InSession Magazine- October 2022

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Cortina Peters


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President's Column Greetings FMHCA Members!

I hope each of you enjoyed a wonderful summer! Please know this past quarter, your FMHCA team has been hard at work on a myriad of things: growing FMHCA, completely re writing the FMHCA Bylaws, the 2023 Annual FMHCA Conference, scheduling Live and On-Demand Webinars, hosting Live Regional Events, and The Great Giveaway and more! Two of my top goals as President were growing membership and adding new chapters. When we grow the membership and add new chapters, it allows FMHCA to do more things, i.e., offer each of you more benefits, and grow our PAC fund which allows us to get legislative goals accomplished, (like the Counseling Compact last legislative session.) Please know FMHCA has added two new chapters, Miami, and Broward, since our 2022 Conference, and we continually increase in membership each month. If you would like to take part of this growth and get rewarded, check out our Plus One Campaign. Updating the Bylaws became a priority of mine soon after I started my term as FMHCA President. Bylaws govern the way a group must function and governs the responsibilities of its Board Members. They also help FMHCA define its purpose and how FMHCA goes about its business. With FMHCA’s wonderful and expanded administrative team, I found the roles and responsibilities of Board Members had changed since the last version. I want to create Bylaws that will accurately reflect how FMHCA operates and will serve FMHCA well into the future. Working on Bylaws is certainly not a glamorous aspect of the job, but it's vital to FMHCA and its future. You will have the

opportunity to vote on the new Bylaws at the 2023 Conference. Additionally, the Board voted in August to expend the terms of service of Board members from one to two years. This means I will be your President again next year.

I’m also working on updating FMHCA’s Leadership Manual, and I’m creating a new, distributable document titled “How to Start A FMHCA chapter.” The Leadership Manual gives each board member and administrative member the specifics of the duties and expectations of each role. Again, the duties and expectation had changed dramatically since the most current edition. The “How to Start A FMHCA Chapter” manual will be available to every FMHCA member so that if you, for example, live in Jacksonville or Tallahassee where it currently is no chapter, you will have a step-by-step guide in how to begin a new chapter. Also, for the remainder of 2022 my focus will be continuing to strive to meet your needs, strengthen FMHCA through continued growth, i.e., increasing membership and increasing chapters, and accomplishing our legislative goals in the upcoming legislative session. As always, I welcome your feedback and ideas! My job is to serve you, and I welcome your opinion. Thank you very much for the opportunity to serve you! Respectfully,

Laura Peddie- Bravo Laura Peddie-Bravo, LMHC, NCC FMHCA President

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- October 2022 | 3


Page 3 President's Column

Page 9 Young at Heart: How Young Adult Literature is Relevant for Therapy with Adult Clients Page 12 Ask AMHCA- FAQs from AMHCA's Code of Ethics Page 16 The Silent Theif Page 18 Why #therapytok is Good News for the Mental Health Field Page 22 Analyzing Coercive Control With Communication Data: A Practical Panacea Page 29 Counseling and Culture Page 32 Feature Article: The Girlfriend Therapist, Cortina Peters Page 36 DID is a real thing Page 39 How to be More Effective in Counseling Clients with Relationship Distress and Adjustment Disorder 4 | InSession- October 2022 |

MAGAZINE Page 42 Inner Child

Page 44 The De-mystification of Feeling Page 47 Ask The Expert with The Health Law Firm Page 49 The Importance of Assessing Invisible Wounds Page 55 Politics and Legislative Timeline- 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- October 2022 | 5

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Young at Heart: How Young Adult Literature is Relevant for Therapy with Adult Clients Professional Resource Article

Approximately 72 percent of adults in the United States report reading at least one book per year, and the average American reads 12 to 14 books per year. Young adult literature is one of the most popular genres; many young adult series top the New York Times Bestseller List. Yet there is stigma about adults reading young adult literature. A controversial article by Ruth Graham stated that adults should be embarrassed about reading young adult literature, because the books are meant for teenagers and adults are too mature for the material. However, just because books are written for teenagers does not mean that adults cannot and should not be reading them. In fact, between the many prominent themes in young adult literature and the many benefits of reading, adults can have meaningful experiences just from reading young adult literature. What is Young Adult Literature (YA Lit)? YA lit is considered a relatively new genre; the classification of young adult literature was first used in the 1960s. While currently no set “definition” of what counts as young adult literature has been established, there are several features that

appear in almost all books classified in this genre. First, the main characters of the books are typically between the ages of 12 and 19. However, not all books with child and/or adolescent protagonists are considered YA Lit. In traditional YA literature, the tone and voice of the narration focus more on what is happening in the moment rather than reflecting past events. Similarly, the themes are presented in a way that is consistent with the way adolescents think and feel. YA lit specifically takes the perspective of the adolescent characters, in fact, the narrative is written in ways representative of how teens think and talk. The last common feature of YA lit is that it’s typically written between a 7th and 12th grade reading level. Despite the recency of the “official” establishment of the young adult literature genre, it has been becoming more and more popular over time. In fact, publishers and bookstores began trying to specifically distinguish young adult literature as its own type of books, choosing to market them directly toward teens in the early 2000s. As a result, the number of books published every year that are classified as YA lit has been growing rapidly. For | InSession- October 2022 | 9

example, approximately 4,700 YA books were published in 2002, while over 10,000 were published in 2012. It is important to note that young adults are not the only demographic consuming young adult literature; nearly 70% of all YA titles are purchased by adults between the ages of 18 and 64. These books may be “designed” for teens, but a significant number of adults are reading them too. Common Themes in YA Literature The structure of young adult books allows authors to seamlessly incorporate a large amount of different themes into their narratives. Some of the most common include: race, culture, and ethnicity; sexuality and gender; and mental health issues. Race, Culture, and Ethnicity Many YA authors feature characters from a variety of cultural perspectives. Authors like Tamora Pierce and Rick Riordan feature diverse characters in their books. In particular, the main characters of Riordan’s Kane Chronicles series are biracial siblings with different skin colors. Readers see them frequently encounter people who do not believe that they are siblings because of their different skin colors. Books written by authors who are ethnic and/or racial minorities give insight into the minority experience from the perspective of minorities. The autobiographical graphic novel Persepolis details the author’s experiences growing up in Iran and later Austria. Anne Frank’s Diary of a Young Girl was written during the Holocaust by a teenage girl living through it. Stereotyping, prejudice, and racism are prominent parts of society, and racial issues appear in YA literature. For instance, many books portray slavery. The book Trickster’s Choice actually explores slavery from a firsthand perspective, when Alianne, the main character, is sold into slavery after running away from home. While authors like Tamora Pierce clearly denounce slavery, in the Harry Potter series slavery is normalized. House elves are slaves to wizarding families. House elves’ slavery is viewed as normal in this universe, to the point where house elves are assumed to enjoy being slaves. One elf, Dobby, is considered “weird” for wanting freedom, and when Hermione advocates for house elves, she is derided and dismissed. Many discussions about culture solely refer to cultural practices of different ethnic and/or racial groups; however, many populations feature unique cultural practices. Religions, social groups, and even different age generations have distinct cultural practices. Young adult literature often portrays different types of cultures and discrimination they face. Although it technically predates the establishment of the genre, The Outsiders is a great example of discrimination based on social class. The narrator, 10 | InSession- October 2022 |

Ponyboy, his siblings, and his friends, are poor. They often face ridicule from the wealthier kids in their town. In fact, the main conflict of the book is a direct result of the tension between the poor “Greasers” and the wealthy “Socs.” Fantasy and sci-fi literature often contain allegorical or metaphorical elements which provide opportunities to discuss sensitive subjects such as racism and discrimination in indirect ways. For instance, in Cassandra Clare’s Shadowhunter universe, the Shadowhunters are the dominant population, but relationships between Shadowhunters and other supernatural beings are incredibly tense. Because Shadowhunters are tasked with protecting the world from demons and other threats, the belief that they are superior to other supernatural beings and the “regular” humans is common. Before the events of the first book, the members of a group called The Circle routinely attacked and killed many other supernatural beings in order to assert Shadowhunter dominance. Racism and prejudice are clearly major themes in these books, but because the Shadowhunter universe is fictional, these minority groups do not exist in real life, making prejudice and hatred are more palatable to audiences. Sexuality The number of YA books with LGBTQ+ characters quadrupled between 2010 and 2015, and they address the good and bad experiences that an LGBTQ+ person can face. There are characters who struggle to accept themselves and come out, like Nico in Rick Riordan’s Heroes of Olympus series or Simon in Simon vs. the Homo Sapiens Agenda. While Simon vs. the Homo Sapien Agenda is told from Simon’s perspective, Nico is not one of the major characters in the Heroes of Olympus books. As such, readers learn of his sexuality as the other characters do. His sexual orientation and visible struggle to accept himself is first introduced in the book House of Hades, to the character Jason. Although Jason and Nico are not close, Jason supports Nico, promising not to out him. When books are part of a larger series, readers often witness the characters grow and change. Nico starts scared that people will find out he’s gay and reject him; however, over the course of several books Nico comes out and gets a boyfriend. Like works featuring different cultural experiences, young adult literature covers a spectrum of experiences of LGBTQ+ individuals. Not only do stories feature characters coming to terms with their sexuality/gender, readers see characters who have already come out. The Magnus Chase and the Gods of Asgard series features the openly gender fluid character Alex. While Alex does struggle to be accepted by their peers, their gender identity is not the issue: many characters suspect Alex of

being a spy for their father, Loki. By the end of the series, Alex is trusted, and even a romantic relationship with the main character, Magnus. After spending so much time with Alex, Magnus knows them so well that he is able to get a sense of whether Alex is feeling more masculine or more feminine on any given day and adjusts his use of pronouns accordingly. Gender Roles and Norms When The Secret of the Old Clock was published, readers were introduced to Nancy Drew, an incredibly intelligent 16-year-old girl who solves mysteries. However, despite the popularity of Nancy Drew, female characters in media have historically been portrayed badly. The early 2000s saw the rise of young adult series with complex female protagonists who defy traditional gender roles and play crucial roles in society. Lyra, the main character of Phillip Pullman’s His Dark Materials series, is a stubborn and deceitful 12-year-old girl. However, those qualities, which are almost universally known as negative, ultimately help her succeed. In the book The Golden Compass, she successfully deceives a supposedly untrickable armored bear. In addition to Lyra’s petulant personality she is the child of a prophecy, known as “Mother Eve,” and she saves the universe simply by falling in love and exploring her sexuality. Female sexuality, particularly in children and teens, is often highly stigmatized; however, Pullman (a male author) specifically features an adolescent girl developing as a sexual being in a positive way as the crux of the plot. Mental Health Young adult literature does not shy away from depicting horrific events. Many authors put their characters through trauma and depict the effects of that trauma. Readers see Katniss’ mental health decline throughout the Hunger Games books as she experiences multiple traumas. Similarly, while the show was considered incredibly controversial for its depictions of mental health, the book Thirteen Reasons Why demonstrates how Hannah’s experiences led to her suicide. YA Lit and Therapy Despite the frequent use of allegories and metaphors, literature mirrors life in many ways. People tend to find ways to identify with the characters in the books they read. From a therapeutic perspective, YA lit has been shown to have numerous benefits for adolescents. Particularly, books that explore themes such as identity can help people understand themselves better, especially when they highly relate to specific characters who are going through similar things as they are, which has a positive impact on identity development.

