjunct professor in psychology at Florida Keys Community College. Michael was President of the Upper Keys Interagency Council in 1997. Michael was the first Intensive Onsite Services Counselor in the State of Florida.


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



The first consideration its to make sure you are complying with your state law in determining whether you are required or allowed to report information regarding a client is infected with a communicable disease or, if on the other hand, your state law requires that such information be kept confidential. The Code addresses this issue in section I.A.2.c which provides: “The release of information without the consent of the client may only take place under the most extreme circumstances: the protection of life (suicidality or homicidality), child abuse, abuse of persons legally determined as incompetent, and elder Do I have a duty to report this situation, can I be abuse. CMHCs are required to comply with state and federal statutes required to disclose this to public health officials, concerning mandated reporting”. Under this section of the Code, a or am I required to maintain my client’s privacy and disclosure to protect against a potentially lethal infection may be the confidentiality of this information? appropriate when it is consistent with your state law. For years, I have been asking whether I am required to report a client who is-positive with a communicable disease and may be exposing others to infection. Recently this issue arose, and my client refused to allow me to disclose to his family that he may be exposing them to serious infection. We have treated this as a clinical issue.


My client has sent me a letter containing a written request for a copy of her treatment records. This client’s diagnosis is paranoid schizophrenia. I am afraid that she will feel stigmatized by this label, and that she will be confused not only by the diagnosis in her file, but also by the test data contained in it. Am I required to turn over to this client a copy of her chart?



Code section I.A.2.b apples in this instance. It states: “The information in client records

Can I practice telehealth across state lines in a jurisdiction where I am not licensed?


It is not advisable to practice therapy in a jurisdiction where you are not licensed. CMHC need to be familiar with state laws and regulations

34 | InSession- July 2022 |

belongs to the client and shall not be shared without permission granted through a formal release of information. In the event that a client requests that information in his or her record be shared, CMHCs educate clients to the implications of sharing the materials.” Some state laws require that health care providers and CMHC give a copy of their treatment records to clients, upon request; however, many state laws agree with HIPAA standards which provide that the counselor’s “psychotherapy notes” need not be shared with clients, who are entitled to a progress report, which is a treatment summary. Disclosure to this client of her treatment notes and records could be harmful to her, due to the client’s inability to process diagnoses, labels or discussions of her history. Thus, if state law allows a CMHC to provide the client with a treatment summary in this instance, it would undoubtedly be an appropriate judgment on the part of the CMHC to do that.

in both states in which services will be rendered (CMHC Code B.6.f.). In some states, it is a crime to practice as a health care provider or therapist if you are not licensed or approved to provide treatment in that state. Insurance coverage may not apply to claims which involve a criminal act. You may be able to contact the other state to seek approval to provide telehealth across state lines, and you need to document any such authority carefully.

Congratulations to the FMHCA Registered Mental Health Intern Licensure Exam Scholarship Winners! Twice a year, FMHCA awards scholarships to qualifying RMHI's to cover the cost of the NCMHCE exam. This is a donation-based initiative that rewards a different amount of applicants per cycle.

Lina Zelcer considers herself a special person, honest sincere and very passionate about her work. Lina loves humanitarian causes and demonstrated her love for others helping and supporting every time she can have the opportunity. Lina's long term goal is become a good mental health counselor, she wants to use her untiring commitment and drive to bring more dignity and autonomy to the people who is suffering of any mental health condition.

Tristine Barry has a deep affinity for understanding her clients emotionally and making that connection in order to instill trust, hope, and restoration. She looks forward to partnering with her clients in a customized, and personal manner to help them utilize their full potential and meet their goals. Tristine has experience in Cognitive Behavioral Therapy (CBT), Trauma Informed Care, Acceptance and Commitment Therapy (ACT), Mindfulness, and more.

Melissa Cooper is a College Professor and former Professional School Counselor for 15 years. Her passion is to help others, particularly children, is apparent in her work and past volunteer experience. It is Melissa's belief that a child's resilient nature can inspire any adult to believe that positive growth and change is always possible. Melissa looks forward to contributing to the Central Florida Community in the field of Mental Health Counseling. | InSession- July 2022 | 35

36 | InSession- July 2022 |

Trauma in the Black Community: The pain of misconnection Professional Resource Article

The black community has experienced generational traumas that have caused some of my clients to feel they cannot connect to a therapist that is not a person of color. As a community mental health therapist, I sometimes will get referrals where the client is requesting to have a “therapist like me”. I am an uncommon sight as a black male therapist and clients that seek me, or those like me, will report that they have more hope that I will understand when they share about the struggles they face. Some people are hesitant to try therapy because of misconceptions about mental health services, but my black clients have expressed concerns about feeling that they will not be truly heard and believed. A proper therapeutic alliance cannot form without a sense of connection, and my clients that share in the experience of being black in America feel I am one who is on the same journey as themselves. I am afforded the opportunity to be a cosojourner of sorts in their quest for healing, and it is in that moment that I am able to provide a model of the connection that many feel they never had. My observation is that many in the black community have felt that the society that they live in sees them as a threat so they pull away into exile. I am defining community as a grouping of people knit together for mutual survival and mutual benefit. In addition, communities have their own culture which I will define as set of practices, values, expressions, and expectations for those that engage in the community. In light of the events of 2020, | InSession- July 2022 | 37

