Becoming Competent

Becoming a counselor or therapist or some other helping professional is in some ways a disillusionment. We spend 2-5 years in a graduate program that tells us that we are going to become wonderfully skilled clinicians upon graduation. Some of us believe this. Even if we had not so great experiences in our practicums and internships we believe that we have what it takes to make it in this land of mental health.

Yet the reality sets in that we really don’t know what the hell we are doing when that first “real” client sits down across from us.  I have come to believe that our Graduate training actually is our foundation. After we are set free into the world it is our responsibility to build upon it.

The picture for this post shows two “baskets” made out of Keva planks. These planks are uniform pieces of Maple that are stacked together in order to create wonderful structures. Keva Planks do not use any kind of fastener. The goal is to create the greatest structure that your mind and imagination will allow. This “basket” stood close to five feet tall.

I believe becoming a competent counselor is a bit like building with Keva Planks (or building with anything really).  One must start with a strong foundation that can support the dream of the rest of the structure. The foundation may not be aware of what it will be supporting but it does know that it will be strong enough.

It is up to us to build upon the foundation that our training gives us. Unfortunteately I have heard from clients that there is bad therapy being conducted. OK, a caveat: Therapy may not be appropriate for some instances and clients may not be willing to engage in therapy for a variety of reasons. Nonetheless, I am struck when a client shares with me that after many therapists the family support worker that came to their home was the most effective.

Do we neglect building our therapy structures? Maybe. I have come to realize that there is a lot to learn in this field. There are many many theories and techniques that could be used to help with almost any kind of problem. It is up to us to build our knowledge through experience and ongoing learning. I believe that we should work very hard at learning all that we can in service to our clients, which means going outside of the required CEUs to maintain our license.

Becoming competent is our efforts to build upon the foundation that our training has given us. We grow when we build. When can grow in areas in which we are weak. We can build our professional knowledge and expertise into anything that we can dream.

Recently I decided that since adolescent clients keep coming in through the door, I better learn how to do effective work with them. In an effort to do this I picked up Tough Kids, Cool Counseling form ACA, which I highly recommend.

 

Have a great weekend and build your knowledge!

 

 

The End of a Journey…

Yes, I am coming to the end of my time in clinical supervision. The last two and a half years have been insightful, fun, heart breaking at times, and most of the time wonderful.

I started the process of becoming a counselor 7 years ago. I got my behind back into college and this time around (I think this was my 3rd attempt at going to college) applied myself. After finishing up my undergrad I went straight into Graduate work, internship, and now working for an employee assistance program. I love the work that I am doing…

…But I am haunted by the nagging feeling that I need to move on. Maybe not right away and certainly not because I don’t enjoy the company I work for. Quite the contrary, I believe that the company I am working for is doing good work in the communities it serves.

Yet, I want more. Reading Seth Godin and Hugh MacLeod probably has something to do this. Also, I have been talking to other counselors,  reading books, and gathering information from Twitter. So, yeah, I haven’t been great on discipline with this site. But, I am working on a website for my private practice. I have been dreaming up and writing new intervention tools for my clients. I am helping my church revamp their website. And I have been watching True Blood with my wife.

Life is busy. Discipline is hard. And I need to do better shipping.

I became a counselor to make a difference. I cannot be stuck in place for too long. But I doubt I would ever be OK with “settling”. That’s why I went back to school; to learn a trade that can help people change lives.

I have learned something in the last few days: Helping people change their lives means putting your butt on the line.

Comments? Love to hear them!

What Have You Been Doing?

I was looking over a draft of a post just tonight and realized that it is now October and not September anymore, and man, this blog is starting to collect some cobwebs. I told myself that I would not do this. I told myself that I would be engaged and active and keep this up no matter what. But I let myself down; I repeated the same cycle over again. That cycle is 1. Coming up with a great idea 2. Not doing the planning necessary to make it a success 3. Stepping away when the going gets tough.

Sheesh, not great huh?

But, while I have not been as engaged online I have been making contacts and getting involved in the “real” world. Over the last couple of months I have become very involved in my church, have been investing time in my marriage, and making sure my kids don’t die.

Enough of that “personal” stuff. I have also become involved in my community and in my professional associations. In September I started a leadership class offered by the chamber of commerce aptly titled Leadership Nebraska City. One of the goals of the program is to nurture new leaders for our community by introducing students to local business and civic leaders. I hope to gain an understanding of the needs of the town so that I can become involved in making this a better place to live.

I also attended the Nebraska Counseling Association’s annual Fall conference a couple of weeks ago. I had a great time meeting other counselors in my state and learning of the different programs and specialties that other counselors are offering. At the end of the conference our divisions meet quickly. To my surprise I ended up elected to chair of District II. Yikes! This means that I have to help plan a training or event of some sorts for the district. It is good that I have lots of support from the previous chairs.