Most places define 18-year-olds as adults, and a key component of high school is determining what type of career an individual wishes to pursue. Adolescents are expected to know what they want to do for the rest of their lives when they are still trying to figure out their identity. Additionally, many school districts have taken classes like home economics and personal finance out of curricula, which leaves an unfortunate number of teenagers not learning how to do things like cook, do laundry, make a budget, or pay taxes. As a result, teens become adults who don’t know how to ‘be an adult.’ Many adults, particularly those in their 20s and even early 30s, subsequently feel like they should have their life figured out and then feel bad that they do not. The reality of society is that many adults struggling with the exact same issues as teens, and they have added pressure of feeling like they are supposed to have everything figured out in their lives, because they are adults. Millennials, individuals born between 1981 and 1996 are normalizing and destigmatizing mental health struggles, potentially because of the high rates of mental health concerns they experience. As many as 49% of Millennials state having mental health issues. Additionally, approximately 12% of Millennials have been diagnosed with an anxiety disorder, compared to the approximately 6% of Baby Boomers (those born between 1946 and 1964). One of the biggest advantages of Young Adult literature is the reading level at which it is written. Currently, the average American adult has about a 7th grade reading level. YA lit, then, is written at a level easily consumable. The narrative structure of Young Adult literature naturally enables a more relatable story. Readers follow the characters’ thoughts, feelings, and responses to the events of the story as they experience them. That sense of immediacy makes the impact of reading the book and the ability to relate to the characters stronger. As counselors, it is important to keep up with therapeutic methods, but therapists also benefit from keeping up with trends in popular culture. Reading is such a popular hobby in the United States, and therapists should capitalize on opportunities to use YA books to engage with their adult clients in a meaningful way. From a theoretical perspective, both bibliotherapy and narrative therapy emphasize depersonalization in treatment. Clients are encouraged to recognize that they exist separately from their mental health struggles. By reading books about characters who go though the same things they go through, adults can potentially see their problems from an outside perspective, enabling them to gain insight that they hadn’t considered before. Furthermore, seeing characters grow and heal can be incredibly encouraging. It inherently promotes optimism and hope that | InSession- October 2022 | 11

they, too, can heal and grow.

Written By: Melissa Gomez-Erickson,

Now more than ever, it is essential for therapists to capitalize on the popularity of young adult literature and use those narratives with adults. The many works I’ve mentioned are great starting points, but there are tens of thousands of young adult books, both fiction and non-fiction. No matter what issue a client is dealing with, there’s probably at least one YA book that features it. It’s just a matter of looking for the material and applying it in the best way possible.

Registered Mental Health Counselor Intern Melissa is a RMHCI with Casa Feliz Counseling and Aspire Health Partners who specializes in working with teens and adults, particularly within the LGBTQ+ community. Melissa frequently incorporates popular culture and media into her work with clients, including literature. Her knowledge of counseling and her background in education enable her to approach therapy from the perspective of using materials clients are already familiar with to aid in the therapeutic process.

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


I am a grief counselor and too many of my elderly clients had spouses who died from Covid-19. Their loss is made worse by the circumstances attendant to the death and the fact that these clients could not be with their spouse in the hospital with they died. One of my clients is planning to do counseling with me, using her cellphone. She does not have a computer. She says that she mailed all the consent forms to the agency a week ago; staff inform me, however, that only a signed treatment contract was received, but not the


What are good resources for learning the legal and ethical standards for telehealth? In order to comply with standards for telehealth, consult your state laws and licensing board rules and regulations (B.6.e.). In addition, consult the Codes of Ethics for professional associations such as the American Mental Health Counselors Association (AMHCA), the American Association for Marriage and Family Therapy (AAMFT), the


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 belongs to the client and shall not be shared without permission granted through a formal

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Consent Form for Telehealth. What can I do? This grieving woman needs help.


Make sure that your client reads her Consent Form and agrees with it. So long as your state does not mandate (B.6.e) the signing of a Consent Form for Telehealth by clients, you can proceed with grief counseling as soon as the client tells you that she consents to the process. Document your client chart with the fact that you discussed the telehealth process with the client, and she understood the disclosures and wants to proceed with telephone counseling. Also document that your client signed the Treatment Contract, which she had received & returned to the Agency.

American Psychological Association (APA), American Counseling Association (ACA), and the National Association of Social Workers (NASW). The U.S. Department of Health And Human Services (HHS) has adopted policies during the Covid-19 crisis to make telehealth in general an easier process, one in which the HHS Department states it will not strictly enforce HIPPA Regulations regarding the platform used for telehealth and telehealth. The HHS website includes FAQs for dealing with Covid-19 in the home and in the workplace, which are very practical and provide the guidance that the CDC has issued for the safety of the public. Of course, workshops and webinars on telehealth are offered by professional associations at national, state and local levels, online.

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. | InSession- October 2022 | 13

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The Silent Thief Professional Experience Article

Dementia is a thief. Over several years it stole functioning and connection from my husband, then finally stole his life. Alzheimer’s, one type of Dementia, is a terrible way to die. It was a shock to my daughters and others, but not to me. I already knew what to expect from years as a Gerontologist and developer of geriatric programs that were subjects of several of my books. Did that make it easier? Only in the sense that firefighters headed into another wildfire know what is ahead but not exactly how it will feel when they are engulfed by flames. I heard other families complain and blame the care staff as their loved ones declined. So, I spent time often at the nursing station and during care meetings engaging Compassion Fatigue approaches to affirm them. It’s a tough job. There are no winners with Alzheimer’s – no cure, no successful treatment, and no positive outcome. . . at least not yet. So, what can Mental Health Counselors do? Our primary role is with the families. This is the long goodbye. It is watching a person rewind - - skills fade, communication decreases and mobility is lost. We can help families deal with the changes, the loss of connection and finally the death. We can also prepare them for the Role Exit. Blau’s theory of Role Exit deals with sudden or expected changes in life roles. This happens with any loss yet for spouses and families the role changes in dementia are progressive. 16 | InSession- October 2022 |

Keep in mind that Alzheimer’s is just the “brand name” of dementia like Kleenex is often the better-known name for tissue. The old term, Multi-infarct Dementia is more commonly known as Vascular Dementia. There are others related to diseases or injury such as CreutzfeldtJakob, Wernicke-Korsakoff, Lewy Body Dementia and Huntington’s disease. Dementia is not “old timers disease” – it is not a respecter of age, ethnicity, or gender. Older adults and their families are also robbed literally by fake, unproven and frankly nonsensical “cures”. Spouses and families are desperate to reverse what medical science has not been able to cure so they are easy prey. Counseling with spouses and families of persons with dementia is helping them deal with the immediately discernable losses and how to uplift the patient. Connect them with the nearest Alzheimer’s Association office. There are support groups as well as validated information for all family members. Look on the web site, for excellent resources such as age-appropriate books to help children and grandchildren understand what is happening with the changes in their grandparent. This disease is growing in numbers worldwide. There are Walks to End Alzheimer’s around at several Florida locations. Walkers often carry color coded flowers. At the end of each walk is an area designed as the Promise Garden

where walkers place those flowers or flower symbols. Purple flowers mean you have lost someone to Alzheimer’s or another Dementia. Yellow is for dementia caregivers; blue is living with a person who has Alzheimer’s and orange is for supporters and professionals helping others. Someday those gardens will be smaller… just not in time for our family.

Written By: Kathie Erwin, Ed.D., LMHC, NCC, NCGC Dr. Kathie Erwin is a Professor at Divine Mercy University School of Counseling and Green Cross Academy Certified Master Traumatologist. She is a Licensed Mental Health Counselor, National Certified Counselor, National Certified Gerontological Counseling and AMHCA Diplomat in Geriatric Counseling. Dr Erwin was appointed Fulbright Specialist teaching at University of Iceland. She has served as Secretary/Board Member and is President Elect for FMHCA | InSession- October 2022 | 17

Why #therapytok is Good News for the Mental Health Field Professional Experience Article

With the combination of being a registered mental health counseling intern as well as a borderline gen-z’r (the cut off year is ’96, and I was born in ’95) I am generationally designed to enjoy tik tok. During the pandemic the inevitable disconnection I felt from the world around me felt haunting. Tik tok offered a quick way to feel less isolated as it sprinkled my day with choreographed dances, storytimes, and POV from internet creators all over the world. Tapping the tiktok app gave me a sense of belonging on top of a rush. A rush of “what might I learn today?”. And it’s not only the videos - it’s the comments from other viewers such as, “I have never had an original experience in my entire life” and “they said FYP and they meant it” FYP for those not on tiktok means for you page. It’s the homepage where videos fit the algorithm according to the videos you watch the longest, and the one’s you most interact with. I don’t remember seeking out #therapytok more than other sub genres of tiktok but the tiktok gods must have known (or the algorithm works really well and really quickly). Here are a few of my thoughts as to why #therapytok is good news for the mental health field. On the average 20 minutes a day I find myself scrolling on the app itself I switch between feeling inspired, challenged, and entertained. Videos posted with the #therapytok hashtag feel like short quips from real life sessions with clients. We validate, we explain, we hold space, we show up as human. All are involved with removing the mask between client and therapist. I think that is my most favorite part of being on therapytok – the question of what can happen in the therapy office is removed. Therapists on tiktok are able to express themselves in a way that feels creative, inspired, and supplementary to the roles we play in session. It loosens up that 50 min time frame we sit in sometimes hours back-to-back. It allows space for expression of what we so often see and teach on. It opens up the space for that to be seen by hundreds, thousands, and for some creators on tiktok millions. 18 | InSession- October 2022 |

Therapytok provides this, “you have felt this way too?” sense of belonging and deeper understanding. It possibly shows those who have yet to experience their own healing journey in psychotherapy to get a taste of what that space can bring to them – belonging, understanding, and the benefit of “feeling your feels”. It breaks down the fear of the unknown concerning the types of questions a therapist may ask. It reinforces the fact that therapists educate clients day in and day out about attachment styles, how trauma feels in the body, and why they can’t just “move on” from that one ex. When clients enter our office they have preconceived notions about what we might say, how we might dress, and how quickly the healing process may take. #therapytok provides authentic insight to the realities about how a. emotional healing, on average, takes more than 10 therapy sessions, b. not all therapists wear cardigans, and c. the relationship between client and therapist is unlike any other relationship they may ever have. To put it simply #therapytok provides example after example as to how psychotherapy can be life changing, and not THAT scary or unknown. It fills in the gaps for the average person who is scared of sitting in a room alone with a stranger who is asking them questions about their childhood, dating history, and relationship to their parents. That’s why I believe #therapytok is an incredibly beautiful space – it is healing, accepting, and educational. It replicates the many benefits our clients glean from sitting in a 50 min session with us – without the added music, captions, and comment section. Written By: Dallas Trese, MA, Registered Mental Health Counselor Intern Dallas is passionate about working with trauma survivors, adolescents, college students, young adults, and female entrepreneurs. She is trained in mind - body approaches such as EMDR, yoga, and brainspotting. Dallas is a Registered Mental Health Counselor Intern in the state of Florida. She is a member of FMHCA & SMHCA. | InSession- October 2022 | 19

FMHCA's Favorites The Boy with Big, Big Feelings Highly recommended by parents, teachers, and therapists for children navigating feelings and coping with an array of emotions. The Boy with Big, Big Feelings is relatable for any child -- especially for a child experiencing anxiety, extreme emotions, a child identified as a Highly Sensitive Person, or a child on the autism spectrum. Beautifully illustrated and written in rhyming verse, children and adults explore the whole spectrum of feelings and readers navigate the emotional challenges they face throughout the day.

