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Mental Health Wellness and Counseling

Personal Goal:

Establish and implement personal care plan for health, mental support, and growth

Professional Goal:

To graduate ASU with a 4.0

From the Course:
Improved understanding about trauma and practical applications to working with those in trauma

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Destigmatizing Mental Health Disorder- Implicit Biases

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Destigmatizing Mental Health Disorder- Implicit Biases

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Gena Camacho Reference Guide for Mental Health Disorders  (1)

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Developmental Discussion on Trauma- Board Posts 1-4

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Developmental Discussion on Trauma- Board Posts 1-4

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Implicit biases are impossible to avoid because they are subconscious survival instincts that exist outside of our main awareness. And yet, they wield great power. For me, the main two questions to determine if I am operating on an implicit bias are:

1. Am I predicting an outcome?

2. Am I surprised by the outcome?

If I answer "Yes" to one or both of those questions, and that answer is not rooted in known fact, it is a good indicator that I am operating from an assumption which could reflect my own implicit bias.

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In the aftermath of an unconscionable act of random violence, many people are inclined to label the perpetrator "crazy." Although the criminal may have a mental illness, automatically assigning the label "crazy" does a great disservice to people who live with mental illness every day.

In reality, somebody with mental illness is much more likely to be a victim-rather than a perpetrator-of violence. Calling a violent offender "crazy" spreads a dangerous stereotype and belies the complex relationship between criminality and mental illness.

The media teaches us about people with whom we do not routinely interact. This constant flow of data gives us incessant social cues about the nature of other groups of people-including which groups of people should be praised or scorned.

Media portrayals of those with mental illness often skew toward either stigmatization or trivialization. Consequently, all forms of media-including television, film, magazines, newspapers, and social media-have been criticized for disseminating negative stereotypes and inaccurate descriptions of those with mental illness.

What Is Stigmatization?

Stigma involves negative beliefs, attitudes, and behaviors directed toward people based on some distinguishing characteristics. In the case of mental health stigma, it involves the presence of mental health symptoms or a mental health diagnosis.

In other cases, stigma can also involve health conditions, disabilities, gender, race, sexuality, culture, religion, and sexuality.

Stigma happens when some person is viewed as an "other." A person considered an "other" is denied full social acceptance.

The impact of mental health stigma is serious. Evidence suggests that it is linked to worse mental health outcomes because it reduces the likelihood that a person will seek help, receive adequate care, and adhere to their treatment plan.

Stigmatization of Mental Illness By the Media

Stigmatization of mental illness in media is abundant. For example, certain mental health conditions, such as schizophrenia are seen as being so disruptive that people with those conditions must be isolated from society.

The stigmatization of mental illness is so entwined with the media that researchers have used newspaper articles as a proxy metric for stigma in society.

Media accounts tend to focus on the individual with mental illness rather than framing mental illness as a societal issue. Consequently, media consumers are more likely to blame an individual for the illness.

Mental Illness Is Overgeneralized

For instance, common depictions are that all people with depression are suicidal, and all people with schizophrenia hallucinate. In reality, 60% and 80% of people with schizophrenia experience auditory hallucinations. An even smaller number of people experience visual hallucinations.

It's also not uncommon for media portrayals to discount that many people with mental illness don't need to disclose their condition to everyone around them.

Instead, mental illness often goes unrecognized (whether by intention or not). The portrayals in the media tend to present situations where everyone in a character's life knows about their mental illness.

Trivialization of Mental Illness By the Media

The media can also trivialize mental illness, either by promoting mental illness as not being severe or being less severe than it really is.

For instance, many people with eating disorders such as anorexia nervosa feel that their condition is made out to be less severe than it really is. This is in part because people with the condition portrayed in the media often minimize its seriousness and hide the severe consequences of the disease.

The truth is, the death rate for people with anorexia is high. In reality, anorexia has one of the highest mortality rates of any mental health condition. Research suggests the risk of dying is 10 times higher for people who have anorexia nervosa.

The symptoms of mental illness are sometimes portrayed as being beneficial. For example, in the popular television series Monk, the protagonist is a detective with OCD. The fact that he pays close attention to detail helps him solve crimes and advance his career.

People who do not have disabilities can use media channels to mock people who do have disabilities, such as by appropriating mental-illness terminology. For instance, the hashtag OCD (#OCD) is commonly used on Twitter to describe one's attention to cleanliness or organization.

Depictions of Schizophrenia in Film

Probably the most disparaging stigmatizations of mental illness in media lie in the film portrayals of antagonists with mental illness. In particular, when characters with schizophrenia are presented as "homicidal maniacs" in "slasher" or "psycho killer" movies.

In one study, researchers analyzed 41 movies that had been released between 1990 and 2010 for depictions of schizophrenia.

