1 Jonathan Shay 1 Clinical Mental Health Counseling: Key Assessment: Interview Term Paper Taunia Locker is an LPC in Statesboro, GA and though at this time she is working as a visiting professor at Georgia Southern now, she has an abundance of field experience. From these experiences I was able to draw out some very useful information for up-and-coming counselors. Ms. Locker has worked in a variety of settings, from an agency, to a prison, to universities. In each of these settings she took on separate roles all of which pertained to the counseling profession. Ms. Locker is currently an assistant professor, took part in research at the University of Kansas, worked with and helped develop a Dialectical behavior Therapy (DBT) program for clients with borderline personality disorder in a Kansas agency, and worked in rural communities where counseling services were extremely limited. Due to her experiences she defines her role as a counselor as highly varied with her passion being working with and determining appropriate and effective treatment for the severely mentally ill. Taunia received her Master s Degree in Clinical Psychology from Fort Hays State College in Hays, Kansas. She was trained in this program to work in rural settings within special populations. She soon received certification as a Licensed Master s Level Psychologist (LMLP) continuing on the rural counseling track. After her two mandatory years of supervised practice (under a psychologist) she moved to New Mexico to pursue an opportunity to receive free training in substance abuse counseling and to work in a local prison. Because New Mexico does not have an equivalent degree to the LMLP that Ms. Locker already had, she had to apply for
2 Jonathan Shay 2 licensure as a Licensed Professional Counselor (LPC). She later upgraded to a Licensed Professional Clinical Counselor (LPCC) after receiving her supervision hours which was the state designation for an LPC that can counsel completely independent of supervision. After working several years in the prison Ms. Locker moved back to Kansas, to Kansas City, to work at the University of Kansas. Because Kansas does not recognize the LPCC designation, her previous designation as an LMLP was resumed. This was further complicated by ongoing legislature (pushed through by psychologists) that would change the licensure from LMLP (which contains the term psychologist ) to LCP (Licensed Clinical Psychotherapist). She had to pass the Examination for Professional Practice of Psychology (EPPP) with a grade no more than 5% below the cutoff of that required for certification as a psychologist. Additionally she had to pass one of the NBCC examinations according to the states new legislation. While back in Kansas she conducted research at the university and later received her certification in motivational interviewing. Taunia finally moved to Georgia and again resumed her title as an LPC. She commented though that despite 14 years of experience counseling, she almost did not regain this designation. Ms. Locker s training involved supervision by psychologists and psychiatrists and in Georgia (at least at the time) your supervision hours must be completed by an LPC to be considered valid for licensure. Luckily, Taunia had previously received certification as a Certified Professional Counselor Supervisor (CPCS) which allowed her to retain her LPC status. She is currently working on her certification as a Cognitive Behavioral Therapist (CBT).
3 Jonathan Shay 3 Throughout her career Ms. Locker has experienced several ups and downs associated with the counseling profession. Her greatest joy is seeing people get well. She particularly likes to see people regain life after being trapped under their own disorder. Taunia describes the counseling profession as the most rewarding low paying job in the world. She did have some downsides to her profession as well. The first is the increasing amount of paperwork that needs to be completed. She stated that the amount of paperwork has increased every year since she has been licensed without fail. The next thing she mentioned (and perhaps her largest gripe) is having a bad supervisor. She stated that supervisors that are unclear in the information they expect from you and unclear with their direction of you are incredibly difficult to work under. Contributing to the development and improvement of the available body of counseling research is very important for the progress of counseling as a profession as discussed by Calley (2009). Further, Marquis points to the importance of creating evidence-based practices for counseling services. Not only is research important for the creation of new practices, but also in making current processes more efficient. Updating older models of treatment to apply to separate cohorts or generational differences is imperative. Ms. Locker mentioned that in one of the agencies where she worked she did just this. She teamed up with another counselor who was developing a DBT program for borderline clients. She mentioned that it was incredibly exciting being part of a new treatment method; entering new territory and making discoveries about their techniques. But, because the idea was new, they encountered occasional setbacks as a large portion of their methods were trial and error.
4 Jonathan Shay 4 DBT is a newer therapy approach that combines CBT with Rogerian principals of person centered therapy and mindfulness practice (van Goethem et al. 2012). It is a relatively new treatment method that is been used primarily for the treatment of clients with borderline personality disorder (BPD). Taunia and her colleague used the available research to construct their own treatment methods that applied more directly to their agency s BPD population. When I asked Ms. Locker about her use of the DSM she simply replied without it you don t get paid. Insurance will not cover a person unless that person is ill; a diagnosis must be given as proof of that illness. Such regulations are typical in agency setting where managed care is the framework for the primary methods of treatment (Gladding & Newsome 2010). She did admit that some practitioners operate cash-only business models but she believes that they probably struggle, especially in the Statesboro area. Aside from the payment/insurance aspect of the usage of the DSM, Taunia seems to support the use of the manual for other reasons. She stated that the manual helps the counselor correctly identify the issue and in-so-doing help the counselor correctly treat the client. Ms. Locker agreed that labeling can be an issue but that sometimes clients are comforted by hearing that their issues are not unique to them or even uncommon in some cases. She mentioned that clients like to know that there is someone like [them]. To take this a step further she suggested that using person first language when notifying someone of their diagnosis help tremendously with the labeling issue. In other words, you should label the disorder not the person.
