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When you hurt another, you may ask forgiveness from them. The Pope has asked forgiveness of those molested by priests and for the treatment of indigenous people in the New World. People convicted in court may ask forgiveness just before sentencing. Preachers and politicians ask forgiveness when caught in sin and then enter rehab to prove just how sincere they are. All of us do wrong at some time. Forgiveness is an issue that comes up often in life and in counseling. What does that word mean?

It does not mean saying that the wrong is now okay. “Sure you hurt me, but I forgive you, now it is okay.” That definition makes forgiveness extremely difficult if not impossible. It is giving a gift of dispensation to the one who harmed you. There is another view. Forgiveness can mean, “I don’t like what you did, and it is not okay but I will let it go. It doesn’t mean I want to have anything to do with you again, but I am not going to let anger and resentment devour me.” A quote attributed to the Buddha is that holding onto anger is like grasping a hot coal. The one who gets burned is you.

Many years ago I was having a conversation with a person who was working on recovery in AA and was doing step work. The eighth step is making a list of people you have harmed and you become willing to make amends to them. The ninth step is to make direct amends to those you have harmed except when to do so would injure them or others. It became quickly obvious that the person’s goal was to seek forgiveness even though in that case it would cause pain to the person wounded and to others. There was no talk about making amends. One universal principle throughout cultures and spiritual traditions (including secular ones) is to give without thought of return. When the Bodhidharma met with the Emperor Wu, one of the questions Wu asked was how much merit he had earned for all the monasteries he had built and all the other good deeds he had done in the name of the Buddha. “None,” said Bodhidharma. According to the story, the conversation was a short one. There are times when asking forgiveness is a manipulative act. We are asking forgiveness of the one we have already harmed with the sole purpose of making ourselves feel better. What is the merit of that? None. You are just doing more harm.

This is a place where the steps give good guidance. Look into your heart. It may be better to seek how you can make amends to those you hurt rather than ask forgiveness. Forgiveness belongs to the one harmed, and it is for them and within them that forgiveness occurs. If you are going to ask anything, ask how you can make amends and even then, only ask when doing so causes no further harm. Making amends with no expectations (including the expectation of forgiveness) may be a better way and work better at allowing yourself forgiveness with time.

For further thoughts on working on reconciliation and the process of forgiveness I strongly recommend “Negotiating the Nonnegotiable: How to Resolve Your Most Emotionally Charged Conflicts,” by Daniel Shapiro. Shapiro is the founder and director of the Harvard International Negotiation Program. As a psychologist and negotiation specialist, he has worked with families as well as corporate and governmental groups including conflicting parties in the Middle East. He provides a very thoughtful and guided method for the process of forgiveness and reconciliation.

You may be at a point in your life where you want to go out on your own in a private practice and maybe even do some consulting.  Or you may have a passion for something and feel inspired to start a nonprofit supporting the cause. Or you may already have taken one of these steps and want to maintain or grow what you have started. You may find that for you, deciding to make these changes follows the same stages as the transtheoretical model of change – pre-contemplation, contemplation, preparation, action, and maintenance.  The preparation stage is critical.

There are many web resources for persons deciding on whether to go into business or whether to embark on starting a nonprofit. There are also many web resources for those on low budgets as sole proprietors of a counseling practice, and there are also some resources for nonprofit organizations to save money and to help develop the organization. Let’s explore some of these.

Contemplation and Preparation Resources

For Counselors Graduate school teaches you all about how to be a counselor. They don’t teach you about the business aspect. A good resource for counselors is ACA and VCA. Network and talk to therapists you already know in private practice and see what has worked and not worked for them. Again, do your research and preparation.  You can get connected to liability insurance through VCA and ACA. If you are going into private practice, allow time for getting added to insurance panels – it can take months for the process to be completed.  You may have to complete forms and submit information to individual companies. There is CAQH – for streamlining the process. You also need a national provider number. Information on this is at

Business Resources for Entrepreneurs – If you have thoughts about going into business for yourself, or if you or your group needs help with business plans and marketing and other issues, check out these resources.  You may also find help at your local government website, including the process for obtaining a business license, or the local chamber of commerce web site. For example, you can find the Williamsburg Chamber resources at and Hampton Roads at .  To find your Virginia local government website, the state has a list of these at  – just scroll down the page for the lists. If you are in a state other than Virginia, you can find listings at And you want to check on liability insurance for malpractice and also for property, injury, etc.