Table Top Fire Pit Add a spark to your parties this holiday season! This tabletop fire pit is great for desserts and ambiance for you and your guests to enjoy. Shop here.

Mental Health Stickers Place them on your laptops, water bottles, or even give them to your clients- these stickers are the perfect little reminders to have in your day. Shop over 13 designs here

Pumpkin Oat Cookies

Self Care Gift Set We all know someone who feels stressed, overworked, or even downright exhausted. Help schedule some much-deserved "me" time into their busy life with four wellness gifts in one!

INGREDIENTS 2.5 cups (250 g) rolled or quick oats 1 cup (240 g) pure pumpkin puree 2–3 tbsp maple syrup, agave syrup or coconut sugar 1–2 tsp pumpkin pie spice or cinnamon, optional but recommended 1/2 cup dairy-free chocolate chips, optional but recommended INSTRUCTIONS 1. Pre-heat oven to 350 degrees. 2. Mix all ingredients in a bowl to form a thick dough. Start with 2 tbsp of sweetener and adjust sweetness as desired. I use 3 tbsp of maple syrup. 3. Use your hands to create 12 cookie shapes. The cookies will not spread or change shape during baking so be sure to create the shape you want before baking. 4. Prepare a baking pan with parchment paper or place cookies directly on the pan. Bake for 10 minutes. 5. Remove from oven and enjoy warm after a few minutes. Let cool completely before storing. Store at in a sealed container at room temperature for 3 days, in the fridge for up to 1 week or freeze up to 3 months. 20 | InSession- October 2022 |

On-Demand CEU Webinars

Reusable Food Beeswax Wrap This reusable, biodegradable alternative to plastic wrap has everyone buzzing. Bee's Wrap Single Medium Wrap is made from beeswax, organic cotton, organic jojoba oil, and tree resin. Measuring in at 10" x 11", this wrap provides more than enough coverage for a sandwich, cheese, fruits, and vegetables without all the waste of singe use plastics.

Earn CEU's on your own time! Did you know that FMHCA has over 30 on-demand webinars with topics like... Building Hope and Resiliency in Children Affected by Adverse Childhood Experiences (ACEs) Adult Children of Immigrant Parents & Mental Health Creative Strategies in Developing an Ethical and Profitable Private Practice Working with Clients who have Chronic Health Issues and Chronic Pain A Workshop for Mental Health Professionals on Compassion Fatigue An Introduction to Accelerated Resolution Therapy (ART) Integrating Transpersonal Theory and Energy Therapies for Spiritual Clients & more!

Paint by Numbers Kit

Getting Better: Stories of Mental Health Podcast Hosted by licensed therapists Micheline Maalouf and Nadia Addesi, Getting Better: Stories of Mental Health speaks with special guests like Rebel Wilson, Chris Bosh, Meghan Trainor, Ian Somerhalder, and more on their experiences with mental health such as living after an injury, motherhood, social media, physical health, immigration, and more.

Broth Bomb Set

Discover your inner artist by completing a paint by numbers art piece!

Give your soup an infusion of fun and fragrant flavor (plus, save time on prep, cooking, and cleanup) with Andrew and Renee Laurent's scrumptious and unexpected broth upgrade. Drop one of their bombs into your stock pot and watch as it fizzes herbs and spices into your stew, chili, or curry. Simply add veggies and legumes for a complete meal. Each variety pack includes four flavors. Handmade in Florida. Shop here.

KEY BENEFITS Scientifically proven to reduce stress and anxiety Create focus, builds confidence, and promote mindfulness

Weighted Robe Get all the stress-relieving benefits of a weighted blanket in the form of a warm, cozy robe. This robe is like a wearable weighted blanket, designed to relieve stress and anxiety to promote a sense of calm. Extra weight in the shoulders provides deeptouch stimulation, which can help relax muscle soreness and joint pain. | InSession- October 2022 | 21

Analyzing Coercive Control W Data: A Practical

Professional Re

Highly disputed child custody cases where a parent also displays domestic violence or coercive control tendencies present the most difficult challenges for mental health counselors. Both parents are passionately and aggressively presenting their positions as they defend their actions. Both parents are rebutting the accusations of the other parent and are using terms like “wrong,” “false,” and “deceptive.” And parents frequently use text messages, emails, and third-party diary services, which generate huge amounts of communication data.


It is no surprise that mental health counselors feel overwhelmed when facing the almost insurmountable challenge of making sense out of the avalanche of emotional information dumped in their laps. As they strive to “do their best,” that effort may translate into making judgments about the client which are less informed and more biased than is appropriate.

Mental Health Professionals in Family Law

There is good news on the way, however. The same technology that created ubiquitous communication channels used constantly by co-parents can also be harnessed to bring order out of chaos. Instead of looking like an insurmountable challenge, the huge volume of communication data can be parsed, chronologically sorted, and organized by subject matter to display patterns of behavior of each parent. These patterns of behavior are a step up from, and supplement, standard assessment tools because they are based on data-driven, quantitative, measurable, and objective 22 | InSession- October 2022 |

This article first explains how we came to this point using standard assessment tools, and then how the influx of huge amounts of co-parenting communication data shifted the paradigm. Next, we examine the evolving state of domestic violence and coercive control laws, and how these laws require patterns of behavior to be proven. Finally, we identify approaches and new technology products which use co-parenting communication data to show patterns of behavior.

Over two decades ago, emails, text messages, and third-party diary services did not exist for co-parenting communications. Therefore, mental health professionals relied on information gathered from: Written statements and oral interviews; The administration of empirically validated psychological assessment instruments; Direct observation of the family members; and Collateral documentary evidence. This generally accepted historical approach promoted theoretical and predictive models based on anecdotal circumstantial evidence. When technological advances made emails, text messaging, and cell phone calls cheap, easy, and always on1, the proponents of the historical approach did not readily

adapt. Thus, a mental health professional who ignores relevant and direct documentary evidence of co-parenting communications “…would not be behaving as an expert on this occasion if they were to provide a report of evidence without evidence for that report.”2 What happens if the evidence relied upon by the mental health professional does not exist or does not support the opinion? This can occur when a parent is victimized by the other parent using coercive controlling behaviors and reacts emotionally and passionately in interactions with the mental health professional. As a result, the victimized parent is described under existing assessment instruments as “a restrictive gatekeeper” or “highly exaggerating interpretations in their intensity.” Seasoned mental health professionals know from experience that a deep dive into massive amounts of co-parenting communication data is not cost-effective. Relevant and direct documentary evidence contained in that data will not be used or considered. This can lead to the best interests of the children and the victim parent to be sacrificed for costeffective measures designed to protect the mental health professional. Laws Which May Apply to Contentious Custody Cases Pre-1990 laws and enforcement of domestic violence provided little protection for abuse victims. A historical summary of domestic violence laws written over a quarter century ago by the

With Communication Panacea

esource Article

U.S. Department of Justice lays out this stark view: If not dangerous, spouse abuse was viewed by the police and the courts as an intractable interpersonal conflict unsuited for police attention and inappropriate for prosecution and substantive punishment (citation omitted). In fact, many police departments had “hands off” policies prior to the 1970s, and police training manuals actually specified that arrest was to be avoided whenever possible in responding to domestic disputes (citation omitted).3 Today virtually all U.S. states and territories have domestic violence laws. Coercive Control Laws In the past decade, state legislatures have begun recognizing that existing domestic violence laws are limited because of their focus on physical injury caused by a perpetrator. This excludes entire areas of potential injury from domestic violence, including psychological and emotional tactics. Some states have passed laws to take these tactics into account, including the states of California, Connecticut, Hawaii, and Washington. Several other states are considering similar laws4. The 2022 Coercive Control law passed by the State of Washington, which became law on July 1, 2022, added the following definition of coercive control5 to the definition of domestic violence6: “Coercive control” means a pattern of behavior that is used to cause another to suffer physical, emotional, or psychological harm, and in purpose or effect unreasonably interferes with a

person's free will and personal liberty. In determining whether the interference is unreasonable, the court shall consider the context and impact of the pattern of behavior from the perspective of a similarly situated person. Examples of coercive control include, but are not limited to, engaging in any of the following: (i) Intimidation or controlling or compelling conduct… (iv) Controlling, exerting undue influence over, interfering with, regulating, or monitoring the other party’s movements, communications, daily behavior, finances, economic resources, or employment… (vi) Engaging in psychological aggression, including inflicting fear, humiliating, degrading, or punishing the other party [emphasis added]. In the past it was virtually impossible to prove a pattern of behavior involving non-physical violence. Today information communication technologies (ICT) channels can actually facilitate violent attacks by perpetrators. In a series of papers studying “The Dark Side and Decline of Relationships,” one group of researchers discovered: …divorced parents who have particularly contentious relationships and thus weaker coparenting ties may use multiple ICTs out of necessity (e.g., to prevent one parent from withholding information or to increase the quality of information) rather than a function of closeness between coparents (citation

omitted)….ICTs may be harmful when divorced parents have a history of intimate partner violence by allowing harassment, controlling tactics, and violence to continue (citation omitted). With the burgeoning of ICTs and the instantaneous nature of communication, former partners are no longer restricted by geographical boundaries, and they can communicate anytime, from anywhere (citation omitted). Thus, ICTs must be handled with care or could be used to humiliate, stalk, and harass former partners (citation omitted). In some cases, court officials (i.e., judge and parent coordinator) will mandate strict methods of secure web-based communication to limit and document all exchanges between co-parents, in the interests of reducing inappropriate communication and conflict (citation omitted)[emphasis added].7 Emails, texting, and third-party diary services, all of which capture and timestamp these communications, represent a rich evidentiary source of content and context to prove harmful patterns of behavior with relevant and direct documentary evidence. Practical Ways to Show Harmful CoParenting Behavior Expansion of Assessment Tools to Include Communication Data Concrete evidentiary data in the form of co-parenting communication data is still relatively new and as a result has not been fully incorporated into existing assessment tools. Mental health | InSession- October 2022 | 23