there has been much discussion and controversy within the black community, but I, and many others in the black community, have seen much of these issues replayed over and over again well beyond that. Throughout life, many of my clients cite personal experience and the experiences of siblings, of parents, and of other first-degree relationships as reasons to feel they are seen as a threat and in turn causes them to feel unsafe in many spaces and environments. I have been told of situations where clients have had racial slurs hurled at them, harassed, or told they did not belong. In the therapist office is the last place any person wants to feel their exile status. I have found that in times of distress people seek what is familiar because that rings of what is safe so what could be more familiar than a face that is part of your community? I have learned to conceptualize my clients’ felt sense of disconnection from the larger American culture as a type of developmental trauma and that seems to present itself as a form of insecure attachment to the larger American culture. When a person’s first impression of their therapist is that they are an outsider they would be mistrustful toward the therapist; I think that is a part of why members of the black community are not as open with therapists that are not black. Members of the black community have a history of past painful learning that resonates with other members and despite never discussing it with each other there is a sense of understanding. In contrast, some of my clients have expressed mistrust toward my white colleagues because they perceive them as an outsider. Thinking from a developmental perspective, no child connects, securely, to a threatening or inattentive caregiver. It is more typical that the child will develop an anxious or avoidant attachment style, so in this sense I would like to draw parallels between the 38 | InSession- July 2022 |

black community and the larger framework of American society. In the black community, people sometimes feel they do not share in a secure form of attachment in relationship to the the larger framework of American culture. So I see in some of my black clients the assumption that they cannot be understood because they have not had the felt experience of being known and embraced by the larger society. The sense of feeling disconnected, or feeling rejected for some, from the larger society seems to have developed a sense of unity in exile. My assertion is that an insecure attachment to the larger American society coupled with feeling pushed into community exile results in the trauma of misconnection. The wound of being misconnected to the larger American society has resulted in traumas in the black community. Complexed trauma is repeated and chronic exposure to traumatic events that impart a mental message that distorts perception of the self. An example of this could be a child growing up with neglectful parents, an inmate that has become institutionalized, or the victim of abuse in a long term marriage. I tell my clients that, especially with complexed trauma, an internalized negative self belief that is rooted in a distressing event can lead to chronically feeling unsafe and on edge. There have been numerous major events that have occurred throughout American history where the black community experienced complexed trauma— American slavery, the Civil Rights Movement of the 1950s and 60s, and even the events that unfolded in 2020. In addition to these events there are other day to day issues that impact black people more regularly. Racially insensitive comments or jokes, portrayal of negative stereotypes in various forms of media, being asked to speak on behalf of all black people in an uncomfortable setting, or

being ignored when expressing feelings of discomfort due to a comment someone has made regarding race. These types of encounters carry a message that makes many in the black community feel unwelcome and the emotional learning from these situations can make a person feel they are unsafe. Members of the black community share in these feelings. The experience of feeling like an exile in one’s own home town can lead to the emotional learning that “you are unwanted” and the shared traumatizing history that members of the black community share in unites generations in feeling like an outsider in their own home. If you have a community in exile that is preferable to being alone, and a community forged in exile can be difficult, though not impossible, to enter for someone that looks like an outsider. As a therapist that is part of the black community, my role is to help my client process their past painful learning and provide an understanding face to the clinical aspects of therapy. The basis of therapy is that we build positive rapport with our clients so that they will trust us as we impart coping skills. I believe finding emotional healing for the trauma of misconnection requires the therapist to provide a version of a healthy relationship to help our client develop a new relational paradigm. This rapport will provide a safe emotional setting for the therapist to utilize clinical skills to aid that client find personalized meaning for the pain they see in their community, but emotional learning that is born in trauma is not accessible due to shame and negative self appraisal. When trauma can be healed, the past painful learning ceases to be a source of negative self reflection and instead can lead to new insights and growth. When a person achieves post traumatic growth the once overwhelmingly negative experience becomes both emotionally and

intellectually accessible to the client. They can then begin the work of assigning meaning to that experience that is not based in shame. I am able to work with my clients to help them find ways to engage in the larger society as they wish, learn skills to manage distressing thought content born from past painful learning, redefine the role they play in the larger American society, and the role they play in the black community. I have found that as a black therapist, I am seen as a familiar face that can be trusted, so I am invited into their experiences and traumas to act in a helping role. I think it is important for therapists to be aware of how black clients may struggle with feeling alienated by the larger American culture and that can lead to mistrust in a therapist that is not black. Therapists that are not members of the black community can still act as effective helpers as long as they remember to approach their clients with a sense of curiosity and to remain open to their experience in exile.

shared with me that they have had this pain dismissed or that some try to explain it away. A few accuse therapists in the past of, unintentionally I assume, reinforcing the thought that they will not be heard or affirmed. We, as therapists, must remember we have to earn the client’s invitation into past painful learning. Attempting to immediately help the client reframe negative self talk without having the context about where they came from or how they came to that conclusion comes off as dismissive. Being a member of this community affords me some benefit of the doubt but that is not enough. I take on the role of co-pilgrim on the journey to heal but I also provide clinical skills that I can impart to my client, at the right time, to help my client heal and live past painful learning. It is my opinion that in order for a therapist, black or otherwise, to be able to offer effective services they must be curious about their client’s experience and emotional learning in their exile.