  • SCORE – – SCORE is a nonprofit association dedicated to helping small businesses get off the ground, grow and achieve their goals through education and mentorship. They have been doing this for nearly fifty years. SCORE is supported by the U.S. Small Business Administration (SBA), and thanks to a network of 11,000+ volunteers, they are able to deliver their services at no charge or at very low cost. They also provide a mentoring program as well as workshops and local volunteers.
  • Small Business Administration – – This site has a wealth of information for starting and growing a business.
  • Business One Stop – – Guide to starting a business in Virginia
  • Enloop for writing a business plan –

Business Resources for Nonprofits – If you are a 501(c )(3) nonprofit organization, you can get a lot of help from Grass Roots. For starters you can get free website space at Blue Host. You will be able to put up a straight HTML site or use one of the content management systems listed below, plus a whole lot more software. It also includes email, store software, and plug-ins for your content management system, as well as learning management systems.  But there is so much more to Grass Roots. Their website describes the organization as helping “nonprofit organizations succeed, by leveraging technology to accelerate their charitable efforts. When you join, you join with thousands of nonprofits, volunteers, businesses and donors working together to change the world.”

Action Resources

These are some general tools you can use regardless of the business you are in.

Office Software – The standard office suite is Microsoft Office. It can be costly, and various packages have different software included. For example, Publisher and Access are not included in the Home and Student Office edition. There is a subscription plan for Office 365. What are the low cost or no cost options? Open Source office suites have been around for years.  Open Source means that the software code is open to modification by anyone and is the software is free to download, install and use. That also means, though, that you are pretty much on your own for support. There are communities you can join and ask questions, and the software site typically keeps support, frequently asked questions and support sections. Click on the links for more information about each application. Both Google and Microsoft have online versions of office products.

Online Storage, File Sharing and Collaboration – With these you can write and create projects together and share files with others. You can keep a file private – just for you – or you can share it with individuals you specify, or you can make it open so that anyone can see it. Google and OneDrive have the office software built in. The others are online or “cloud” storage.

Encryption – There are times when for privacy and confidentiality you may want to encrypt files or your entire hard drive. For instance, you may want to keep records in a document or spreadsheet template you create rather than pay for electronic health records software. To keep your documents private, you can store them as encrypted files or you can encrypt your entire drive.

Getting the Word Out – There are lots of options here. You can use MailChimp to set up your own direct electronic mail list or newsletter for your business or your organization. There is a free version, and you can create your own templates if you want. You can set up listservs with Yahoo Groups and Google Groups. SlideShare allows you to embed your PowerPoint presentations on your website or sites like LinkedIn. Twitter has an option that allows you to embed your account feed into your web page so you can easily update information to your site with just a Tweet. Blogger is owned by Google, and you can add newsfeeds and your Facebook feed to it for constant fresh content. You can also monetize it with Google Ads. You can also embed video from your YouTube Channel and slide shows of photos from Picasaweb. The list below includes social media, pod casting, blogging, and other sites for sharing information.  Lastly, don’t forget about press releases. You can find a how-to with examples at

One thing to remember about these is that they take time and work. Don’t overdo them or over commit. You can end up spending all your time on your web projects and not have much time for your business or your organization. Have a clear vision of how you want to use them. For social networking sites, be mindful of the boundary between personal and business and what you want kept private. We won’t discuss each of these since many of them change formats and options periodically. Just click the links and explore.

Graphics Software – Photoshop is great tool, but it is also costly, and is now on a subscription basis.

Surveys – You may need surveys for feedback from customers or stakeholders, or you may need it for a research project. Both these products have free versions.

Collaborating Live – These products allow you to collaborate online in various ways – conference calling, videoconferencing, sharing files, instant messaging, etc.  Google Voice allows you to set up an account in which you can embed a gadget on your web page so that people can call you from your site. When someone leaves a voicemail, you can call for it, check it on your Google Voice page, and receive both a text and an email with the message. The text and email use voice recognition to change the vocal into text, and the quality varies depending on the phone connection and the enunciation of the caller.