professionals continue to rely on standard assessment tools, such as the Minnesota Multiphasic Personality Inventory, which are predictive models using constructs developed from indirect, circumstantial testing data. But the standard tests to collect data amount to a mere snapshot of personality attributes. Furthermore, these tests usually are administered over a day or two, and sophisticated subjects can mask their behaviors over the short data collection period,8even with techniques used to detect and control biased responses.9 It goes without saying that the best predictor of future behavior is past behavior.10 But as noted above, seasoned mental health professionals know that including vast amounts of co-parenting communication data has not been financially cost-effective for them. Thus, relevant and direct documentary evidence contained in co-parenting communication data will often be ignored. The result of this omission is a reliance on what one iconic clinical psychologist calls the “fireside induction,”11 or commonsense, anecdotal, introspective, and culturally transmitted beliefs about human behavior. By not including co-parenting communication data in the application of assessment tools, mental health professionals run the risk of coming to inaccurate opinions and using ineffective tools based on incomplete data. Consequently, harmful, coercive, and even violent, behavior by perpetrators likely will continue without meaningful change or intervention.12 For example, an authoritarian parent13 with dominant and controlling behavioral attributes may apply similar tactics of unquestioning obedience by, and exertion of excessive control over, the non-dominant co-parent. A perpetrator co-parent may adopt tactics of coercive control rather than physical assault or 24 | InSession- October 2022 |

other forms of overt aggression, so a judicial focus on the latter may downplay or ignore other forms of abuse or violence.14 Coparenting communication data provides a window to evaluate nonphysical assault or covert aggression, especially where the perpetrator coparent “plays the victim.” Such data also supplements testing data collected from subjects in connection with the application of standardized personality inventories. This information, used in combination, gives a more accurate picture of patterns of behavior that are creating conflict and difficulty for victim co-parents and their children. Analyzing Co-Parenting Communication Data Technology exists today to process coparenting communication data and present the data in infographic timelines. There are five sequential steps that should be applied to 100 percent of coparenting communication data from each information communication technology (ICT) channel used by the parents:

Hundreds of emails between the parties were reviewed. There were some emails from both parties that expressed their anger. The most notable, and atypical, from [FATHER] was from ________, 20__. [MOTHER] emailed that she was not longer going to keep his napkin drawings. [FATHER] asked that they be kept in his lunchbox at least. [MOTHER] agreed but stated if they were “dirty or soiled” she would throw them away. [FATHER] responded, “No they will ALL be kept per [CHILD]’s request and mine. If they need to be throw (sic) away, we will do it here. Also, I wish you would really consider stopping this annoying interference. It is clear that you have placed your own emotions in the way of preserving some things [CHILD] or I deem as significant.” In contrast, the results generated from the PatternViewer process in the same case noted above shows forty-six (46) long emails regularly and consistently sent by a co-parent (father in this case) to the other parent (mother in this case):

Sort the data chronologically, Organize the data into like-kind categories, Tag the data to describe the content and context of the data, Display the data, because “A picture is worth a thousand words,” and Report on the patterns of behavior displayed by the data. As an example, Factimize PatternViewer is a technology company which processes and displays communication data15. Factimize PatternViewer provided the following to illustrate the difference between a mental health professional conclusion, compared to the results generated from coparenting communication data. Below is a mental health professional’s conclusion that there were only “some” emails in which the co-parents expressed anger:

PatternViewer also identified certain behavioral attributes of the father which tended toward a dominating behavior. As the figure below shows, the subordinate

attributes displayed in the lower half of the timeline reflect the words of the father directed at the mother:

The three infographic figures, which are based on and supported by the relevant and direct documentary evidence in this case, contradict the expert opinion displayed above. Despite the claim that “[h]undreds of emails between the parties were reviewed,” the expert either: (1) did not have access to all of the communication data; (2) ignored much of the coparenting communication data; or (3) interpreted or “cherry-picked” the communication data in a manner best described as “biased” in favor of the father. Conclusion

Finally, PatternViewer identified certain behavioral attributes of the father which tend toward impulsive and angry behavior. Once again, each of the subordinate attributes in the lower half of the timeline reflect the words of the father directed toward the mother:

Co-parenting communication data will continue to be a significant source of information which accurately describes the relationship and ultimately identifies which solutions would be in the children’s and the victim coparent’s best interest. Mental Health Professionals who (1) are versed in domestic violence and coercive control tactics, and (2) embrace the need to include complete co-

parenting communication data in their assessment tools, can provide coparents with more accurate expert opinions and more effective behavioral change therapies. Technology (such as Factimize PatternViewer) can be used to consistently process coparenting communication data by sorting, organizing, tagging, displaying in easily understood infographics, and reporting on patterns of behavior. | InSession- October 2022 | 25

1 Newport, F., The New Era of Communication Among Americans, Gallup (November 10, 2014)(; Puri, F., Business test messaging stats across use cases and industries, Textline (January 14, 2021)( 2 Harris, A.J.L., Hahn, U., Madsen, J.K, and Hsu, Anne S., The Appeal to Expert Opinion: Quantitative Support for a Bayesian Network Approach, 40 Cognitive Science 1496, 1502 (2016). 3 Fagan, J., The Criminalization of Domestic Violence: Promises and Limits, National Institute of Justice, U.S. Department of Justice (January 1996), p 8. 4 See, e.g., 5 Substitute House Bill 1901, Chapter 268, Laws of 2022, Sec. 1 (37(a)) (amending RCW 7.105.010). 6 Final Bill Report, SHB 1901, Ch. 28, L. 22, July 2022, p 2. 7 Russell, L.T., Ferraro, A.J., Beckmeyer, J.J., Markham, M.S., Wilkins-Clark, R.E., and Zimmermann, M.L., Communication technology use in post-divorce coparenting relationships: A typology and associations with postdivorce adjustment, 38 Journal of Social and Personal Relationships 3752, 3755-56 (2021). 8 Donovan, J. J., Dwight, S. A., & Hurtz, G. M., An assessment of the prevalence, severity, and verifiability of entry-level applicant faking using the randomized response technique. 16 Human Performance, 81–106 (2003). 9 Paulhus, D. L., Chapter 4: Socially desirable responding: The evolution of a construct, in Braun, H.I., Jackson, D.N., and Wiley, D.E. (eds.), The role of constructs in psychological and educational measurement (2002). 10 Janis, I.B. and Nock, M.K., Behavioral Forecasts Do Not Improve the Prediction of Future Behavior: A Prospective Study of Self-Injury, 64 Journal of Clinical Psychology 1, 3 (2008). 11 Meehl, P.E., Law and the Fireside Inductions (with Postscript): Some Reflections of a Clinical Psychologist, 7 Behavioral Sciences and the Law 521, 522 (1989). 12 Michie, S., van Stralen, M., West, R., The behaviour change wheel: A new method for characterising and designing behaviour change interventions. 6 Implementation Science 1-11 (2011). 13 Baumrind, D., The influence of parenting style on adolescent competence and substance abuse, 11 The Journal of Early Adolescence 56-95 (1991). 14 Stark, E., Rethinking Custody Evaluation in Cases Involving Domestic Violence, 6 Journal of Child Custody 287- 321 (2009). 15, see U.S. Patent 9,466,050 B2

Written By: Tommy Black, Ph.D., LMHC, LPC Dr. Tommy Black is a Licensed Professional Counselor (GA) and Licensed Mental Health Counselor (FL) in private practice since 1998. Dr. Black primarily completes forensic assessments in family, criminal, and civil courts. He worked 10 years as an Adjunct Professor of Psychology and Counseling. Dr. Black has special expertise in testing and assessment, custody evaluations, and forensic evaluations. Dr. Black is frequently requested to provide expert testimony and consultation in court cases in multiple states.

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Counseling and Culture Professional Experience Article

When we think of culture, we think of the beliefs that encompass who we are. We seldom think of how culture can influence our being as a whole. An individual’s psychological make up often include his/her actions, beliefs, and personality from their cultural perspective. Diller (2011) ponders that culture affects and shapes the fundamental nature of how work in a clinical setting is accomplished. Therefore, counseling and culture cannot be treated as separate entities. Diller (2011) proclaims, “It colors the following areas: ·How problems are reported and how help is sought ·The nature and configuration of symptoms ·How problems are traditionally solved ·How the origin of presenting problems is understood, and ·What appropriate interventions involve,” (p. 102). There are varying differences within the plethora of cultures in today’s society. Diversity in counseling therapy is essential in order to meet the needs of the multiple ethnicities seeking help. Complications can emerge when a counselor seeks to superimpose his/her cultural and/or world viewpoint on a potential client. Diller (2011) asserts that therapists tend to be

ethnocentric and narrow-minded in their thought processing. They often falter in acknowledging and accepting multiple versions of reality in a therapeutic setting. Allowing themselves to think outside of the box can open counselors up to new frontiers in the therapeutic relationship. It is essential that we discuss how culture can influence the psychological process and the method that an individual seeks help. Leong, Kim, & Gupta (2011) acknowledges that it is important that counseling as a modality be analyzed to understand cultural barriers. Difficulties in the counseling relationship will always exist. What if cultural impediments to therapy could be reduced? Doing so may reduce the alienation that clients feel when they walk into a therapy session with someone who looks different from them. Leong et al. (2011) fosters that the exploration endeavors into issues jeopardizing the therapeutic relationship will be beneficial if they target cooperatively comprehending the barriers to culture. This correlated with the lack of utilization of services regardless of the setting could improve treatment outcomes. One possible issue hindering those seeking help is their need to | InSession- October 2022 | 29

choose between abandoning tradition or retaining traditional culture. Contingent on how the counselor responds, governs if The client believes s/he needs to adapt, integrate, detach, or suffer being ostracized. Because of acculturation, clients who decline to accept the new culture tend to find it very difficult to seek help. As a counselor knowing this, reducing this obstacle must take priority. There is a need to create a trusting environment that encourages the client to connect to their therapist. The mistaken belief a client may have would need to be carefully addressed. Doing so could assist in diminishing any negative beliefs the client may foster about receiving counseling. Furthermore, this area could serve as the focal point to finding the root of the client’s problems.

Therefore, the underlying key to differentiating treatment, centers on utilizing a variety of approaches to help the client within the therapeutic encounter. In conclusion, It is the counselor, realizing that treatment must include an in-depth analysis and understanding of the individual’s culture and beliefs before attempting to assist them with fixing their particular issue. There is a place for both counseling and culture in a therapy. References Diller, J., (2011). Cultural diversity: A primer for the human services (4th ed.). Belmont, CA: Brooks/Cole Cengage Learning.

