SAQ, Part 2: How To Be A "Real-World Authority"

Last week you may remember I wrote about the questions I thought that Beginning Counselors should be asking (SAQ) instead of the questions that are most frequently asked (FAQ.) While I don’t blame you – I certainly didn’t know I needed to ask these questions, I want you to thrive as a Beginning Counselor, not just survive.

Read last week’s SAQ, “What kind of a counselor do I want to be?” here.

This week’s “should-ask” question is “What do I need to do now to become a real-world authority on the needs of my clients?”

What do I mean by Real World Authority”? Well, fresh out of school, we know theory and academia inside and out. We don’t often know, though, what else is going on outside of this. In other words, we don’t know what is going on in the real world.

Our clients will turn to other people and resources outside of our services before coming to us. Sometimes, they will want to use those resources in conjunction with our services as well. If you don’t know what resources they are using, you are putting yourself and your clients at a major disadvantage.

If you don’t know what your clients are reading, who they’re listening to, and what else they’ve already tried to do to help their problem, then you don’t know:

• What assumptions they’ve taken in about the way things are…some of which may be completely contrary to your methods of counseling or even established scientific facts.
• What level of knowledge they already have about the subject at hand; they may be more advanced than you are expecting, or perhaps their knowledge is more basic than you've realized.
• How you can develop the skills and techniques you offer them in contrast to those other resources that they are using, giving them a different value for their time and effort than what they’ve already experienced.
• Whether you need to warn them about certain choices they are making. (Did you know that taking St. John’s Wort – a common ‘natural’ remedy for mild to moderate depression – in conjunction with other medications, such as birth control, can render them ineffective? That’s certainly valuable to be able to share that information with someone who doesn’t want to get pregnant!)

Every counselor needs to have a strong working knowledge of what resources are available to their clients to solve their problems in addition to their services as a counselor. Pop quiz: would you know what to say in response to any of the following questions?

• What books should I be reading in between sessions?
• What do you think of Tony Robbins?
• Is there an app to help me with my anxiety?
• I’ve heard that peppermint extract is good for stress relief. Is that true?
• Is there anything out there that can help families of sexual assault survivors?
• What things might be helpful for a couple who has just experienced a pregnancy loss?

If you don’t know what quality resources are out there to enhance your therapy work, then you risk:

• Having both you and your client work harder than would be necessary if they took advantage of some of the other things that are out there for them.
• Losing valuable talking points that can come from introducing another’s ideas into the therapeutic conversation.
• Overlooking helpful homework assignments.
• Providing care in a way you can’t on your own. (Therapeutic tools, alternative methods of healing, and so forth.)

It takes TIME to develop these knowledge bases, however. Which is why the perfect time to start for you is NOW. Here’s how you can start making that happen, today.

First, choose a general area to start researching. If you know who you want to work with specifically, you have a bit of a head start, because you can narrow down your research to that major area or topic. But if you’re not sure which group you want to work with, don’t despair.  You can still do your research, your topic will just be a bit broader.

Then, ask yourself two questions:

1. How will they look for help?
2. What will they not know to look for?

Discovering the answers to these questions and compiling a shortlist of recommended resources will be how you can become a real-world authority for your clients. As a result, you'll be a more informed  - and more effective counselor. 

I realize though, that this is easier said than done. Which is why I'm providing a little extra help. I've created a free 2-page worksheet for you that you can use to help you on your way to being a Real World Authority. Click here to instantly download.

Was this second SAQ helpful to you? Do you have any questions about becoming a Real World Authority? Post in the comment section below!

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[Guest Post] Acing The NCMHCE Examination

[[Please Note: This post was originally written 1/8/2015. Check with your state licensing board to make sure all information is still accurate, as rules change!]]

Graduate school is over - but you still have a lot on your mind! 

You’re wondering where to start first and where to go next. Well, while that is usually an individual decision (because there are a lot of directions you can take) many of you will be interested in getting your licensure as a professional counselor. If so, then you have probably already started to think about the licensure exam! Most of us would like to tackle the exam as soon as possible (though others may decide to wait and take it at a later point!)

Either way, when it’s time to sit down and register for the exam, you probably have forgotten where exactly it is you have to go and which exam it is you need to take. That can be quite stressful! But don't worry. Today, I will be sharing with you everything you need to know to ace the National Clinical Mental Health Counselor Exam.

What exactly is the NCMHCE? 
It’s the National Clinical Mental Health Counselor Examination, and many states require this examination before granting licensure.