Based on the findings of the analysis, researchers drew several conclusions.

Most of the characters displayed "positive" symptoms of schizophrenia, with delusions being featured most frequently, followed by auditory and visual hallucinations.

The majority of characters displayed violent behavior toward themselves or others.

Nearly one-third of violent characters engaged in homicidal behavior.

About one-fourth of the characters committed suicide.

The cause of schizophrenia was infrequently noted. However, in about one-fourth of the movies it was implied that a traumatic life event for the character had been a significant causative factor.

Of the movies that alluded to or showed mental illness treatment, psychotropic medications were most commonly portrayed.

Why Such Portrayals Are Damaging

These portrayals are not only incorrect but damaging-and for several reasons.

They Spread Myths About Mental Illness

The portrayals of schizophrenia often focus on symptoms such as visual hallucinations, bizarre delusions, and disorganized speech, and present them as commonplace. In reality, symptoms like decreased motivation, poverty of speech, and flat affect are more common.

They Link Mental Illness to Violence

Several movies have spread the false stereotype that people with schizophrenia are prone to violence and unpredictable behavior. Some films even presented people with schizophrenia as being "possessed."

They Exaggerate Suicide Risk

While suicide is a significant concern for people with schizophrenia, the research on media portrayals of schizophrenia found that this risk is often exaggerated in film and tv representations. In one study, 24% of the characters with schizophrenia committed suicide.

In reality, estimates suggest that between 4% and 13% of people with schizophrenia die by suicide, and approximately 18% to 55% attempt suicide at some point in their lifetime.

They Misrepresent Who Is Affected

Demographics is another aspect of mental illness that is often misrepresented by media portrayals of mental illness.

For example, characters with schizophrenia are frequently depicted as being white males, but schizophrenia disproportionately affects African Americans. It also affects men and women almost equally.

They Spread Myths About Causes of Mental Illness

In a few movies, schizophrenia was depicted as being secondary to traumatic life events or curable by love-both of which are misrepresentations of the condition's causes and treatment.

Press Play for Advice On Navigating Mental Health Advice on Social Media

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What's Accurate In Media Portayals?

Not all the information presented about schizophrenia was found to be incorrect, misleading, or stigmatizing.﻿﻿ For example, in more than half of the movies that researchers analyzed, the use of psychiatric medications was depicted or alluded to.

Even when some movies get it right, the negative media portrayals-especially those that are violent-of people with schizophrenia and other severe forms of mental illness still contribute to stigmatization, stereotyping, discrimination, and social rejection.

Impact of the Media on Mental Health

The impact of mental health stigmatization by the media can contribute to a number of different effects.

Self-stigma: Media portrayals can contribute to self-stigma, which refers to feelings of internalized shame, negative beliefs, and negative attitudes that people have about their own mental health condition.

Incorrect information: Because of media portrayals of mental illness, people often get incorrect ideas about the symptoms of mental health conditions. It can also lead people to develop inaccurate ideas about how mental illness is diagnosed and treated.

Barriers to treatment: Media messages can also create barriers to treatment. Because people internalize stigmatized attitudes about mental illness, they may be less likely to seek out help or treatment when they experience symptoms.

Poor treatment adherence: People are more likely to adhere to their treatment if they have social support and encouragement from others. Negative attitudes toward mental illness and stereotypes portrayed in the media may contribute to worse attitudes about mental health treatments and poorer adherence.

Self-diagnosis: People might also be more likely to self-diagnose themselves based on viral social media posts seen on Tik Tok and Instagram. Such information is often shared by people who are not mental health professionals and is often inaccurate.

What Can Be Done?

We need a better understanding of how these messages are disseminated by the media before we can rectify them. There is limited research looking at how media promotes mental-illness stereotypes, stigmatization, and trivialization.

Nevertheless, certain suggestions have been made on how to improve the depiction of people with mental illness in the media, such as:

Analyzing mass-media production procedures to better understand screenwriters, producers, and journalists' current practices, needs, values, and economic realities (for instance, understanding the balance between being newsworthy or emotionally arousing and verifiable).

Implementing a mental health short course when training journalists.

Including expert input from psychiatrists during a film's production.

Preferring non-individualized descriptions of mental illness and instead focusing on the societal aspects.

Presenting mental illness only when relevant to the story.

Using mental-health terminology with precision, fairness, and expertise.

As individuals who consume copious amounts of mass media and engage with social media, the best thing we can do is stop using words like "crazy" and "deranged" in a derogatory or flippant fashion. We also need to remember that it's best to avoid making a psychiatric diagnosis outside of a clinical setting.