Audio Recording and Editing and Video Converting and Recording – Software to help you put together audio and video projects for you site, your podcast, or your video channel. Screen recorders enable you to record your computer screen so that you can produce tutorials from your computer.

Space for Fee Websites – There are lots of places you can start your own website besides Facebook. Here are a few. You can still buy your own domain name, like, and then have a site at one of these servers and point your domain to your free site. If you are using Google Sites, your free URL is Just go to the control panel of the company you bought your domain from (like Blue Host, Fat Cow, Yahoo, GoDaddy and many others) and point your domain name to the URL. The company you bought your domain name from can explain how that is done. It is actually a very simple process.

Content Management Systems and Learning Management Systems – These allow you to have more than one person be responsible for various sections of the site, each with their own log in. They are open source so you would have the responsibility of doing the upgrades and security updates.


If you know of other resources, please feel free to share them. We all get better when we work together.

Setting goals is important, and how you frame them is critical to succeding. A goal can be as broad as “I want to live a life of integrity” to as specific as “I want to run a four minute mile.” With the former you need to define just what integrity is – how will you know when you are living that life and when are you veering off course. How do you get back on course? For the latter, you need training, a workout schedule and a sense of just how realistic that goal is. Whether your motivation is internal or external also has an effect on succeeding. You are less likely to burn out if you are focused on getting better for you.

One thing both those goals have in common is that they are positive goals. Positive goals are “I am going to do something.” They are action oriented in that something will happen and you will know it. It gives you a place to move towards. All too often we define our goals in a negative fashion – “I am not going to do something.” There are many problems with that. First off, you are activating your brain to think about what you don’t want to do. Do not picture a blue jay in your mind at this moment. What picture just appeared in your mind? I spoke with someone recently whose goal was, “I don’t want to be lonely.” “Well, what do you want to be?” I asked. How will you know you are not lonely? Focusing on loneliness tends to leave one lonely. So we began to look at how she wants to connect with people, what kinds of relationships does she want, and first off, what kind of relationship does she want with herself. It is much easier to be in the company of someone who is comfortable and secure with themselves. Negative goals too often become self fulfilling prophecies. I can’t tell you how many times I have heard someone say, “I didn’t want to be like my parent.” And then they realized that in focusing on what they didn’t want to become, they took on those qualities and became what they vowed they would not be.

A negative goal is inactive. Tough to prove a negative. So when you are setting goals, make them positive, something you will know is present. Put in as much detail as you can. It is like writing a good story of what you want to do or become. You can even use a 10 scale to track your progress. A ten is you have achieved the goal.  A zero is you haven’t even begun. Where are you now? Track your progress up the scale. That gives you some flexibility, too. Stuck at five? Reevaluate and redefine and see what you need to do to move up even to a 5.1. Edit your story.  One of my favorite exercises is “start-stop-continue” from Jerry Lynch and Chungliang Al Huang. What do I need to start doing, stop doing and continue doing to function at a higher level? And remember the concept of wu wei or effortless effort. Sometimes when you push too hard, you push yourself into the ground and get stuck. Have a plan but relax into it and have fun. It is hard to stick with a goal when the process is something you hate or find punishing. That is why so many resolutions for diets and exercise programs fail. Flow and adapt, and make your goals positive.

Recently I spoke with a graduate student in counseling who needed to interview someone in the field for a paper he was writing for class. He told me he had called numerous therapists but was told that they were too busy to talk. I have gotten to talk to many students, both graduate and undergraduate, over the years and it has always been a very enjoyable experience. I encourage therapists to make time for students and to give back to them. Many have helped us along our path.

What follows is a result of several conversations with students looking for internships. It was originally published in the newsletter of the Virginia Counselors Association.

Even though it is spring, it is not too early to begin planning for a fall practicum or internship for your graduate program. Slots at agencies and programs can fill up early, especially with the number of graduate programs these days. You are not only competing for spaces with others in your program, but with students from programs at nearby schools, from online degree programs, and sometimes from students who may go to a school from a distance away but who live close by you and look for placements near home.

