1 Running Head: A DAY IN THE LIFE Final Project 1 A Day in the Life of a Mental Health Counselor Thomas F. Collura Walden University May 17, 2010 A Master of Science in Mental Health Counseling COUN Final Project
2 Running Head: A DAY IN THE LIFE Final Project 2 A Day in the Life of a Mental Health Counselor Outline Introduction The Day Begins Client Intake, Assessment, and Treatment In the Service of Research The Challenges of the Team The Day Ends Introduction In researching this project, I met and spoke with Dr. Dick Genardi, a Ph.D. level psychologist working with troubled, injured, and disabled youth and adults in a semi-urban center in Ohio (personal communication, April 18, 2010). He has been a counselor since 1966, and is now in a group practice. He related to me some important concepts and details relating to his practice. His day includes handling crisis calls, working with other staff, conducting biofeedback therapy sessions, doing evaluations for disability and workers compensation, and performing intake and diagnostic assessments. His average client load is 6 to 9 per day, sometimes more. On the business side, he is involved with rebuttals for insurance denials, paperwork for retirement benefits and disability, for which the practice has 3 secretaries. Dr. Genardi has to interact with carriers such as the United Auto Workers, state-level associations, lobbying groups, and political action committees, in pursuit of financial support for the services his clinic provides.
3 Running Head: A DAY IN THE LIFE Final Project 3 The majority of Dr. Genardi s clients are medically complicated or physically injured. At times, they are too disabled to make it to the counseling sessions. Issues may include having enough money for gasoline or overcoming their pain or physical distress in order to come into the clinic. Some clients are in crisis, and the clinic has to handle individuals who may be violent, delusional, or suicidal. Dr. Genardi commented that he never expected to be integrating the physiological with the psychological to the extent that he does. He uses biofeedback and other interventions to address the client s physical, as well as mental, well-being. Building on his Ph.D. in Behavioral Psychology and his years of experience, he emphasizes a pragmatic viewpoint, recognizing that no one approach can address all issues. To summarize his philosophy, he states,. I want my client to understand that they are where they are through normal means of the human experience. They had abnormal factors influencing them but the mechanisms that got them where they are normal. Based upon this perspective from Dr. Genardi, along with the resources learned in this course, I will outline a day s activities as a mental health counselor in the practice I hope to build. I will note that my plan is not to emulate Dr. Genardi s, or any other counselor s practice. Due to my unique circumstances, I expect a different type of experience. My intention is to create a practice that provides mental health counseling and biofeedback services primarily on a cash basis, and primarily to clients who have an interest and motivation towards our particular approaches. I do not intend to be seeing 6 to 9 clients per day, although we may at some time add staff to cover the demand. Rather, my emphasis will be on developing and deploying
4 Running Head: A DAY IN THE LIFE Final Project 4 methods for assessment and treatment that can be used as evidence-based models for other practices (Thomason, 2010). In other words, my initial priority will be on prototyping and validating clinical practice models, rather than on seeing a large number of clients. In addition to this priority, the fact that I will be entering this profession near my 60 th birthday has an effect on my plans. I do not intend to move into a highly demanding or stressful environment, at this phase in my career (Sterner, 2009). Rather, I hope to have a practice that is based more upon principles of relaxation, acceptance, and self-awareness, as paths toward personal growth and health. For example, we will likely be seeing clients interested in stress reduction, sports, art, and self-actualization, in addition to those suffering from immediate distress. The Day Begins I arrive at my office at 9:00 AM. In an effort to preserve some sanity in what will be my usual, unpredictable day, I do not schedule anything for the first hour. During this time, I attend to several important ritual duties. These do not include checking my , listening to phone messages, or surfing Facebook. They do include 20 minutes of meditation, a review of the day s schedule, and some time spent reading books or professional journals. By 10:00, my demeanor, level of energy, and blood glucose and caffeine levels should be sufficient to set me up for a relatively productive day. I have designed my work to present me with challenges every day, and my practice includes a moderate amount of one-on-one clinical work, but also a significant research, writing, and professional leadership component. I am 60 years old, and have entered counseling as the latest in a long and varied career. My master s in mental health counseling is my fifth college degree, following in a path that has
