Volume 18, Issue 6

June

President’s Message Greetings! As I write this it occurs to me that this will be my last column as President of FMHCA. President-Elect, Erica Whitfield will be taking on this mantle as of July 1, 2018. Rest assured that Erica will be leading this organization to a new level of activism and functioning. I cannot help but to feel immense gratitude for what I see as a major highlight of my Mental Health Counseling career. And I never thought retirement would have been this adventurous. In this parting let me say what a joy it was to work with the FMHCA board members all of whom bring their unique experience in problem solving, brain-storming, and tending to the matters that count the most for FMHCA. How fortunate we are to be served by such a talented, creative, and committed bunch! I wish to thank Frank Hannah for hanging in there for one more year as the Board’s Parliamentarian and I send the best of wishes in devotion to your mental health project. You will be missed. Stepping into Frank’s seemingly unfillable shoes will be Michael Holler who has been boning up on Robert’s Rules so that as a board we are fully in-line with the correct order in conducting our meetings. Welcome, Michael. I wish to report that I am pleased with the Regional Directors model which was put in place approximately 3 years ago. The goal has been to create a level of leadership that would work with chapters within their region in development of grass roots activism but, most importantly, to develop and grow additional networks and chapters within the regions. Individual chapters and networks are the life blood of FMHCA and we wish to continue our growth through efforts within each region. Joe Skelly: Northwest Region Cindy Wall: Northeast Region Elisa Niles: Southwest Region Tania Diaz: Southeast Region In gratitude for stepping into this role and beginning the process of consolidating strength, developing programs for networking, and then stepping up to serve again.

And, finally, Darlene Silvernail and her dynamo staff who oversee FMHCA finances, plan and develop our annual conference, maintain the website, and generally take up all the slack to keep this engine running smoothly. Words would diminish the meaning of how incredible you are in nurturing this organization. Diana and Laura And so, with neither ceremony nor fanfare, I say thank you for this wonderful year and the opportunity to serve.

Louise Sutherland-Hoyt, LMHC, CCMHC, NCC, MAC

Board of Directors 2017 - 2018 President Louise Sutherland-Hoyt LMHC, NCC, CCMHC, MAC lsutherland@flmhca.org

Darlene Silvernail Executive Director Leonel Mesa Past-President Erica Whitfield President-Elect

Kathie Erwin Secretary Benjamin Keyes Treasurer Cindy Wall

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Our growing membership leads me to believe you realize FMHCA is dedicated to your progress in the State of Florida. We are already looking forward to our 2019 Annual Conference. It will be held in Lake Mary, Florida at the Orlando Marriott Lake Mary (the same hotel this year's conference was held at). Quick reminder call for presenters is going on now! Deadline to submit is JULY 1 Each year millions of Americans face the reality of living with a mental illness. During May, FMHCA and the rest of the country are raising awareness of mental health. Each year we fight stigma, provide support, educate the public and advocate for policies that support people with mental illness and their families.

Regional Director NE Joe P. Skelly Regional Director NW Tania Diaz

Regional Director SE Elisa Niles Regional Director SW Frank Hannah Parliamentarian Diana Huambachano Executive Administrator FMHCA Chapters Broward County Central Florida Emerald Coast Gulf Coast Miami-Dade Palm Beach County Space Coast Suncoast

I encourage you all get involved in any of FMHCA' committees, let your voice be heard, join a chapter as a local member and see firsthand how association efforts can benefit your career, your client base, and your scope of knowledge. Take advantage of our webinar series in order to strengthen your professional identity, and get to know the leaders within our organization. Make connections in your community and beyond by getting to know your local chapter presidents and local mental health advocates. Join a local chapter in order to support the community at large, your future depends on it!

As clinicians I encourage you to get involved, this is a very political and economically challenged time and we understand the stressors that clinicians are facing however in order to make rather create change it’s important that you be a change agent and join FMHCA . Sincerely, Darlene Silvernail PhD, LMHC, CAP Executive Director

We l c o m e O u r N e w F M H C A 2 0 1 8 - 2 0 1 9 B o a r d o f D i r e c t o r s !

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Volume 18, Issue

Early Bird Rates Happening Now until November 1st, 2018 Click Here To Register

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The politics and policies of June As the lobbyists for the Florida Mental Health Counselors Association (FMHCA) it’s important to relay pertinent updates to the Association even when the Florida Legislature is not holding its annual 60-day legislative session. The FMHCA Government Relations Committee (GRC), Board of Directors (Board) and dedicated association members work year-round to ensure that FMCHA is poised to react to Florida’s policy and political landscape on behalf of the mental health counseling industry. Heading into June, both politics and policy are in-play. The midterm elections are heating up and FMHCA is already engaged in discussions with the state board, Florida Department of Health (DOH) and other industry leaders regarding the topic of license portability – a topic that could result in a bill next year. Florida is in throws of a turbulent midterm election season. From open seats to races where incumbents preside, a slew of ardent-hearted, money-toting candidates are already trading punches, defending records and spending millions on 30 second media buys in anticipation of the August primary and November general election. And rightly so. The stakes are high. The Florida Senate is currently made up of 23 Republicans and 17 Democrats. It’s believed that the Democrats may bring the upper-chamber closer to balanced. In addition, Florida’s four cabinet seats are up for grabs and the race for governor will be one of the most watched in the nation. If the “blue wave” persists (Democrats won a massive upset in Florida’s most recent special election. Margaret Good beat Vern Buchanan, son of Congressman Buchanan by a whopping 8 points in a district that Donald Trump carried by more than 4 points; article here) the state is likely to see a subtle shift toward the Democrats. It’s possible that the “blue wave” will flatten and that the Democrats will make only minor gains, but any movement toward Democratic leadership would be abnormal for Florida’s recent history. The last time a Democrat served as governor of Florida was 1999 and the Senate

