What would I want a first-year counseling student to know?

This week I was approached by a first year master’s student in the clinical mental health counseling program at Jacksonville University here in FL to do an interview regarding my experiences in this industry and my opinions on some hot topics.

And I thought it might be cool to share it with you as I probably do 2-3 of these a semester.

My interviewer, Ms. Lea Herbert, obtained her Bachelor of Arts degree from Pitzer College and says she wishes to become an awareness builder, confidence guide, and an intuition coach…sounds familiar, right?? 😉

Do you have a specialization or clinical focus, if so, what is it?

Yes; I specialize in sexuality and spirituality and often how those two intersect. My private practice is now the number one provider for LGBT issues, polyamory, and kink in the greater Pensacola area. I also work with a lot of spiritual abuse and trauma victims

How do you view coaching and its relationship to counseling?

The two dove tail one another in my opinion. I personally provide both, although coaching is currently not a regulated field in the United States and as such, it is not reimbursable under our current insurance legislations.

If counseling can be equated to healing and restoring, then coaching can be thought of as empowering and thriving. As one of my colleagues, Dr. Ashlee Greer puts it – “Counseling is like reaching down and pulling people out of the mud while coaching is boosting them into the sky.”

Another way of looking at it is that coaching is more stringently present focused and solution oriented while counseling allows for more in-depth processing of the past including possible traumas. Clinicians who offer both services must screen carefully to ensure that a client seeking coaching does not need dual therapy. While this can be difficult to discretely distinguish, level of distress and dysfunction may be two good indicators. If a client’s presenting concerns or functionality fall outside the realm of what coaching may provide, a referral for counseling should be made in my opinion.

Extra resources – https://erickson.edu/blog/coaching-vs-counselling/

(I personally take issue with the idea that all counselors give advice or present themselves as the expert in the room however. Check out the comments below the article as well.)

What led you to choose a career in the mental health field?

Everyone has their favorite puzzle. Mine happens to be psychology. From the second I walked into my Psych 101 class in undergrad, I fell in love. The study of human behavior is a never ending pursuit and the many facets of theory and application provide for endless opportunities for research and clinical implementation.

Having grown up in a conservative Christian household that was also multicultural because we were military and traveled frequently, I was fascinated by that which brings humanity a sense of meaning and purpose. Neuroscience and psychology provided answers for me as to how and when mental and emotional suffering takes root and what might be done about it.

I became passionate about providing a bridge between modern psychotherapy and truly holistic heuristics. In my private practice, we work closely with alternative medical practitioners offering such things as yoga, massage, acupuncture, energy work, chiropracty, neuro-nutrient therapy, biofeedback, etc. depending on client preference.

What therapeutic techniques/counseling skills do you use with clients?

Like most counselors, I consider myself eclectic.

My main go-to lenses for conceptualization however are: existential theory, choice theory, and emotion-focused theory as well as internal family systems theory and Buddhist psychology.

I frequently use assessments from choice theory/ reality therapy and also internal family systems theory including needs strength assessments as well as “parts cards” (a deck of cards depicting different parts of the Self) as conversation prompts. Additional handouts, bibliotherapy readings, suggested homework exercises (e.g., journaling, meditation, couples communication training) etc. is also a commonplace occurrence with me.

I’m a big fan of teaching mindfulness/ meditation and also cognitive reframing in session. I strive to find ways of pointing out a client’s strengths, resiliency, and exceptions to their distress. The end goal for me is always increasing clients’ felt sense of empowerment, locus of control, and authentic connection to self, others, and their version of a higher power/ source energy.

In what ways do you utilize multicultural counseling competencies in your work?

Daily I work with clients who differ from me in one aspect or another, be it sexual or gender identity, race, spiritual worldview, age or more.

Time spent examining my own stimulus value (i.e., the natural unconditioned response provoked from clients simply by being me – e.g., 37-year-old, Caucasian, partially shaved head with tattoos, female, etc.) is invaluable in preparing me to keep any of my own biases or potential counter-transference in check before I even sit down with a client.

Additionally, extra trainings and readings on multicultural issues is absolutely paramount and cannot be overstated. For me personally that has meant keeping abreast of transgender issues, marriage equality, and various spiritualties such as Candomble, Santeria, Ifa, and more.

Because one of my specialties is sex therapy, it’s important for me to ask about spiritual worldview as religion typically colors the lens through which humans examine their sexual behaviors. For example, in many Abrahamic faiths, sexual intercourse during a woman’s menstruation is prohibited as can masturbation or pre-marital sex etc. It’s important for counselors to know these things so as not to potentially offend and face therapeutic rupture.

Do you see yourself as an advocate in your profession? If so, how do you work as an advocate?

Yes and no.

Yes; in that I am an advocate in voicing my concerns regarding over-regulation in our field (it’s a soapbox I could rant on for hours) and I am an advocate for further research regarding therapeutic outcomes, multi-modal treatment, and minority issues etc., and I am an advocate for my clients attempting to navigate the copious amounts of red tape within our current medical models.

I am an active member of local networking groups, offer trainings to local universities and one-on-one in case conference with clinicians.

