The Obligatory Thanksgiving Post

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Two things have influenced today's Thanksgiving-themed post. 

One, that Thanksgiving inspires all kinds of people to share what they are thankful for. While occasionally, the daily thankfulness post on Facebook can be nauseating (so glad you are married to your best friend, your one true love, your soulmate...but enough already) ultimately, the idea touches something in me that I find very valuable. At any moment this could all be over. Today is the third anniversary of my Mimi's death, one week after her 86th birthday. Thanksgiving 2010 was the last holiday she spent with us. And I am so freaking grateful we had that together before she breathed her last, holding my hand in a room with all but one of her children and grandchildren. 

There's something about gratefulness that never gets old, and never should. Today I'm grateful for so much:

• My sister-in-law Ashley's birthday, even though we can't spend it together! 
• My brother Shawn who is  spending his holidays defending our country overseas.
• Starting this holiday season with three bonus sisters in addition to Ashley, who married my husband's brother this year! 
• A network of "business" colleagues like the Mind Your Own Business group and of COURSE all my beginning counselors, who are truly more friends than business acquaintances. 
• My husband, my family, my home, my dog...and so much more.

Second, because a friend (whom I am also thankful for) reminded me the other day how therapists have to have some balance in sharing with other people how awesome our job is. If we go on about it ad nauseum, we can run the risk of boring people with how excited we get about people's big & little changes. 

Because of that, she says that we should share that excitement primarily with one another, the people who "get" it. I couldn't agree more. 

So today and this Thanksgiving weekend, I'd love to challenge everyone reading this to COMMENT and share something they're thankful for about being in the counseling field. 

While being careful to disguise details (it's perfectly okay to "lie" about an experience if it's to protect a client's confidentiality), I want to encourage you to state something specific you are thankful for. 

For instance:

• I am thankful for the distance technology that allows me to serve clients who are temporarily out of the country or unable to regularly attend sessions with me.
• I am thankful for my new second location and the psychiatrist who works there, enhancing my knowledge of fusing cognitive-behavioral therapy & medicine. 
• I am thankful that while sometimes I don't love everything about counseling, several years later I am still continually challenged, exhilarated, humbled, and overjoyed by what I do for a living.

Now it's your turn. What are you thankful for? There's no better audience to share it with!

Finding A Paid Internship

It's the great white whale.

A paid internship. Getting to earn an income while getting the required hours for your license. It's a beautiful thing. 

And can seem just as hard to capture as Ahab's whale. 

Imagine this: You're a few weeks from graduation, getting excited about all that comes next. But there's a big problem. After you cross the stage, after you pick up your diploma and apply for your license, you have to get a job. You have to earn your hours.

And that's the part that gets you really nervous.

If you're lucky, you've made a great connection with your practicum site and have at least a partial contract with them, hopefully for paid hours. But that's not what happens for everyone. Some people have no connections, or have moved, or the places they've worked with simply don't have the availability. 

If this is you, it probably seems like you're pretty helpless. Like your promising career has tanked before it's even off the ground.

But you do have options.

I'm not going to say it is easy. But it's not hopeless, either.

When you start looking into finding a paid intern job, you run into three main areas of challenge in finding one:

1. Finding out whether these internships exist or not. That can be the hardest question to overcome. In order to find what you're looking for, you first have to believe that it is out there. 
2. Finding the right kind of internships. Searching for counseling jobs of any kind can be an exercise in misdirection. A query of "counseling jobs" turns up jobs for legal counsel, camp counselor, and academic counseling. "Therapy" brings up occupational therapy, physical therapy and more. Throw "intern" into the mix and the results are even more diverse. 
3. Qualifying for the jobs that are out there. The ever-present question of "What experience do you have?" can short-circuit an application before it's submitted. There are further divisions by degree and internship opportunities - internships only for MSW, LPC, LMFT or doctoral candidates, respectively. 

Challenging problems require creative solutions.

Believing in the possibilities. Every time I've tried to find a counseling job, whether in practicum, internship, or full-time LPC work, I've struggled with having hope. I hit a few dead ends, and my energy for applying starts to fade. I start to wonder if it's worth the effort, or if it's just going to be another failure.

We as counselors tend to look for meaning in circumstances, and this is one of the cases it can turn around and bite us. Yes, it's disappointing to have leads not pan out. It's difficult when you interview for a great job only to find out it pays barely above minimum wage. But just like finding your soul mate, it "only takes one." It doesn't matter how many bad leads there are out there for you. You only have to find one that works. 

Stating exactly what you want. I was surprised by the interesting opportunities that came up with I searched

SimplyHired for "paid counseling intern jobs." Sure, some were inapplicable sales counselor jobs, but some were jobs that I could have qualified for in my intern years. I started to wonder what would happen if I got even more specific. I searched on job sites, and on Google, and things started to come up, just using some additional specifiers. I'd encourage you to see what you can find when you get more specific with your search term(s), using phrases like:

• Paid LPC-Intern
• Paid bilingual counseling intern
• Paid couples counseling intern
• Paid adolescent counseling intern
• Paid counselor training
• Paid student counselor

Who knows what you might find? 