I believe a therapist that is not black can still be invited into the experience of exile that members of the black community face. All that is required is to be trustworthy and I believe much of the work is found in some basic counseling skills. Therapists must be attentive to what their black clients are saying about their struggles and it can be helpful to ask probing questions to show you are listening. In addition to being attentive and being curious it is important to be honest about not having earned the client’s trust if that is what you are sensing. To be honest with your client about what you are seeing and to ask tentatively if you are correctly sensing apprehension will gain respect and possibly an invitation into their more tightly held painful learning. Many of my clients feel no one cares about their pain or they feel no one is willing to hear them out when they speak on it. Some have

Clients can sense counter transference in a therapist and if that therapist is responding to feeling uncomfortable with the client’s feelings is not discussed it can harm the therapeutic alliance. The sense of being disconnected to a culture that the therapist identifies with strongly can cause the client to give up on trying to build a therapeutic relationship and in the best case they ask to be transferred to a black therapist. In order to help clients heal from this trauma the therapist must develop a sense of comfort with discussing this openly. If a therapist becomes uncomfortable but is pretending they are not, then the client will likely see this incongruence and therapy will stall. I would suggest asking the client, assertively, what they feel you are missing or to ask the client for feedback on how they think the therapeutic process is unfolding. Being able to receive that feedback with humility can be a

groundbreaking moment in the therapeutic relationship. Honest communication is a necessary part of any relationship and in the therapist office this is important to meet the treatment goals and modeling this type of honest communication and humility to listen to feedback create an emotionally safe therapeutic environment. The emotional learning that lead to exile could possibly be put on a pause in order to make an exception for the therapist that is not black but is still willing to listen. A therapist that is not black may not be able to be seen as being on the same journey but they can be a person that is seen as a restful presence to share with. As a therapist that is part of the black community, I am hopeful that the trauma of misconnection can find healing in therapy. I have had clients verbalize relief at finding a black therapist and because we are part of the same community they have the feeling of seeing me as a person on the same journey that they are on. I also think therapist that are not black can still be a supportive presence if they build enough rapport. A therapist does not need to be black in order to help those of the black community they only need to be open to learning of the client’s experience and be a trustworthy presence. Written By: Eric Chatman, LMHC Eric is a LMHC working in a community mental health agency in central Florida. He has experience working with a variety of clients but specializes in treating traumatic stress. He has training in EMDR, Combined Parent-Child CBT, and other evidence-based tools for treating trauma. He hopes to be of service to his clients and colleagues in an effort to spread awareness about the impact of traumatic stress disorders. | InSession- July 2022 | 39

Therapist Burnout Professional Experience Article

“Burnout is what happens when you try to avoid being human for too long”- Michael Ginger. These words couldn’t resonate more with a mental health professional. As a mental health professional our job includes guiding clients through emotional and mental stressors that can cause them to shut down. When asked if I love my occupation, of course I do. It is an essential job where I help individuals cope with the stressors of everyday life. The reality of this occupation is that burnout can happen. Burnout is the result of being mentally exhausted. Putting it into perspective, I have many roles besides being a therapist. I have the role of a daughter, friend, sister, granddaughter, niece, and aunt. Mentally I am to be present during these roles, even if I had clients. It can be difficult to manage all roles, including being a therapist and worrying about one's own mental health. People think being a therapist means we know how to manage our own emotions better. The fact of the matter is we are still human and are prone to making mistakes. In this field, I have encountered colleagues who are feeling burnout at an earlier rate, who take on many clients and attempt to juggle their roles. We are helping develop therapeutic relationships with our clients and setting goals. Yet we fail to set our own goals to not feel overwhelmed.

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Just as a phone needs to charge when it is low on battery, so do therapists. It is solely to protect oneself and avoid emotional exhaustion. Over the years I realized, I excel better when I have a schedule. A schedule after work that allows me to be creative with dance or exercising. Taking breaks for self-care is equally important. Practicing being kind to yourself and establishing your limits can help you maintain mentally equipped for your job as a therapist. It is important to be reminded that as humans, we all need to love ourselves more. Written By: Jessmary Echevarria, LMHC Jessmary is a LMHC in Orlando, Florida. She currently works in a mental health agency with kids, teenagers, and adults. She specializes in working with depression, Bipolar, and Post Traumatic Stress Disorder. She is certified in EMDR and has taken trainings to better her understanding of human behavior. She believes that a different perspective can change how we perceive our stress and how to manage them more efficiently. | InSession- July 2022 | 41

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We Should Stop Talking About Triggers Professional Experience Article