For my clients, I go to bat frequently in helping with issues such as medication evaluation and re-evaluation, gender identity transitioning and hormone therapy etc., as well as adding my voice in public forums such as podcasts, magazine articles, and even TV segments from time to time.

And no; because I am a strong proponent of our field of counseling psychology as a whole changing.

I actually think the coaching world has a lot to teach us in being less pathologizing and more flexible in the way we treat clients.

What do you see as current issues that the profession is facing?

A broken insurance system. Managed care is f’ing both clients and clinicians. And while I don’t have the answers, I know damn sure something has to give!

Not every client is even fortunate enough to have insurance (although praise be to Obama for at least trying here…his mandate to add mental health services to health insurance plans has helped many), but even if they DO have insurance, they have to find a therapist willing to take it, and then find one who has current availability….AND THEN they are often limited to a very small number of sessions (likely 6-12) and some insurance plans can even dictate what TYPE of therapy can be provided (typically CBT).

This leaves clinicians like myself incredibly frustrated. First of all, I very seldom use a strict CBT model so I would have to be potentially slightly disingenuous. And let’s talk about diagnosing shall we? It’s an art and a science. If I want my client to be able to use their insurance plan, I HAVE to provide a diagnosis. What if they don’t meet the “criteria” for one? And what if they have a federal, state, or military position? Any diagnosis on file can put their employment in potential jeopardy and flags their file and for any future employment. It’s no wonder we still face the heavy burden of stigma in trying to get clients in our doors!

The other big issue we are currently facing is how to regulate online counseling/ tele-health. The US is the ONLY country that can’t get its act together here. Despite accrediting bodies such as CACREP and MCAP and national licensure exams like the NCMHCE and NCE, because we are the United STATES of America and not just America, each and every state is allowed to set its own regulations, causing massive problems. With my counseling license, Florida allows me to counsel online anyone within the state boundaries or anyone overseas. If someone lives 20 miles away in Alabama, they’re out of luck, even if I provide a specialty or treatment modality they would prefer. The UK has actually cautioned their clinicians against providing online therapy to clients in the US because we can’t agree from state to state on this issue. It’s downright ridiculous in my opinion. We need nationwide licensure, but I don’t anticipate seeing that happen anytime soon which is sad.

What do you like most (and least) about your work?

I most love time in session. Doesn’t every counselor though?

After all, that’s why we get into it – to help people; to be a witness to powerful change. I love seeing marriages turned around and women empowered to go after their dreams. I love the feeling of connecting with another human being on a transcendent and transpersonal level. No boring 9-5 here! The work is different from hour to hour. Each session bringing a new challenge and the potential for new fulfillment.

I least like the over-regulated ridiculousness (see my previous rant). Do we need to make sure people are ethical, competent, and well-trained? Hell yes. However, some of the rules that certain states come up with are just beyond what would make any sort of common sense! And I have seen it breed near anxiety disorders in clinicians as they freak moment by moment about making sure they’re complying with an ever changing regulating body.

I can only speak for Florida since that’s where I practice, but for example, you can practice sex therapy but don’t you dare call yourself a sex therapist without that extra $8k certification. We’re the ONLY state that has that rule by the way. Same goes for art therapy. Even though my colleagues and myself have extra training in art therapy, we can only say we offer “art therapy informed techniques.”

Or how about the fact that an LCSW with the right classes on her transcripts can offer clinical supervision to MHC interns but an LMHC cannot do the same with MSW interns?!

Or that the VA will only hire LCSW’s and not LMHC’s despite the fact that MHC programs provide extra coursework in theories and applications beyond systems theory? (My sister’s an LCSW and we love chatting about this LOL).

How would you describe your personal boundaries with clients?

I don’t sleep with them, I am careful of other dual relationships, I answer client communication within normal business hours only except for extremely rare select crises that aren’t 911 worthy, and I am heavy on informed consent both before treatment and periodically during treatment as needed as well.

I am less boundaried than many of my colleagues however in that I use self-disclosure when therapeutically appropriate to do so.

What kinds of problems do you like to handle?

I love working with anxious, perfectionistic self-identified misfits and mystics; helping them navigate existential concerns and thrive in their relationships. As my website says:

It’s been my experience that we all have to answer FOUR SACRED QUESTIONS:

• Who am I? really, beyond and beneath the projections – the hopes, fears, dreams, and “curses” – of my family and others?
• What am I doing here, and how is my life unfolding?
• Where is life taking me: am I still on the path of my purpose?
• Who will come with me? who can I count amongst my allies to help me meet this purpose, and who must I let go of?

The issues I’m most known for treating are:

• Identity exploration and personal empowerment
• Guiding couples on rebuilding relationships, intimacy, and sexual connection
• Non-traditional issues: LGBTQ+, polyamory, and kink
• Spiritual abuse and trauma

Can you describe your life after graduating from the MHC program? How was the process of finding employment, interviewing, and gaining clients?

The first few months were the hardest. Despite starting my job search 4 months ahead of time, no one wanted to interview me until I had my final transcripts in hand or my state registration as an MHC intern. Because I had a family to provide for, failure was NOT an option. Ironically this ended up being my saving grace as it forced me to get creative. I started seeing clients on the side out of my supervisor’s office for free when she didn’t need it and also found a local non-profit willing to let me use their offices for free if I saw at least 2 of their clients pro-bono as well.