A Word From Verywell

Only a specialist can make a diagnosis of OCD, depression, bipolar disorder, schizophrenia, and other mental health conditions. When we give someone the label of being mentally ill without clinical evidence, we hurt people who live with mental illness on a daily basis.

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How Mental Health Issues Are Damaged by Mass Media

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Get information on how movies, film, and social media often stigmatize and trivialize mental illness.

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I was incredibly shocked and saddened about the statistics relating to eating disorders- particularly AN. I have a dear friend whose child has a form of AN and her stories of their experiences, fears, and sharing of other stories, plus this statistics makes me feel such alarm about these disorders. I feel like growing up, we were way casual about these terms and I never fully comprehended that people are literally starving themselves to death. I guess I always assumed that at some point the survival instinct would kick in and override it, but when I think about it as a disorder it becomes painfully clear that isn't always the case.

As a person who wants to work with college athletes, I can feel comfortable thinking that at some point, research shows that at some point I will encounter this. (Wang, 2023) feel like I need to learn more on prevention and recognition and help us create a culture that emphasizes those factors create a body positive culture. It may not be the overall cure, and it can help in our corner of the world.

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Youth & Juvenile Gang Prevention and Threat Assessment Project

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Youth & Juvenile Gang Prevention and Threat Assessment Project

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https://www.mentalhealthfirstaid.org/

Implict Bias Test:

https://implicit.harvard.edu/implicit/takeatest.html

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Brain and Behavior Foundation:

http://www.bbrfoundation.org/

National Association on Anorexia Nervosa and Associated Disorders:

http://www.anad.org/

National Eating Disorders Association

http://www.nationaleatingdisorders.org/

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Home Page | Brain & Behavior Research Foundation

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BBRF funds research to better understand causes, treatments for brain & behavior disorders. Sign Up to Receive the Latest Research News in Our Weekly eNewsletter.

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This assignment left me with two main thoughts:

1. Nearly everything can be traced back to childhood.

2. It says something, that is not great, that students today are better equipped to deal with mass shootings at schools.

The impact of ACEs on development are profound and when I look around our campus, I wonder how many of those are playing out in classrooms and in sports. College is stressful enough and "Compounding the effects of college-related stress, student exposure to childhood adversity has been associated with anxiety, depression, and PTSD" (Mackay-Neorr, 2019).

I've heard coaches yell and even cuss at their players and am curious if any of that is triggering to a particular student. In fact it seems that thinking you can do that and the other person will simply take it in stride, feels like the exercise of a privilege. I think it is not about coaches or faculty being "soft" but rather them being emotionally mature enough to be intentional and purposeful rather than reactive and out of control. I know from working with my students the impact of believing in them and showing genuine care for them.

This kind of impact was evident in this year's JV Basketball team. I showed up to every one of their games- even driving 2.5 hours to see their last one. They were floored and throughout this year they have shown up for me - to appointments, tutoring, events, etc. I hold them accountable through grade checks and deadlines. And they accept it and work hard to meet requirements. They kept referring each other until the entire team had me as their advisor. And I've seen the same impact with baseball, cheer, volleyball, and soccer. I show up and yell for them (by name) and they come in and answer when I text. It's not fear or bullying but actual relationships where I model what I expect from them. And it's not always easy. It's just always worth it.

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This assignment actually has the most immediate and direct impact on where I am right now. Part of my professional responsibility is to serve on the Disaster and Trauma Response Team. They asked me to be part of it due to my crisis intervention background.

This training is PERFECT for this team which is set to tackle everything from natural disasters to student suicide and it one that I am ABSOLUTELY going to recommend to the team this summer. In fact I feel like it should be required to everyone on the team and everyone who will be working in a mental health support capacity.

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PFA Online:

https://learn.nctsn.org/course/index.php?categoryid=11

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As part of the National Child Traumatic Stress Network (NCTSN), the Learning Center for Child and Adolescent Trauma offers Free Online Education with:

300+ FREE CE certificates

50+ speakers

200+ online webinars

90,000+ members

Psychological First Aid (PFA) and Skills for Psychological Recovery (SPR) are promising practices for disaster behavioral health response and recovery. Both PFA and SPR were developed by the National Center for PTSD and the National Child Traumatic Stress Network, as well as other individuals involved in coordinating and participating in disaster response and recovery.

PFA and SPR intervention strategies are intended for use with children, adolescents, parents and caretakers, families, and adults who are survivors or witnesses exposed to disaster or terrorism. PFA and SPR can also be provided to first responders and other disaster relief workers.

While grounded in the same foundations of disaster response and recovery, there are several differences between PFA and SPR.

Psychological First Aid (PFA) and Skills for Psychological Recovery (SPR) are promising practices for disaster behavioral health response and recovery. Both PFA and SPR were developed by the National Center for PTSD and the National Child Traumatic Stress Network, as well as other individuals involved in coordinating and participating in disaster response and recovery.