What states require the NCMHCE for State licensure? 
As of right now some states require one (the NCMHCE) OR the other (the NCE), in order to obtain a state licensure. Below is a list that shows which states ONLY accept one or the other, right now:

Some states will accept either (NCMHCE) OR (NCE) exam for their licensure. So, essentially, if you are moving from any of the above states to any of the below states, you wouldn’t necessarily have to take another whole exam, you would still be able to use your scores from the NCMHCE. 

Here are the states that will accept either exam:

Now that we have established some of the basics, you may want to note the differences between the words “accept” and “require.” This criterion will be your main determination of which exam you need to take and where to put your focus, if you want to get licensed in any of those states. For example, if you live in Florida (like myself) and decide you want to move to Texas, I would have to take the NCMHCE to be state-licensed in Florida and then also take the NCE to become state-licensed in Texas. However, If I moved to Georgia instead, I would be able to use my scores from the NCMHCE that I used for my Florida licensure. (Yes, very confusing I know! I am right there with you! But you can do it!)

As you’re reading this, you’re probably wondering, what about the National Certification? (NCC) "Can’t I just take one test and be Nationally Certified?" Well...you can... BUT, it’s a certification and not a licensure so, each state will still have individual requirements they need from you to become licensed in their state. Simply put, the NCC alone is not enough to practice legally in your state. That issue is a whole separate topic in itself so, for clarity’s sake, we will just keep our focus on the NCMHCE for now!

When you have decided you want or need to take the NCMHCE, here are a few basics that you need to know:

What is the NCHMHCE like?

• Stimulations that cover a broad area of competencies, rather than simple facts to remember. 
• You will be given 10 clinical cases.
• Each case is divided into 5-8 sections that will be classified as either:
• Information Gathering (IG), or:
• Decision Making (DM)

What does the exam cover?
The exam will assess 3 main areas of your clinical competency:

1. Assessment and Diagnosis:
• Your ability to integrate client assessments, observations, and identification of precipitating problems, and individual/family/relationship problems.
2. Counseling & Psychotherapy:
• Your ability to inform the client about ethical standards, practices, counselor/client roles, treatment plans and evaluation of referrals. 
3. Administration, Consultation & Supervision:
• Will determine how well you maintain case notes, records, and files as well as how you determine if services meet client's needs. Also, will examine how you orally communicate with other professionals as well as your ability to assist clients with obtaining social services. 

What can I expect the exam to look and feel like?

• The exam will assess your clinical problem-solving abilities, which will include your ability to identify, analyze, diagnose and treat clinical problems.
• It will be presented in "real-life scenario" type format such as a paragraph with key information about a client, including information such as age, gender, presenting problem, etc. 
• You will be expected to gather appropriate information (IG from above) which might include missing information that is not provided, but necessary for a true diagnosis. For example: family background, physical health, previous experience in counseling, etc. 
• You will also be expected to make clinical judgments and/or decisions (DM from above) such as what to do with the information you have gathered, know, or have been provided such as making a diagnosis, a referral elsewhere, other social services, etc. 

Is there a right or wrong answer? How will my exam be scored?

• Yes and no. You should know that this is not a fact-based examination and that some questions will have multiple correct solutions. You should select all options that are appropriate for that question. There will also be some questions that are "single best answer" which will provide more than one acceptable option but, only one option is "generally" more acceptable than the other. I know! I know! Trust me, they are really testing your clinical abilities with the NCMHCE and as we all know, real-life scenarios are not black-and-white, and we have to assess each situation individually. That is exactly what this test is designed for. 

So, how can I prepare?

• I, personally, would prepare by allowing yourself to develop professionally first, and gain experience in real-life situations, during your first year of post-graduation licensure. Coming straight out of grad school we have been tested over and over again on factual, black-and-white, right-or-wrong answers! However, that's just not what the NCMHCE is looking for. So, allow yourself some time to adjust to the "grey" area of real-life diagnosing, analyzing and decision-making first. 
• Then, prepare to study! There are numerous resources available but, here are a few that have worked well for others and have been suggested as resources that can help!
• The NBCC website. They supply a good list of study guides that others have found to be useful. Here's the link.
• Dr. Linton's DSM-5 Online Study Prep for the NCMHCE, 6th Edition, which includes online simulations & prep, prior to the actual exam. Many therapists have used this and suggest it as a great way to pass the exam! 
• Click here for access to the main website & other study resources, such as the online subscription service mentioned above. 
• Click here to purchase the Study Guide for the DSM-5 on Amazon.com (Paperback).
• Click here to purchase paperback, Nook, Kindle, or pdf versions from Dr. Linton's website. 
• Dr. Howard Rosenthal's Encyclopedia of Counseling, a.k.a. "the purple book," is a great resource to use complementary to the resources mentioned above, and as a refresher on areas that you need help with. However, this format is primarily designed for passing the NCE. 
• Click here to purchase the Encyclopedia of Counseling package (2009) on Amazon.com.