Stracuzzi et al. (2011) relays that perception, recognition, and respecting the differences and similarities amongst clients is vital in a successful multicultural counseling relationship. Stracuzzi et al. (2011) states,

Leong, F., Kim, H., & Gupta, A. (2011).Attitudes toward professional counseling among Asian-American college students: Acculturation, conceptions of mental illness, and loss of face. Asian American Journal of Psychology, 2 (2), 140-153).

These characteristics have been conceptualized as a universal-diverse orientation (UDO) toward other people that include cognitive (e.g., interest in diversity), affective (e.g., comfort with similarities and differences), and behavioral (e.g., contact with diverse sociocultural groups) dimensions. (p. 300)

Stracuzzi, T., Mohr, J., & Fuertes, J. (2011).Gay and bisexual male clients’ perceptions of counseling: the role of perceived sexual orientation similarity and counselor universaldiverse orientation. Journal of Counseling Psychology, 58 (3), 299-309.

Written By: Roydrick V. Jones, CRC, Doctoral Candidate Roydrick is a substance abuse therapist, certified recovery coach and case manager in a community mental health setting. He has experience counseling adolescents, teens, adults, and seniors working to build sobriety from substance misuse. Roydrick has received certifications for Motivational Interviewing, Stages of Change, Forensic Specialist Training, Recovery Coaching, and Recovery Coach Trainer. He is a doctoral candidate. Roydrick’s main focus is on assisting colleagues in mitigating burnout and/or compassion fatigue through strong self-care practices.


FMHCA is looking for webinars that focus on emerging issues in the field of Mental Health Counseling. This is an excellent opportunity to contribute to the profession, further establish yourself as an expert, build your CV, and gain experience in teaching and training. Learn more & Apply here

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The Girlfri


Licensed in Florida, Georgia, Texas, & Wisconsin, Cortina Peters, aka The Girlfriend TherapistTM, is an EMDR trained licensed mental health counselor. She is also an International Life Coach, Best Selling Author, Motivational Strategist, and Mentor who motivates people to win in every area of their life. She completed both her Master’s in Mental Health Counseling and her Bachelor’s in Psychology from Nova Southeastern University. She obtained a Ph.D. in Clinical Sexology. She also holds a certificate in Women’s Entrepreneurship which she received from Cornell University. Cortina started her career in sexual health education and overall wellness over 20 years ago. She has been providing professional counseling services since 2009 and was voted as the first black president of the Mental Health Counselors of Central Florida, a position she currently holds. Empowering individuals to become and be better individuals is a deeply held passion of hers. This passion was the springboard that caused her to launch Boundless Living Coaching, Counseling, & Consulting, a counseling and consulting firm aimed at helping individuals, organizations, and companies thrive and function at optimum potential. Since 2010, she has focused her attention and efforts on the field of inspiring change. As The Girlfriend TherapistTM, she helps to dispel the myths of what it means to see a therapist. In 2020, she began to focus on social injustice and racially related issues that impact mental health and wellness. Because of this, she developed The NOIR Center for Intuitive Health & Counseling. She has received numerous awards and has been recognized by professional peers, colleagues, and community organizations for her positive work with her patients, clients, and community. Her experience ranges from providing individual counseling sessions to speaking on conference stages in front of large audiences. Be it big or small; she motivates all. Her therapeutic specialties include sex therapy, race-based trauma/stress, relationships, transitional challenges, and mood disturbances. As the creative developer and visionary of The W.O.W. Effect®, she bridges the gap between people just living life. She helps them become individuals who can experience life on a deeper level. She is a two-time cancer (Lymphoma) survivor and Lupus warrior; she has dedicated her life to helping individuals heal, motivating others, and encouraging clients to live as authentically as possible. She is an advocate for change and an activist in her own right. Having to fight for her life in ways many people would not understand, she serves as a light to those who might be in dark, dull, or dim places. Her bubbly, outgoing personality makes it easy for anyone to connect with her and feel her genuineness and commitment to seeing and showing people how to win. Her motto is iWin|iWon|iWOW, which is something she encourages others to do as well. 32 | InSession- October 2022 |

end Therapist

na Peters Where it all began

I was born to Kathy and Derek Crist in West Palm Beach, FL. Shortly after my arrival, we moved to Jacksonville, North Carolina, because my father was in the Marines. When I was three years old, my parents divorced. From then to now, Florida has been home. My life is full of twists, turns, and loop de loops, but I always seem to come out on top. I am an only child, but I have always yearned for a sibling. I have a very close nit family, so my cousins and I were raised like siblings. Early years As I look back over my life, I can’t help but have gratitude for the things I’ve been able to survive. Some people look at me and think life was a piece of cake. Well the truth is- it was far from it. Growing up, I’d always felt like the black sheep. I never really felt as if I fit in anywhere. I was different, I felt misunderstood, and I felt very alone. I carried so much pain and hurt due to traumas and unfortunate incidents I’d experienced. Despite having everything given to me in my childhood, I still felt empty. I grew up wanting to please everyone around me, and I never took the time to do things that made me happy. I never wanted to be a disappointment and strived to be perfect. I was introduced to therapy early; however, I never felt I could connect with any of the therapists I interacted with. It may have been due to not feeling entirely comfortable and the therapist providing services to me was not what I needed. This fact always stood out to me and I remembered how I felt as a recipient of therapeutic services. Tough times Despite overcoming so many obstacles in my childhood, adulthood was a whole new story. In 2005 I was diagnosed with Lymphoma. I was also told that I would likely be unable to have children. When I was informed of that, I didn’t care too much. You see, I never wanted children. It wasn’t until the first Chemo treatment that a shift occurred inside me. For the first time, while

sitting and looking at the bags of chemo medications slowly entering my body, did I have the desire to want to become a mother. I thought, “What had I done by not freezing my eggs.” To my surprise, in May of 2006, I found out that I was pregnant. I was over the moon and knew immediately that I wanted a baby girl. Due to my health history, it was a high-risk pregnancy that could have ended my life. On December 12th, 2006 I had to have an emergency c-section due to the doctors not being able to find a heartbeat on her. Thankfully, she was born healthy. However, 5 weeks after giving birth, I ended up in the hospital with a blood clot in my jugular. As a result, I was put on Lovenox injections for the next nine months. During this time, things in my marriage were not the best and as the years went on, so did the violence in my marriage. I never considered myself a victim, so I kept the abuse occurring in my marriage a secret. It wasn’t until I had had enough that I decided to do something about it. I had worn a mask for most of my life and I wanted to be free. I wanted to live for me. I had experienced bouts of anxiety and depression and as a result of the abuse, had a very sensitive startle response that still affects me to this day. I know what it is like to keep it all inside and not feel as though there is a place where you would be understood. Introduction to the field At the age of 15, I was introduced to the field of sexual health. At that moment, I knew I wanted to further my knowledge and pursue a career in sexual health education. I decided to get a BS in psychology. Psychology, sexual health, and all things abnormal were areas of interest. My first job out of college was a family consultant position at a community health agency. I enjoyed it and realized then that I would have to continue my studies to go further in psychology. While working on my master’s degree, I obtained a job at Planned Parenthood as a Sexuality Educator. I absolutely loved what I did. Once I graduated with my master’s degree, I was lucky enough to land a position as a director of clinical services. Everything I learned, I had to learn on my own. This was, in my opinion, a blessing. Due to this, my | InSession- October 2022 | 33

understanding of the administration side of mental health blossomed. For ninety percent of my career in mental health, I held administrative or executive-level positions. I guess you can say I got lucky. I was passionate, hands-on, and ensured patient care was always the focal point of services. At some point in my career, I realized I had a knack for substance abuse care. I loved working in that area of mental health. In 2014 created my company, Boundless Living Coaching Counseling & Consulting. Due to my vast knowledge of CARF, The Joint Commission, and DCF standards, I was contacted as a consultant to assist with accreditation and certification site visits. I had found my groove. In 2015, I was relocated to Orlando by ARS and hired as the clinical director for Orlando Recovery Center. Due to that position, I had to slow down on my counseling and consulting firm. Still true to my passion, I put programming and patient care first. Once leaving Orlando Recovery Center, I took a position at Harmony Hills, which would be my last position before I went into full-time Private Practice. During my time in recovery health, I noticed a stark imbalance in the rates of Black patients who sought care. Making the shift, an uncomfortable stretch It wasn’t my choice to go into private practice full-time. I was comfortable in my position however, and God had other plans for my life. Once I could release control and allow God to guide me, my life flourished more than I could ever imagine. When I stepped out on my own, I released a book, went into full-time private practice, and even expanded my practice to a group practice. It was uncomfortable; however, this stretching process was necessary to get to my destiny. Going back to my personal and professional experience, the lack of representation of the Black community in the mental health field was very problematic for me. Because of this, I set out to create something different, something unique, and something needed in the Black community. In 2020, on top of COVID, there was a surge of Black pain. The racial tensions mounting could be felt in the air. The lives of Black and Brown individuals were being rocked, and there was a need for more clinicians of color who were able to hold space for the souls of Black folx. 34 | InSession- October 2022 |

Paired with my passion for sex therapy, I decided to shift my clinical focus to that of racial trauma by providing much-needed services to Black patients. I wanted to create a safe space for patients who looked like me. I understood the need for Black mental health services. I wanted to help fill the gap, bring awareness to mental health challenges in the Black community, Paired with my passion for sex therapy, I decided to shift my clinical focus to that of racial trauma by providing much-needed services to Black patients. I wanted to create a safe space for patients who looked like me. I understood the need for Black mental health services. I wanted to help fill the gap, bring awareness to mental health challenges in the Black community, and educate communities of color on the services available. understanding of the administration side of mental health blossomed. For ninety percent of my career in mental health, I held administrative or executive-level positions. I guess you can say I got lucky. I was passionate, hands-on, and ensured patient care was always the focal point of services. At some point in my career, I realized I had a knack for substance abuse care. I loved working in that area of mental health. In 2014 created my company, Boundless Living Coaching Counseling & Consulting. Due to my vast knowledge of CARF, The Joint Commission, and DCF standards, I was contacted as a consultant to assist with accreditation and certification site visits. I had found my groove. In 2015, I was relocated to Orlando by ARS and hired as the clinical director for Orlando Recovery Center. Due to that position, I had to slow down on my counseling and consulting firm. Still true to my passion, I put programming and patient care first. Once leaving Orlando Recovery Center, I took a position at Harmony Hills, which would be my last position before I went into full-time Private Practice. During my time in recovery health, I noticed a stark imbalance in the rates of Black patients who sought care. Making the shift, an uncomfortable stretch It wasn’t my choice to go into private practice full-time. I was comfortable in my position however, and God had other plans for my life. Once I could release control and allow God to guide me, my life flourished more than I could ever imagine. When I stepped out on my own, I released a book, went into full-time private practice, and even expanded my practice to a group practice. It

