Registration now open for July 20, 2020 session

TraumaOnline

The newsletter of the

International Trauma Training Institute (ITTI)

www.traumaonline.net

Mike Dubi, Ed.D., LMHC, Editor

Jeanne Thomas, MBA, Associate Editor

June 2020, Vol. 3, No. 2

With deep sorrow we mourn the loss of J. Barry Mascari, Ed.D. who died on May 18 after a lengthy battle with COVID-19. Barry was a contributor to ITTI and an Advisory Board member and also the chair of the graduate counselor education program at Kean University in New Jersey.

Barry leaves a legacy as a national leader within the counseling field, as well as a reputation for kindness and compassion with his students in the classroom and beyond.

“Barry was a true leader in every sense of the word,” said Kean President Dawood Farahi, Ph.D. “His students benefited from his experience in counseling, as well as his engaging and empathetic approach. Hundreds of Kean alumni are better counselors because of Barry, and we are forever grateful for his service. He was a scholar, a superb teacher and a gentleman. We all shall miss our friend Barry.”

Barry is survived by his wife, Jane Webber, Ph.D., an assistant professor and doctoral program coordinator in the Kean counseling department, and also a contributor to ITTI. (See Responding to Pandemics: Preparing Counselors, J. Barry Mascari and Jane Webber, Traumaonline, Vol 3, No 1).

Both Barry and Jane were named fellows of the American Counseling Association (ACA), the world's largest organization representing professional counselors in various practice settings, last year.

“Our whole community within the Nathan Weiss Graduate College is deeply mourning Barry’s loss,” said Christine Thorpe, Ed.D., Kean's dean. “He was not only an amazing educator, but he was a voice of compassion for students and faculty. Our hearts go out to Jane, their children, and the rest of their family.”

After working in schools and outpatient drug treatment, Barry began his career at Kean as an adjunct in the 1990s and became an assistant professor in 2004.

Barry was among the founders of the New Jersey Council on Divorce and Family Mediation, co-authoring one of the seminal works in family mediation. He also appeared on television and radio.

Barry co-authored the New Jersey counselor licensing law; led the state Mental Health Counselors Association and the ACA state branch, New Jersey Counseling Association; chaired the New Jersey licensing board; and was president of the American Association of State Counseling Boards. His work led to the creation of the 2020 Summit on Counselor Licensing Portability and Identity, where he was referred to as the “grandfather” of the initiative.

“Barry’s contributions to the field of counseling will have a lasting impact for years to come through his direct work on those important initiatives as well as his influence on hundreds of students over the years,” said Suzanne Bousquet, Ph.D., vice president for academic affairs. “It is a terrible loss and one that reminds us all of the devastating impact of COVID-19 across the world.”

Barry shared his teaching philosophy on his Kean faculty profile , writing, “I may have expertise but am not THE expert in everything as some of my students know more about certain areas than I. So we are a community of learners, as this process is never done. Learning is best accomplished through an empathic, nurturing and patient environment that recognizes the complexities of being human. I remind students it's not where you start, it's where you finish as counselor preparation is a journey that we are on together.”

I was fortunate to be Barry's advisor and dissertation chair during his doctoral studies. Very quickly it became apparent that the relationship was one of co-mentorship. We learned from each other and became firm friends ever after. I miss him deeply.

Mike Dubi, Ed.D., LMHC

President

Much of this tribute to Barry was adapted from a Kean University memorial.

Coming in August:

Trauma and the Brain

Webinar with

Mike Dubi, Ed.D.

This 1-hour webinar will allow 15 minutes of Q&A. Registration open soon at traumaonline.net

TELE-HEALTH COUNSELING

Now may be the time to investigate tel-conferencing systems. There are a number of them out there, some even free. Providing mental health counseling remotely should be on all our minds right now. There are also many volunteer opportunities available.

Mental health professionals have always heeded the call when needed. Now is the time.

Click here for an ITTI primer on Tele-Mental Health by Harry Morgan, Ph.D.

beginning on

July 20, 2020

To see course descriptions and to register, click this link:

http://traumaonline.net/online-training/

ARTICLE

Counseling in the Time of COVID-19

Lee Schlanger, LMHC

In one month, the world seemed as though it turned upside. Maybe it was even in one day. One day, everyone in America was working and living their lives as normal, and the next, we were preparing for the impending pandemic that was and is COVID-19. As someone who has lived in Florida for the better part of my life, preparing for a disaster is something I have become accustomed to. It seems that nearly every year there is a hurricane to prepare for. Everyone runs out, preps food, water, and fuel supplies, and then waits. Eventually the storm arrives and passes or misses us completely. Either way we prepare. With COVID-19 the storm arrived, and never left.