PFA and SPR intervention strategies are intended for use with children, adolescents, parents and caretakers, families, and adults who are survivors or witnesses exposed to disaster or terrorism. PFA and SPR can also be provided to first responders and other disaster relief workers.

While grounded in the same foundations of disaster response and recovery, there are several differences between PFA and SPR.

Psychological First Aid (PFA) Online is 5-hour interactive online course that helps participants learn the core actions of PFA and describes ways to apply them in different post-disaster scenarios and with different survivor needs. This course also covers provider well-being before, during, and after disasters. This course is relevant for new providers who are wanting to be oriented to PFA, as well as for seasoned practitioners who want a review of the PFA concepts.
This 5-hour interactive online training offers certificate of completion with 5 CEs upon completion.

Skills for Psychological Recovery (SPR) is a 5-hour interactive course designed for providers to help survivors gain skills to manage distress and cope with post-disaster stress and adversity. This course is for individuals who want to learn about using SPR, learning the goals and rationale of each core skill, delivering SPR, and supporting survivors in the aftermath of a disaster or traumatic event.
This 5-hour interactive online training offers certificate of completion with 5 CEs upon completion.

Los Primeros Auxilios Psicológicos constituyen un enfoque modular basado en la evidencia y cuyo objetivo es ayudar a niños, adolescentes, adultos y familias a afrontar las consecuencias inmediatas de desastres o actos de terrorismo. En este curso en línea, Rosaura Orengo-Aguayo, PhD, ha adaptado el entrenamiento de PFA en un formato de 3 horas, en Español. Luego de ver este curso en línea, los participantes recibirán 3 créditos de educación continua.

Destrezas para la Recuperación Psicológica (SPR por sus siglas en inglés) es un curso de 3.5 horas diseñado para que los proveedores ayuden a los sobrevivientes a adquirir destrezas para manejar la angustia y afrontar el estrés y la adversidad luego de un desastre. Este curso es para personas que desean aprender sobre el uso de SPR, conocer los objetivos y la justificación para cada destreza básica, brindar SPR y brindar apoyo a los sobrevivientes después de un desastre o evento traumático. Luego de ver este curso en línea, los participantes recibirán 3.5 créditos de educación continua.

Skip Contact Us

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learn: psychological first aid (pfa) and skills for psychological recovery (spr)

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Learn: Psychological First Aid (PFA) and Skills for Psychological Recovery (SPR)

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As part of the National Child Traumatic Stress Network (NCTSN), the Learning Center for Child and Adolescent Trauma offers Free Online Education with: 300+ FREE CE certificates 50+ speakers 200+ online webinars 90,000+ members Psychological First Aid (PFA) and Skills for Psychological Recovery (SPR) are promising practices for disaster behavioral health response and recovery.

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At Ranger College, my program Student Support Services, work with youth identified as vulnerable. They are low-income, first-generation, or students with a disability. Our proactive approach to building relationships and working with this population produces better academic results than any other program on campus. A review of last year's participants produced the results above. 

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At my college, gang initiation or introduction happening on campus is not something we are encountering, but we do have students who have come from environments where they actively participated, were associated, or were exposed to gang activity and culture.

Brittany Morton who works as an academic program manager for a LA organization specializing in gang intervention notes the need to address "the stigma people with gang affiliations can experience on and off campus due to “visible markers,” such as gang tattoos that can alienate them from peers, and “emotional” markers—experiences of violence and trauma that can affect their well-being." (Weissman, 2022)

Gang members attending college, particularly one in a rural Texas setting, are uncommon. However, gang associated students are here and it is important they are seen and heard since, "kids who spend time with family members who are involved in gangs can often be treated “the same or worse” in their K-12 schools because they’re assumed to be connected to gangs, too." (Weissman, 2022).

In my work I have made a sense of belonging a crucial component of my advising and program structure. It happens in big ways- supporting students, highlighting achievements, bringing groups together for events- and in small ways- introducing students who cross advising appointments, inviting students to sit together at games, and helping connect students with peer tutors. The idea is for them to build a supportive network and to feel accepted and empowered by peers like them.

This project highlighted how important it is to have belonging and connection in place for students- particularly ones vulnerable to gang activity. These students often see college as a way out of this environment, but can struggle to find effective studying, time management, discipline, support, and skills to meet their academic goals. It's not impossible for them. It just requires more individualized attention, which again ties into the necessary foundation of a student believing it is possible for them.

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Threat Assessment Toolkit

https://txssc.txstate.edu/tools/sbta-toolkit/

Creating Belonging on College Campuses

https://www.insidehighered.com/news/student-success/academic-life/2023/09/13/survey-how-increase-belonging-among-college-students#:~:text=Students%20who%20have%20active%20learning,new%20research%20from%20Tyton%20Partners.