was uncomfortable; however, this stretching process was necessary to get to my destiny. Going back to my personal and professional experience, the lack of representation of the Black community in the mental health field was very problematic for me. Because of this, I set out to create something different, something unique, and something needed in the Black community. In 2020, on top of COVID, there was a surge of Black pain. The racial tensions mounting could be felt in the air. The lives of Black and Brown individuals were being rocked, and there was a need for more clinicians of color who were able to hold space for the souls of Black folx. Paired with my passion for sex therapy, I decided to shift my clinical focus to that of racial trauma by providing much-needed services to Black patients. I wanted to create a safe space for patients who looked like me. I understood the need for Black mental health services. I wanted to help fill the gap, bring awareness to mental health challenges in the Black community, and educate communities of color on the services available. Because of this, I created The NOIR Center for Intuitive Healing & Counseling: A place where Afrocentric roots meet the luxury of mental and emotional wellness. The NOIR Center offers safe therapeutic spaces for individuals of color by providing highquality, reality-based therapies in a nontraditional way. There are so many services that I created as part of the culture of The NOIR Center. I wanted the individuals who visited the center to feel at home and comfortable enough to share their stories with professionals with whom they could identify. The stretch was a huge transition; however, I would not change a thing. I am living my dream and getting to do what I love daily on my terms. I get to provide services that help fill a void in mental health care. I absolutely love what I do. How I see life People often look at me and who I am today and have no clue what scars I bare. I don’t consider myself to be a victim but a victor. One of the most important lessons I’ve learned on this journey is the power of looking within. Taking time to reflect on my thoughts, feelings, and realities has been the greatest gift I could give myself. Learning that everything I encounter is a part of the journey and not my final destination

helped me to look past situations in my life that appeared negative, unfair, or unfavorable. I am intentional about enjoying life and all it has to offer. I know what it is like to face death. I know what it is like to feel alone, and I know what it’s like to feel trapped and without options. Because of this, I value every day I am blessed to open my eyes and experience another day. I share my story with you as a reminder that no matter where we are in life, we all have a story. Everything we go through molds and shapes us into the individuals we become. I can’t just focus on the mountain highs without acknowledging my valley lows. I embrace all of me. Even the most difficult parts of me are still part of me. I hope to inspire individuals to learn to love and embrace themselves as much as they can. This is an integral part of the process of self-love and acceptance. I am finally at a place in my life where I’ve discovered the beauty of radical self-love and acceptance. Where to next? It is my goal to open a center in every state I am licensed in. Personal life As I reflect on my life and all that I’ve been through, I am grateful for all the lessons learned along the way. I live my life with more intention, more love, and more peace. I now live with my soon-tobe husband, 15-year-old daughter, and two bonus children. No matter what I’ve gone through, I have always felt compelled to give back and pay it forward. I am living my best life and on October 15th, 2022 I marry my love and best friend. Life gave me lemons, and I am reaping the harvest of freshly squeezed lemonade. I did the work and was committed to my growth; I hope to inspire someone somewhere, and if I do, my life will not have been in vain. “Every great dream begins with a dreamer. Always remember, you have within you the strength, the patience, and the passion to reach for the stars to change the world.” - Harriet Tubman Thank you Cortina for sharing your light & heart in this article. FMHCA is proud to feature you as a loyal and longtime member, presenter and friend. -The FMHCA Office | InSession- October 2022 | 35

DID is a real thing Professional Experience Article

Dissociative Identity Disorder is a diagnosis that is very controversial in the minds of many clinicians today, which I find very confusing. A recent study found that this disorder is just as prevalent as Schizophrenia, which no one seems to question or disagree with. In addition, the diagnosis of DID has been a part of our diagnostic manual for many years. So why are so many clinicians in denial about this condition? I believe it is because of the complexity of how people with the disorder present themselves. I started working with the population on a regular basis when I noticed some peculiar changes in the clients I was working with. One day a quiet and demur southern woman I had been seeing stomped into my office and glared into my face. This was not the same presentation that I was used to with her. As I explored more, I realized that she was certainly not the same, and had a whole other set of values and ideas to the client I had seen for the past year. When I spoke to her the following week, she barely remembered the previous session, and I told her about what I had seen. I think clinicians struggle both to notice these changes, and to deal with them effectively. As I present at conferences and talk to my students about this condition, the fascination of both them and myself seems to grow. I would love to see more clinicians start to work with these individuals, or rather become more aware that they are in fact doing so whether they know it or not. We need to increase 36 | InSession- October 2022 |

the standards we have for ourselves in terms of trauma competence and understanding the role that the brain and the body play in the mental health of our clients. I ask all of you to be mindful when working with clients that have trauma, as well as the common misdiagnosis of Bi-polar, Borderline, and psychotic Disorders that all of my DID clients have suffered under in the past. DID clients are expert at hiding themselves, but if you can see them for who they truly are, you will be able to help them in a way that perhaps you never had before. Written By: Rhett Brandt, Ph.D, LMHC Dr. Brandt is a Licensed Mental Health Counselor in Florida and a Licensed Professional Counselor in Alabama. He has been a practicing psychotherapist for 20 years. He earned a Ph.D. in Counselor Education from the University of Alabama in 1997. His dissertation looked at the formation and use of theoretical orientation in counselors. He moved into private practice 17 years ago. He began noticing more and more that emotional repression and childhood trauma were the precursors to mental health instability. His passion in a clinical setting involves working with trauma and dissociation, in particular clients that suffer with Dissociative Identity Disorder. His core belief is that the expression of emotions is the path to growth, and that creating an environment where those emotions can be brought forward is my role in the process | InSession- October 2022 | 37

38 | InSession- October 2022 |

How to be More Effective in Counseling Clients with Relationship Distress and Adjustment Disorder Professional Resource Article


Trust and Collaboration

Counseling is among the most effective means in ensuring that clients encountering lower levels of functioning return to their normal lifestyle. Counseling is a useful tool in treating problems related to relationship distress and adjustment disorders stemming from relationship breakup. Relationship distress and adjustment disorders are among issues that have been associated with depression, anxiety, suicides, etc. The focus of this article is to address strategies to be considered in making counseling more effective.

Trust and collaboration starts being built upon from the moment the session begins. A counseling session cannot be effectuated, nor the goal of the session be achieved if there is lack of trust. Building trust is also associated with how therapists build rapport with their clients. Levels of trust from the client can be gauged through many aspects including boy language, how much a client reveals about themselves, and their willingness to share. It is also important to note that giving the client space to dictate the pace of the counseling session enables building the trust necessary for collaboration. The therapist should also note that this goes in line with allowing the client to focus on topics they welcome. This is significant in enabling clients to share sensitive content associated with the distress encountered within their relationship, in addition to the struggles in adjustment that may come with relationship breakup.

Communication One of the most important personal and professional characteristics of an effective therapist is communication. A therapist must be clear and effective in both oral and written communication. Active listening is also an essential tool which is used throughout the therapeutic relationship, as it enables the therapist to note issues that are affecting the client, thus enabling the therapist to form the best approach. Paraphrasing allows the client to feel heard, understood, and builds trust within the therapeutic process. Collaboration with the client will have a long-term impact on the path to treatment planning and working towards the client’s goals. To ensure the effectiveness of the therapeutic relationship, a therapist should consider communication that features attentiveness to ensure an understanding of the presenting problem, as this impacts the therapeutic alliance.

Multicultural Competence and Mindfulness When working with clients, the need for multicultural emphasis is imperative. Therapists have an ethical responsibility to provide professional services they demonstrate respect for the cultural worldviews, values, and traditions of culturally diverse clients. To better serve clients after a relationship breakup and exhibiting symptoms of adjustment disorder, ascertain from your client what these things mean in their culture and what it means to them on an individual level. | InSession- October 2022 | 39

According to a study by Caldwell (2012), mindfulness is a building block that facilitates change in the emotional realm. Despite being noted that therapists should have an array of skills, Caldwell (2012) noted that a therapist also should consider a more quality relationship than skills. In counseling, mindfulness has an important role in increasing selffocused attention and change in characteristics that feature flexibility and non-reactiveness. Reassurance In relationships, reassurance mainly focuses on confirming a feeling in a partner. Considering that counseling is a therapeutic relationship between a client and the therapist, reassurance is an important tenet that focuses on ensuring the relationship thrives and enables collaboration. Reassurance in a therapeutic relationship is an aspect that focuses mainly on the communication and actions of the therapist that reduces the feeling of fear, doubt, and stress associated with the distress within a relationship or relationship breakup and adjustment. In most instances, clients question the reasons for relationship distress or for the break up, what they or their partner may have done wrong, etc. In adjustment disorders, there is always the aspect of fear and anxiety. As such, in effective counseling, the therapist promotes efficacy by reassuring the client about their feelings and guides in reframing negative-self talk. Grief and Relationship Breakup Grief, seen on many scales, also manifests with the loss of certain relationships. Therapists must aide clients in their understanding of the grieving process, in addition to exploration and identification of stages in which the client has experiences thus far. With knowledge come more effective transitions from one stage to another. Generally, as an effective therapist, it is essential to consider different communication efficacy strategies that will impact the transition throughout the grieving process. Crying, a natural response to a range of emotions, has been scientifically proven to help process grief. According to research by Sharman et al. (2020), crying is associated with releasing stress hormones, including cortisol, which builds up in the body, causing emotional stress. A study by Allison (2022) also noted that crying has been proven to stimulate the production of endorphin, a hormone associated with positive feelings. In relationship and adjustment disorders, for instance, there is an accumulation of stress hormones which may have long-term impacts on the grieving and healing process. Therapists are recommended to allow and encourage their clients to cry, considering that this has a positive impact on the natural healing process. This can be achieved through the reassurance process and instances that bring about crying 40 | InSession- October 2022 |

during the early stages of counseling. Unsolicited Advice Despite the role of counselors in enabling their clients to have a successful transition in grieving breakups and issues with adjustment disorders, there are additional stressors such as outside advise and unsolicited advice that may serve as stressors, which can minimize the chances of a successful therapeutic relationship. As noted in a study by Prass et al. (2021), in the study that considered the involvement of solicited and unsolicited advice, when unsolicited advice was used, there was a significant reduction in the cooperation of the client and the therapist, especially with those clients who were anxiously attached. When counseling clients grieving the loss of a relationship and show symptoms of adjustment disorder, considering the effects of unsolicited advice on clients in the therapeutic process may prove beneficial. Through the consideration of unsolicited advice, therapists gain a better understanding of the issue at hand before ensuring that the strategies considered in successful counseling are effectuated. Conclusion Conclusively, counseling clients that going through a relationship breakup or suffering from adjustment disorders can be challenging. As noted along the key considerations, the most effective counseling features are the therapeutic relationship with the client, and how the therapist guides the relationship. It should also be noted that skills and relationship efficacy are all relevant in enabling a smooth transition from grieving to a normal level of functioning. As such, therapists in counseling sessions should always be conversant on how to effectively maneuver each session. They should in conversant with the outlined aspects noted above, among others relevant to acting professionally troughout the process. References Allison, C. (2022). Dr. Stanton Capstone May 11, 2022 The Monopoly of Modern Medicine. Caldwell, K. L. (2012). Mindfulness matters: practices for counselors and counselor education. American Counseling Association VISTAS Project, 1, pp. 1-9. Prass, M., Ewell, A., Hill, C. E., & Kivlighan Jr, D. M. (2021). Solicited and Unsolicited Therapist Advice inPsychodynamic Psychotherapy: Is it Advised?. Counseling Psychology Quarterly, 34(2), pp. 253-274. Sharman, L. S., Dingle, G. A., Vingerhoets, A. J., & Vanman, E. J. (2020). Using crying to cope: Physiological responses to stress following tears of sadness. Emotion, 20(7), p. 1279.