The first step is to check with your school for a list of agencies and programs with which the school already has a valid affiliation agreement. Affiliation agreements involve the school and the program exchanging agreements signed by the directors of both entities with each program having an original of the agreement. The agreement states the responsibilities of both parties and the liability insurance information. Students can get liability insurance for free with their ACA membership, or at a tremendous discount (approximately $35) with their membership in VCA. It is a good idea to have your own insurance even after you are licensed and working for an agency that has insurance that covers you. The insurance that the agency has looks out for you, but the primary responsibility is to the agency. If the agency can prove you failed to follow policies or procedures, you may be left on our own. Your own insurance’s responsibility is to advocate for you. If you find a place that you would really like to intern and there is no agreement, most likely you will need to find a person at the agency who is willing to follow through on getting an agreement. This can take time, and if the process is not started early, it may not be done in time for the start of the placement, if it occurs at all.

Larger agencies and schools may use the same process for taking on an intern as they would for hiring a new employee (except without the pay). This includes going through an interview process, having references, providing a transcript, resume, and completing a job application. Make sure your references are easily reachable. I remember instances when a reference had a full voicemail box and did not respond to several messages left with the receptionist nor to multiple emails. I had to ask the student for an alternate reference. Also make sure that you provide documentation as requested. If a sealed transcript is required, providing a personal copy will not work. Your placement may be delayed or may not occur at all. If a job application is required in addition to a resume, repeatedly writing “see resume” for questions on the application may not be acceptable either. Sometimes bureaucracies put their needs over user friendliness to applicants.

Once you begin at the placement, you may go through an orientation in which you learn about the organization and its structure, policies and procedures. There may also be criminal background checks, DMV and social services checks, finger printing, and drug screens. And then there is training to be done. If you are at a facility that is licensed by the Dept of Behavioral Health, that will include things like CPR and First Aid (if you have these already and the certifications are valid through the time you will be at the agency, you may be able to present your card and not have to take the training again), behavior management, client rights, cultural competency, ethics, confidentiality and privacy of health records, developing treatment plans, health record documentation, and infection control among others. You would also have to learn the ins and outs of whatever health record system the agency uses and more and more that means an electronic health record. Being comfortable with computers has become a pretty essential part of the behavioral health workplace. You may also learn about whatever other forms the agency uses, such as incident report forms.

You will probably have an easier time finding a placement at larger agencies, or at least places that provide for fee services. Since you are not licensed yet, services that you provide cannot be billed to insurance companies. If you are at a stage where you could meet the Medicaid criteria for qualified mental health provider, the agency might be able to bill for services such as case management or intensive in-home services, but not for psychotherapy at the office, unless the client pays out of pocket. The for fee services would be things like services contracted by entities like courts, Community Corrections, probation and parole, Alcohol Safety Action Program, jail programs, or social services. This may involve intake evaluations, individual counseling, group counseling and psychoeducation. The focus may be mostly on groups. Groups can be for drunk driving offenders, possession of marijuana, underage possession of alcohol, family violence, and anger management. Groups may also be part of programs like intensive outpatient programs and partial hospital programs. You may also be asked to do breathalyzers and drug screens, including observing urine drug screens. You may also have to make reports to referring agencies like probation or social services.

You will also learn the ins and outs of the culture of the workplace. Some are very nurturing and mentor very well. At the other end are toxic places with lots of office politics rife with turf and ego wars. And many have a various mix of the two. Like most things, office cultures seem to follow a bell curve from very healthy to very unhealthy with most somewhere in between. You may run across hierarchies based on credentials and clashing philosophies. The practitioner as expert pathology-based medical model versus client centered strength-based recovery model are two examples of competing philosophies that cause friction in the workplace and a difference in ideas of how best to work with clients. How would you cope with that?