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School Behavioral Threat Assessment Toolkit | Texas School Safety Center

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School Behavioral Threat Assessment Toolkit provides a proactive, evidence-based approach for identifying

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The ABC model of Crisis Intervention is a process I am already familiar with, but I really appreciated and learned more by walking through the case study and the expansion of the model- especially the portion on identifying cognitions which is something that I think could get easily get overlooked. And simultaneously a person's thoughts, beliefs, and attitudes, are so foundational it can be one of the most frustrating roadblocks for healing.

As part of the crisis response team, I think a summary of these skills could also be helpful for team members who might not be familiar with crisis intervention skills.

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Exploring more about black mental health concerns:

https://ct.counseling.org/2020/07/black-mental-health-matters/

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Racial violence and discrimination are woven into the fabric of the United States. The way policies and laws are implemented. The weaponization of Whiteness and privilege. Disparities in education and health care. The horrible and senseless killings of Black people throughout our nation's history and into the present day.

How do daily acts of racial violence, injustice and discrimination affect the mental health of Black Americans? What is it like to work and live beside people who don't value you as a human being? What is it like to live in a country where your rights are frequently threatened?

DominiqueHammonds, an assistant professor and testing coordinator in the Department of Human Development and Psychological Counseling at Appalachian State University, provides a quick glimpse into the complexities of being a Black woman and counselor in a racist society. Hammonds, wearing a shirt that read "Black and Educated," was shopping in Walmart recently when a White woman passed by her and casually said, "You're disgusting." In that moment, Hammonds felt powerless. She feared the consequences of saying or doing anything in response.

Hammonds left the store and shortly thereafter went into a counseling session where her client recounted feeling powerless, angry and upset because of injustices they were experiencing in their life. Hammonds had to compartmentalize her own feelings of powerlessness to help the client.

Counselors play an important role in helping Black Americans cope with and heal from racial stress and trauma, but they can do more. Namely, they can also take steps toward changing an unjust and racist system that powerfully and negatively affects the mental health of Black Americans.
A distrust of mental health
Research indicates that Black Americans are 20% more likely to report serious psychological distress than are White Americans, yet they are less likely to use mental health services.

LoniCrumb and Janeé Avent Harris, who are both assistant professors of counselor education at East Carolina University (ECU), examined, along with two of their colleagues, the negative perceptions of mental illness and treatment among Black Americans. They found that stigma, a lack of trust in mental health care and a mislabeling of Black people's presenting concerns make this group more apprehensive to seek counseling. Financial constraints and a lack of access to culturally responsive mental health care are additional barriers, explains Crumb, a research and innovation associate with the Rural Education Institute in the College of Education at ECU. (See their article " African Americans' perceptions of mental illness and preferences for treatment" in the Journal of Counselor Practice for a more detailed discussion of their findings.)

This distrust is not unfounded. Black Americans have been misdiagnosed and overdiagnosed with schizophrenia for decades, for example. (For more, read " The historical roots of racial disparities in the mental health system " by Tahmi Perzichilli at CT Online.)

Angie D. Cartwright, an associate professor of counseling at the University of North Texas (UNT), stresses the importance of looking at how and why the mistrust of mental health began in the Black community. "Institutional and systemic racism is the foundation of a lot of our medical treatments, including mental health counseling," Cartwright says. "And, historically, when [Black people] invite others into [their] homes and communities, then problems happen."
Sitting with discomfort
Counselors, not clients, should be the first to broach issues of racism. This isn't necessarily easy or comfortable.

Counselors often conflate comfort and safety, but they are two different things, insists Cartwright, a licensed professional counselor and licensed sex offender treatment provider who is the clinical director and owner of North Texas Counseling and Wellness.

As she explains, being comfortable enough to broach the topic does not mean the topic itself will be comfortable. "It's not comfortable to say, 'I was discriminated against,' 'I had a gun pulled on me' or 'I was fired because my boss is racist,'" she continues. "There are some conversations we will always feel some discomfort talking about. And that's OK." But clients should feel safe enough to share their experiences - ones that will often be uncomfortable for counselors to hear, she adds.

"You have to get comfortable with being uncomfortable," says Hammonds, a licensed clinical mental health counselor (LCMHC) in North Carolina. "Part of the [counseling] skill set is learning how to have these discussions in a way that feels comfortable." For example, can counselors say the word Black, acknowledge their own ethnic identities or discuss racism knowledgeably? If not, then clients know they won't be able to go beyond a surface-level discussion with them, Hammonds explains.

