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Carlos Zalaquett, Ph.D.

FMHCA President 

July 2013 -2014
Board of Directors


President Elect

Darlene Silvernail, PhD, LMHC, CAP  


Past President

Elvis Lester, MA, LMHC



Norman Hoffman



Kathie Erwin, PhD, LMHC 



Joe Skelly, MS, LMHC



Bob Decker,PhD, NCC, LMHC 


Newsletter Editor

Darlene Silvernail, PhD, LMHC, CAP



Nancy Montgomery

Professional Administrator
More for Your Money!

We have four main reasons to be proud of our 2014 annual conference. First, it is well organized and filled with key presentations on issues that affect your practice.  Second, it is packed with programs to sharpen your clinical skills. Third, it facilitates colleagues connections and networking. Last, but not least, it provides an opportunity to achieve all of the above as well as complete CEUs in a cost effective way.  Yes, the conference is approved to provide CEUs by CE Broker and NBCC. Attending our conference will help you obtain CEUs, and complete courses required by the  491 Board, such as Domestic Violence (2 CEUs), Ethics (3 CEUs), and Medical Errors (2 CEUs). Furthermore, the pre-conference programs and the conference presentations will teach skills that easily translate into practice and effectiveness as a mental health counselor. Kudos to Dr. Darlene Silvernail and her team for planning such a great conference! Where in the world can you enjoy the wonderful facilities of the Orlando Marriott -Lake Mary, learn new clinical skills, mingle with friends, meet new colleagues, get to know the FMHCA Board, and earn CEUs, all for one sensational price? Plus there is more!  If you register before November 11th you could take advantage of our early registration fee of  $159 for our clinical members and $270 for clinical non-members (tip: become a member to save even more!).  Hope you will let your colleagues know about the many ways in which the conference gives you more for you money!

Look forward to meeting each of you at Orlando Marriott -Lake Mary!

Click here to learn more.

Carlos Zalaquett, Ph.D.
FMHCA President 2013-2014
FMHCA 2014 Poster Session
Annual Conference -
February 7-8, 2014


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FMHCA's Mission... 

The Mission of the Florida Mental Health Counselors Association is to advance the profession of clinical mental health counseling through intentional and strength-based advocacy, networking, professional development, legislative efforts, public education, and the promotion of positive mental health for our communities.

Why hire a lobbyist?

Legislative lobbying is an attempt to influence a legislator's opinion or to enlist his or her assistance in supporting legislation that is helpful to your group or in defeating legislation that adversely affects your group. Associations and businesses "don't hire lobbyists for fun," suggested a 2012 story covered by NPR's Alex Blumberg. They hire them to achieve their legislative goals. The same is true for associations like the Florida Mental Health Counselors Association.


Even though FMHCA is not a multi-national corporation with profits equaling those of companies studied in Mr. Blumberg's story, a proportional return on investment may exit between the corporations and associations that hire lobbyists and those that don't.


In the case of the NPR story, a study was conducted by a tax professor at the University of Kansas, Raquel Alexander, about which companies benefited from the tax breaks offered by the American Jobs Creation Act. The study compared companies that had lobbyists versus those that did not. The "Return on Investment (ROI) to Lobbyist," for the 93-out-of-450 firms that retained lobbyists, was twenty-two thousand percent (22,000%).


It's nearly impossible to estimate exactly how much most organizations earn from retaining a lobbyist. However, there is a reason that all successful industries - bee raising and poultry farming to hospital staffing hospitals and pharmaceutical sales - continue to see the ROI from Federal and state-level lobbyists.


Mixon and Associates is the lobbying group representing the Florida Mental Health Counselors Association. Though FMHCA could choose from many lobbyists, our firm has proven to be a good "fit" for the membership size, professional roadblocks and long-term goals of this association. This is partly because Mixon & Associates specializes in association lobbying. We value sitting through a two-hour association board meeting, reviewing annual conference income and celebrating a two-percent-membership-bump.