COVID-19 preparations came almost out of nowhere. There was no radar image of a storm to watch and track, there were only numbers, and confusion. So much confusion that one day I went to work thinking I would be running a substance abuse group that evening, and by 4pm that same day, the Health Department had issued a mandate that groups of people were no longer allowed to meet in person.

It was in this moment that the scramble began. What would I do? How would I be able to counsel my group? What about my individual clients? How was I to stay safe without abandoning those who came to me regularly for help? How could I keep my clients safe? I had to create a plan, and fast. How would all of this work? In order to even begin understanding this, we must first look at why this crisis has been so unique for all mental health clinicians.

This crisis has been rife with unique factors for all of those providing mental health counseling and support services. First off, rarely do counselors find themselves in the exact same circumstances that their clients do. Usually a client can come to us, talk about their situation, their fears, and their emotions and we can do our very best to empathize with their feelings and to connect with them. Very often this has to be done through trying to imagine what it might be like to be in their shoes or by drawing on past experiences.

However, counseling during COVID-19 has been entirely different . We are all experiencing this global crisis at the same time and we are living through it, and with it, together. After a client spends an hour speaking to me about their fears of going to the grocery store, I may have to go out to my car, put on my own mask and gloves, and go to the grocery store, all while feeling that exact same fear that I just helped my client to process.

To say this is a unique set of circumstances is an understatement. Additionally, very often in counseling, we are able to help a client process their fears by pointing out that they are catastrophizing or having an irrational fear response due to blowing it out of proportion.

With COVID-19 , many of the fears that clients are coming to counselors with are not irrational. In fact, they are very much based in reality and there is no amount of processing or talking that can make those specific fears go away. In short, COVID-19 can’t be talked away. Due to this, previous counseling and treatment goals might currently be unreachable. It is important for every counselor to realize that this is ok. This is a time of crisis management, and it is unrealistic to think that a client will be able to work through a true process of self-actualization during this period.

Instead, as counselors, we have to adjust our expectations of outcomes and recognize that right now, emotionally, surviving is good, and surviving without being overwhelmed by fear is better. Eventually we all will get back to thriving, and until then, support should be looked at as just that, support.

Once we realize these factors, we have to recognize the physical limitations of the current situation. No longer was it safe for a client or counselor to sit in a room with a group. No longer was it safe to sit in a room and connect with and counsel an individual client. This prompted an immediate need to transition to tele-health or tele-counseling services. The question was, how do you transition an entire in-person counseling practice to an online based practice in a matter of days?

The first step was to choose a platform. There are many of them out there. You’ve probably heard of ZOOM, Doxy.Me, G-Suite, TheraNest and more. All of these could potentially be viable options for using tele-counseling for your practice as long as you make sure you know what to look for. First and most importantly, is the platform you have selected HIPAA compliant? For example, ZOOM is not HIPAA compliant unless you purchase a license to operate ZOOM’s Healthcare Suite. In order to do this, you have to pay a fee (this can vary based on the size of your practice) and sign a BAA, or Business Associate Agreement.

The BAA is a document that outlines how the business in question will protect any confidential information that may be shared with them. For example, how will the tele-counseling platform that you choose protect the email address of clients that you send invites to? These are important questions to ask of each platform, and I can’t stress this enough, make sure that you have a copy of the BAA in writing.

After you have selected a platform , it is important that you take time to decide if you are going to get a tele-health or tele-counseling credential or certification. Currently in the State of Florida, there is no specific legal requirement to do so (this may differ in other states). In my opinion, even if this is not a legal requirement, this is still an absolute must. A good tele-health course will teach you the laws, rules and regulations of your tele-health practice, as well as protect you against potential liability should something go wrong. You don’t want to be the counselor who says, “I didn’t know I couldn’t work across state lines” while you are having to actively defend yourself and your counseling license. There are many places to get tele-health certifications and CEU’s, however I’d recommend checking out the website of your state licensing board and seeing what their recommendations are.