What counselors say doesn't even have to be overly complicated, notes Hammonds, an American Counseling Association member. They can simply say, "I just want to check in. There's a lot going on around us right now. What's that been like for you?" or "I'm curious how you as a Black American might be affected by racial violence and oppression."

Being open and brave about this topic will likely result in some missteps. That's part of the process, says Hammonds, who encourages counselors to use those mistakes as opportunities to learn.

One misstep may be getting defensive when clients express anger, distrust or sadness about their experiences. "If you find yourself getting defensive - trying to explain away the client's experiences or identifying with client experiences and feeling like you have to apologize ... on behalf of the system - don't," Hammonds says. "All you're doing [in getting defensive] is communicating to the client that you're still not comfortable and haven't done your own personal work around this." And apologizing just puts clients in a position where they feel obligated to say, "Oh, it's OK," she adds.

Instead, she advises counselors to reflect on their own internal experience and to tune in to what might be prompting that response. Perhaps it's a case of the counselor wanting to protect their own ego, or maybe they are masking their own discomfort or lack of knowledge. If counselors find themselves becoming defensive in session, they can tell the client, "I feel like I'm reacting to something right now, and I recognize that I need to do some self-reflection. But I don't want to heap that on you." But do this briefly, Hammonds says, or else the session becomes about the counselor rather than the client.

Building trust and rapport also becomes critical to creating a sense of safety for these clients. Too often, counselors jump to diagnosis and treatment because the mental health system encourages them to have a solid plan and work toward a goal fairly early in treatment, Hammonds points out. She encourages counselors to slow down and first invest time in establishing good relationships with their Black clients.
Context matters
As Avent Harris, an ACA member, points out, counselors won't be aware of needing to broach the topic of racism unless they understand its historical and political context. Put simply, they have to know what to look for and ask about.

"You don't learn this context or gain this cultural awareness by just reading the DSM [ Diagnostic and Statistical Manual of Mental Disorders]," says Avent Harris, who specializes in multicultural considerations in counselor education and the role of spirituality in Black mental health help-seeking behaviors. She advises counselors to move beyond reading only counseling texts to explore the works of Black scholars, theologians and authors.

Counselors may also need to adjust a technique or approach to better fit with their clients' experiences. For example, the thought of going for a run in the evening sounds straightforward, but for many Black people, and Black men in particular, it can evoke a sense of fear. They question whether they will be safe or if their choice to run could cost them their life.

If a client brings this fear up in session, it could be dangerous for the counselor to use a thought-stopping technique, with the aim of interrupting, removing and replacing the client's "problematic thoughts," Hammonds explains. Suggesting that the client simply stop thinking that running could harm them ignores their experiences and the existence of the racism embedded in society, she says.

Instead, Hammonds, president-elect of the North Carolina Counseling Association, says the counselor should consider the context around the client's fear of running alone at night. Where does that fear come from? How does society contribute to or perpetuate this client's fear and anxiety?

"Those are the types of discussions that we need to be making space for," she says.
Self-awareness and honesty about biases
Hammonds stresses the importance of counselors reflecting - honestly - on their own experiences and biases. As she points out, counselors often like to think, "I took this multicultural course, or I've worked with clients from diverse backgrounds, so I'm doing OK." But it may not mean that at all, she emphasizes.

This self-awareness starts with counselor training. Working with diverse clients is the best way to learn to appreciate differences and to examine one's own biases and beliefs, says Crumb, an LCMHC in North Carolina.

This diversity should also extend to counselors' consultation groups. Avent Harris, an LCMHC associate in North Carolina, looks for colleagues who will provide honest feedback and challenge her own thoughts and beliefs. She says that if she has an uncomfortable moment in session, these colleagues would ask, "So, what made you uncomfortable in that moment? What questions do you need to ask yourself to reflect on that moment?" They wouldn't just echo her thoughts or tell her "not to worry about it," Avent Harris says.

Hammonds recommends that counselors continue to record and watch themselves in session just as they did during graduate school and supervision. "There's so much value in replaying your words and listening from that outsider's perspective," she says. The process affords counselors a chance to (re)consider their words, think about the purpose of their statements or actions, and evaluate whether they really listened to and heard their clients.

Counselors should also get their own counselor. "Some of this stuff is deep-rooted. It takes time to dig up those roots, to understand them, to untangle them and to repot them," Cartwright says.

She jokes that her mother always told her, "Never trust a beautician with bad hair." This same principle applies to counselors, she says. They have to make sure they take care of their own mental health before working with clients on their well-being. "And clients will be able to tell if you ... have done your work," she adds.

Cartwright, the project director for UNT Classic (a program that addresses disparities in mental health services for Black and Hispanic populations in the Dallas-Fort Worth metro areas) and UNT ICBH Project (a program that supports graduate students during clinical training), suggests that her colleagues, especially those who hold identities associated with privilege, work with a counselor who identifies with a marginalized group or with intersections with which the privileged colleague struggles.