It is imperative that you research the places you are applying to as much as possible and make yourself a list of questions to ask when you talk to them. They are interviewing you to see if they want to work with you and for fit, but you are also interviewing them to see if it is a place you would want to be and if it would be a good fit for you. You may feel you need to positively impress them, but they also need to positively impress you for you to consider them. This research is crucial, particularly trying to talk to folks who work there to get an idea of what it is like. Management isn’t always straightforward on what the real conditions and expectations are like, so sometimes interviews have about as much predictive value as say an SAT or GRE for academic performance – none. Write out the questions you want to ask during the interview and take them with you so you are sure to remember them. It is useful, too, if you know someone who has gotten services at a place to talk with them and see how they were treated – more than one person if possible. Also people who make referrals to a place can be a help, though less so for various reasons. But I think those who get counseling from a place can give you a pretty good idea of the treatment philosophy of the program. Also talk to students and graduates who have been placed there before if you can. Find what kind of situations they were put in and what kind of guidance and mentoring they received or did not receive. Find out if there are individuals there who will advocate for you, and who can do so effectively. And always advocate for yourself, and that especially includes after you begin the placement. If things are not going well, do not wait to the end of the semester to bring up what has not been going well.

So if you are planning on starting a practicum or internship in the fall, the time to start working on it is now. You can find out more about the Virginia Counselors Association at

APA  Presidential Task Force on Evidence-Based Practice  defined evidence based practice (EBP) as “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences (Task Force 2006, p. 273).  The application of research evidence to a given patient always involves probabilistic inferences. Therefore, ongoing monitoring of patient progress and adjustment of treatment as needed are essential (Task Force, 2006, p. 280). (From Barry Duncan)

For several years there has been an impetus for the use of evidence based practice in counseling and psychology. The logic is simple enough. In a medical model, you diagnosis and you base the treatment on the best practices care for that diagnosis. The symptoms and lab work show a specific disease with a specific treatment that works, and you prescribe that treatment.

This sounds very simple and straightforward but there are a couple of problems with it.  First of all, diagnoses in the Diagnostic and Statistical Manual are behavioral diagnoses, not medical diagnoses.  There is no lab work, there are no x-rays.  There is only comparison to a list of behaviors associated with each diagnosis.  To come up with these diagnoses, psychiatrists and other mental health professionals review research, make proposals and vote. What is a disorder in one edition of the DSM may not be a disorder in the next edition. There are proposed changes for substance use disorders in the upcoming DSM V. Among them are dropping the term “dependency” and using the word “addiction.” Problems with law enforcement as a symptom will be dropped. Gambling will be added as an addiction. You can read more about the proposed changes at To quote Shirah Vollmer, MD,No matter how DSM V will be written, it will be flawed. There is no psychiatric diagnosis which has an objective measure. At the moment, all diagnoses are clinical diagnoses, meaning they are subjective. This is a field of humility. There is a lot that we do not know.” (

There are cultural biases in how mental health diagnoses are made. A black male in America is much more likely to be diagnosed as schizophrenic than a white male with the same symptoms. (  After the Christmas tsunami a few years ago, there was concern afterwards about the export of the American version of post traumatic stress disorder and some of our responders ignoring local cultural ways of dealing with disaster and using our model. Ethan Watters has just published “Crazy Like Us” which documents the spread of the American version of mental illness around the world.  He points out at least two factors. First, the notion of persons with mental disease and brain disorders actually has the effect of increasing stigma rather than reducing it. (For an in-depth discussion of the history of how mental illness came to be defined in Western culture, I recommend “Models of Madness: Psychological, Social, and Biological Approaches to Schizophrenia”.) Historically, persons in the third world have had better recovery rates from mental illness than those in the West. In the West, we treat with medicine and institutions. Cultures in the third world keep the individual in the community and the family.  The second point is how Big Pharmacy has helped with the export of our concept of mental illness to spread markets and increase revenues. Indeed there is documentation of research being ghost written by pharmaceutical companies with a physician on payroll to submit the work for publication. There is also the problem of research that shows certain drugs or approaches as not efficacious or even damaging not being published.  Ioannidis (2005) published an article called “Why Most Published Research Findings Are False.”  Leavitt (2003) discussed as to whether addiction research can be trusted. (