Written By: Alecia Rodriguez, PhD, MFT, MHC Dr. Rodriguez is a mental health professional providing services in the Miami, Florida area. She utilizes a strengths-based, person-centered approach to help support clients on their personal journey. Dr. Rodriguez is also a published children’s book author. Her professional affiliations include ACA, AMHCA, FMHCA, and FCA.




LEARN MORE | InSession- October 2022 | 41

Inner Child Professional Experience Article

“The wound is not my fault, but the healing is my responsibility”, Denice Frogman. Within mental health disorders, one common theme seems to be healing the inner child. As professionals, we want to help our clients reach their full potential. To help them reach their full potential we have to re-evaluate ourselves and any area that we need to heal. To assist our clients, we need to lead to have healed our own inner child. The inner child continues to live within us, yet we have to understand that they cannot take control of our emotions. Healing the inner child starts with looking within our childhood and asking the question, “what did I need from myself?”. This could lead to many answers. From these answers we explore our inner child and learn to listen to it. “Did you feel secure in your household?” “How were finances handled in the house?”, “How was love demonstrated to you”, “Did you trust your parents/guardians around you?” A wounded inner child comes with guilt, unhealthy relationships, fear of abandonment,and neglect. Individuals who have trouble saying the words “no”. Feeling codependent with others or left out when a friend does not invite you out.Describing yourself as a “people pleaser” or super “achiever”. Answering these 42 | InSession- October 2022 |

questions would determine the position of your inner child. Art can be used as a technique to see how your inner child looks to you. Analyzing how you drew your inner child and details of it. “What are your feelings when looking at the picture?, “would you change anything?”, “have you forgiven yourself?”. If you haven’t forgiven yourself then what challenges are you facing that need to be discussed. Healing starts differently for each of us. It could be re-visiting old hobbies or places we used to go to as children. As professionals, do we need to take a step back to watch the clouds go by, enjoy nature, or simply eat our favorite childhood candy. Affirmations that could continue to provide the love and support needed. Looking at an old picture and being able to repeat these affirmations could engage our inner hcild. To add on, being able to censor our inner critic allows us to be present with our feelings. Although life can be busy, what time can be taken to give back to our inner child. Embracing our inner child and learning to understand, forgive and love this child is a step towards healing. Written By: Jessmary Echevarria, LMHC Jessmary is a LMHC in Orlando. 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 the human brain. | InSession- October 2022 | 43

The De-mystification of Feelings Professional Experience Article

Here it is August 2022 and, as I ponder a movie I viewed last night for the second time, I am aware of feeling enlightened. I recall originally viewing this movie September 1999. The movie, The Sixth Sense, tells a story of a dedicated child psychologist played by Bruce Willis, whose earthly goal was to help a troubled young child. This very bright child experienced numerous fears and anxieties, resulting from his inability to communicate the secret that led to his fears. With the trust that he gradually developed in his psychologist, he was eventually able to reveal his secret-he saw and heard dead people.These apparitions appeared to be the spirits of departed souls who continually attempted to communicate with him. With the help of his psychologist, the young boy finally came to realize that the answer to his dilemma lay in his ability and willingness to listen to their spirits. He possessed, the movie suggests, a “sixth sense” which led to the multitude and intensity of feelings that he experienced. By finally no longer fleeing from the reality of his visions, but rather confronting and listening to their voices, he thus freed the souls to find rest and move on. By feeling his feelings, the child freed himself from the fears that had previously enslaved him. Do we possess a sixth sense? I don’t know. I do believe, however, that we, too, fear feeling our feelings. Feelings – what exactly are they and why do they elicit diverse and intense reactions

within us? Is it possible that one is not aware of his or her feelings, or could it be that one consciously chooses to avoid exploring such feelings? The dissociation from feelings may temporarily numb oneself; however, such a practice usually leads to an unconscious act, which in turn could become a negative habit. Compulsive binge-eating, bulimia, anorexia, alcohol, drug use, gambling, overspending, to name a few, become the coping mechanism for something else.What is that something? Feelings, of course! What are we afraid of? Is it a sense of the unknown or is it a fear of losing control? I cannot nor would I attempt to answer this for you. However, I believe that when we do not listen to our thoughts and experience our feelings, they lead to dysfunction, negative coping strategies and negative habits. In addition, I believe that we have an inner sense and that we would be in a better place if we listened to this voice. Perhaps with this communication, we could find purpose, peace of mind, greater understanding and, most importantly, a new way to cope with that which caused the original negative feeling. Disordered eating and other negative and abusive behaviors are complex. The answers are represented as pieces of a puzzle, which need to be strategically placed to form a whole. When faced with the act, we need to stop and listen to our internal messages that caused the negative behavior. Just like the young boy

in The Sixth Sense, we must listen to ourselves. Such a practice could lead to restitution. Is it easy to do so? No! Will one experience fear when attempting this? Yes! Will our honest introspection resolve the problem? Maybe the answer will be yes or no. However, with each introspection, the deepening of a new feeling may develop – one of understanding and peace. Our ability to be honest about what our needs are leads to growth. What type of growth you may ask? I am referring to a growth that leads to a healthier mind, body, and spirit. Once we set forth to grow this way, I believe that our life’s journey takes a new direction and a more positive meaning. Just like the boy in this movie, we embark on a journey in which the “mystery” of feeling becomes “demystified”. Overall, the ability to stop, look, and listen requires the courage and willingness to face our feelings in the pursuit of a meaningful life rather than in the pursuit of negative behaviors. As health care professionals who work with individuals with abusive and addictive behaviors, we can utilize this approach to help our clients. Once trust has been developed, the encouragement to listen to one’s inner sense and face the accompanying fears can be suggested and worked with. Hence, we become a catalyst in our client’s growth, understanding and eventual independence and freedom. This enables them to face their fears thus grow and pursue a more positive journey.

Written By: Louise Parente, PhD, LCSW, CEDS Louise is a certified eating disorder specialist, psychotherapist, supervisor, educator, and coach. She has presented at a variety of symposiums, conferences, and hospitals; has worked as an adjunct lecturer at New York University, School of Social Work. She is the recipient of the Marquis Who's Who Lifetime Achievement Award, 2020 Dr. Parente is the author of Parting Is Such Sweet Sorrow. Saying goodbye to an eating problem which focuses on changing your relationship with food using Loss and Grief as a treatment model. She divides her time between Florida and New Jersey.

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46 | InSession- October 2022 |

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.


I am a mental health counselor. I am leaving a therapy practice with an employer assistance program (EAP) company. What rights do the clients have to follow me to my new practice? Clients always have the right to select their own health care professional. The client's choice may be affected by whether or not their insurance company and/or their employer will pay the professional's fees.

However, your question seems more likely to be about what your rights are regarding providing later care to these clients. This will depend on what your contract with the EAP company states. If there is a written contract, then it will probably address what party owns the client records, whose clients they are, and whether you are allowed to provide competing services if you leave the EAP company. If there is no written contract with the EAP company, then your clients may follow you to your new practice and you may provide the clients services.


I hear counselors saying that they ask their clients to leave reviews on Google and other sites at the end of a session. Is it ethical or legal to request that in session? Is it okay to have a link to a place for reviews in your e-mails? Is that okay?

As a general rule, it seems unprofessional to be requesting clients to leave reviews (a thing of value to the counselor) during a session. The client (or insurer) is paying for your time during the session and may think that you are using the client's therapy time to solicit reviews. The better practice would be to have signage in your waiting room, at the receptionist's desk or where the patient checks out, that alerts the client to how the client can leave a review. Providing flyers or cards with this information on them at the same locations might also avoid an appearance of unprofessionalism. The following sections of the American Counseling Association's (ACA) Code of Ethics (2014) appear to be on point: "C.3.b. (Testimonials): Counselors who use testimonials do not solicit them from current clients . . . or any other persons who may be vulnerable to undue influence. . . ." "C.3.f. (Promoting to Those Served): Counselors do not use counseling . . . to promote their products or training events in a manner that is deceptive or would exert undue influence on individuals who may be vulnerable. . . ." Additionally, you may also want to review the following sections: A.6.b. (Extending Counseling Boundaries);A.6.e. (Nonprofessional Interactions or Relationships); A.10.f. (Receiving Gifts); B.1.b. (Respect for Privacy); and B.7.a. (Respect for Privacy). You should have few or no communications with your clients via unencrypted e-mail because of the lack of security for confidential information in such communications. 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. Want your question featured in the next InSession issue? Submit Here Must be a FMHCA member to submit. Become a FMHCA member by clicking here. | InSession- October 2022 | 47