So now what? Recently I read David Diana’s excellent Marketing for the Mental Health Professional from which I took away the thought: Be awesome. OK, so that it is my boiled down nugget, but the point is to add value and to do good work.

So even though I have failed in some ways or have at least not paid attention to some of my goals I now have a renewed spirit. I aim to make my time as District II chair awesome. I will find ways to add value for the members so that they see what the organization has to offer. I am going to do my best to be an awesome member of Leadership Nebraska City. I am also working on launching a mental health blog that will tie into my private practice, which will be awesome (I hope).

So, what have you been up to?

Google+ New Toy or Great Networking Tool?

By now you have likely heard of the new kid on the social media block Google+. Right now the platform is in beta, which means you have to have an invite in order to start using it. Google+ combines elements of Facebook (news streams, games,  and friends) and Twitter (microblogging) into a sleek design. Google hopes that Google+ can add a social layer to the current web experience.

That’s great but how can therapists  use Google+? Great question! First, some basics: Google+ allows users to place people they would like to connect with into circles. When someone wants to post something in he or she can decide which circles to share the information with. For example, I could let my family circle know about plans for a birthday party or let my mental health colleagues know about an upcoming workshop. Only the circles selected will see the information shared. Also, users can lock posts ensuring that those wild convention pictures don’t get to your boss’s desktop. Another great feature of the platform is the ability to start a group video chat with your circles, called a “hangout”, allowing users to connect instantly to others online.

Yet I still haven’t really answered the previous question. Google+ has great potential as a networking tool. Mental Health Professionals could use the platform to connect to one another. Perhaps online consultation could be an option. But a better use would be for someone to send a quick question or request for a resource to his or her “therapist circle” (or whatever you call it–I have one titled “Epic People”) and get a response. No one else would see the question. Google+ could be the social media solution for therapists that are concerned with blending their personal and professional lives online.

Also, imagine connecting with current clients. I am not suggesting that Google+ be used to provide therapy, but the platform could be used to connect with attendees of a workshop or group therapy session to provide follow-up support.  Again, one could select what information would be shared with which group.

But what if clients add you? Well, as far as I can tell anyone can add you, but you don’t have to add them. So, if you share something with specific circles it will not be seen. Only the posts you label “Public” will be seen by people who have added you.

I for one would love to see more networking by Mental Health Professionals. Especially by us counselors. I feel that we are too disconnected. The only therapists we are friends with are the ones we work with (hopefully). I could see Google+ taking the place of listservs because it offers a more robust and immediate connection. I for one am paying more attention to this platform than Twitter and Facebook because my goal online is to network with other like minded individuals. Most of us seem to only use social media to push our products or dredge for new clients.

The potential is there. I for one hope that once this comes out of beta that Google+ takes off. Until then, you can get an invite here if you don’t have one already.

 

What do you think? Am I talking the “crazy talk” out here in Middle America?

Let me know below.

Outcomes and Ratings

Hi! In a previous post I shared that I have begun using the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS) in my work as an EAP counselor. I have been using these measures for about a month and I am going to share with you what I have learned along the way.

First, trying new things is hard, especially in session. My wife was very gracious in allowing me to practice administering the forms on her (that’s a first for us). The first few times with “live” clients were very awkward. But, as the manual suggested, I would become more comfortable with practice. Plus, while getting ready to use the ORS/SRS is not particularly hard, it does require a bit more paper and time to organize it all.

Second, my clients did not look at me like I was crazy. Actually, they seemed to expect something like this in coming to see a counselor. Most of my clients understood the measure right away. But I have noticed that some are somewhat dismissive about it.

Third, using the ORS/SRS has provided me with a bit more structure. For example, I usually begin with the client’s problem and try to work our way to formulating goals. Now (and when I am mindful to work a bit harder at connecting the ORS to the client’s experience) I can focus in on one problem area a bit faster. One reason I was drawn to the ORS is that it seems to embody solution-focused brief therapy (SFBT) techniques rather well. I can point to a question and ask what would help move the score up a little bit.

Fourth, I have noticed a subtle change in my clients. Most people have become a little bit more open with me and are more forthcoming in asking questions of me and what I can do to help them with their problems. I appreciate this because one of my biggest frustrations has been client’s telling the EAP that we did not address their goals months after the counseling ended. (The EAP sends a questionnaire out after services have ended. Clients usually receive these one to two months after their last session.)

Finally, I have become more focused in my approach. Incorporating these measures has been good for my professional confidence; I have become more bold. I suppose using these measures confidently and linking them to client’s experiences and problems has made me feel like I know what I am doing.