Mixon and Associates' roots are education. Juahn Mixon was a teacher, then a school administrator followed by associate superintendent and finally, deputy commissioner at the Florida Department of Education. When Juhan's (pronounced "John" by most) DOE position expired, he used his expertise and knowledge of public education to retain clients. Though, not all of Juhan's clients were in the education sector. The firm quickly learned that many of our clients had one thing in common. They were one body of people representing thousands of like-minded Floridians.


We excel as a firm not only because we manage political action committees that give us access to hundreds-of-thousands of dollars in campaign contributions every two years, but also because we understand how associations work. We know that every few years a new board of directors is faced with managing membership efforts, annual conferences and lobbying the legislature. Mixon and Associates maintains constant mental health industry focus year-after-year and board-after-board. We are not just hired help. We consider ourselves a part of the FMCA team.


Mixon and Associates has been in business since the early 90s. We've been lobbying for FMHCA for XXX years. We understand the 491 statute and the threats against it. We are passionate about ensuring a safe climate for people seeking mental health services both statewide (eliminating the ability for interns to "practice" for 10-20 years) and federally (ensuring Medicare recognition and filling VA internships with MHCs). We hope that FMHCA continues to value the importance of having a voice in Tallahassee by having a year-round lobbying team representing your membership.

Over the next several months, we will begin to provide you with updates surrounding the Florida legislative committee weeks and relevant bills. We are glad that your organization sees the RIO in us and we are happy to represent Florida's mental health counselors.


Additional information about lobbying process:

A lobbyist provides factual and anecdotal information intended to defend a specific position. Lobbyists are expected to anticipate opposition to their clients' goals and to provide information refuting that opposition.


Professionally, lobbyists are issue-oriented rather than ideological. The personalization of issues is counterproductive for lobbyists and their clients because the same legislator who opposes them this legislative session could be their ally on an issue the following year. Although personalities and personal perspectives play a large role in politics, especially during election years, legislators and lobbyists seldom make decisions intended to harm law-abiding Floridians.


Lobbying occurs on a year-round basis. When the legislature is not in session lobbyists are:

  • Identifying any unintended consequences of past legislation
  • Contributing to statewide House and Senate campaigns
  • Helping clients develop legislative platforms
  • Finding bill sponsors for the next year's legislation
  • Maintaining relationships with Legislators
  • Attending annual client meetings (presenting often)
  • Working in political campaigns during election years
  • Being the "eyes and ears" of our members in case harmful legislation is being crafted by outside interests that will impact their profession

On average 2,500 are filed jointly between the House and Senate. Typically only 280 of those bills will pass largely because lobbyists are fighting to keep them from passing.

Register Soon to Take Advantage of the Early Bird Special! 

FMHCA is offering three Pre-Conference Workshops prior to our annual Conference. We invite you to take a look at our offerings now.

Qualified Supervisor Training - 2 Day Workshop, Earn 16 CEU, CE Broker#: 50-748 (State of Florida)
Become a Qualified Supervisor! Enhance your professional worth by becoming a Qualified Supervisor!   Prospective employers NEED Qualified Supervisors on site - you can immediately make yourself a more desirable hire by becoming a Qualified Supervisor.  You can also increase your income potential and gain personal enjoyment and satisfaction by becoming a role model for new counselors. Cost is only $155! or $235 if you wish to add Saturday Conference Day.

Forensic Mental Health Evaluators Certification - 1 Day
Because the professional counseling industry has taken a major turn in receiving a significant decrease in our third party reimbursement, it has become imperative to licensed professional counselors to develop additional resources to stay afloat. NBFE in cooperation with FMHCA is offering a one full-day forensic mental health certification-training workshop for licensed professional counselors. The cost of $500.00 is only offered to those also registered for the FMHCA Conference.