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hasn’t seen a Democratic president since 1993. These changes could impact how policy is made. The Republicans have remained extremely loyal to their leadership and have accomplished a wealth of their priorities as a result of their cohesion. A closer ratio of Democrat to Republican means extensive negotiating would need to occur in order for legislation to pass. Many of those negotiations would become more bipartisan. The makeup of the Florida House and Senate has an impact on FMHCA and all Floridians. Contrary to popular belief, state politics has as much, if not more, impact on your daily lives, both personal and professional, than national politics. This Association is the only entity advocating solely for the practice of LMHCs and the people you treat. One example of that advocacy is FMHCA’s recent involvement in a state board workshop to discuss developing legislation to create a portable licensure system or multistate licensure compact. FMHCA holds a valuable seat at the table where the bill may be written. If FMHCA supports the measure, its lobbyists will advocate for the legislation during the 2019 session which begins in March. If the bill is crafted in such a way that FMHCA cannot support it, we will work to kill the legislation. The concept of portability is relatively new in Florida. The injection of fresh faces into the Florida Legislature and Cabinet may bring forth the opportunity for contemporary ideas. Being a member of FMHCA is one of the most important roles you can play. The profession and its title exist in statute because your professional predecessors engaged in political races, crafted legislation and advocated for the distinction of LMHC. Your lobbying team and GRC will continue to update you about the topic of licensure portability as well as the upcoming election. We are proud to lobby on your behalf.

Lobbyist Report, by Corinne Mixon, Rutledge Ecenia, P.A.

FMHCA is seeking Graduate Students and Registered Interns to contribute monthly articles for our newsletter. This is a wonderful opportunity to share your point of view and your journey to licensure with others while getting professional exposure. We're looking specifically for articles that will you're your peers navigate the journey to graduation and licensure - study tips, resources, how-tos... there are so many relevant topics worthy of investigation and discussion.

Submit an Article Here

Develop Your Plan of Action – Writing & Speaking (part 5/5) People do business with people they know, like and trust. ThisV oseries about taking l u m e is 18 , Issu e 6 action on your goals:Pto a gget e 7 J u n e gain credibility and likability; and earn their trust. Each self-promotion strategy highlighted will give you noticed; an opportunity to do what it takes to achieve your goals. WEB STRATEGY I believe that every therapist looking to grow a private practice needs a basic website. Even a one-page website will suffice, as long as it answers the 3 bit questions most readers have of any site they visit: “Who are you?”, “How can I find you?”, and “What can you do for me?” If you want to use the web to take your business beyond the dollars-for-hours service we provide with counseling, the web can give you the biggest bang for your buck. Start small on your own, or invest in a coach to help you expand this part of your business. Benefit to you: You can start to sell programs and products as an alternate means of income for your practice. You can use the web to promote your counseling services and any trainings or workshops you might develop. You can post videos and generate educational emails for your subscribers. Benefit to them: People will have access to all of your offerings. They will get the opportunity to get to know and trust you better by reading about you and by participating in your programs or buying your products. Action plan • Identify 1 program, product, or service you’d like to promote online. This can be geared for your target market, or it could be something very different. It might be something as easy as offering a monthly newsletter for subscribers to your email list). I did that, and my first product was a video-series that helped people manage their panic attacks • Have fun putting together the details of your idea. This is a time for you to be creative. Use your talents – art, acting, music, etc. – if you like • Keep it simple when determining the process. For example,  I will help my prospective clients get to know me by offering a free video about “5 Ways to Manage Stress When You’re Having a Baby”  Create the video an upload it to YouTube (so you can get a link to share)  Put an “opt-in” on the homepage of your website (that box where people can sign up with their email) to get the video  Manage the opt-ins yourself or make it easy with a free trial using Constant Contact, AWeber, or any other email marketing option  Develop a “thank you” email to send along with the link to your video once they opt-in  Follow up from time to time with helpful information your audience will appreciate (this is made easy using the email marketing service). They will get to know you and hopefully they will be willing to do business with you in the future – perhaps a 3-hour online training for “New Moms”  Alternate streams of income can be a challenge, but can also keep things interesting for you in your business. They can provide an outlet that face-to-face therapy cannot. They can also give you ways to make extra money in the process. REMEMBER: A goal without action is just a dream. Now is your chance to show yourself just what you’re willing to do, to get what you say you want!