Not that I have got this whole counseling thing nailed down completely, but this has seemed to help!

Comments or questions? Let me know below!

Battling Yourself

Over the last few weeks I have been having a battle of sorts with myself. I know feel my confidence growing as a counselor and am no longer intimated by most client problems. I am growing more confident in my approach and my ability to connect with people. I also know that I want more. I read a lot of blogs and have been inspired by many: Susan Giurleo, Mike Langolis, Daniel Franz, Tamara Suttle, Linda Esposito and others. Through their stories, insight, and mostly their tenacity to pursue their own direction I have become inspired to step out myself.

But it scares me to death.

But I started anyway.

In a previous post I stated that I wrote a Mental Health Tip Sheet to help people coping with the Missouri River Flood. Since then I have decided to start a website devoted to providing mental health information to people in and around my community. Why? Well, it is my perspective that people in my community are savvy enough to be on the internet but many do not know where to begin to find good quality information. I want to provide quality information and links to the various resources available. I have come into contact with so many great resources and professionals through my online communities that I want to pass it forward (so to speak).

But it scares me to death.

Why? Well, I know that I am insecure. But I have been doing nothing but pushing myself out of my comfort zone for the last 6 0r 7 years. Yet, I am scared to put this out there. What if I don’t well. What if this tanks?

But I would be more mad at myself if I fail because I didn’t try.

So, the website is up and started. There is not a lot of content on there yet. Part of my vision is to have other professionals write some content to the site as a public service. I would also like to provide contacts to local providers (but not be a “hardcore” listserv).

I am excited about the dream.

But it scares me to death.

I get sick to my stomach thinking of emailing and calling other professionals and asking them to contribute to this project.

But I know this could be great.

I know that I can conquer my self-doubt.

But it’s scary to battle yourself.

You can check out my work in progress: Nebraska City Mental Health 

I appreciate you comments! And thanks for listening to my inner struggle.

Improving Services

Over the last two weeks I have become practically obsessed with the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS). Mental Health Pros reposted a blog post of theirs that teased using these measures to improve your counseling services in just two minutes. Wow! Two minutes! I had to see this. Plus, they said that I could become twice as effective as I am now. What new counselor doesn’t want to become more effective? So, I hunted down the measures, downloaded the administration manual, and have made enough copies to start using them with clients.

Dr. Barry Duncan who heads up the Heart and Soul of Change project and website is out in the trenches preaching that in order to improve outcomes with our clients we need to solicit their feedback and use it to guide our treatment. The ORS is given at the beginning of the session and asks how the client is doing on four domains (Individual, Social, etc.). From the beginning of the session the counselor has much to work with. The client potentially has identified problem areas and which areas may contain strengths that he or she can draw upon. Similarly, the SRS is given at the end of the session and asks the client to rate the session. Yep, instant feedback, if the client is willing to be honest with you. From the answers on this measure the counselor can then adjust approaches and head in a direction that the client wants to go in.

I am attracted to using these simple and quick measures (each is only four questions) because it allows counselors and clients to track progress from session to session and encourages the client to be forthcoming with what they think is working and not working in the counseling relationship. Also, it will allow me to capture feedback before services end. The blessing and curse of where I work is that we ask for client feedback only after their file has been closed. Also, not everyone returns our questionnaires. From what I have read so far on the ORS/SRS system using these measures improves services because the client is made a part of the process even more. Plus, I am looking to put a stop to clients’ telling me that I did work on what they wanted to work on after the fact.

Has anybody else worked with these measures? If so, what has your experience been? I will be starting to use these with my new clients starting tomorrow and I will report back in a month. Please keep me accountable!

If you are interested in reviewing the measures for yourself see The Heart and Soul of Change website.

Do I Dare?

Two blog posts this week have inspired me; Daniel Franz’s post on “What I Wished I Learned in Grad School” and Susan’s Giurelo’s  “How to be Excellent”.  I believe that these therapists (and many more like them) are blazing the way ahead for those of us just stepping into our counseling careers.

What struck me about these posts? Well, Daniel Franz commented that he learned that he could start a private practice and fulfill his dreams, but he had to learn that on his own. Susan Giurelo’s post challenges therapists to adapt to the changes in healthcare lest they be left behind and become outdated. After reading each I had a little more “umph” in my step and found myself saying “hell yeah!”.

Which brings me to my current situation. As you may or may not be aware the Missouri River is experiencing a historic flood. As a result some communities may be lost completely. My hometown (which is the one I still live in too!) is no housing approximately 300-500 displaced persons from surrounding areas that had to evacuate. A friend of mine, who sells real estate in town, came to me to inquire if I could provide counseling services. His initial idea was to have me provide services during a relief event he is planning, but this is a bad idea for a lot of reasons.