Hypnosis Basic Training Program - 1 Day Workshop, Earn 6 CEU, CE Broker Course Tracking #20-406870
This is designed for participants who have no prior knowledge of or experience in Hypnosis or hypnotic changework or interventions. The program emphasizes the elicitation of trance & various altered states & ways to utilize these states in focused interventions for optimal functioning. Whether you are interested in this course for your personal development, for becoming a Hypnotherapist & developing professional proficiency as a hypnotherapist, or acquiring greater depth & flexibility as a communicator, you will learn powerful skills & techniques that you can immediately incorporate into your life & your work. This workshop only costs $75.


register now  

Darlene Silvernail PhD LMHC CAP
President Elect

Become an FMHCA Member! 
There are four types of memberships to choose from. Each membership is for one year! 

As a FMHCA member you will be able to enjoy many benefits:

  • Help shape public policy that makes FMHCA a powerful advocate for our profession
  • Keep abreast of legislative and rule making efforts through our interactions with the 491 board
  • Improve upon your skills and experience by taking advantage of educational opportunities through FMHCA's continuing education programs;
  • Connect with fellow professionals on LinkedIn through our online groups such as the LinkedIn Member Group, Qualified Supervisor Group or Chapter Leadership Groups.

As you may already know, FMHCA is the only organization in the state dedicated exclusively to meeting the professional needs of Florida's Licensed Mental Health Counselors. For more than 20 years, FMHCA has diligently served its members in a variety of personal and professional ways, proving that it is dedicated to your success as a mental health professional and the growth of our profession.


We invite you to contribute your efforts and encourage you volunteer as there are numerous opportunities for you to get involved and make a difference!


We look forward to having YOU as part of FMHCA this year!


sign up today  

The Registered Mental Health Counselor Intern's Corner


Facing the Challenges as a Registered Mental Health Counselor Intern

By Coralis Solomon, Registered Mental Health Counselor Intern  

Now that graduate school is over, a new journey as a Registered Mental Health Counselor Intern begins. Whether you are at the beginning,or halfway into this journey, the pathway can be a bumpy road. Thinking about the difficulties ahead, I find inspiration in the marathon swimmer Diana Nyad. A few weeks ago, Diana became the first person to swim from Cuba to Key West without the protection of a shark cage. At the age of 64, this was her fifth attempt in 35 years. She finally accomplished her goal, swimming a distance of 110 miles arriving on shore 53 hours later.   Her words at arrival were, "We never, ever give up, never too old to chase dreams and never a solitary sport, it is a team."


What does swimming from Cuba to Key West have to do with overcoming the challenges of being an *RMHCI? If you look closely there are a number of similarities. To begin, Diana trained for thousands of hours preparing her mind and body for the challenge. As an RMHCI in the state of Florida you need at least 1,500 hours of face to face counseling and a minimum of two years practice in order to become licensed. Diana swam 110 miles; this compares to the required 100 hours minimum needed for supervision. Diana needed the help of a skilled team to get her to shore. As an RMHCI you need the support of colleagues, family, and most importantly, a reliable supervisor. Finally, just like Diana's words at the finish line, never ever give up when times get difficult.


If you are a registered intern, I invite you to join me in this journey.   As a FMHCA representative for the Registered Mental Health Counselor Interns, my goal is to support you with any issues or concerns that you may have. I hope that in this column you will find a source of inspiration and useful information for your professional career as a new counselor. You don't have to do this alone or as Diana would say, "Never a solitary sport, it is team."


*RHMCI is used only in this context for the readers benefit. RMHCI as an abbreviation is not to be used when representing oneself to the public.