Deb Legge, PhD CRC LMHC DrLegge@gmail.com Deborah A. Legge, PhD, CRC, LMHC, is a nationally known private practice expert who specializes in helping entrepreneurial therapists grow their practices, including a special focus on how to create growth with private pay clients. For over twenty-two years, she has maintained a highly successful clinical practice and a coaching practice that has helped thousands of clinicians fill their appointment books using her proven success strategies. Building a successful private-pay private practice can be a big challenge, but you are not alone. Go to: www.privatepaypractice.com for her allnew free training, Market Magnets: How to Fill Your Book with Private Pay Clients… And End Your Insurance Struggles for Good

June

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We are so thankful and impressed by our Military Committee leadership. FMHCA Military Committee Chairperson and President/CEO of Veterans Counseling Veterans INC, Ellsworth "Tony" Williams, received special recognition from the Tampa City Council on Sunday, May 20th, 2018. The FMHCA Military Committee and Veterans Counseling Veterans work closely with one another and we consider their achievements a success for our community.

Treating Tobacco Dependence: Serving Low-Income Clients Tobacco use is down across the United States, and has been steadily lowering since 1964—when the Surgeon General’s Warning first linked smoking to increased chances of lung cancer. Since this time, we have expanded our knowledge of the negative health effects of tobacco use, including cancer, cardiovascular disease, diabetes, rheumatoid arthritis, reproductive health issues, premature aging, and osteoporosis (Centers for Disease Control and Prevention [CDC] , 2014; U.S. Department of Health and Human Services, 2014). Low socioeconomic status (SES) is linked to higher risks of many of these diseases, including cardiovascular disease (Jones et al., 2009), diabetes (Rabi et al., 2006), stillbirth and neonatal death (Larson, 2007), and cancer— especially late-stage cancer that had previously gone undetected (National Cancer Institute, 2008). Thirty-two percent of adults living under the poverty line smoke cigarettes (CDC, 2017)—a rate twice as high as the general population (16%) (CDC, 2015)—and almost three-quarters of all smokers live in low-income communities (Truth Initiative, 2018). And while smoking is certainly not the only contributing factor to health disparities, the U.S. National Cancer Institute and World Health Organization issued a report in 2016 stating “tobacco use accounts for a significant share of the health disparities between the rich and the poor”. So what accounts for the disparities in tobacco use between the rich and the poor? A major contributing factor is direct marketing from the tobacco industry. Back in the 1940’s, the relationship between smoking and income was reversed: people with higher incomes were more likely to use tobacco than people with lower incomes (Truth Initiative, 2018). However, as word spread that tobacco was bad for your health, people with higher incomes stopped smoking and tobacco companies started directly targeting low income consumers. Both Phillip Morris and RJ Reynolds, major tobacco companies, created a new market profile for their consumers: the “downscale” market (Apollonio & Malone, 2005). RJ Reynolds concluded that this “downscale market”, that is low-income, lower-education populations were (and this is a direct quote from their 1989 marketing study, ellipses included in the original) “more impressionable to marketing/advertising… they’re more susceptible. They’re less formed intellectually… more malleable” (Apollonio & Malone, 2005). The company partnered with the U.S. Department of Agriculture in 1976 to directly market to low income populations by including cigarette coupons in the envelopes containing food stamp benefits (Brown-Johnson, England, Glantz, & Ling, 2014). Talk about target marketing. The target marketing hasn’t stopped, despite legal crackdowns on the way tobacco companies are allowed to market their products. Low-income neighborhoods have more tobacco retailers, are more likely to have tobacco retailers located within 1,000 feet of schools, have larger sized storefront advertisements, and lower average product price than middle- and high-income areas (Seidenburg et al., 2010). In addition to direct targeting by the tobacco industry, people with lower incomes face additional barriers to quitting. More people in low-income communities smoke, meaning it is not just more socially acceptable to do so, but also that people currently trying to quit have to deal with more exposure to tobacco in their day to day lives. Additionally, people with lower incomes have less access to healthcare providers who can give them information about free cessation resources that include counseling and medication. If you would like to take part in improving access to free tobacco cessation resources for your clients—whatever their income, contact your local Area Health Education Center (AHEC) at www.ahectobacco.com. The website provides online resources for your office, including posters, quit kits, and factsheets. The Tobacco Free Florida AHEC Program provides free, in-person tobacco cessation all over the state of Florida. The program also provides training to health professionals, including continuing education trainings available in-person and online, and a three-day Tobacco Treatment Specialist (TTS) training where professionals earn the TTS credentials. For more information about TTS training, visit www.med.fsu.edu/ahec. Click Here To Access References

Writer: Kat Jacobs, MSW, TTS FSU College of Medicine Area Health Education Center