Those of us who are involved in addiction treatment, either as counselors, administrators, or consumers should stop using the word “trigger.” In common usage “trigger” refers to an internal response to an external stimulus – usually something experienced through the senses. The APA calls it “a stimulus that elicits a reaction” (American Psychological Association , 2020). It can be a reminder of previous experiences or something that in the past would have resulted in using the substance or behavior of choice. For someone seeking to establish or maintain a recovery program, a trigger is an unpleasant experience because it can initiate cravings or thoughts of use.

quickly escape for fear of impulsively using the drug of choice. A common goal of a treatment plan is to identify triggers and find new ways to manage them. This goal illustrates how triggers are considered a negative factor in substance abuse recovery. The attitude is that triggers are to be avoided and a person with solid recovery will not have any triggers. This attitude eliminates opportunities for self-exploration and growth.

For persons who have experienced trauma, a trigger can be a reminder of events of the past. No one likes to recall these memories and there is a tendency to push them away as quickly as possible with the thing that works best – an addictive Most people recoil from a trigger and quickly find a way, substance or behavior. There is a fear of the emotions that arise hopefully positive, to distract themselves. Treatment providers encourage persons experiencing triggers to call a support person, when events are relived. Triggering a trauma memory can read some recovery literature, take a walk, take a nap, or perform transport that individual from the current moment to the time and place where the event occurred because of a split-second some other self-caring activity. Some respond by choosing an sensory input. That smell, sound, color, touch, or glimpse of an alternative negative behavior – instead of using the drug they object can stir a person into emotional dysregulation. suddenly crave; they will eat something unhealthy or engage in connection with someone equally toxic. Others will lose No one wants to be reminded of an uncomfortable memory. themselves in some technical black hole of scrolling through their However, in recent years, the term “trigger” has become phone, playing a video game, or bingeing on a streaming service. ubiquitous and over-used. It has become an excuse to isolate and A trigger is seen as a negative experience from which one should avoid interaction with others. Some have used the word as an | InSession- July 2022 | 43

excuse to avoid positive recovery experiences such as twelve-step trailhead as an opportunity to grow in recovery. Trailheads meetings. And it has become an excuse to relapse. More than one therefore are not an excuse to return to using but to learn more client has told me a relapse occurred because “I was triggered.” about oneself and to utilize that information to make changes. I propose that we change the language and borrow a phrase from Encouraging curiosity and courage to explore a new experience can be growth-producing. And, like the advice given to hikers on Richard Schwartz, developer of the Internal Family Systems many popular trails, including the Appalachian Trail, “don’t go model. Let’s substitute the word “trailheads” for “triggers.” A alone.” Taking a trusted person down an unknown trail, whether trailhead is the beginning of a trail. It can represent excitement, that person is someone from a support network, a sponsor, or an mystery, and even fascinating. It is the start of a journey of exploration and discovery. Rather than shy away from it in fear of addiction professional, can make the path safer and friendlier. what will be revealed, we are invited to begin exploring and discovering what is beyond on the trail. A trailhead in recovery is an invitation to begin to explore the internal response to an external stimulus. We can encourage others and ourselves to travel this trail of self-discovery and uncover a deeper understanding of our natures.

Encouraging exploration of a trailhead can be similar to encountering a new path. Mindfully recalling what was happening just before the trailhead was encountered is the start. What do you notice? Do you feel anything in your body? What are your thoughts? These can be shared in a journal or in a conversation and will likely lead to new self-awareness.

We should teach the individuals we work with to welcome a

So let’s encourage finding trailheads.

Written By: Theresa Ritz, LMHC, MCAP Theresa Ritz earned a bachelor’s degree from Wheeling Jesuit University, in Wheeling, West Virginia. She earned a Juris Doctorate and a Master’s in Science in rehabilitation counseling from West Virginia University, where she serves as adjunct faculty in that program. She is an LMHC and is certified as a master’s addiction professional. She is clinical director at Footprints Beachside Recovery in Treasure Island and owns a private practice in Clearwater specializing in trauma.

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Addressing Cyberbullying, Suicidality, Suicide, and Psychological Distress in Youth Populations: Clinical Implications for Mental Health Counselors Professional Resource Article

Abstract Understanding the impact of social media and technology on child and adolescent mental health is paramount in improving clinical approaches and overall behavioral outcomes. The increase in electronic communication modalities such as Facebook, WhatsApp, TikTok, and Snapchat by youth in America has led to a revision of therapeutic practices to address the current patient's needs. A poll by the United Nations International Children's Emergency Fund (UNICEF) found that in 30 countries, one-third of students reported that being cyberbullied was associated with higher-income families than lower-income families (UNICEF, 2019). According to the 2019 Youth Risk Behavior System Surveillance (YRBSS), 15.7% of students have been victims of cyberbullying in the previous year in the United States (, 2021). International communities have explored the impact of cyberbullying on child and adolescent populations; however, limited research on clinical practice in the United States has been conducted (Byers, Mishna, and Solo, 2019). Cyberbullied students have higher rates of selfharm, suicidality, suicide, substance abuse, and gender differences than in-person bullying. The access and increase of usage of electronic devices by youth have led to higher exposure rates and susceptibility/development of mental health illnesses. By mental health counselors implementing a holistic, systemic approach, mindfulness-based therapies, updating clinical intake questionnaires, and identifying at-risk populations through school belonging programs, youth can process their phenomenological experiences. This article discusses the challenges and implications of cyberbullying on adolescent and youth populations and the future of counseling research and clinical practices.