Coralis Solomon is a Registered Mental Health Counselor Intern for the State of Florida. As a graduate of Troy University, she holds a master's degree in Counseling/Psychology. She is currently serving as Registered Intern Representative for FMHCA and MHCCF. Her private practice Quiet Minds Counseling is located in Orlando, Florida. She practices under the supervision of Joe Salg, LMHC. For questions related to Registered Interns please email them to

Available Job Postings 

Special Note: Job postings for our newsletters must be submitted by the 25th of each month and we will run your posting for one month. Please submit your your posting to

Disability Rights Florida - Employment Opportunity - Executive Director

Disability Rights Florida, Inc. operates Florida's federally mandated and state designated protection and advocacy system for persons with disabilities. The organization is a private, non-profit corporation with a staff of 59 who work in the Tallahassee headquarters office, two regional offices, and other strategic locations across the state. The Search Committee of the Board of Directors is conducting a search for an Executive Director. The Executive Director is stationed in the Tallahassee office, but some in-state and out-of-state travel is required. The Executive Director is responsible for managing the operations and staff of the organization and reports directly to the Board of Directors.


The ideal candidate will have extensive experience and knowledge of Florida's service delivery system for persons with disabilities, excellent written and verbal communications skills, managing a wide range of activities related to the organization's fiscal affairs, staffing and personnel, program operations, public policy and legislative affairs. Proven leadership, planning and organizational skills, the ability to build collaborative relationships with like-minded organizations, and the ability to earn the trust and respect of, and work effectively with diverse groups of people are required. Juris Doctor is preferred, but not required.


Interested and qualified candidates should submit a resume, references, salary requirements, a writing sample, and a narrative explaining personal and professional motivation for seeking this position to the Board of Directors Search Committee, Disability Rights Florida, Inc. at; mailing address: Search Committee, c/o Disability Rights Florida, 2728 Centerview Drive, Suite 102, Tallahassee, FL 32301; fax number 1-850-488-8640. Equal Opportunity Employer; Drug Free Workplace. For more information about Disability Rights Florida visit our website at 


Deadline for submission of materials is: November 15, 2013

FMHCA seeking exhibitors & sponsors

FMHCA is seeking exhibitors and sponsors for our Feb 7th & 8th Orlando conference. For additional info please explore or download the form here.
NBFE 2014 Conference

National Board of Forensic Evaluators
Invites you to attend the second 
Annual Webinar/Conference
March 7th, 2014

How to Become a Dangerous Expert Witness
(Defeating Opposing Counsel's Deposition and Cross Examination Tactics)

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Advertise: Get your Agency Recognized!
Did you know our educational platform reaches over 9,000 professionals a month? See our various advertising opportunities below. 

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8 Hour Florida Laws and Rules    

Who would have thought that learning, really learning 300 pages of Laws and Rules could be fun? The oldest and most successful Laws and Rules Course in the state of Florida, offering the infamous Masochistic Combo (8 hour laws and rules, 2 hours domestic violence, 2 hours medical errors, 3 hours HIV/AIDs) all in one long, gratifying day. Read more...

(8 CEU hours)

To register:
Live Course, click here. (Pursuant to Board rules, this course must be interactive and is not available online or as a home study...but our live course is awesome!)


Do You Want to Become a Florida Qualified Clinical Supervisor?  

Qualified Supervision Training will be offering a Pre-Conference Workshop prior to FMHCA's 2014 Annual Conference!
  • Enhance your professional worth
  • Become a more desirable hiring choice
  • Increase your income potential
  • Increase personal satisfaction
  • Become a role model to new counselors

Join Dr. Denny and Dr. Wiggins on Thurs. and Fri. February 6th & 7th in Orlando. This two day course will complete the educational requirements to become a Qualified Clinical Supervisor in Florida.


Register before November 11, 2013 for an excellent reduced rate of $155!   


You can register for this Pre-Conference workshop at 


You may also choose to add on Saturday (the final day of the FMHCA Annual Conference) for just an additional $80. This will provide an even greater opportunity to connect with other Florida mental health professionals as well as receive valuable training and earn additional CEUs.   


To reserve your room at the conference rate of $119/night, contact the Lake Mary Marriott Hotel at 407-995-1100.