5 Jonathan Shay 5 Taunia does see the grey area associated with the use of the DSM however. One issue that she addressed was that the new version of the DSM was going to remove gender identity disorder from the manual. She thinks that it is great that this is happening, that having a different gender identity does not mean something is wrong with you. However, because of the assumption that these people are not normal by society people with gender identity issues are often in need of psychological services. Without a DSM designation there will be no code to categorize exactly what the person is going through. This can create problems as far as treatment plans are concerned but more importantly where payment for services is concerned. Oh yes was the response Ms. Locker gave when I asked her if she had ever faced any ethical or legal dilemmas when she was practicing. She had three major examples. The first was from when she worked within the prison system. She said that it was often unclear who the client was. She was employed by the prison to help prisoners such that order could be maintained within the facility. She was expected to report on suspected drug use among prisoners as well as any notable tensions between prisoners. These regulations often interfered with what she considered to be the correct treatment of the clients. It became confusing whether the counselors main objective was to treat the clients or help maintain order in the environment. Her second example was with legal issues. While Taunia was working for an agency in Kansas she was approached by two men who claimed to be FBI agents that were looking for records on one of her clients. The men had badges and wore black suits. Taunia stated that she could not release records without a court order. At this point the FBI agents threatened to detain her for obstructing justice. At this point Taunia
6 Jonathan Shay 6 unsuccessfully tried to contact the agency s attorney. She held her ground before successfully contacting the attorney on her second attempt. She said that when she had returned from her conversation with the attorney the men had left. She still has no idea if the two men were actual FBI agents or not. She mentioned that the man they were requesting records for did have a shady history but the rule stands, no court order, no records. Her final example was the use of Certified Peer Specialists (CPS) within one of her agencies. CPSs are people that have a diagnosed mental disorder that are rehabilitated to the point that they can be certified to assist peers that are going through some of the same troubles they themselves had experienced. Research suggests that CPS involvement can speed up recovery times and even reduce treatment times for clients with severe mental illness (Bellamy & Eps 2010). Unfortunately, some of these peer specialists were also clients with some of the counselors on staff. This was not usually a problem but on one occasion the van driver (who was a CPS) had an episode if dissociation after dropping of agency clients at their destination. When she called to tell the agency she was lost the agency workers were unable to tell her supervisor due to confidentiality issues. So the counselors became stuck in a situation where they had to acknowledge the confidentiality of their client but also had to lookout for the danger (though not imminent) that this employee could cause to other agency clients. In such situations Ms. Locker advised against any sort of dual relationships even though in other situations dual relationships may be unavoidable. She mentioned that there is an ethical blur here and that sometimes that blur overflows into competency issues. In certain areas, where there are only a few available mental health
7 Jonathan Shay 7 professionals, dual roles and working with clients that do not fall within your area of expertise is an unavoidable obstacle. Therapists are faced with denying clients services altogether or helping them in any little way they can. Such places may even be so small that you see your clients routinely outside of therapy. While such situations are uncomfortable and maybe even unethical to some degree, they are necessary. Taunia concluded by giving advice to future counselors. She had four major points: apply for licensure where you think you want to live for long period of time (at least), find a good supervisor, consult and document, and take as many people down with you as you can. Obtaining licensure is a hassle and can be quite difficult. Given Ms. Locker s experience in this area it is easy to see why becoming licensed in a place you think you will stay is very important. This is becoming more complicated given the inter-state reach of technology and online counseling methods according to Hughes et al. (2000) and McAdams and Wyatt (2010). Finding a good supervisor is especially important for your first few years as a counselor. Someone who is not only your boss, but a mentor that can show you the ins-and-outs of the profession is invaluable in building your foundations. Consulting and documenting is imperative in every health related field. If something is not documented it never happened. If it never happened you will not get paid, you will not have evidence if you get sued, and you will not be able to prove your innocence should a rogue client press charges against you. Connected to this is her phrase, take as many people down with you as you can; which essentially means consult with your associates so that you can arrive at the best treatment plans/courses of action available. This way if you are wrong so are
8 Jonathan Shay 8 several of the other individuals you talked to. Having the opinions and ideas of your colleagues supporting your own will never lead to a path where you take all the responsibility for a failure. In fact, if you follow this you will rarely run into such a problem.
9 Jonathan Shay 9 Bibliography Calley, N. G. (2009). Comprehensive Program Development in Mental Health Counseling: Design, Implementation, and Evaluation. Journal Of Mental Health Counseling, 31(1), Eps, B. & Bellamy, C. (2010) Creating Replicable and Sustainable Peer Support Services. Mental Health Weekly: March 21, 2011: 5-6 Gladding, S. & Newsome, D. (2010) Clinical mental health counseling in community and agency settings. New Jersey: Kevin Davis. Hughes, R. S., & ERIC Clearinghouse on Counseling and Student Services, G. C. (2000). Ethics and Regulations of Cybercounseling. ERIC/CASS Digest. Marquis, A., Douthit, K. Z., & Elliot, A. J. (2011). Best Practices: A Critical Yet Inclusive Vision for the Counseling Profession. Journal Of Counseling And Development, 89(4), McAdams, C., & Wyatt, K. (2010). The Regulation of Technology-Assisted Distance Counseling and Supervision in the United States: An Analysis of Current Extent, Trends, and Implications. Counselor Education And Supervision, 49(3), Pistorello, J., Fruzzetti, A. E., MacLane, C., Gallop, R., & Iverson, K. M. (2012). Dialectical Behavior Therapy (DBT) Applied to College Students: A Randomized Clinical Trial. Journal Of Consulting And Clinical Psychology, doi: /a Salzer, M. (2009). Pennsylvania Certified Peer Specialist Initiative: Training, Employment and Work Satisfaction Outcomes. Psychiatric Rehabilitation Journal, 32(4), 301. doi: / van Goethem, A., Mulders, D., Muris, M., Arntz, A., & Egger, J. (2012). Reduction of Self-injury and Improvement of Coping Behavior during Dialectical Behaviour Therapy (DBT) of Patients with Borderline Personality Disorder. International Journal Of Psychology & Psychological Therapy, 12(1),
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