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Volume 18, Issue

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What LMHCs in Florida Should Know About Requests for Emotional Support Animal Letters

written notice, as using a service animal and being qualified to use a service animal or as a trainer of a service animal commits a misdemeanor of the second degree, punishable At a recent webinar I presented for the National Board of as provided in s. 775.082 or s. 775.083 and must perform Forensic Evaluators (NBFE), I polled 50 LMHCs on the 30 hours of community service for an organization that question of how many requests for emotional support serves individuals with disabilities, or for another entity or animal letters they’ve received from clients. Seventy percent of attendees reported that they had received at least organization at the discretion of the court, to be completed one such request, and 40% reported that they received 3 or in not more than 6 months” (Florida Legislature, 2017, para. 9). I am concerned that any LMHC, as more requests. Increasingly, mental health counselors are well-intentioned as he or she may be, who erroneously supbeing asked to write these letters, but few of us have any formal training on the complex nuances of addressing such ports the portrayal of an ESA as a service animal may be opening himself or herself up to liability if the client is ever requests. charged for misrepresentation. To complicate matters, in many cases people seek ESA letters not because they have disabilities and require the ESA FACT #3: THE USE OF ESAs ARE PROTECTED BY FEDERAL LAW IN ONLY TWO CONTEXTS to function in a society, but rather because they want to transport their pets with them on trips inexpensively, or Federal law extends unique protections to ESAs (compared they want to move into an apartment or condo that prohib- to other animals) in only two contexts; air travel and its certain animals, or maybe just because they enjoy housing. The Air Carrier and Access Act (ACAA)/14 CFR, bringing their pets with them to public places, none of Part 382 extends protections to “any animal shown by which are legitimate requests for ESA letters. documentation to be necessary for the emotional well-being In this article, I’ll outline five facts that I think are vital for of a passenger” (U.S. Department of Transportation, 2016, LMHCs to know before they consider writing such a letter, p. 1). In fact, the ACAA essentially treats ESAs about the and then, having researched the professional literature and same as it does service animals. federal and state legislation pertinent to this issue, I’ll provide LMHCs with suggested practices and resources to aid them in addressing ESA letter requests.

The ACAA requires airlines to permit ESAs to sit with clients, provide service animal relief areas at airports, and prohibits airlines from requiring clients to sign waivers of liabilFACT #1: ESA’s ARE NOT RECOGNIZED AS SER- ity for harm to ESAs, but there are several stipulations and exceptions. The ESA cannot obstruct the aisle or emergenVICE ANIMALS UNDER THE ADA cy exit, the passenger must provide a current letter from a The Americans with Disabilities Act (ADA) defines a serlicensed mental health professional, the animal must be vice animal as “a dog that has been individually trained to trained to behave appropriately in a public setting, the ESA do work or perform tasks for a person with a disability” may be prohibited if it is deemed “unusual” (e.g., snakes, (U.S. Department of Justice, 2011, para. 3). ESAs, on the other reptiles, ferrets, rodents, and spiders) or is considered other hand, are “animals that provide comfort by being a direct threat to the health or safety of others, and the cliwith a person” (U.S. Department of Justice, 2011, para. 5). ent may be required to provide up to 48 hours’ advanced ESAs are NOT protected by the ADA., so employers are notice to the airline and check in one hour before the usual not required by the ADA to accommodate the use of ESAs check-in time (U.S. Department of Transportation, 2010). by employees or by the general public. The letter from a licensed mental health professional must FACT #2: IT IS ILLEGAL TO PORTRAY AN ESA be no older than a year, be printed on the professional’s AS A SERVICE ANIMAL letterhead, include the professional’s type and state of It’s important for you and your clients to know that it is licensure, and document that (a) the client has a mental or illegal to portray an ESA as a service animal. For example, emotional disability as defined by the DSM, (b) the client a woman recently came into our counseling office with an needs (i.e., not wants, prefers, or would benefit from) the untrained (though adorable) puppy donning a red vest ESA to travel, and (c) is under the care of the mental health labeled “Service Animal” with an ID badge obtained online professional (U.S. Department of Transportation, 2010). that inferred that the animal was protected under the ADA. The client was cautioned about Florida Statute 413.08(9), which reads “A person who knowingly and willfully misrepresents herself or himself, through conduct or verbal or

The Fair Housing Act defines an ESA as an animal that “provides emotional support that alleviates one or more identified symptoms or effects of a person’s disability” (U.S. Department of Housing and Urban Development, 2013, p. 2) and is not conceptualized as a pet. If the rationale for an ESA is well-documented and the accommodation request is reasonable, then landlords and property owners may be required to permit tenets to have an ESA in properties that otherwise prohibit animals. If there is not sufficient evidence to support the assertion that a client needs, versus wants or would benefit from, the ESA, the request may be denied. FACT #4: TO WRITE AN ESA LETTER FOR A CLIENT, LMHCs MUST FIRST CONDUCT A DISABILITY EVALUATION/FUNCTIONAL LIMITATIONS ASSESSMENT Both the Air Carrier Access Act and Fair Housing Act require clients to not only have a mental disorder, but to have a disability, and it is the LMHC’s responsibility to determine whether a client has a disability prior to writing an ESA letter (Bonness, Younggren, & Frumkin, 2017; Younggren, Boisvert, & Boness, 2016). There are many definitions of disability, some legal and some clinical. I favor a definition offered by Gladding (2018):