They should also intentionally put themselves in a position in which they are the minority, continues Cartwright, a member of the ACA Advocacy Task Force and president of the International Association of Addictions and Offender Counselors, a division of ACA. For example, she suggests that White counselors attend a Black church one Sunday. "If you are uncomfortable for that short time that you're there, imagine what your Black clients feel like on a daily basis when they are constantly in spaces dominated by White people," she observes.
Finding voice and value
Black clients report to counseling with the same common presenting concerns that other clients have. But in addition, Hammonds says, they often seek counseling because of issues of "voice and value." They have experiences that either minimize their voice or communicate - overtly or covertly - that their ideas, opinions and problems don't matter or don't matter as much as those of others, she explains. Feeling undervalued, dismissed and unheard can lead to anxiety, depression and other mental health issues, she adds.

Cartwright specializes in underserved populations in counseling and counselor education, mentorship in counselor education, and offender and addictions counseling issues. She once worked with a client who was experiencing racism and discrimination at her job. The former client was the only Black woman on a large corporate team, and she noticed that meeting times would suddenly change without anyone alerting her. She also got the sense that her co-workers were talking about her behind her back. At first, she internalized this discrimination and started thinking that she must be bad at her job. She felt like an impostor.

But after another colleague confirmed the woman's suspicions of racial discrimination, the former client filed a lawsuit and won. The win came at a cost, however. She learned that co-workers had purposely changed meeting times without letting her know. Other colleagues whom she had thought were well-intentioned had made racist and hurtful remarks about her that were uncovered during the lawsuit and investigation.

As a result, the client began to question her judgment and worth. Cartwright helped the client learn to feel valued and trust herself again. They worked on challenging the client's thoughts that she wasn't good enough. For instance, they used self-affirming techniques such as daily affirmations and "I" statements that allowed the client to identify and acknowledge her strength and resilience.

Even if counselors can't relate to being discriminated against at work, they probably can identify with feeling like their voice hasn't been heard, Hammonds says. With that perspective, counselors can take intentional steps to empower these clients in session.

For example, Black clients often feel like they can't or shouldn't tell counselors if they didn't like the way the counselor phrased something or if a moment in session made them uncomfortable, Hammonds notes. But they should be made to feel comfortable voicing those thoughts, she continues, and it's up to counselors to create a space that invites that feedback.
Hidden struggles
A May 31 article in the Washington Post reporting on protests in the wake of the killing of George Floyd described a less visible impact of racial violence: "the private weariness and anguish felt by many [B]lack people in the country." In other words, many Black people are exhausted.

Emotional exhaustion is another reason that Black individuals often seek counseling, Hammonds says. Besides being fatigued from the discrimination and injustices that they experience daily, they often find it necessary to code-switch - changing the way they talk and express themselves when they are outside of their homes and Black communities.

To help explain this concept, Hammonds uses the analogy of counseling professionals switching their "hats" or roles. They may go from teaching to supervision to having a counseling session with a client and back to teaching again, all in the same day, which can be taxing.

"Switching roles, having to constantly pause and reconsider how much you can share and what is your role in this new context, and always being aware of what you can and can't say and what you can and can't do is exhausting," Hammonds says. "And that's an emotional labor that many White Americans aren't required to do."

Black women often face an extra burden. As Avent Harris explains, "Black women are expected both inside and outside their community to not be vulnerable, to not share emotions and to carry the weight of everything on their shoulders."

This unrealistic expectation can take a toll on mental health. In fact, many of Cartwright's clients struggle with the " Black superwoman syndrome " - the myth that Black women are impermeable. They feel pressure to do it all and to do it well. Although this isn't really a syndrome, it does help explain the chronic stress these women endure while trying to juggle multiple roles and keep up with the daily demands placed on them by family, work and community.

Cartwright's clients often discuss feeling misunderstood at work and how co-workers minimize their experiences. Cartwright normalizes these experiences for her clients, but she also expresses how sad it is that this is their "normal."
The trauma of racial violence
Instances of brutality and violence against Black people are not new, and neither are the racial disparities that regularly confront them. The main difference today is the ability to easily document such instances, says Hammonds, whose research interests include technology in counseling, multicultural counseling and community determinants of mental health. Almost everyone today has a smartphone in their pockets, and more people are using them to record acts of race-based violence and to demand justice and accountability.

These videos also continually expose others to these traumatic and heinous acts. This can be particularly traumatizing for Black people, who often internalize the traumas they witness because they know it could have easily happened to them, Hammonds says.