Keywords: Clinical practice, cyberbullying, suicide, suicidality, social media Introduction Cyberbullying is using electronic devices where content can be shared online, SMS, forums, chatrooms, or social media and viewed by others to communicate mean-spirited messages to intimidate, harass, shame, or spread false information about another person (, 2021). Pew research center reported that 81% of adolescents use social media (Memon, Shive, Mohite, Jain, 2018). During the Covid-19 Pandemic of 2020, there was a notable increase in suicide attempts by 50% in female populations and a 4% increase in male populations for ages 12-17 compared to the 2019 statistics (Smith-Schoenwalder, 2021). Based on currently limited data collected from the Covid-19 pandemic, researchers found that the number of students who experienced online bullying decreased due to online learning; the rates have returned to pre-pandemic levels as children and adolescents return to in-person learning (Martinez and Temkin, 2021)—as such, addressing the challenges currently impacting this vulnerable population is imperative. Cyberbullying victims reported higher risk-taking behaviors of self-harm, substance use, and sexting (Long and Dowdell, 2021). Victims are more likely to seek out online relationships to validate and accept their behaviors through watching videos online and chatting online with others to gain acceptance. At the same time, they may find acceptance for self-destructive behaviors or become subjected to online abuse (Long and Dowdell, 2021, Memon et al., 2018). For these reasons, it is essential to understand the underlying issues to clinical challenges when counseling cyber victims and perpetrators of cyberbullying. The higher use of online and social | InSession- July 2022 | 47

networking accounted for higher psychological distress, suicidality, and lower self-esteem (Memon et al., 2018). Many studies have examined traditional bullying, and fewer have focused on the escalating cyberbullying crisis. Much research has conclusively indicated that internet usage alters human psychological behavior. Cyberbullying is the new frontier that clinicians and communities must contend with and implement a systematic, holistic treatment and pragmatic program development approach. Self-harm and suicidality in adolescents experiencing cyberbullying. The prevalence of self-harm and suicidality in children and teenagers has been identified as increasing risk factors for cyberbullying. However, research on the influence of cyberbullying on suicidality and self-injury is limited. Although self-injurious behavior in adolescents is not always associated with suicide intent, self-injury typically starts around 13 or 14 years of age. (Fridh, Lindstrom, and Rosvall, 2019). A study in Sweden involving many 9th and 12th grade students identified a strong correlation between self-injury and cyberbullying. A significant contribution from the student found that adolescents who experienced mental distress for at least two weeks consecutively are often socioeconomically disadvantaged, involved in cyberbullying, and reported higher levels of risky lifestyles such as tobacco, alcohol, and narcotics. This association between self-injury and peer victimization in cyberspace, especially among victims and bully-victims, is a significant public health concern that needs to be addressed since 20-30% of these cases of self-harm among children and adolescents, according to the study, could be prevented if cyberbullying was addressed (Fridh, Lindstrom and Rosvall, 2019). This previous study design is limited by not establishing causal relationships on whether cyberbullying encourages adolescents to self-injure or whether adolescents who engage in this behavior have a higher risk of experiencing cyberbullying.

harm, such as self-cutting and self-burning. (Dorol-BeauroyEustache and Mishara, 2021). An even higher risk for suicidality and self-harm could arise from adolescents experiencing disabilities or specific medical conditions since these children have a higher incidence of cyberbullying. Another cross-sectional study on 14–17-year-old adolescents in Australia found that a history of sexual activity and eating disorders among bullying victims had a higher risk of involvement in suicidality and selfinjury. The study further examines the percentages of self-harm with a 32.8% prevalence in cyberbullying victims compared to a 22.3% prevalence in traditional bullying; Suicidality, in contrast, suicidality had a 34.4% in cyberbullying victims, while traditional bullying had a prevalence of 21.6%. This finding implies a higher prevalence of self-harm and suicidality in cyberbullying victims than in traditional bullying victims, with girls at a higher risk of experiencing suicide attempts and self-harm than boys. (Islam, Yunus, Kabir, and Khanam, 2022). Further investigation of cyberbullying and self-injurious behavior could provide insight into policy efforts to reduce the prevalence of cyberbullying and strategies for additional appropriate coping mechanisms among adolescent populations. Children and adolescents with these risk factors may have an increased association with cyber discrimination or stigmatization, which may exacerbate depression symptoms and lead to youth selfharming, suicidality, and suicide if no social support is available.