Disability: A physical, behavioral, or mental condition that limits a person's activities or functioning. A disability may be either temporary or permanent. It prevents a person from performing some or all of the tasks of daily life, such as taking care of bodily functions, walking, talking, or being independent of a caregiver (Kindle locations 2933-2935).

have rescinded. If the counselor does not have a thorough and specific understanding of the client’s disability and the role of the ESA in ameliorating that disability, then the counselor should not write a letter attesting to such needs. What might happen if an LMHC doesn’t assess disability thoroughly before writing an ESA letter? There are several court cases that shed some light on this issue. One such case here in Florida is Hawn v. Shoreline Towers Phase I Condominium Association, Inc., ND Fla. 2009. In this case, a psychologist wrote a letter opining that “the plaintiff suffered from severe panic attacks; was unable to properly cope with anxiety and stress; and was particularly vulnerable ‘while residing at his home/condo due to past occurrences on that property.’” (Ensminger & Thomas, 2013, p. 107). The psychologist then prescribed an ESA to “provide support and help plaintiff cope with his ‘emotionally crippling disability’” (Ensminger & Thomas, 2013, p. 107). The psychologist wrote this letter based on a template his client gave him after just two one-hour counseling sessions and no in-depth or formal evaluation process. The court determined that this assessment process was insufficient to meet the legal standards outlined in the Fair Housing Act. This case is important to reflect on when a client who you’ve hardly worked with and have not formally evaluated for disability requests an ESA letter.

A tool recommended in the DSM-5 for assessing disability, the World Health Organization Disability Assessment Schedule, Version 2.0 (WHODAS 2.0), is free at https://www.psychiatry.org/psychiatrists/practice/dsm/e In the fifth edition of the Diagnostic and Statistical Manual ducational-resources/assessment-measures and relatively of Mental Disorders (DSM-5), disability refers to the func- easy to learn to administer and interpret. The WHODAS 2.0 enables LMHCs to identify functional impairments that tional impairments in social, occupational, and other important life activities (American Psychiatric Association, may constitute disability. 2013). Federal legislation typically refers to an individual However, the WOHDAS 2.0 is entirely dependent on acwith a disability as someone who “has a physical or mental curate and insightful feedback from clients and/or their impairment that substantially limits one or more major life family members. Because some clients are prone to falsify activities” (U.S. Department of Labor, n.d., para. 3). or exaggerate information in order to obtain an ESA letter, I strongly recommend that LMHCs use tools and measures Prior to writing an ESA letter, the counselor should specifically determine how the client’s symptoms interfere designed to detect signs of malingering, feigning, and exagwith his or her ability to perform important life activities, geration of symptoms. Examples of such tests and strucand specifically how the ESA enables the client to perform tured interviews include the Personality Assessment Inventhese activities. For example, suppose a client with Panic tory, Structured Interview of Reported Symptoms-2, and Disorder has a history of severe panic attacks and responds the Structured Interview of Malingered Symptomatology. Additionally, securing records from other treatment proby avoiding public places, eventually developing viders and corroborating information from family memAgoraphobia, but finds that when accompanied by her emotional support animal, she finds her panic attacks to be bers may be appropriate measures. bearable enough to remain in public until the symptoms

FACT #5: ESA LETTERS ARE NOT ALWAYS CLINICALLY APPROPRIATE NOR ETHICAL, AND CAN SOMETIMES BE DETRIMENTAL TO A CLIENT’S RECOVERY I think it is best to offer a few real case scenarios to illustrate this point (some details have been revised to honor client confidentiality).

how likely it would be that Emmett’s girlfriend’s possible disorder(s) could simultaneously be so severe and limiting that she needed an ESA to function in a society, yet she was not concerned enough about her mental health to need any form of treatment.

Generally speaking, I am concerned about treating mental disorders by fostering dependence on any single person or animal rather than working with clients to help Case #1 them develop inner coping strategies sufficient to access— Ralph was recently “kicked out” of his home by his wife, and thrive in—the world around them. I am concerned who is now considering divorce because of his chronic that reinforcing a client’s belief that she can only cope with alcoholism and lack of follow-through with recovery. life if she has an animal by her side may maximize dependRalph took the family dog with him and moved into an ency while minimizing independence. Other questions apartment. He shows up for his next therapy session with arise, such as what happens if or when the animal dies or is his dog with him, who is not very well-behaved. Ralph no longer able to travel due to its age or physical condition. discloses that he has continued drinking and has not attend- If we replaced the term “ESA” with a significant other, ed AA meetings because he cannot leave his dog alone. He does it sound so healthy to say, “I can only cope with the also requests an ESA letter so that he can bring the dog world if my boyfriend is by my side?” Wouldn’t the optiwith him into public places that don’t permit dogs. mal therapeutic outcome be for the client to participate in Case #2 society without needing someone or something outside herJuanita shows for her initial appointment with a three-tiered self? baby stroller containing two Chihuahuas and a cat (one ani- Lastly, if too many people acquire ESA letters that aren’t mal in each compartment). During the appointment, she truly necessary, and government, airlines, etc. start to “crack appears anxious, disheveled, disorganized, stressed, and dis- down,” how might this impact others in society, including tracted, tending to the needs of her restless animals so inindividuals with legitimate disabilities who require trained tently that she often has to interrupt herself or the therapist. service animals to perform essential activities of daily living? She reports that she is not certain she will have much time I believe these are all important questions to ponder as a for therapy because she is very busy with her “fur babies.” clinician expected to filter dilemmas through ethical values She wants an ESA letter, stating that she doesn’t need ther- of autonomy, nonmaleficence, beneficence, justice, fidelity, apy or medication, just her “kids” (referring to her animals). and veracity. Case #3