5 Running Head: A DAY IN THE LIFE Final Project 5 led to undergraduate degrees in philosophy and biology, and graduate degrees in engineering. In the past, I have been a biomedical engineer, computer scientist, clinical neurophysiologist, university professor, contract engineer, and medical instrument manufacturer. The decision to add counseling to this was founded on a continued commitment to the evolution of the science of the brain and mind. It has long been my interest to apply technology to the understanding of the brain, and to develop assessment and treatment methods that are based on electroencephalography (EEG) and related technologies. On typical clinical days, I will spend the remainder of the day interacting with clients and associated staff. In addition to these days, I will plan research days that will be more focused on compiling clinical results, analyzing data, and working on assessment tools. I plan for the research activity to be combined with the clinical work, to provide a solid base for relevant findings. Client Intake, Assessment, and Treatment At 10:00 AM on clinical days, I begin interaction with clients. If a client is scheduled for an initial assessment, the nominal appointment is for 2 hours. This provides sufficient time to get acclimated, spend some time in casual or nondirected conversation, then move into the structured activities. Among these, some initial assessments are conducted, primarily questionnaires used to gain a perspective on the client s overall condition and concerns. Depending on the circumstances, additional testing for problem-specific areas might be required. For example, attention issues might indicate the Interactive Variables of Attention (IVA) or Test of Variables of Attention (TOVA). Depression indicates the need for the Connars scale. Autism or related disorders indicate the need for the Autism Quotient (AQ). Generally, I also try to
6 Running Head: A DAY IN THE LIFE Final Project 6 obtain a quantitative EEG (QEEG) to assess underlying brain dysfunction. Once initial assessment has been addressed, some of the initial appointment can be spent in the initial stages of counseling, particularly the orientation and expectations of the client. There is an ethical need to clarify the counseling relationship, and sufficient time needs to be spent on this dimension, as well (ACA, 2005). It is important that the client does not feel rushed or otherwise slighted during the first appointment. If the client feels closure has been reached, the appointment can be terminated before 2 hours. In any case, this scheduling avoids the awkward and uncomfortable situation that may arise if the first meeting has to be terminated before the client feels at ease with the counseling relationship. On clinical days, the afternoon is also devoted to client interaction. Because I have set aside time at the beginning of each day and on research days, I am able to devote my full attention to clients during this time. Most clients in the afternoon will be returning clients, who are receiving various types of counseling and therapy and, very often, biofeedback training. Biofeedback training will be integrated with the other clinical interventions including mindfulness therapy (Shapiro 2009), to provide an integrated approach. As the individual learns self-regulation and mindfulness on various levels, their mental and emotional issues can be addressed with new perspectives and new tools, facilitating natural levels of control and wellbeing. In the Service of Research On research days, I will be primarily occupied with compiling, analyzing, and writing up findings from the clinical research program (Mellin & Pertuit, 2009). This will include quantitative electroencephalography (QEEG) data on most clients, as well as suitable indicators
7 Running Head: A DAY IN THE LIFE Final Project 7 chosen to assess and monitor client progress. Generally, there are tools that are written, such as surveys and questionnaires which are primarily mood or subjectively oriented, and those that are automated, such as the Interactive Variables of Attention (IVA) or Continuous Performance Task (CPT), used to assess attention and related objective variables. Much of the value of systematic research will be in validating approaches by comparing results from different tools, in light of various interventions. The Challenges of the Team The daily challenges of working in my practice are in working with a small yet diverse group of professionals, in an area that is innovative and demanding. Practitioners in this field need to be knowledgeable of mental health concerns and approaches, physiological aspects including effects of medication, physical disorders, as well as the realities of conducting therapies including biofeedback. This can be overcome with training and education, as well as the cautious and careful selection of staff. The daily challenges of working in my particular community include the fact that this is an economically depressed area, and that mental health care is not widely recognized for its value and importance. For these reasons, the practice will need to have an outreach component that works with community entities to communicate and interact with those who have need of services. For example, speaking at a church on the topic of mental freedom and selfempowerment can be a powerful way to reach those who can benefit from modern mental health techniques.