Whew! Now that we’ve established everything you need to know about the NCMHCE and what to expect, you’ve probably got a lot MORE on your mind than you did before you read this. The most important thing to remember is to take the test at your own pace, when YOU feel most ready for it.

For more information about cost, the DSM-5, how to register and where to go for the exam, visit the National Board of Certified Counselors (www.nbcc.org) and always check with your state to find out which exam they require. Some states will also require “pre-approval” to sit for the NCMHCE through the NBCC first.

If you have any additional resources for studying, or experience you with taking the NCMHCE that you would like to share please feel free to post in the comments below! We always love to hear what has worked and hasn’t for others! 

Jessica Richards is a Registered Mental Health Counselor Intern for the State of Florida. As a graduate of NOVA Southeastern University, she holds a master's degree in Mental Health Counseling. With the help of Stephanie Adams, Jessica established Beginning Counselors of Florida, a support group for beginning counselors leaving grad school and seeking licensure. She is currently serving as Registered Intern Representative for FMHCA. She currently contracts with several community agencies while working on establishing her private practice.

5 Ways To Broaden Your Training Experience (Even If You’re In A Single-Focus Internship)

Thrilled with your current position as an intern at a domestic violence shelter, a hospital ER, or a faith-based counseling center, but wishing you had the chance to explore more of the variety that is out there in the counseling field?

Here’s your guide to getting the most out of the time you have in training – no matter what your internship focus is!

1. Multitask. Whatever you’re doing for hours now, think

about how you can get the most possible experience for your time there. Can you spin your work with preschool play therapy into some parent coaching sessions? Can you develop and use different sets of skills with the same group of clients, like trying cognitive-behavioral & EMDR-based methods on your trauma clients?

2. Observe. Other interns in different specialties. Your supervisor. Any other counselor that will allow you to watch them in practice. 

3. Read. Case studies, journal research articles, autobiographies, memoirs, counselor-authored practice books. Here’s some possibilities to get you started:

Journeys To Professional Excellence: Lessons From Leading Counselor Educators And Practitioners 
Ariadne's Thread: Case Studies in the Therapeutic Relationship 
On Being A Therapist 
Inside the Session: What Really Happens in Psychotherapy 

4. Volunteer. Any kind of social services agency will work!

5. Man (or Woman) a Hotline. Sexual assault recovery, crisis pregnancy, suicide prevention, LGBT, domestic violence – there is a hotline for almost any specialty you might want to explore further. While you would likely be a volunteer in this position, it’s still worth your time to pursue if it’s of significant interest to you. 

Right now, you may be feeling stuck, or out of options. But you have more flexibility than you realize. This is literally the only time in your life when you are new to the field of counseling, AND you have the assistance of a trained supervisor to help you with any and all of your counseling-related questions.

And that’s the key that’s going to make the suggestions above work for you. Any of these suggestions on their own might do you some good. But if you consciously filter these new experiences that you’re having through that lens of new counselor experience you will have insights you’ve never gained before and some you’ll never have again. If you take notes back from these experiences to discuss with your supervisor, or practice with a fellow intern, you’ll find your intern experience to be both diverse and more rewarding than you ever thought it could be! 

How do you suggest finding diversity in a more narrow internship experience? Comment and share below!

What's Your Dream?

One of my favorite things about Beginning Counselor is that we support each others' dreams. This is something I wanted for us from the beginning, but it hasn't come about due to me - it's something you guys have done completely on your own. And I love it!

Now, you can find that kind of support on Pinterest. I've created a secret board just for Beginning Counselors to share their dreams, inspiration, and support for one another. 

This secret board will be a place for all of us to share things like:

• Trainings & certifications we want to pursue.
• Office setup & decor ideas for our future workplaces!
• Projects & charities we want to support.
• Counseling-related changes we want to support.
• Inspirational quotes we believe in.
• Goals we want accountability on.
• Blog posts that teach us creative techniques.
• Resources for future practice.

In other words, it's a place where you share your dreams for the future!

If dreaming is a step in planning, the more we share with one another - in a safe, private, encouraging environment - the more likely we are to see our dreams realized.

Here's an example of my dream pins for you to take inspiration from. 

This article discusses the two remaining “building blocks to counselor license portability" and what needs to happen to remove them. Dream: Common licensure title, scope of practice, and education requirements.