RECOMMENDED STRATEGIES

Emmett contacts a therapist and asks if he can get an emo- Bonness, Younggren, and Frumkin (2017) offer the followtional support animal. He explains that he and his ing strategies for addressing ESA letter requests: girlfriend are going to fly up north to visit family. His 1. Assess whether the ESA-related accommodation will girlfriend has a Chihuahua that she does not want to leave lead to improvement in the client’s psychological condibehind, as it makes her anxious. “Plus,” he explains, “dog tion (i.e., is it therapy-related). If so, make reduction of kennels are expensive, and so are fees for bringing them on the need for the animal a long-term therapy goal. a plane.” 2. Conduct a comprehensive disability determination evalThe therapist explains that if Emmett’s girlfriend would like uation, including assessment measures designed to detreatment for her anxiety, she can come in and the therapist tect malingering and exaggeration of symptoms can conduct an assessment and treatment plan, which may or may not include an emotional support animal. Emmett 3. Develop an evidence-based protocol for addressing ESA letter requests. responds, “Oh, she doesn’t want treatment, she just wants to bring her dog on the plane.” 4. Limitations should be offered in the letter (e.g., time restrictions) In the first and second scenarios, my conclusion was that the clients’ animals were actually interfering with— not aiding—the client’s progress and participation in therapy and/or recovery, and in the third scenario I questioned

RECOMMENDED RESOURCES If I’ve done my job well in exploring the nuances of writing ESA letters, you hopefully now see how complex this matter can be. Fortunately, there are some resources to help you learn more and ensure that you are following legal requirements and recommended practices. The National Board of Forensic Evaluators (NBFE), which is partnered with Florida Mental Health Counselors Association (FMHCA), has graciously offered a link to all FMHCA members containing an ESA Assessment/Letter Checklist, sample ESA letter, and copies of a PowerPoint on a recent webinar, all downloadable for free at https://app.box.com/v/ESA. In addition, FMHCA members can view a 1.5-hour video recording of the ESA assessment webinar on YouTube at https://www.youtube.com/watch?v=N0G3L46jpXE. It is my sincere hope that FMHCA members find these resources helpful.

About the Author and References

Aaron Norton, LMHC, LMFT, MCAP, CCMHC, CRC, CFMHE

“The Importance of Mental Health Hygiene: Learn to Live Not Just Survive” In most cases, when people reflect on the meaning of health, they recognize nutrition and exercise as fundamental components associated with wellness. And while nutrition and exercise are recognized as two essential elements necessary for maintaining a healthy lifestyle, mental health is often overlooked. In today’s fast paced world of gadgets, projects, and work commitments, the importance of Mental Health ranks low, if it at all, on the daily “To Do List”. Despite the growing body of empirical evidence that confirms numerous health-related ailments attributed to prolonged stress such as high blood pressure, fatigue, gastro intestinal problems, sleep disturbances, irritability, depression, and headaches, mental health hygiene is often overlooked. Perhaps mental health hygiene is easily dismissed because its symptom manifestation fails to surface in palpable ways unlike medical conditions that are assessed with instruments leading to tangible outcomes. Outcomes that are intangible and unexplained are often discredited, shunned or dismissed because they fail to produce quantifiable measures with consistent results. The propensity for society to address stress-related symptoms with pharmaceutical treatment is on the rise. The fast acting remedies allow people to continue to push themselves further without becoming aware of the underlying causal factors that tend to implicate both the body and mind. Failure to address the causal agents that lurk beneath the daily activities of life may cause simple to treat conditions to graduate into needless chronic diseases. As such, learning to listen to your body and what it’s attempting to tell you should take priority. Understand that your body holds an innate wisdom that will send you alerts indicating it is time slow down, recharge, and replenish. As such, honor your body and treat it with respect. Learn to listen to what it needs and what it is trying to communicate to you. To help create a balanced lifestyle, find an activity that regenerates you such as taking up a hobby, schedule a walk in nature, register for that salsa class you have always put off, take to the mat with yoga, learn to meditate, attend a workshop on health and wellness or simply use heart-centered breathing to help you center yourself daily. Whatever you choose, learn to invite new experiences into your life that allow you to balance your personal and professional life. My humble philosophy is that you can only give to others that which you have to give. Hence, as a parent, spouse, student or employee, take care of yourself emotionally, psychologically, spiritually, and physically for they are all intertwined in a beautiful tapestry called life. Dr. Tania Diaz Faculty, Albizu University