8 Running Head: A DAY IN THE LIFE Final Project 8 The daily challenges of working with my client population include the demands of working with children who may be obstructive or violent, or who lack motivation to improve (Mellin, 2009). Similarly, the population may include adults or children who have head injuries, who experience anxiety or depression, and need to be shown that they have the power to overcome these obstacles. This can be addressed with communication, and with sound application of techniques such as cognitive/behavioral therapy, psychotherapy, and biofeedback, in a constructivist approach (Borsos, 2006). It is my hope that our practice embodies a philosophy that can be well articulated and understood, and an underpinning of each client s personal journey. As an example of one such interaction, I was recently asked to perform a QEEG evaluation on a woman who had suffered a brain aneurism, so her therapists might better plan her treatments. When analyzing the EEG data, I did see some evidence of the damage (slow wave activity), but it was very localized and not very extreme. At the same time, I saw compensatory activity (beta waves) in other areas, that suggested that her brain was working to compensate for the injury. The woman reported that she was continually working to retrieve her memory and other mental faculties, and felt that her efforts were working. Her clinicians corroborated that she was responding very well to occupational and physical therapy. I noted that her brain looked like a healthy brain that had been injured. She found this odd, and a rather new perspective. Her caretakers also responded to this view with curiosity. I explained, that physiologically she appeared to have a healthy brain, but one that had suffered an injury. I noted that injury is normal, when something like a blood vessel bursts. At the same time, the process of recovery was occurring, and producing results. In other words, she was not unhealthy, and she had the ability to restore her health, through natural processes. This insight helped her and
9 Running Head: A DAY IN THE LIFE Final Project 9 her clinicians to restore faith that as the physical injury was addressed, her mental functions could be restored. It would be interesting to pursue this small observation, and see what possible value it may have generally for those with brain injuries, as a way to evaluate possible future interventions. These plans elevate a number of ethical issues, which will be likely be encountered on a daily basis. These will include patient confidentiality, counselor responsibilities, interaction with other professionals, and other issues. In order to ensure that the practice adheres to relevant ethical guidelines, an approach such as that described by Calley (2009) can be used to indicate that policies and actions are in concert with ethical principles. A regular review of ethical issues and policies will be included in the schedule of periodic meetings that will be mandatory for all staff members. The Day Ends As the day ends, I reflect on what has been learned and accomplished. It is notable that each day is unpredictable, and one can never predict what may be learned. It may be a comment made by a client, a change noted in some physiological response, or something learned from a colleague. The most important thing about this work is that it is hands-on, and is based on working with real clients with real issues. This factor ensures that current and future developments of our technology are evidence-based, and founded in practical and effective clinical practice. What I find rewarding about this work is that it has substance and meaning, and has the possibility to provide lasting benefits to society. After years of study and contemplation
10 Running Head: A DAY IN THE LIFE Final Project 10 regarding the human mind and brain, and how they interact to construct our individual realities, it is clear that mental health care can incorporate a more enlightened and effective approach, in contrast to the traditional mechanistic view. Rather than labeling individuals as abnormal and treating them with medication, mental health counseling can provide an alternative means of change, one that emphasizes individual control and self-actualization, rather than the masking of symptoms, with the buildup of negative side-effects. My involvement in this career impacts me personally by allowing me to see what is essentially a lifetime of study and research bear fruit in a large-scale human endeavor. I always considered myself to have some responsibility to help change the world for the better, and to impact humanity in a lasting, positive way. The motto of my elementary school, Hawken School in Lyndhurst Ohio, was (and still is) That the better self shall prevail, and that each generation introduce its successor to a higher plane of life. I believe that this endeavor suits the highest meaning of this purpose, and does something substantial and lasting to put it into action.
11 Running Head: A DAY IN THE LIFE Final Project 11 References Borsos, D.P. (2006) Bringing theories into practice: towards an integrated model of psychotherapy. In Palmo, A.J., Weikel, W.J., and Borsos, D.P. Foundation of Mental Health Counseling. Springfield: Charles C. Thomas. Calley, N. (2009). Promoting a Contextual Perspective in the Application of the ACA Code of Ethics: The Ethics into Action Map. Journal of Counseling & Development, 87(4), Retrieved from Academic Search Complete database. Mellin, E. (2009). Responding to the Crisis in Children's Mental Health: Potential Roles for the Counseling Profession. Journal of Counseling & Development, 87(4), Retrieved from Academic Search Complete database. Mellin, E., & Pertuit, T. (2009). Research Priorities for Mental Health Counseling With Youth: Implications for Counselor Preparation, Professional Development, and Research. Counselor Education & Supervision, 49(2), Retrieved from Academic Search Complete database. Shapiro, S. (2009). The integration of mindfulness and psychology. Journal of Clinical Psychology, 65(6), doi: /jclp Sterner, W. (2009). Influence of the Supervisory Working Alliance on Supervisee Work Satisfaction and Work-Related Stress. Journal of Mental Health Counseling, 31(3), Retrieved from Academic Search Complete database.
12 Running Head: A DAY IN THE LIFE Final Project 12 Thomason, T. (2010). The Trend Toward Evidence-Based Practice and the Future of Psychotherapy. American Journal of Psychotherapy, 64(1), Retrieved from Academic Search Complete database.