Dr. Denny Cecil-Van Den Heuvel received her Ph.D. in Counselor Education with a minor in Psychology. Dr. Denny is a Licensed Mental Health Counselor and a Licensed Marriage and Family Counselor in the state of Florida. Dr. Denny is a past President of the Mental Health Counseling Association of Palm Beach County and Past-President of the Florida Mental Health Association Dr. Denny is the Chair of the Clinical Mental Health Counseling Master Program at South University in Royal Palm Beach, FL.

Marsha Wiggins, Ph.D. is an LMFT in Florida and has over 20 years of experience as a counselor educator and supervisor. For 18 years, she was on the faculty at the University of Colorado Denver where she chaired the counseling department. Currently, she is the Executive Director for ACES (Association for Counselor Education and Supervision), a division of ACA. She has published in the area of clinical supervision and multiculturalism, with an emphasis on integrating religion and spirituality into counseling.

The QST course meets supervisory training and requirements of rule 64B4-6.0025. 

CE Broker #: 50-748/

This course also meets Ethics and
Professional Readiness for CAP Certification. (FCBAP)



Did You Know?
Do I have to have Domestic Violence this cycle? Two (2) hours of Domestic Violence are required every third license cycle. If not required this license cycle and you complete 2 hours of Domestic Violence, this will become your selected license cycle for the Domestic Violence requirement.

Please note a maximum of six (6) of the required thirty (30) hours of continuing education may be accrued for credit during one biennium by attending programs designed for the purpose of enhancing the licensee's administrative, office management, or other non-clinical skills.


Contact for your educational hours



Making the Most of Happenstance
by Kathie Erwin, Ed.D., LMHC, NCC, NCGC


A new client pours out a story about unexpected downsizing that caused a plummet from the executive suite to near homelessness. A recently divorced single parent attempts to push aside personal grief to normalize life for the children as much as possible while dealing with a contentious ex-spouse. A graduate student who overcame life in an alcoholic family is conflicted about whether to take a lucrative job with a liquor distributor in order to pay for the final year of school or take longer to graduate at a lower paying job.


These three "down on their luck" clients have common threads of grief, loss, anger and self-doubt all of which deserve acknowledgement and attention. However, if a counselor camps out on the losses without guiding the client to explore the opportunity within these seemingly disastrous, random events, then the mystical wonder of "Happenstance" is missed.


Dr John Krumboltz struck out on his dream of playing in major league baseball. Dr Al Levin received demoralizing career advice as a student, which eventually perked his interest in career counseling. From those early disasters, Krumboltz and Levin found constructive ways to use failure as the launch point of the next positive career move. Their book, "Luck is No Accident: Making the Most of Luck and Happenstance in Your Life and Career" (2010), and the stories in each chapter sparked lively discussions in my Career Counseling class. Much as clients and counselors gravitate toward identifying a problem, brainstorming and finding solutions, Krumboltz and Levin (2010) metaphorically bungee jump into exploration of " Wake Up Before Your Dreams Come True" (Ch. 3) and "Go Ahead and Make Mistakes (Ch. 5). For me, this book is a classic with timeless stories to illustrate concepts of change.


In counseling related to career and future life goals, the messages and stories of "happenstance" are powerful platforms for interaction. The client who has acquired beliefs such as " I was born under a dark cloud" or "I'm just not lucky" is too conditioned to look for the cloud to see a glimpse of the silver lining. Whether the counselor decides to put "Luck" in the "empty chair or wrap the client's dilemma into a "Miracle Question", the exploration of happenstance fits into a variety of therapeutic contexts.