"I" Statements verses "You" Statements WHAT’S THE DIFFERENCE BETWEEN, “YOU MAKE ME ANGRY” AND, “I DON’T LIKE IT WHEN YOU SAY THOSE THING” Conflict in relationships starts in many ways. Our needs and wants drive the conversation and sometimes we have a hard time seeing the other persons position or perspective. Conflict can also be driven by fear, control, jealousy, and a poor self-esteem. But the easiest way (not meaning the best) is to use a “you” statement to persuade your idea or perspective. The phrase in the title, “you make me angry” will start an argument if you’re not in one already. Now this statement is expressing in an emotion which could be healthy on its own but it’s the “you” that brings that attack and what the other person mainly hears. But how else am I supposed to get across my feelings of rejections, abandonment, or maybe insecurity, you may ask? I can think of at least two ways to state your feelings in a healthy way: 1. A gentle startup in any conversation is recommended by the literature in the Gottman couples manual to reduce conflict between couples. But I have found the literature falls short of explaining what the gentle start up means. It’s true the idea of gently bringing subjects, especially potential conflictual information, is recommended for couples and I have it seen it benefit more than one couple. I add three ways to see this gentle startup more clearly using these three ideas: Curiosity—bringing up issues in a curious way leads to potential humility and furthering the conversation Questions—rather than a “you” statement, asking a question in a compassionate way can suspend judgement and give the other person a chance to answer the question without feeling evaluated or criticized. “I need” statements—I need expresses emotions or wants without demands or manipulation. Simply saying, “I need compassion from you in this moment” will get a better response than, “you make me angry” which is projecting onto another. This idea of a gentle start up takes preparation as to what and how you will communicate your needs. But with a little practice I have found many couples and clients can more effectively communicate using this idea of gentle start up. 2. Another form of healthy communication is think less passively or aggressively and more assertively. Judith Belmont in her worksheets on, “The Three Styles of Communication” from her website (belmontwellness.com) explains that a part of assertive communication is: Expressing yourself honestly and kindly Refrain from physical or verbal force Use “I” statements Is more concerned with being kind than right Often our communication becomes either passive or aggressive which can lead to not expressing ourselves in a healthy way or to express in an aggressive way, like using “you” statements instead of “I” statements. I find this works well in helping teens explain their feelings in a healthy way without having to argue or disrespect parents. Our relationships need healthy communication to grow and thrive in a world where so many things pull us away from relationships. But even now with phones, tablets, and Netflix people are still coming to see me for relationships and the desire to for better communication. And the soul satisfying feeling that I get as a therapist when relationships are healed and reconnected is worth working through all the “you” statements, rough start ups, and aggressive/passive communication. References Belmontwellness.com—three styles of communication. Gottman training manual for couples—ways to reduce conflict—gentle start up. Scott Jones LMHC (Licensed Mental Health Counselor) CAP (Certified Addictions Specialist) Qualified Supervisor, State of FL Email: scottjones@newdirectionscounselingfl.com Website: newdirectionscounselingfl.com Online Counseling for therapy and supervision through GoToMeeting Based out of Orlando FL

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Check it out! Erica Whitfield Erica discusses her priorities for presidency; gaining new members ! Click Below To Watch https://youtu.be/PswdEBmGoug

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Increasing Counselor Knowledge of Disabilities: Understanding Global Perceptions, Available Resources, and Engaging in Advocacy 22 June 2018 2:00 PM - 4:00 PM CE Broker Tracking #: 20-601735 The Centers for Disease Control and Prevention (2015) reported that more than 53 million adults living in the United States have a disability. In fact, the United States Department of Labor (2017) stated that persons with disabilities form the largest minority in the country. Regardless of these numbers, persons with disabilities have been marginalized and mistreated for centuries. Our responsibility as professional counselors is to ensure the highest level of care to our clients, and as such, it is vital that we aim to increase our counseling competencies by learning more about persons with disabilities. This webinar will begin by defining the term disability, and explain what constitutes a disability. It will then highlight the evolution of psychosocial attitudes towards individuals with disabilities, and describe various laws and regulations enacted in support of those with disabilities. The webinar will conclude with a discussion of services, resources, and reasonable accommodations that clients with disabilities may benefit from. Learning Objectives: •

Define the term disability and explain what constitutes a disability

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Discuss the evolution of psychosocial attitudes held towards persons with disabilities.

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Highlight laws and regulations that have been enacted in support of persons with disabilities.

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Provide a list of services and resources that clients with disabilities may benefit from. Don't miss out! Register here: https://fmhca.wildapricot.org/event-2749855/Registration Daniel Balva is a recent graduate of the Clinical Mental Health Counseling and Vocational Rehabilitation Counseling master's program at Florida International University. Daniel is a National Certified Counselor and Certified Rehabilitation Counselor. He is currently working towards attaining licensure in the state of Florida. Daniel’s clinical experience includes working for the Division of Vocational Rehabilitation, working in an adult outpatient setting, a crisis stabilization unit, and for a nonprofit agency focused on providing services to court-mandated adolescents.