But what could I do? Right now I am working on some information and resource sheets that he could share with these people. Afterall, he has turned some of his properties for sale into rentals. Also, I am planning on sitting in on a CBT for PTSD in July. I also believe that there is opportunity to start a support group or provide group counseling in the future.

Do I Dare? Do I take a risk and put myself out there even though I am still under clinical supervision?

I believe the answer to these questions is “yes”, even “hell yes!”. After following Daniel and Susan for awhile now I have come to believe that this profession is what you make it.

But you gotta dare to put yourself out there.

Counseling and Plumbing?

Last week we called a plumber to come in and clear a drain for us. Now, I had tried what I could to get the drain in the shower in the basement flowing again, but with the tools that I had I was unable to do the job. I tried to snake the drain and tried to “blow out” the mess with a Drain King (which has helped our bathroom sink on more than one occasion). Why did I call the plumber? Because what I was doing wasn’t working any longer. I needed professional help to fix the issue at hand.

The plumber who came out did a fantastic job, by the way and I am glad that I called him. He had to cut a length of pipe out to get to the clog. I did not have the tools to do that and me (who is not very handy) doing that job would have involved most of the day and several trips to the hardware store.

I started thinking how our profession is similar, and different, from other professional problem solvers like plumbers. Like plumbers people call us when what they have tried no longer works. Our clients want a solution to their problem. Unfortunately, emotional and behavioral problems are more complicated than clearing out a drain.

From my experience, this is may be what interacting with a plumber would be like if he approached the problem like a therapist:

————————————————————————————————–

Me: Hey thanks for coming out. I’ll show you the drain that needs to be cleared.

Plumber: Wow. The water doesn’t really flow at all. So, what’s your goal with me coming out today?

Me: Um, for the drain to be cleared….

Plumber: OK, great. What have you tried so far?

Me: I tried snaking out the drain, etc….

Plumber: OK. Sometimes we need a bit more a bigger tool [pulls out a bigger and better snake]. What I would like you to do is take this snake and run it through the drain…

Me: What!? Isn’t that your job? I called you to fix it….

Plumber: You know your drains better than I do. It would be more helpful if you learned how to deal with this so that there isn’t a crisis in the future.

Me: You’re kidding me. You mean I have to do the work here?

Plumber: Yep. My job is to help you see that you already have the skills and the strength to solve this problem. I’m sure you have solved other problems in the past….

————————————————————————————————–

And on and on it goes. I can understand why clients may get frustrated with the process of therapy. After all, they come to us for a solution to their problems and we have the audacity to suggest that the answer lies within them. Yet we know that in order for real change to occur people must decide to do things differently. Getting to this point can be a hard and tough road to climb.

I have been learning recently that interventions work when they feel natural to the client and if they originate from the client. So, I have to take a different tactic from the plumber above and only give the bigger and better tools when the client thinks its a good idea.

And on another note, like plumbers, counselors clean crap from people’s (mental) plumbing. :) Please forgive for that one, I couldn’t help myself.

Thoughts? Please share below!

I can be Pushy!?

I tend to be a bit transparent on this blog, which, for me, is quite liberating. This is part of my process. That being said I have discovered that I can be much more assertive in counseling than I usually am in my “real life”.

Working for an Employee Assistance Program for 2 years has been interesting. One of the bane’s of this job is that they send questionnaires to the clients after they have completed counseling. I learn a lot from this. What works and what doesn’t work so much. And of course, the negative comments are the ones that rock me back on my heels. They take me down a notch and shatter my fragile “I’m an awesome counselor” ego.

Recently a comment came back that I looked too young (hey, I’m turning 32 in August!) and did not have the life experience to relate to the client’s situation. My supervisor and I had a really constructive conversation about this. During the conversation I shared that I was able to be confident and be rather assertive and blunt with a married couple when they asked for feedback. The couple, both who are in their 50′s, challenged me by questioning if someone my age could even help them. I thanked them for the comment saying that I appreciate that they could share that with me. A few  minutes later the wife exclaimed “What do you see?” after they had argued about their “issue” for a while. I laid out my opinion bluntly and stated that I was not signaling anyone out but they asked me what I was thinking. This helped solidify our relationship. In another session they commented that they appreciate that someone can give them feedback and point out things that are not working.

I am slowly learning that I don’t always have to be nice and laid back. I practice unconditional positive regard, but I have come to realize that clients at times want to be pushed. The next step now is to learn which clients want to pushed and when to push them.

Have you out there had similar experiences? Share below!