Counselors who feel stuck in their current work can also apply happenstance to find the next step forward. Some are hanging onto agency or hospital jobs when their desire is to develop private practice yet fearful of losing a predictable paycheck. Others are bound by their successes and defined by colleagues and clients as the specialist in a certain modality that has become rote and less fulfilling. Moving into a new specialty means giving up the "expert" chair and becoming a student again, but what about the commitment of time and money to make that possible? What if the agency/hospital drastically reduces staff and counselors become hourly paid contract workers instead of employees? Or what is lost if the expert counselor reaches burnout and moves on to a different field rather than train for a new specialty? Happenstance can be at work in these seeming losses . With a bold move forward present losses are the foundation of a revitalized career. Think about it for yourself and your clients.


Krumboltz, J.D. & Levin, A.S. (2010). Luck is not accident: making the most of luck and happenstance in your life and career. (2nd edition). Atascadero, CA: Impact Publishers.

Kathie Erwin, Ed.D., LMHC, NCC, NCGC is an Assistant Professor and the Associate Coordinator of Masters in Counseling Programs (CACREP) for Regent University. 

Dr Erwin is the author of 7 books, the most recent is Group Techniques for Aging Adults, 2nd Edition (2013), Routledge Publishing.
ACA Government Affairs Update
Dear Colleagues, Graduates, and Students, if you are a member of ACA  please tell your senator to co-sponsor S.1155 for our veterans. Furthermore, help mobilize other ACA colleagues and students you know. Acting is of essence.

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Carlos Zalaquett
President of FMHCA and Professor, USF

Explore DSM-5 at the 2014 FMHCA Annual Conference

by Aaron Norton, LMHC, CAP, CRC    


It's been six months since the release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and counselors are gradually shifting towards full implementation of the new criteria. For many, this task is overwhelming and perhaps unwelcome.


After all, human beings are in many ways creatures of habit, and counselors are no exception. It takes a great deal of time and effort to re-educate ourselves every time the "bible of psychiatry" written in dry, academic prose gets tampered with, and if you're like me, you're pretty busy and can think of much more interesting things to do with your limited spare time. Personally, the best way I could think of to force myself to learn about the DSM-5 was to register for a number of trainings and start scheduling my own presentations on the topic, paying homage to the old saying, "We teach what we need to learn" (or is it, "Those who can't, teach?").


Still, this nearly 1,000 page snoozer offers us far more utility than bibliotherapeutic treatment of insomnia via bedtime reading, filling an empty space on our office bookshelves, or serving effectively as an expensive paper weight. The DSM-5, as imperfect as it may be, is the "gold standard" of diagnosis and case formulation here in the U.S. It helps us organize our thoughts, identify effective treatments, and measure clinical progress. Knowledge of its contents is required of counseling students in CACREP-accredited programs, interns sitting for their licensure exams, and clinicians who work with third party payers who want to ensure that we're submitting claims for treatment of a disorder vs. preventative care. In this professional climate, updating ourselves on DSM revisions is a matter of necessity, not luxury.


FMHCA is doing its part in helping counselors accomplish this daunting task by providing a two-day conference this February dedicated to updating counselors on a variety of changes impacting our field. By my count, the conference includes nearly nine hours of DSM-5 update training, including my three hour workshop on using the DSM-5 and the newly released 2013 American Society of Addiction Medicine (ASAM) treatment criteria to conduct quality substance abuse assessment and evaluation. I'm hoping to make the DSM-5 update easier by focusing on the paradigm shift in the new edition and connecting each change to that shift.


What do I mean by "paradigm shift?" Let's start with a brief glimpse of the history of the DSM. The first edition, published in 1952, was dramatically brief in comparison to the heavy volume we're now so familiar with. It consisted of brief, psychodynamic-oriented descriptions of disorders. The next paradigm shift of the DSM came with the third edition published in 1980, which implemented a medical model with very specific criteria for disorders and a litany of statistical data supporting each. Not surprisingly, the DSM expanded dramatically in length with that edition.