Distance Counseling in Florida 27 Jul 2018 2:00 PM Unsilencing the Voice Within: Expressive Writing as a Therapeutic Tool 24 Aug 2018 2:00 PM Pornography Therapeutic Interventions 28 Sep 2018 2:00 PM LMHC Exam Preparation 26 Oct 2018 2:00 PM

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Jackson’s ALL WELLness Services, LLC “Transforming lives, one individual and family at a time.” Professional Services (for professional men and women) Research Presentations Based on Dr. Daniella Jackson’s qualitative multiple-case study Supervision for Florida Mental Health Counselor Interns Dr. Daniella Jackson utilizes a strength-based model for intern supervision Professional Meetings Every other Month Mental Health Counseling Services (for adult men and women) Dual disorders, addictions (i.e., alcohol, illicit substances, food, technology), addiction related problems, impact of addictions on self, ACOAs, adult children of addicts, early and long-term recovery problems, codependency, and more Individual Therapy Group Therapy Family Therapy Health Coaching Services (for adult men and women) For professional women, university students, graduate students, doctoral students (before and during the dissertation phase), parents, grandparents, women before, during and after pregnancy, women over 40, and more Individualized Wellness Sessions Wellness Classes JAWS Pregnancy Class – face-to-face class JAWS Family Class (for men and women) – face-to-face and online classes JAWS Longevity Class (for women over 40) – face-to-face and online classes Daniella Jackson, Ph.D., LMHC Jackson’s ALL WELLness Services, LLC Founder, Owner, and CEO Researcher Licensed Mental Health Counselor Qualified Supervisor for Florida Mental Health Counselor Interns Certified Health Coach 7813 Mitchell Boulevard, Suite 106 New Port Richey, Florida 34655 Phone #: (727) 767-9850 / Fax #: (727) 767-9851 Web: www.daniellajackson.com Email: daniella@daniellajackson.com Facebook: https://www.facebook.com/JacksonsAllWellness/

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FMHCA Annual Conference January 31st– February 2nd, 2018 in Lake Mary, Orlando PRESENTER PROPOSALS DUE BY JULY 1 FMHCA’s goal is to provide education, legislative oversight, and networking opportunities, our Annual Conference provides an opportunity for advanced professional training. Take advantage of this opportunity and present at the FMHCA 2019 Annual Conference! Possible Dynamic Approaches May Cover: 

Behavioral and Mental Health

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Expressive and Creative Therapies

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Approaches to Healing

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Multicultural Counseling

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Innovative Treatments and Skill Building

Practice

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Legal Issues/Family Law Grief and Loss Post Partum Depression And Many More! Benefits of Presenting: Presenters will receive a $50 discount on conference registration.

Promotion of your name and credentials on our website and in all electronic and print marketing materials, where appropriate. Recognition of your expertise by FMHCA and by other industry professionals Networking opportunities. Presenter Eligibility: To be considered, presenters must have professional qualifications in good standing with their professional regulatory board, if applicable, possess the technical expertise necessary to present on a subject effectively, and meet one or more of the following:

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EMDR and Trauma Work

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Substance Abuse

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Military and Veteran Mental Health

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Ethics, Domestic Violence , HIV, Laws & Rules

Have extensive experience including at least five years of practical application or research involving subject of presentation

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Mediation

Submit a Proposal to be a Presenter:

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Social Media

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Homelessness

Submit on-line at https://fmhca.wildapricot.org/Callfor-Presentations

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Evidence Based Interventions

Please Submit Questions at office@FLmhca.org or



Best Practice for Individuals with Autism

Call 561-228-6129

Have received specialized graduate or post-graduate level training in subject of presentation; and/or

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We Need Your Help!!!! Benefits for using a Lobbyist- but we cannot do this alone and need your attention Florida Mental Health Counselors Association benefits from using a lobbyist to get our voice heard in government. Your voice is important to us! Our membership fee’s help to support our legislative presents and contribute in making a difference for our members and the client’s we serve. Did you know that lobbyists can take your message to Congress? Lobbyists enable organizations to draft legislation, develop strategies for new regulations, connect and stay informed, and proactively reach out to elected officials prior to new policies being drafted. Florida Mental Health Counselors Association is asking that you take a look at the direction of our healthcare and industry, wont you help us make a difference? Re-new your membership today Ask a colleague to join FMHCA www.FLMHCA.org

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Thank You to our Amazing Sponsors! Advertise On Our Website & In Our Newsletter! Increase your professional exposure by becoming a FMHCA sponsor! FMHCA's website gets hundreds of hits a day from members, nonmembers, and prospective members. Becoming a sponsor with FMHCA lets other professionals know that you're out there - it's a terrific way to network and grow as a professional. There are two ways to becoming a sponsor - you can purchase a flashing banner across the top of our pages or one of the sponsor blocks at the bottom of our website pages. Best of all, you get a full year of sponsorship for one low price! Artwork must be submitted in one of the following formats: png, jpg, tif, tiff, or psd. After you have completed payment, submit your artwork to us at office@flmhca.org

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