Searching outside the box. While the internet is a great place to start, it also shouldn't be the only place you look for a paid counseling internship. In this day and age, there are gatekeepers in the form of online applications that keep the human connection out of the job application process. In order to get a good internship in a people-centered industry like this one, you may just have to inject the personality back into the process. 

• Drop by the office and introduce yourself to the receptionist. He or she is usually the one everybody listens to, anyway. 
• Call upon anyone you know who might be a good source of connection to the counseling field - doctors, lawyers, spiritual leaders, schools, nonprofits. 
• Cold-call counselors, supervisors and counseling groups, asking politely if they are looking for counselor interns or know of anyone who is. Ask to leave a message with the clinical director stating the same question, if you can.
• Talk to your supervisor, if you have an off-site supervisor. See who they might know that could connect you to a good internship.

This is a way to find paid intern jobs, but also a way to get around the more arbitrary blocks of past experience and qualifications. When potential employers see you as the person, it opens up so many more possibilities.

Present your qualifications confidently for what they are. What special training have you had in counseling outside of the norm? What interpersonal skills do you have to offer potential clients? Whether you realize it or not, you do have something significant to offer your clients, right now. 

Ask yourself this: "What benefits do my clients experience after working with me?" If you have not had the opportunity to see clients yet, ask yourself how you have helped ease the pain of family and friends in the past. Have you helped people better describe their problem? Do you make people feel listened to? 

Some jobs will close the door on you due to a factor outside of your control. You can recapture those that aren't so arbitrary by focusing on knowing what you do WELL. 

Above all, know that this can and will happen for you, if you take this into your own hands and refuse to give up. The paid counselor internship is elusive, but that only makes the capturing of your white whale that much more satisfying.

Have you obtained a paid internship? What advice would you give to other students trying to accomplish the same? 

Additional Resources:

How To Find a Counseling Internship: 3 Essential Characteristics ACA Blog

What's Wrong with the Counseling Intern Picture? ACA Blog by the founder of CounselingInternships.com, an internship listing site.

Obtaining a Mental Health Counseling Internship or Fieldwork Placement Time2Track

5 Mandalas in 5 Days: A Guest Post By Amy Flaherty

Today's guest post is about a new and creative therapy technique I (before now) knew nothing about! Hence, the guest post by play therapist and creative thinker Amy Flaherty. I know you'll learn a great deal from her, as I did. Thanks, Amy, for sharing! ~Stephanie

The mandala symbol has been around for thousands of years. It is probably best known from Eastern religions as tool for focus, meditation and creating sacred space. But nowadays, they are gaining additional traction in many therapy circles as well.   Art therapy, play therapy and mindfulness communities are finding therapeutic use in this this powerful technique. 

The word “mandala” originates from the Sanskrit language meaning circle.  Sounds simple, but mandalas are so much more than simple circles.  Just in the process of creating 5 mandalas, I experienced an array of emotions, including but not limited to anxiety, despair, enlightenment, fear, delight, and gratefulness.  Quite a large and varied set of feelings to originate from a simple circle! 

I found that for me the power of the mandala lies in its ability to allow one to just be.  Not do or think but just sit with yourself.  For me, this was a scary risk to take.

To fully experience the power of the mandala, I chose to complete 5 mandalas in 5 days.  I believe that in order to endorse a technique to my clients, I need to understand the process of the technique myself.  I came into the project fairly open-minded, given the rave reviews from fellow therapists about the power of mandalas.  However, I must admit I was somewhat nervous about sitting with my thoughts for ANY length of time.  My thoughts, left to run wild, usually end up in a continuous spiral of anxiety. Nevertheless, I decided to give this ancient meditative practice a chance to help with my issues.

Photo Credit arttherapyblog.com

I purchased a mandala workbook pretty cheaply from Amazon.  In addition, I found that many Pinterest boards or websites have them for free to download.   

The defining aspect of mandala is a circle with a smaller circle inside near the middle.  The circle draws the eyes inward and aids in meditation, inspires mindfulness, and harnesses energy.  Some expressive therapists encourage clients to make their own mandalas. I’ve seen some really detailed and inspiring ones created for therapy purposes.

Because I did not feel like I had the time or energy to undertake an art project from scratch, I choose to color the already formed mandalas from my workbook.  I used colored pencils because they are efficient at working with the tiny details in the mandala (make sure you keep a pencil sharpener close)!

Photo Credit Hannah McLain-Jesperson

The instructions to complete a mandala are simple: Just color. No rules, no time tables.  I usually instruct my clients to try to breathe deeply into relaxation and be aware of what comes into the mind.  When thoughts creep in (and they will), notice them and then let them go. 

While I was completing my mandalas, I noticed the several things about myself.  For me, completing a mandala was a lot like meditating.  I got twitchy, wanted to get up, and thought about everything I need to be doing.  The trick, I found, was to keep going...even when I felt like I was going to crawl out of my skin. 