The DSM-5 was intended to establish a new paradigm shift within the context of the existing medical model of diagnosis. As I see it, the six most salient examples of this shift include efforts to:


  1.  Reduce the dichotomous nature of diagnosis (i.e. "You either have the disorder, or you don't") by shifting towards a spectrum approach to classifying disorders with more specific information attached to the diagnosis (e.g. more specifiers available for each diagnosis, including extra scales of severity);
  2. Streamline and simplify diagnosis by combing similar disorders and then providing more options within the diagnosis in the form of new specifiers. (You'll be happy to know, by the way, that for the first time in DSM history, the volume actually decreased in size.);
  3. De-pathologize "different" by more clearly delineating between abnormal and disordered human experience;
  4.  Reduce the frequency of inaccurate or generic diagnosis;
  5. Enhance consideration of cultural and developmental factors in the diagnostic process; and
  6. Eliminate the phenomenon of "mind-body dualism" inherent in previous editions. It's official; the large group of psychiatric professionals tasked with developing the new edition have decided that our brains are, in fact, part of our bodies. Consequentially, it no longer makes sense to separate the physical aspects of human wellness from the mental aspects of wellness as though the two are entirely separate realms with no overlap.


Changes made to substance use and related disorders provide an excellent example of all of these paradigm shifts:

  1. Streamline and simplify diagnosis and reduce the dichotomous nature of diagnosis: Because the DSM-IV diagnoses of Substance Abuse and Substance Dependence differed primarily in severity, the two disorders have been collapsed into one substance use disorder with an added spectrum of severity in the form of mild, moderate, and severe specifiers based on the number of symptoms the client meets. This measure also solves the problem of "diagnostic orphans," a concept a little too complex to address in this article (although it will be covered at FMHCA's annual conference). It also eliminates the DSM-IV problem of the absence of a diagnosis for Nicotine Abuse. Previously, only Nicotine Dependence could be diagnosed, but in the DSM-5 a milder tobacco use disorder is available. The symptoms have also been reordered into groups that may make more sense to the clinican.
  2. De-pathologize: The more loaded terms "abuse and dependence" have been replaced with the more neutral phrase "substance use disorder." Also, the threshold for the number of symptoms needed for a diagnosis has increased from one to two to strengthen the legitimacy of the diagnosis.
  3.  Reduce the phenomenon of inaccurate or generic diagnosis: The diagnosis Polysubstance Dependence has been deleted, because it was so frequently inaccurately applied by clinicians. For the first time, craving (a strong desire or urge to use) has been added to the diagnostic criteria;
  4. Increase cultural and developmental sensitivity in the diagnostic process: The symptom for recurrent problems with law enforcement was eliminated "because of cultural considerations that make the criteria difficult to apply internationally" and many of the statistics on substance use disorders provide detail on differences among age groups;
  5. Eliminate mind-body dualism: The specifiers "with physiological dependence" and "without physiological dependence" have been removed. Frankly speaking, the delineation between physical and psychological addiction is silly. Cannabis Withdrawal has been added as a diagnosis based on decades of consistent research and case history of a clear withdrawal syndrome experienced by many chronic, daily marijuana users. This addition contradicts the popular societal myth that marijuana isn't physically addictive; it's just psychologically addictive. Caffeine Withdrawal has also been added, although Caffeine Use Disorder exists only in Section III of the DSM-5 to be considered for future revisions.


As helpful as I view some of these changes, the new criteria raise a few interesting dilemmas for counselors to ponder.


For example, the Americans with Disabilities Act and the Rehabilitation Act acknowledge that Alcoholism and drug addiction (or "chemical dependency" as some government programs label it) can be protected disabilities, provided that other requirements for a disorder to be considered a disability are met and the individual is no longer using the substance. Traditionally, a DSM-IV diagnosis of Substance Abuse was not sufficient to be considered a disability, whereas Substance Dependence may be. Moreover, Substance Abuse could be considered a temporary diagnosis, whereas Substance Dependence was considered a chronic disorder, regardless of whether or not it was in remission. How will rehabilitation counselors, diagnosticians employed by social programs, and others involved in social program eligibility now delineate between abuse and dependence?