Research by Wang et al. (2019) found that one-third of its adolescents were involved in bullying. However, the author's findings outline the overlap of traditional bullying and cyberbullying links with several studies that demonstrate an association between the role of cyberbullying nonsuicidal selfinjury (NSSI) in adolescents and dispositional mindfulness. Mindfulness refers to the self-awareness that emerges when one is conscious of their actions and thoughts in the present moment and nonjudgmentally to the unfolding experience moment by moment (Kabat-Zinn, 2003). The authors found that dispositional mindfulness is associated with higher levels of One limitation of this past research is its focus on participants in psychological well-being and lower psychological distress a clinical setting, failing to provide insight into the (Hanley et al., 2015, Tomlinson et al., 2018). Patients' selfgeneralizability of the other populations, which could have many awareness and efficacy are essential in developing self-esteem unreported cases of self-harm due to cyberbullying. Although an and a greater sense of self-efficacy. association has been identified, examining the impacts and risk factors associated with self-injurious behaviors and suicidality In the two separate studies conducted on dispositional experienced by adolescents involved in cyberbullying is crucial. A mindfulness, one conducted in China by Zhao et al. (2022) and systematic review of 66 studies identified repetitive factors that the other conducted in Spain by Faura-Garcia, Orue, and Calvete influence the impact of cyberbullying on suicidal behavior and (2021), adolescents found that dispositional mindfulness self-harm. The review reported that mental health problems, provides a deeper understanding of the relationship between loneliness, sexual orientation/gender identity, and substance cyberbullying victimization and NSSI among adolescents and its abuse were all associated with a high risk of suicide and selfunderlying mechanisms. However, researchers suggested that 48 | InSession- July 2022 |

intervention and prevention strategies reduce emotional reactivity in youth to help stop cyberbullying victimization leading to the NSSI cycle (Zhao et al., 2022). Emotional reactivity is crucial as a mediator and is defined as a low threshold for negative emotional experiences, high emotional intensity, with a slow return to baseline (Nock et al., 2008). These findings show a relationship between emotional reactivity and cyberbullying victimization leading to the likelihood of engaging NSSI. Emotional reactivity is associated with dispositional mindfulness. Researchers indicated a higher association level with conditional mechanisms and the link between cyberbullying victimization and NSSI. Expanding upon these results in the United States for future studies would aid behavioral institutions and mental health practitioners in enhancing treatment for patients experiencing the sensation of NSSI. The clinical outcomes regarding the use of dispositional mindfulness interventions from Taiwan, China, and Spain are unique in cultural differences and are not directly comparable, given the variances in populations and demographics. Based on these factors, it is crucial to consider cultural settings as a limitation and to focus on adjusting the caveats when working with diverse populations. Culture is an important variable when developing standard questionnaires for those participating in a study or working with patients to connect the context of the bullying phenomenon to their phenomenological experience. Cultural competence is imperative for mental health counselors when utilizing these methods. The findings correlated with cyberbullying and NSSI demonstrate the effectiveness of dispositional mindfulness.

involving early detection, decreased screen time online, and increased cyber usage screenings and community involvement, with access to reporting abuse and supportive services for all parties involved (Byers, Mishna, and Solo, 2019). Other clinical approaches, using trauma-focused approaches for victims and engaging the bully with counseling instead of the punitive approaches utilized by the educational systems, have elicited evidence-based outcomes (Martinez and Temkin, 2021). The use of peer leaders and school nurses in educational settings has been successful in locating victims and bullies within the educational system (Long and Dowdell, 2021). School nurses as frontline workers are the first step in cyberbullying intervention step due to being able to ask questions related to cyberbullying. Upon building rapport with youth patients, pediatric nurses can include screening, educating, and using questionnaires regarding excessive online behaviors, which can assist in working with atrisk youth (Long and Dowdell, 2021). These methods are adaptable for counselors; showing empathy, validating, and mirroring the patient's phenomenological experience of pain, shame, anger, and humiliation from the incidents allows for the expression of feelings of students who desire to extract retribution on bullies in a safe environment which can be then be explored and allows for the patient's ability to regain control over the incident and learn other means of coping with the trauma (Byers, Mishna, and Solo, 2019). In-person group counseling highlights bullying as not an isolated individual experience but a social phenomenon by bringing other victims together in shared suffering and recognizing social pain (Byers, Mishna, and Solo, 2019).

Clinical implications

Protective factors associated with decreased suicidality and Depression, anxiety, self-harm, suicidality, and suicide have been suicide were noted in public health interventions on behalf of the school and the student's home. The more a student felt they indicative of those with increased usage of online and social belonged within the school environment and the school climate media access. Individual or group counseling has been utilized extensively in treating cyberbullying, victims, and perpetrators of was safe, the student was less likely to commit or attempt suicide bullying. Cognitive-behavioral therapy (CBT), Mindfulness-based after bullying (Hertz, Donato, and Wright, 2013). Schools should interventions, and psychodynamic therapeutic approaches have ensure a safe environment for students, which helps decrease bullying incidents and apply a systematic approach by involving a been successful for individuals in gaining self-awareness and increasing self-esteem by building upon self-efficacy, addressing multi-layer approach that includes parents, teachers, and administrators, with an increased focus on the involvement of relational challenges, and reducing NSSI. However, with mental health counselors in the school's community. cyberbullying, a complex system of dynamics, users cannot overcome viewing negative comments or images that may be Limitations shared virally through telecommunications and cannot be removed from the internet, which increases the risk of mental The limitations of this article are the variation in cultural distress, self-harm, suicidality, and suicide. The victims return to differences and limited data on addressing cyberbullying and the cycle of NSSI behavior, cutting, and high-risk behaviors of social media in the United States. The article did not cover the substance abuse, suicide attempts, and sexting. Based on these intensification of mass violence in schools based on bullying assertations, it is evident that the future of program development incidents. Gender identity was not explored due to limited data and interventions should shift towards integrated approaches on the issues associated with the LGBTQA+ community and | InSession- July 2022 | 49