Noticing my thoughts while doing my mandalas often served to provide a magnifying glass for all of my automatic thoughts that try to run me, wreaking havoc in form of anxiety. Here’s some of the thoughts I noticed (and tried not to dwell on) while I was working:

• This is NEVER going to be over
• I’m so stupid for doing this. I could be doing so many more productive things
• Those colors are nice together and I didn’t even try!
• Did I pay the water bill?
• How am I ever going to get everything done?
• Did my friend get the results from her medical test? I need to check on that.

 

And so on and so on…..

Sounds exhausting right?

It was! But oh so worth it!  I was able to notice my automatic thoughts, breathe them out, and return to what I was doing.  It was hard, but I did it.

 Your clients will likely react in a similar vein.  Tell them it just stick with it and just notice what comes up. Clients can use these as a way to practice breathing, being still, or attending to thoughts.

Encourage clients to write and report the thoughts that appear.  These will be excellent fodder for future therapy sessions (I’m sure my therapist will be rubbing her hands together when she sees my list!) 

Here’s a picture of my favorite mandala I created. 

Your mission now? Use mandalas with your clients!  Think of it as another technique in your toolbox. Mandalas have been shown to be effective with the treatment issues ranging from ADHD to anxiety.  I recommend, though, before you assign this as homework to your clients, try a few for yourself.  Notice your thoughts and feelings while creating.  It may be hard, but the insight gained is always worth the effort. 

I’m interested to hear from you about how you've made mandalas work for you in your therapy practice. With what types of populations do you see these having success?

Have you already used mandalas in your practice? If so, what were the results? Please share! 

Amy Flaherty is a Licensed Psychological Examiner-Independent and a Registered Play Therapist in Arkansas. She has been in private practice since 2007 and currently specializes in work with children and the LGBT population. Amy specializes in sandtray therapy and teaches many introductory and advanced sandtray classes. 

Links:

Amazing Coloring Pages

Mandala Madness

Mandala Pages

Everything I Once Learned Is Irrelevant Now; Or, A Reaction To The DSM-V.

Have you ever had a moment when you realized, 

"Huh. Everything I learned is irrelevant now."

For me, that moment occurred hearing the (awesome) guest speaker at last month's Dallas Metro Counselor Association meeting, Justin K. Hughes, MA, LPC, NCC. His topic? DSM-V: Top Ten Changes. 

Original Image Found at http://tinyurl.com/m448joj

Don't get me wrong - his presentation was great. In fact, he's provided a link to a video of it on his website, and I highly recommend you check it out for yourself. (He has a great sense of humor.) But the changes...oh, the changes. 

Hypochondria? Now Illness Anxiety Disorder.

Coding on Axes 1-5? Axes 1-3 are now combined into one. IV & V are covered by a separate notation system. GAF? Gone. 

While I have to admit, not all the changes are ones I disagree with - who gained any value from assigning a Global Assessment of Functioning, really? - the sheer number of changes are absolutely overwhelming.

Here's a few more highlights:

• Asperger's no longer exists. Instead, Autism Spectrum Disorder now encompasses what was Autism, Asperger's, PDD NOS, Childhood Disintegrative Disorder, and Rett's.
• We now have an official code to diagnose PMDD (Premenstrual Dysphoric Disorder) Hoarding, and Excoriation, a disorder based on skin-picking. 
• OCD is no longer an anxiety disorder.
• The DSM-V includes the first-ever behavioral addiction, Gambling Disorder.
• A new category, Depressive Mood Dysregulation Disorder, was developed to reduce the overdiagnosis of bipolar disorder in children. It is appropriate for children under 18 without major mood swings, but persistent irritability and behavioral concerns.
• Reactive Attachment Disorder is now collected alongside Stress & Trauma Disorders.

And that barely scratches the surface.  

Original Image Found At http://tinyurl.com/kcqbxyu

Not surprisingly, many people haven't embraced the change with open arms. 

• Is Grief An Illness? National Post
• The NIMH Withdraws Support for DSM-V Psychology Today
• Is Mental Illness Over-Diagnosed?   Medical Daily
• Prominent M.D., Dr. Allen Frances, stated it most baldly: "The publication of DSM-5 is a sad moment for psychiatry and a risky one for patients. My recommendation for clinicians is simple. Don't use DSM-5. "

But we know any change comes with its' detractors. And every iteration of the DSM has made massive changes, some controversial, but many that people would consider long overdue. So is this really any different than changes than the past?

It is, and for one, simple, narcissistic reason.

It's happening during our timeline.

The adoption of the DSM-V is happening as we are growing into our identity as a counselor. It will impact how we receive reimbursement from insurance panels, and how we classify appropriate methods of treatment. Therefore this change is something we have to react to. 

The diagnoses I learned about in Abnormal Psych may no longer be as valid. 

Sessions that would normally qualify for reimbursement now may not, but there are new disorders now that will.

What are you going to do about it? When it comes down to it, I think that's the only question a new counselor must answer when it comes to the many, many changes in the DSM-V.

How will the DSM-V impact your practice?