In addictions, there are numerous efforts to try to increase the use of evidence based practice.  The Addiction Technology Transfer Center Network says that “Transforming the lives of individuals impacted by the disease of addiction requires a workforce prepared to use the most effective, state-of-the-art tools and techniques. The ATTC Network is committed to helping the addictions treatment and recovery services field stay abreast of what works in order to enhance their skills and change their practice.”  The University of Washington Alcohol and Drug Abuse Institute and the Northwest Frontier ATTC have a website dedicated to evidence based practice in substance abuse. PubMed has listing of 106 EVPs for substance use disorders here and has 320 practice guidelines here. A search of the Mental Health and Substance Abuse Services Administration site for evidence based practice returned 2310 results. SAMHSA has a National Registry of evidence based practices at  A search on the National Institute on Alcohol Abuse and Alcoholism returned 563 results.  Clearly there are many prescribed ways to treat mental health issues in general and substance use disorders in particular. It is not clear to me how changing diagnoses in the DSM V will affect these prescribed treatments for prescribed disorders.

There is an alternative – practice based evidence. David J. Hellerstein, MD discusses this at Rather than take evidence coming from academic work (with which there may be inherent problems and also problems applying it in the “real world”) we need to look at what works in actual practice.

Project MATCH was a rigorous study conducted by the federal government comparing Cognitive Behavioral Therapy, Motivational Enhancement Therapy, and Twelve Step Facilitation.  Information about the manuals can be found at  What was found was that all three worked equally well.  The Cannabis Youth Treatment Study compared several methods of treatment (all of which included a combination of MET and CBT) and found similar results across methods. As Scott Miller, Barry Duncan, and others have pointed out, what matters most within the therapy itself for potential change is the therapeutic relationship. Duncan says that, “The notion, however, that any approach is better than another is indefensible in light of the evidence covered extensively throughout ‘The Heart and Soul of Change’ that support the outcome equivalence of the different models (the “dodo verdict”) as well as the relative influence of other factors than model and technique.” You can read all of his comments at  You can also view the handout from a workshop by Scott on “What Works In Drug and Alcohol Treatment” at

The definition of evidence based practice includes measurement of progress.  Outcomes are very important to all involved in therapy from the therapist (to see how the work is going and to improve one’s work) to payers (such as insurance companies who may mandate evidence based practice) and most especially to those receiving therapy. One method of tracking progress that has been thoroughly researched are the Client Directed Outcome Informed measures – the Outcome Rating Scale and the Session Rating Scale. The former has the person rate how life is going in four categories. The latter has the individual rate the efficacy of the therapeutic relationship with the counselor in four areas. Both are quick and easy to administer and give extremely useful data on progress in counseling. They can be used with any theoretical approach to counseling. To me, these are essential tools in maintaining practice based evidence work.

One of the major factors in how therapy helps is the relationship and the partnership between the counselor and the person getting services.  In many ways therapists are coaches and, like coaches, vary in how they work with people. 

 There are three overall types of coaches. The first is the autocrat, the expert who tells you what to do and sees any questioning as resistance and noncompliance.  Think of Bobby Knight as a model for this. The traditional medical model may follow this style in the hands of persons who think they are more expert on you than you are.  They tell you what to do because they know best and may or may not listen to what you have to say. 

The second style of coach is more laissez faire, there but not giving much feedback or direction.  The person may listen and may listen very well, but that is about it. Decisiveness is not a key part of this style.

The third style is collaborative and teaching.   In coaching, John Wooden was more this style.  He never told his teams to go out and win.  He asked them to prepare and to do their best, and he helped them to find the way to be their best as individuals and as a team.  When we collaborate with each other, we each bring our expertise to the relationship.  You bring the knowledge of you, of what has worked and what has not, and of what you want to change.  It is the therapist’s job to help you define that change and to establish workable achievable goals.  The counselor is there with you, working with you as a unique individual – not as a diagnosis – to help you do your best. There is no resistance.  Resistance happens when the client’s goal and the counselor’s goal are not the same.  In that case, resistance is a normal behavior, and the team – the counselor and the individual – collaborate to get back on track.

A fundamental key in counseling is the therapeutic relationship and the partnership of the counselor and the individual. Collaboration and working as a team can help positive change occur faster and can help sustain that change.

In 2009, after decades in public mental health, I moved into the private arena.  My new location was Psychological Associates of Williamsburg.  In 2019, I retired from working as a counselor, and in 2022, I retired from teaching.

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