And now that the criterion for "recurrent substance-related legal problems" has been removed, how will diagnosticians be able to determine if a defensive client with a significant history of substance-related arrests still meets criteria for a substance use disorder based on the remaining criteria?


And now that the DSM criteria for substance use disorders has changed, what will change with ASAM treatment criteria?


As much as I want to be helpful with this article, I'm not going to give away the farm, folks. I'll be happy to answer explore these issues in detail at FMHCA's annual conference in February. I hope to see you there!

register now

Aaron Norton, LMHC, CAP, CRC
Integrity Counseling & Coaching, Inc.
1101 Belcher Rd. S., Ste. J, Largo, FL 33771
Phone: (727) 403-6208; Fax: (727) 531-0950
Mental Health Needs of Alzheimer's Caregivers
by Kathie T Erwin, Ed.D., LMHC, NCC, NCGC, BCCP

Alzheimer's disease in America is like Hurricane Sandy - the impact is dramatic, the devastation lingers far longer than imagined and the emotional toll is underestimated. Currently 15 billion family caregivers give the equivalent of over 17 billion hours of unpaid care time to the 5 million adults over age 65 who have been diagnosed with Alzheimer's disease. (Alzheimer's Association, 2013).With an average lifespan of 4-8 years after diagnosis, Alzheimer's caregiving becomes a 24/7/365 commitment that typically takes the caregiver away from work, socialization, spiritual expression and vacations (Helzner, et al, 2008). Sadly the mental health issues of spouse and family caregivers are not adequately considered or served.


Granello & Fleming's study (2008) found that Alzheimer's caregivers are at high risk for anxiety and depression yet this often goes unrecognized as medical and social services focus on the Alzheimer's patient. This study recommends that caregivers receive counseling to "ameliorate severity of mental health issues by providing education and support" (p 24). This is a wake up call for Mental Health Counselors, particularly those skilled in family therapy.   Here are some ways to help:

  1. Partner with a medical professional who specializes in gerontology and Alzheimer's disease to offer family groups dealing with the confusion, anger and uncertainty that occurs after hearing this diagnosis. This can be a time limited group or a regular ongoing support group.  
  2. Caregivers are by nature giving people and hesitant to accept help for themselves. Building rapport with them in the group lets them get to know the counselor and feel more comfortable seeking individual counseling.  
  3. Be attentive to the need for the caregiving spouse to deal with the loss of intimacy and interdependence as a couple as the disease turns the caregiver into a parent/nurse role.  
  4. Offer a free depression screening for Alzheimer's caregivers at convenient local community center, library or recreation center. For ideas on how to organize, use an approach similar to that of the National Depression Screening Day    
  5. An increasing number of caregiving families are multigenerational families with three, four or five generations living together. Become knowledgeable in the issues of multigenerational family dynamics which can be different than traditional concepts of family systems.

The anticipated growth of the elder population over coming years and the trend toward living longer means that the mental health needs of older adults will increase. Be proactive and join with FMHCA in advocating for full recognition of Mental Health Counselors by Medicare and all other payment sources. Until there is a cure for Alzheimer's, we have the counseling skills to bring help, hope and support to caregivers who deserve to receive emotional support.


Alzheimer's Association. 2013 Alzheimer's Disease Facts and Figures, Alzheimer's & Dementia, 9 (2).


Granello, P.F. & Fleming, M.S. (Spring 2008). Providing counseling for individuals with Alzheimer's Disease and their caregivers. Adultspan Journal, 7 (1), 13-25


Kathie Erwin, Ed.D., LMHC, NCC, National Certified Gerontological Counselor, is Assistant Professor and Associate Coordinator of the MA Counseling Program at Regent University. She is the author of seven books, the latest is: Group Techniques for Aging Adults, 2nd Edition (2013) Routledge Publishing. 

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