48 | InSession- October 2022 |

The Importance of Assessing Invisible Wounds Professional Resource Article

It is a privilege to be invited to help those that struggle with the impact of past painful learning, and I feel honored to have the opportunity to be allowed to work with clients that have experienced the worst kinds of hurt in life. I am proud that much of my work with clients centers around addressing a variety of trauma histories, but I find that most of the time I am not the first therapist that they have worked with and when they come to me I find that these clients are often misdiagnosed. Accordingly, clients will embrace this misdiagnosis due to placing significant trust in therapists, in general, due to our title or education. I find that my clients will buy into what their therapist is telling them, so it is important that we are giving the most accurate diagnosis possible. I believe, as clinicians, we have to ensure we are properly assessing the symptoms that are present and explaining our treatment course to our traumatized clients as they must navigate those symptoms. In addition to thorough assessment and accurate diagnoses, I believe therapists need to be trained and prepared to educate clients and demonstrate effective skills. When we serve our clients well, they can heal from their past painful learning, so it is important to have the needed clinical skills and assessment tools to serve traumatized clients effectively. Before anything can begin to happen clinically with our clients we must be prepared with proper training and an awareness of the unique aspects of treating traumatic stress. I have seen many children that are misdiagnosed with ADHD when they are in highly distressing environments; no one can properly focus when they feel a constant sense of fear about their safety so this is not always an appropriate diagnosis. I also have seen adults misdiagnosed with Bipolar Disorders but a history of trauma is at the root of their emotional disregulation. It is certainly possible for a person to have a dual mental health diagnosis but it is imperative that we are considering differential diagnostic questions to help make our assessment and rationale for the diagnosis more complete by reflecting on questions like “Does this diagnosis best account for the symptoms?” or “Does this connect the most closely to the appropriate course of treatment?”. How we assess and diagnose should be closely tied into how we are going to treat the client’s symptoms or if we should be referring that client out. As the professional we need

to be aware of our own limitations and strengths and if treating a client with complexed trauma is not in our skill set we must serve that client well by connecting them to a practitioner that will be more suited to their needs. Many symptoms have overlap but the nuance of trauma needs to be highlighted in order to have positive outcomes for our clients. Therapists can make use of appropriate screening questions and assessments in order to bring validity to a diagnosis or clarify any confusion. There are some aspects of diagnosis that are overt and will not require much deliberation but there are subtleties that may require some clarifying. Many trauma survivors are avoidant to the past painful learning that they have experienced so they may not be as open at first, they may not really see the events of the past as being that bad, or they may not want to talk to a therapist about that experience. As clinicians we have to be willing to move at the client’s pace in order to ensure the client has a sense of safety with the therapist. When a client feels they have a safe place to share they are more likely to disclose about past painful learning. I have learned to assess for neglect by asking if a client feels they have been properly nourished across the critical domains of the human experiences. Some clients that have survived chronic neglect may not be aware that they have experienced neglectful practices. I typically will ask “Do you feel you were properly supported emotionally, physically, and intellectually?”. I find assessing for neglect with this question tends to give the person a chance to reflect carefully on what has happened in their life and to appraise it for themselves. At that point I find I can sit back and ask some simple open ended questions and clarifying questions to build rapport and to further assess. In addition, there are some very helpful assessments that I have found useful in starting a conversation with my clients about their trauma history. I find that using an assessment tool gives the client a concrete place to begin the discussion about the past and how it is impacting them currently. The Adverse Childhood Experiences (ACEs) assessment is not intended to render any specific diagnosis but it asks ten simple questions about past experiences that I have found give my clients a moment to think about how those experiences have formed them. I often give the | InSession- October 2022 | 49

ACEs to clients that have not drawn the connection from their past painful learning and their present disregulation and they typically have been told they have a mood disorder. Another assessment tool that I find helpful when clarifying a trauma diagnosis is the Dissociative Experience Scale (DES-II). Dissociation is something that many people do to an extent but in situations where it hinders functioning it is a symptom that is more commonly indicative of a trauma diagnosis. An elevated score on the DES-II can be helpful in differentiating between Generalized Anxiety, Post-Traumatic Stress Disorder, or even a Dissociative Disorder. In more extreme cases, the Multidimensional Inventory of Dissociation (MID) is an intensive assessment with over one hundred questions. The screener does require training to issue because of its indepth nature, but the amount of clinically significant data points it can provide is highly valuable. The assessment provides comparative analysis between the client’s responses and clients that met criteria for Post-Traumatic Stress, Dissociative Identity Disorder, Borderline Personality Disorder, Unspecified Dissociative Disorders, and the Non-dissociative control group. There are a host of other clinically appropriate assessment tools that can be helpful and it is important for therapists to utilize those tools to help clarify diagnosis and inform the course of treatment. In order for clinicians to understand the subtle and overt signs of trauma we must begin undergoing constant continuing education and seek supervision. Training is a way to sharpen the tools in our clinical skill set and the sharper the tools the less it will weary the clinician. This is not to say serving a traumatized population is ever easy but it is much easier when the therapist is prepared with the needed tools to help. When therapists feel more competent to serve a client it increases our ability to act with greater effectiveness, and can serve as a protective factor from secondary traumatization and burn out. For the good of our clients and for the good of the clinical worker we have to invest in our skill set, but we must also know when it is best to refer. I have observed in the last three years as the profession has navigated the impact of the COVID-19 pandemic that some therapists struggle to hear the realities of what our clients face and it has been disheartening. I also think this brings to light that not every clinician needs to be a trauma expert or specialist in treating traumatic stress; it may be that kind of work would be harmful to the professional. As such, there should be no shame assigned to a professional, who is acting ethically, for admitting their limitations, but I do think all professionals should be trauma informed. A therapist that can recognize that they may not be the one to help a given client is an important insight but having the knowledge to see, even to a lesser extent, how trauma could be impacting the presentation of symptoms is a 50 | InSession- October 2022 |

professional minimum. How we engage in sessions with our clients that have a history of past painful learning can be the difference between serving them well or re-traumatizing them. Many of my clients reported feeling that they feel their experiences make it hard to feel understood or truly known, but I find that my being a trauma informed therapist allows me to accurately reflect and in some cases explain their reactions to triggers in a way they have not had someone do for them. The experience of being traumatized can be isolating as it is not one that is universally held. It is important to remember that the client’s experience of an incident, the physiology, and the selfappraisal are the core therapeutic issues and not just the event itself. We have all had bad days and we certainly have all experienced hurt but that is not the same as being traumatized. When people attempt to express solidarity with a traumatized person through the much more universal human experience of pain it can be invalidating; this is even more so true if that comes from the therapist. According to psychiatrist and researcher in the area of posttraumatic stress, Dr. Bessel Van Der Kolk, “Trauma can only be worked through when a secure bond is established with another person”. The therapist can become a safe place for that client to begin the difficult work of processing the lessons that were learned in past painful learning, but the therapist must model the self-regulation and communication that is needed to provide that safety. As I mentioned earlier, not every therapist needs to be a trauma specialist but all therapist must be trauma informed in order to engage traumatized clients even if it is just to refer them. The therapist having some specific trauma training can be extraordinarily helpful as it provides a framework for therapy and helps the therapist to provide an effective guide to the client on what to expect. To a person that has been traumatized, a surprise is often distressing so having a regulated trusted guide to explore their trauma will help reduce tension. The therapist must have strong self-regulation skills and psycho-emotional boundaries in order to properly serve those with profound trauma histories. Having training in an evidencebased trauma therapy model is a major milestone; however, therapists must have the ability to regulate as they are working with the client. As a client begins to disclose their trauma history the clinicians reaction will either send the message “this person is not distressed by my story” or “they cannot handle this”. The metamessage that the therapist is listening, open, and compassionate opens the doors for therapy to become a meaningful experience to the client and that they have a free space to be open. The life experiences of trauma survivors are often difficult to listen to as they are heart wrenching. When a client discloses some of their trauma history

to us, we are being invited into a truly sacred space in the life of that survivor. Unfortunately, the sacredness of that space is wrapped in suffering and painful learning about themself and the world around them. If we are invited into that space and we do not respond with a sense of compassion and respectful curiosity we may send the client, unintentionally, an invalidating response that leads to re-traumatization. When a client is re-traumatized by a therapist it can send the message that they cannot be helped because the helper was too scared to approach the pain the feel. The impact of mental health trauma has been a topic that has gained growing awareness and prospective clients are coming to see a therapist to address their needs in growing number. Therapists must sharpen the skills needed to treat these issues in order to be effective. As clinicians we have an ethical and professional duty to be prepared to treat or refer any client that seeks us out for services. We must be able to help clients understand their symptoms and have some understanding as to what may be some of the best ways to go about offering help. In addition to being mindful of best practices we must also be

aware of things to avoid in order to ensure that we do not retraumatize our clients. As we continue to seek out continuing education we should also be learning about the most appropriate screening tools to help better explain to our clients exactly what is happening to them. Lastly, therapists should model the skills we are teaching to our clients in order to not only demonstrate how effective those skills can be but to help facilitate a safe environment for the client to explore their past painful learning. Trauma therapy is a nuanced specialization within the mental health field and those that engage in treating trauma must be prepared for the challenges that come. 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 t raining in a variety of 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- October 2022 | 51

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Show up to session in style The FMHCA Store has new designs each month of t-shirts, mugs, stickers, notebooks, hoodies, crewnecks, & more! Each campaign benefits The Florida Mental Health Counselors Association. Shop Now | InSession- October 2022 | 53

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Politics and Legislative Timeline Legislative Update from FMHCA Lobbyist, Corinne Mixon

Florida Legislative Timeline: The 2022 General Election is on Tuesday, November 8th. This will be the first General Election under the new legislative and Congressional maps after the decennial census and redistricting process. Across the state, voters will elect a US Senator, 28 members to Congress, a Governor and Lieutenant Governor, an Attorney General, a Commissioner of Agriculture, a Chief Financial Officer, 120 State House members, and 40 State Senators, not including countless local races. All legislators who have assisted FMHCA with passage of bills within the last few years are expected to be reelected. These legislative champions include, but are not limited to, Sen. Ana Maria Rodriguez, Sen. Danny Burgess and Rep. Traci Koster. Fourteen days after the General Election, the State House and State Senate will convene into Organizational Session on November 22nd. During Organizational Session, the House and Senate will select their presiding officers; Representative Paul Renner is the current House Speaker Designate and Senator Passidomo is the current Senate President Designate. It is during the several weeks preceding and post-dating that we will see legislative bills begin to be filed. FMHCA is likely to craft legislation and seek bill sponsors in the House in Senate who can support several key concepts. Once officially chosen by their respective bodies, the new Speaker and President will begin assigning committees and choosing committee chairs. The presiding officers will also schedule Interim Committee Meetings for the purpose of meeting and hearing legislation before the Regular Session. Interim Committee Weeks can be scheduled any time after Organization Session in November until the Legislature gavels into Regular Session at Noon on March 7th. The House and the Senate have 60 consecutive days to hold committee meetings, conduct business, and pass legislation until the conclusion of Regular Session on May 5th, 2023. Action items for FMHCA members: First and foremost, VOTE! FMHCA members must exhibit advocacy in their personal lives to make a difference with political advocacy. Next, at the conclusion of the 2022 General Election, it’s imperative that each FMHCA member identify and research the winner of the race for Florida House of Representatives and Florida Senate. If any FMHCA member knows personally a recently elected person, please share that information with the Association.

Written By: Corinne Mixon, DPL Corinne is a registered professional lobbyist with fifteen years of experience representing clients’ state governmental interests. At Rutledge Ecenia, Corinne represents a broad client base with a particular emphasis on health care practitioners, education and regulated industries and professions. She has been instrumental in passing myriad legislation and killing bills which would have negatively impacted her clients. Corinne lobbies across multiple platforms including legislative, executive and state regulatory board. Corinne’s professional experience also includes association management, political campaign management, providing continuing education, public speaking, crisis communication, and political action committee management. Corinne was recently named Best Lobbyist (Florida) by Florida Politics. Be a part of the change and become a FMHCA member today! | InSession- October 2022 | 55

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