and cyberbullying. While interventions were suggested, the recommendations were not exhaustive. Conclusion The evolving generations of technology and social media usage by youth and adolescents need guidance and interventions conducive to the modern world. A complex, multi-faceted approach is necessary to address cyberbullying in youth populations, suicidality, suicide, and psychological distress, including substance abuse and NSSI. Future research should consider the implications of increasing screenings in assessments for clinical practitioners to include the questions related to hours of usage of electronic communications and questions regarding cyberbullying and in-person bullying. Gender identity and gender differences in approaches should be considered when assessing and developing treatment plans to address the needs of patients. Additional considerations are the social investments by practitioners to work with families, educational systems, and community organizations, to facilitate improved clinical and cultural outcomes from a phenomenological approach for children and youth.

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Written By: Dr. Kimberly M. McCreary, Andrea V. Carcamo, & Rebekah Belkin Dr. Kimberly McCreary, Andrea V. Carcamo, and Rebekah Belkin work for Orlando Health South Seminole Hospital. Dr. McCreary earned a bachelor’s in criminology from the University of South Florida, a Master’s in Counseling and Psychology from Troy University, and a Doctorate in Public Health Leadership from Georgia Southern University. Andrae V. Carcamo earned a Bachelor of Science in pre-clinical Health Science from University of South Florida. Rebehak Belkin completed a bachelor’s degree in Health Sciences. The team shares an interest in pediatric and adolescent research and medicine, volunteering in the community and working with vulnerable populations.

References Byers, D. S., Mishna, F., Solo, C. (2019). Clinical practice with children and adolescents involved in bullying and cyberbullying: Gleaning guidelines from the literature. Clinical Social work Journal. Pp. 4-38. Retrieved from April 18, 2022, from Dorol-Beauroy-Eustache, O., & Mishara, B. L. (2021, September 16). Systematic review of risk and protective factors for suicidal and self-harm behaviors among children and adolescents involved with cyberbullying. Preventive Medicine. Retrieved April 16, 2022, from Faura-Garcia, J., Orue, I., & Calvete, E. (2021). Cyberbullying victimization and nonsuicidal self-injury in adolescents: The role of maladaptive schemas and dispositional mindfulness. Child Abuse & Neglect, 118, 105135. Fridh, M., Lindström, M., & Rosvall, M. (2019). Associations between self-injury and involvement in cyberbullying among mentally distressed adolescents in Scania, Sweden. Scandinavian journal of public health, 47(2), 190–198. Hanley, A., Warner, A., & Garland, E. L. (2014). Associations Between Mindfulness, Psychological Well-Being, and Subjective Well-Being with Respect to Contemplative Practice. Journal of Happiness Studies, 16(6), 1423–1436. Hertz, M. F., Donato, I., Wright, J. (2013). Bullying and suicide: A public health approach. Journal of Adolescent Health. 53 (10); S1-S3. Retrieved from doi: 10.1016/j.jadohealth.2013.05.002 Islam, M. I., Yunus, F. M., Kabir, E., & Khanam, R. (2022). Evaluating Risk and Protective Factors for Suicidality and Self-Harm in Australian Adolescents with Traditional Bullying and Cyberbullying Victimizations. American journal of health promotion: AJHP, 36(1), 73–83. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156. Long, M., Dowdell, E.B. (2021) Cyberbullying and victimization: An examination of online and health risk behaviors in high school. Pediatric nursing. 47(5). 226-23. Martinez, M., Temkin, D. (2021). School bullying has decreased during Covid-19 pandemic, but schools should prepare for its return. Child Trends. Retrieved from Memon, A. M., Sharma, S.G., Mohite, S.S., Jain, S. (2018). The role of online social networking on deliberate self-harm and suicidality in adolescents: A systematized review of literature. Indian Journal of Psychiatry. http: 104103/psychiatry.IndianJPPsychiatry_414_17 Nock, M. K., Wedig, M. M., Holmberg, E. B., & Hooley, J. M. (2008). The Emotion Reactivity Scale: Development, Evaluation, and Relation to Self-Injurious Thoughts and Behaviors. Behavior Therapy, 39(2), 107–116. Smith-Schoenwalder, C. (2021). CDC Study Documents Rise in Adolescent Suicide Attempts During Pandemic. U.S. News & World Report. Retrieved from (2021). What is cyberbullying. Retrieved from Tomlinson, Eve R., et al. "Dispositional Mindfulness and Psychological Health: A Systematic Review." Mindfulness, vol. 9, no. 1, 1 July 2017, pp. 23–43,, 10.1007/s12671-017-0762-6. United Nations International Children's Emergency Fund (UNICEF). (2019). UNICEF poll: More than a third of young people in 30 countries report being a victim of online bullying-Report highlights prevalence of cyberbullying and its impact on young people. Retrieved from Wang, C. W., Musumari, P. M., Techasrivichien, T., Suguimoto, S. P., Tateyama, Y., Chan, C. C., Ono-Kihara, M., Kihara, M., & Nakayama, T. (2019). Overlap of traditional bullying and cyberbullying and correlates of bullying among Taiwanese adolescents: a cross-sectional study. BMC Public Health, 19(1)., H., Gong, X., Huebner, S.E., Yang, X., Zhou, J. (2022). Cyberbullying victimization and nonsuicidal self-injury in adolescents: Testing a moderated mediating model of emotion reactivity and dispositional mindfulness. Journal of Affective Disorders 256–263. | InSession- July 2022 | 51