For example, in Florida, the Department of Health recommends becoming certified through the Center for Credentialing and Education (CCE). CCE offers two approved providers on their webpage that they recommend and accept as part of their “TeleMental Health Provider” program. In fact, either of these programs will allow you to become credentialed as a TeleMental Health counselor. Then you can decide if you want to sit for the additional CCE exam in order to become a “Board Certified-TeleMental Health Provider”. There is no requirement to become board certified, however, it can be a valuable certification to have, and one that can open many doors, and decrease liability. Also, be sure not to forget to update your informed consent form with the limits of TeleMental Health counseling. In fact, the APA has a great TeleMental Health / Tele-Psychiatry Informed Consent form on their website, for free that can be adapted to most practices very quickly and easily.

Once you have gotten your platform set, and your certifications completed, and assuming you have the required technology (a computer, internet access, a webcam, a quiet space to work, etc.), and your clients have the technology that they need in order to engage in a session with you (a smartphone or tablet, internet access, a quiet and private place to engage in the session, etc.), then you are ready to begin offering TeleMental Health sessions.

I can tell you from experience that all of the steps above (including becoming certified) can be completed in about 48 to 72 hours depending on how fast you are willing work and how many hours you want to put into it. In my case, the entire transition took about 2 days to get up and running. By the second week, I was running 5 groups per week and meeting with all of my regular clients, all via a TeleMental Health platform.

The next step is getting your clients into the sessions . The only recommendation I can give for this is to make sure that you communicate with your clients exactly what they will need to do in order to get into the session with you, and communicate to them what they should expect to see when they log in, and how you will handle any technological hiccups (because these hiccups will happen).

Make sure for the first few sessions you give yourself and your clients the benefit of the doubt. Time and time again, I have heard that the first digital session felt strange and after that the sessions began to feel more normal for everyone. It is important to remember that people are adaptable and will get used to this way of counseling.

However, there a few other factors to be aware of. I have been told by many counselors, and I agree, that TeleMental Health sessions feel significantly more exhausting than in person sessions. I know many counselors who have no problem working with 6 to 8 clients in a day who can barely get through 3 or 4 TeleMental Health sessions per day without being exhausted. This is something that counselors need to be prepared for. In my opinion, sitting in front of a screen takes a lot more mental stamina than sitting in front of your client, and tends to cause a lot more eyestrain.

In addition, we tend to spend a lot of time making sure that we are properly in camera frame which can also break our focus because we are looking at ourselves. Another thing I have noticed is that in some cases, there is almost a complete lack of physical cues within sessions. Physical cues that you would normally pick up on without much effort take a lot more concentration to notice. This leaves the counselor scratching their head to put together context and content clues from the sessions. This of course utilizes stamina and energy. Additionally, as counselors, we tend to use silence often while in session. Unfortunately, if silence is used improperly during a TeleMental Health session, very often the client thinks there has been a technological glitch. This can be slightly mitigated by explaining to your client that silence does not mean the session has frozen, however, this does not always work. In addition, several studies have found that gaps of silence that would normally be interpreted as friendly in person, can actually be interpreted as unfriendly over a tele-health platform.

All of this points to the fact that offering TeleMental Health sessions takes a lot more planning, effort, concentration and time on the part of the counselor. (See ITTI’s online primer on Tele-Mental Health at traumaonline.net/tele-mental health). This is a necessary realization in order to successfully transition your practice over to a digital medium. This is why I recommend giving yourself time to get up and walk around in between sessions, limiting the number that you take on per day, and making sure that you get outside and get sunshine each and every single day, even if you are working from home. With enough time, TeleMental Health sessions will feel more natural for both the client and the counselor.

The world may have been turned upside down, but we as counselors still have the ability to be there for, and connect with our clients, even if the specifics of how are different than before. So, while counseling in the time of COVID-19 might be an entirely different experience from anything many of us have ever done before, with the right preparation, effort, and putting in enough time, you and your clients can stay home, stay safe, and continue the counseling process, one day at a time.

ABOUT THE AUTHOR

Lee Schlanger, MA, is a Florida Registered Mental Health Counselor Intern.

ARTICLE

Teaching the Traumatized

Ashley Dodge

Stand in the entryway of any school and you will have a multitude of different personalities from students and faculty either standing and smiling or walking by you at the start of their day. Some students will look at you with awe and excitement, greeting you happily as they are ready to start a new day; some will walk by you without even acknowledging you because they are not fully awake; and some will require assistance. The placement of the faculty members is strategic: for the safety and security of the students, but to offer aid if the need arises. Mornings are often one of the hardest hills to climb in education for students who have PTSD.