By the time the agencies started calling me back two to three months after graduation, I had nearly a full schedule of clients and had to then make the agonizing decision of choosing job security and a regular paycheck of $12-$22 an hour or freedom to be my own boss and do therapy the way I like to and charge whatever I want but without the guaranteed paycheck. Obviously freedom won and I can honestly say I’ve never looked back!

How did your training best and least prepare you for the realities of being a counselor?

My academic program prepared me well for honing in on my own professional voice – my theoretical orientation. While many students appear not to appreciate this aspect, I can tell you first hand that in the real world, this matters greatly! If you have no idea how you view the human psyche and what causes behavior, distress, and dysfunction etc., you will struggle greatly in deciding which treatment options to try with your clients.

You are also at high risk for not being skilled at using any of them and this will come across to clients. No one wants to be treated by someone that doesn’t appear confident in what they’re doing.

My internship at the college counseling center also prepared me well for private practice as opposed to some of the other in-patient sites where I knew I didn’t want to work. By the time I graduated, I felt at ease with note writing, preparing reports, using various assessments, and interacting with other professionals with whom I might be co-treating a client.

I felt least prepared to tackle the business side of it – insurance regulation, marketing, starting an LLC or S-Corp etc. From what I have seen in our field since then, this is pretty common. Most heart-centered entrepreneurs are way more comfortable with people than we are with numbers. For me this has meant surrounding myself with mentors, a great CPA, and financial planner.

What advice would you offer you a beginning counselor-in-training?

Figure out as quickly as possible who your ideal client is, either population (e.g., millennials, LGBT, women over 40) or diagnoses (e.g., mixed-mood disorders, sex therapy) and carve out a niche for yourself. This makes you memorable. When you show up to a networking event you don’t want to be a generalist or no one will remember you or know which referrals to send your way. Think about it this way – if you suddenly find out you have cancer, you wouldn’t scroll through the phone book and pick a family physician; you would find a cancer specialist treating your specific kind of illness.

This also allows you to hone in on an expertise, building self-confidence and self-efficacy. Much better to know a lot about a little than the other way around! So many new therapists struggle with imposter syndrome. The ones who seem to have the least amount and/or navigate it more quickly are the ones with specific niches as you build an expertise much faster that way.

You don’t need to fear losing out on clients either. The paradox is actually that you will draw in your ideal clients faster if you can speak directly to their pain. I still treat nearly everything in the DSM related to clients over the age of 16 typically, but I am known for my specialties.  As I mentioned previously, my private practice is currently number one for issues that are considered “non-traditional” in the greater Pensacola, FL area and that’s something I’m proud of.

Do you have any recommendations concerning how to best utilize the years after graduation?

…For example, balancing your student loans and first year salary… having a masters in counseling but not being licensed yet…do you believe some states are better to get licensed in than others, any advice for LMHC wanting to working within the hospital setting?

Don’t wait to go for your dream. If it’s a hospital setting, apply early and follow up as frequently as possible keeping in mind that hiring is never an agency’s number one priority. If it’s private practice, start seeing clients as soon as possible. Don’t listen to the naysayers and fear mongers. It’s totally doable.

Keep your loans in deferment for as long as possible until you are managing your finances comfortably and then switch to an income-based repayment plan. If you have any questions or concerns about this, your loan provider should be a good help. I highly recommend speaking with a financial planner early on. You do NOT need to have a ton of money or even be interested in investing anything at this point. Just a consultation with one to keep you on the right track and not drowning in debt.

The whole intern phase kinda sucks, not going to lie. It’s like puberty all over again. You’re not a kid but you’re not considered an adult either. Even though you have a degree and experience. It can also be a positive and enriching time too however, allowing you to gain confidence while not having your own license on the line yet.

Study for the licensure exam early and take it whenever you are ready. You don’t need to wait until the end of the two-year period. The online aids were worth the price for me. They were nearly exact to the test and I passed easily where some of my peers failed who didn’t use them.

And yes, from what I hear almost ANY OTHER STATE other than Florida or California is great to start your licensure out in due to certain rumors surrounding non-reciprocity and extra regulations like the above mentioned sex therapy thing etc. Just be sure to check with your intended state’s licensing board FIRST to make sure your degree program, internship hours, and more will carry over. For example, some states require CACREP programs yet not every MHC program is accredited by CACREP. Then again, if you can get licensed in FL, you can probably get licensed anywhere.

ABOUT THE AUTHOR

Tamara Powell, LMHC is a licensed therapist, university psychology instructor, and empowerment coach who believes life should be lived as a journey that is “anything but ordinary.”

Her work is specialized to help individuals break free from toxic cycles of distress, dysfunction, and dissatisfaction with life that are created when trying to live according to someone else’s rules. Only by living what she calls radical autonomy, can one obtain soul nourishing relationships and a sense of true life purpose and inner peace.

If you’re interested in working with her, either in person or online, you can learn more about her services here.

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