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2022 Elections Now in Full Swing Legislative Update from FMHCA Lobbyist, Corinne Mixon

Florida Candidate Qualifying officially closed at 12:00pm on Friday, June 17th. The Florida Department of State has completed updating the Candidate Listing for the 2022 Election and now the 2022 Election Cycle is in full swing. I wanted to provide a political update for FMHCA to help shape the landscape of what the voters will see before them. US Senate On the top of the 2022 Ballot with be the US Senate race for incumbent Senator Marco Rubio’s seat. Senator Rubio was the only Republican to qualify and has taken the GOP nomination unopposed. Current Congresswoman Val Demings is the presumptive Democrat nominee, but there are several other candidates in the race. Although somewhat of a “red wave” has been predicted in the State of Florida, Demings is considered one of the strongest Democratic contenders in the United States. Governor There are multiple Democrats running for the Party nomination to challenge Governor Ron DeSantis and Lieutenant Governor Jeanette Nunez. The Democrat Primary will likely be decided between Congressman Charlie Crist and Commissioner of

Agriculture Nikki Fried. Crist has the current advantage with endorsements, but Fried’s internal polling shows the two tied. Governor DeSantis has a sizeable fundraising advantage over all of his potential democrat opponents. Attorney General Aramis Ayala, Jim Lewis, and Daniel Uhlfelder are competing for the Democrat nominee to challenge incumbent Attorney General Ashley Moody. AG Moody has a sizeable fundraising advantage and is the current favorite to win re-election. Chief Financial Officer Republican incumbent Jimmy Patronis is being challenged by Democrat Adam Hattersley. As the two were the only ones to qualify, there will not be a Primary Election for this race. Commissioner of Agriculture Current Commissioner Nikki Fried has decided to seek the Democratic nomination for Governor instead of running for reelection. Current Senate President Wilton Simpson has obtained the endorsement from former President Trump, Governor DeSantis, as well AG Moody and CFO Patronis. Simpson is the | InSession- July 2022 | 53

current favorite for this race. Redistricting After the completion of the 2020 Census, the State was required to reapportion seats for Congress, the State House, and State Senate. During the 2022 Regular Session, the House and Senate passed SJR 100, establishing the districts for the State House and State Senate. The plan did not require the Governor’s approval and was submitted to the Courts for final approval. For the first time ever, there were no opponents challenging the maps for the first time since judicial review of the maps was established. Unlike the maps for the State House and State Senate, the Congressional maps require the Governor’s signature before becoming law. The Legislature passed SB 102 and sent the Governor the bill to establish Congressional Districts. The Governor vetoed the maps and called the Legislature back into Special Session to draw new maps. The Legislature passed SB 2C, a version of the plan drawn by the Governor’s staff. The Congressional maps are currently the subject of lawsuits, but the State Supreme Court refused to expedite the case and the Court of Appeals decided the Governor’s map will be the one used in 2022.

The majority of policy issues affecting FMHCA members and the people you care for are decided at the state level, so FMHCA is paying close attention to the state House and Senate races. Here’s a breakdown of those dynamics. Both of FMHCA’s recent bill sponsors, Sen. Ana Maria Rodriguez and Rep. Traci Koster, have drawn opposition. These two members were instrumental in passing the Counseling Compact legislation. Florida House All 120 seats of the Florida House are up for re-election. The majority of the districts have members of both parties running, but some districts do not have challengers. Florida Senate Due to redistricting, the entire Florida Senate’s 40 districts are up for re-election. After this election, the elections will be staggered. Those running in an odd numbered district have a 2-year term and will run for a 4-year term in 2024. Even numbered districts will be up for election for a 4-year term in 2026. Election Dates: Florida Primary – August 23rd General Election – November 8th

Written By: Corinne Mixon, FMHCA Lobbyist Corinne is a registered professional lobbyist with more than twelve years of experience representing clients' state government interests. At Rutledge Ecenia, Corinne represents a broad client base with a particular emphasis on health care practitioners, education, and regulated industries.

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