Screaming, crying, yelling (some carrying a few choice words thrown in), and even attempts at running/escaping are of regular appearance during the student’s arrival in many schools across the nation. While most of the time the faculty is already aware of the potential of a student coming in while exhibiting these symptoms due to having worked with them numerous times before; there are times in which a child, particularly ones who have been traumatized, experiences emotional dysregulation throughout the school day itself and the support team is not available for immediate defusal of the situation. What is a teacher supposed to do then?

True, they are given the instruction to clear the room of the other students for their safety if the dysregulated student exhibits violent/aggressive behaviors (e.g., harming others, throwing items, destroying the room, yelling at the top of their lungs) and then to call in assistance by a team, usually composed of the administrators, the school counselor, and a few other members on staff without taking their eyes off the student in need of assistance. What if the presence of these faculty members who, most of the time the student does not see unless they have lost control, causes an escalation of the emotions being displayed?

What about if the student does not exhibit the aggressive emotional outbursts? What if they are just sitting at their desks and only doing self-soothing motions? What if they are just constantly looking around, checking the clock, or the door clearly demonstrating hypervigilance? The student is clearly in a dysregulated state with their stress response having been triggered, but what should the teacher do in that instance? Often, the teacher in charge would likely note the behavior in order to keep records of it yet would not call for assistance as it is not causing a disruption to education, but the student clearly needs help. The teacher might even try to help soothe the child themselves, placing a hand on their shoulder in a comforting manner, only to cause the situation to further escalate. While the intention was to be a caring, soothing, motion; the student could be traumatized by a hand on the shoulder meaning harm was imminent and might react negatively.

Then you have the students who end up hoarding items, either from other students and teachers in the classroom, or they end up taking things from the school’s Lost and Found. While it is easy to deem them as being a thief or a kleptomaniac resulting in loss off privileges and a negative label to go with it, the student might have experienced trauma or neglect where they had to stock pile their resources or they had to gather items because they were unsure if it would be available when they needed it.

What if the student is new to the school, and no information is given by the family/guardians about potential troubled behavior? Or, if they do give the information, there is no official diagnosis or plan of action currently from the LSSP for the district because that person is backlogged two to three months due to a heavy caseload as this is a common occurrence in many districts. What is the teacher supposed to do until they can receive the guidance needed? The steps a school legally have to take in order to get assistance for students takes an extended period of time to perform, but the student will still have their stressors triggered during the wait, they will still become dysregulated, and a teacher who will do anything and everything they can to help the student still lacks the knowledge and training for not only what to do in the situation, but also what NOT to do. What they should not do which can cause the student to further escalate in their already heightened behavior is just as important to know as what to do.

Being a teacher is a calling and not a profession in which to take lightly. Teachers love their profession and every one of their students, but the training they have received revolves around how to teach the new method in which the state has approved. In their college courses, there are no psychology courses required to take even though they will see many different disorders and scenarios during their time as an educator. They are not taught how to handle situations such as these listed above particularly with students who have experienced trauma.

There are counselors on campus, and it would be easy to direct the teacher to lean on their training, but the fact of the matter is this: the school counselors, while they would drop anything to help in a crisis situation, are overwhelmed with 504/ARD meetings, state testing, psychological testing requested by therapists to complete, maintaining documentation for instances of bullying, all while giving their own lessons to all the students throughout the school during their guidance times. Teachers, knowing this, would be more hesitant to call for assistance in a time of need if the student is not acting volatile, leaving them to essentially ‘figure it out’ on their own.

Therefore, this is a proposal for the need of teachers to have some form of traumatic training during the school year. This can be done in the form of Professional Development Hours (PDH) which take place at the beginning of the school year, prior to the first day of school, and then typically once a month throughout the school year. This is not stating that the teachers need to become clinically trained to give therapy to the student who experienced trauma and becomes dysregulated, but for them to understand what PTSD is as well as what they should and should not do until a plan of action is created. Educators should have this knowledge, even those where it is their first-year teaching, so that the students can better have a chance at success. This author is more than willing to work to create a training for educators to attend.

About the Author

Ashley Dodge, MS, holds a Teaching License for the State of Texas: EC-6 Generalist, ESL, Physical Education EC-12, Spec Ed EC 12.