This is what keeps me going as a counselor. Dream: To focus my practice on helping people avoid giving up on their dreams!

Dream: Inspirational office decor!

I can't wait to see what kinds of pins you share that inspire you! 

Here's how you get started:

[A note before beginning: Every Beginning Counselor is welcome, but since it's a secret board (so we can all feel safe to share our hopes and dreams) there is a bit of a process to joining! But hey, it wouldn't be special and exclusive if it was totally easy to join....]

Joining the BeginningCounselor Dream Board

 on Pinterest.

The first step is to follow me on Pinterest. This isn't just a cheap way for me to increase my followers, but also makes it easier when it comes to inviting you to join our board. 

Second, comment on the blog below (if you're reading this in your email, just click here to go to the main blog page) and say "add me!" If you've done the first step correctly, I will be connected to your name on Pinterest already and be able to easily add you. 

This is me typing in Tamara's name to add her to the board. This is what I will do for you after you comment.

PLEASE NOTE: If your name is not included in your Pinterest account, for whatever reason, you will need to let me know the name of your Pinterest account in your "add me" comment. 

To reiterate: 1) Follow me. 2) Comment on this post: "add me" plus your name if not in your Pinterest account. 

Let the pinning begin!

P.S. Have questions about secret boards? Pinterest has written a post with all the answers!

P.P.S. This board will remain secret at all times so that it is exclusive to us. New pinners will have to follow the same procedure as you to join us.

Seeking Advice From Others [Guest Post By Kim Peterson]

I clearly remember one of the most difficult decisions I had to make halfway through my internship. 

The pediatric clinic I worked for throughout graduate school offered me an amazing opportunity with their company, which meant leaving my current internship at a successful group private practice. There were so many factors to consider, such as the fact that I would be changing supervisors, working longer hours away from home, and treating a totally different population.  I remember quickly getting on the phone to my colleagues, friends, mom, dad, grandmother, husband, and so on… I needed feedback from those I trusted most. It was during this time that I truly realized how much I valued the knowledge and experience from each of these individuals in my life. Have you ever stopped to think of the wealth and diversity of life perspectives you have around you, just in your own personal circle?

Interns and new therapists are confronted with challenging decisions like this every day, and often our decisions greatly impact clients and colleagues, as well as family. Seeking advice from others is a must in our personal and professional lives. We all have a great deal of people in our circles, from family members to friends to professional associations, and each individual varies in their background, education, and life experience.

Taking time to discover and learn from others is something I recommend to my clients regularly. We refer to this circle as a “support system,” but I don’t believe people always maximize the benefits of their network.

The worksheets below are intended to generate awareness of who is in one’s social circle and what they can offer. There is an adult worksheet and teen worksheet, and for the purpose of this post, I also modified one for counseling interns.

Learning from Others (Adult)

Learning from Others (Teen)

Learning from Others (New Counselors)

For a complimentary post and self-help worksheet, check out my blog post “Everybody Needs Somebody”!

Just for fun, here are some examples of a few pieces of advice I received from my own family:

Children: Nana- Love them, teach them to respect others, make them lovable enough so others enjoy being around them, teach them good behavior, have them in church.

Aging well: Nana-Stay active and take care of yourself the best you can.

Spirituality: Dad- Without faith there is no hope.

Marriage: Mom- Communication and listening are important to meeting one another's needs and avoiding unnecessary conflict.

Difficult decisions: Dad- The easiest way to make the hardest decisions is to strive to do what is right.

Helping others: Mom- Try to practice this every day because you will feel good and your outlook each day is better.

Being critical: Cody- You will never regret withholding judgment.

Hearing some of the responses, I chuckled (because they were so typical of that person), or found myself surprised and impressed. I encourage you to use this in your own life, as well as use this tool in your clinical practice. Stephanie and I would love to hear your feedback and any questions you may have!

Kim Peterson is a Licensed Professional Counselor-Supervisor and Registered Play Therapist in Kingwood, Texas. She works with individuals of all ages with a focus on child therapy, depression, adjustment, anxiety, parenting dilemmas, and teen issues. Kim is also passionate about educating others on issues in counseling through her blog at www.kimscounselingcorner.com.  Kim can be reached at kim@kimscounseling.com.

Kim's name sound familiar? It should! She first appeared in Beginning Counselor in the blog post Free Worksheets For Therapists on October 3. Click the link to read.

Did you miss it? Kim gave you links to 3 FREE worksheets! Download the worksheets here. Subscribe to her blog for more great advice and free worksheets. 

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?