The disparaging comments on social media can also be traumatizing and triggering for Black Americans, Crumb adds. For instance, they may read a racist comment made by a supervisor or colleague. Then they have to return to work and sit beside that person, knowing how that person really feels about them.

"And so often, [Black people] are expected to move through the world, to hear all this, to see all this, and have no emotional reaction or response," Avent Harris says. Counselors can help change this by validating clients' emotional reactions to racial violence and discriminatory remarks, she adds. This involves letting them know that it's OK to feel disappointed, sad, angry, scared, anxious or whatever else they are feeling.

The trauma of being exposed to racial violence and remarks also has a collective effect. "Collective trauma is exposure to stressful events that threatened a sense of safety on a group level," Hammonds explains.

On a recent episode of The Thoughtful Counselor podcast, Hammonds described how repeated exposure to racial violence and discrimination operates like a wound that won't heal: "That spot's been nicked so many times. We can go about the process of healing, but before you know it, there is another nick. Then you're walking around doing your best to cope, shielding that spot, anticipating situations that might nick you again. ... You are always on edge. You're withdrawing. Your trust is slow to build in other people and situations. You feel angry and sad. And you start to think, 'Is there something wrong with me? Why can't I get out of this cycle?'"

This collective trauma correlates with symptoms of depression and posttraumatic stress disorder such as avoidance, reexperiencing, numbing and hyperarousal, she adds.

If a community experiences stress together, then counseling approaches that draw on the power of relationships are helpful, Hammonds says. These approaches include relational therapies, psychodrama, drama therapies, creative approaches and group therapy.

Hammonds often incorporates music into her sessions with clients. She describes music as being akin to a picture book because it connects people to a certain memory, place, emotion or experience in their life.

When clients can't easily describe their thoughts, feelings or perceptions in their own words, she asks them to think of a song that best captures their emotions or that represents what they see around them. She then pulls up the song and plays it in session, asking the client, "What is powerful about this song? How do the lyrics or beat affect you?"
Impacts on Black children
In the summer of 2016, Philando Castile was fatally shot in his car by a Minnesota police officer during a traffic stop. Castile wasn't alone. His girlfriend, Diamond Reynolds, and her 4-year-old daughter witnessed the entire incident.

After the shooting, Reynolds, who was now in handcuffs, was understandably distraught and emotional. Her daughter tried to comfort her, exclaiming, "Mom, please stop saying cusses and screaming 'cause I don't want you to get shooted." A few minutes later, the girl said, "I wish this town was safer. ... I don't want it to be like this anymore."

The girl's words illustrate how racism and racial violence affect children even at a young age. "Black youth are just as affected as their Black parents are by systemic racism and injustices," says Crumb, an ACA member whose research interests include rural and school-based mental health services. Black children are affected directly and indirectly. They witness racial violence and discrimination themselves, and they hear adults talking about it at the kitchen table. "Then, they assume these thoughts, these fears ... [and] this distrust," Crumb adds.

Again, counselors should take the initiative to broach the topic of racism with these youth. Crumbs calls it "taking the temperature of the room" because counselors can check in to see how children are doing. For example, a counselor could say, "This has been a tough summer with COVID-19 and a lot of people getting harmed and dying. How are you feeling?"

Then counselors should let the children guide the conversations, Crumb says. Some may verbalize their feelings. Others may use play or draw a picture to express their emotions.

Crumb points out that school settings are often the only access that some Black communities have to counselors. But because of mistrust and fear, they may not view counselors and schools as "safe spaces." Crumb advises counselors to be mindful of current and historical racial inequities within school systems and to alter their approaches accordingly in attempting to connect with these children.

Younger children may not have the vocabulary to easily communicate their feelings. They often "speak" through play and toys. So, Cartwright recommends that counselors keep an assortment of toys, dolls and activities that will allow children to communicate in the way in which they feel most comfortable. If they want to use a brown doll, counselors should make sure it is available to them, she adds.

But as Reynold's 4-year-old daughter demonstrated, some Black children possess an early awareness of racism and a vocabulary to discuss it. They often have little choice. Black children will be exposed to inequities earlier than their White peers because of their parents' lived experiences and the conversations they overhear, Avent Harris explains.

Crumb encourages counselors, especially school-based counselors, to be courageous in advocating for Black youth. Black youth are often overlooked academically and are disproportionately suspended, she says. Counselors can be vocal in questioning why that is the reality. Likewise, if diagnoses of attention deficit/hyperactivity disorder and conduct disorders are disproportionate toward one ethnicity, counselors can ask questions and press for answers.

More than that, counselors can do something about such disparities. For example, they can lead professional development trainings for teachers, Crumb says.
Partnering with the Black community
Black people may rely on informal networks of support such as family, friends and their church communities when it comes to issues having to do with their mental health, Crumb says. She add that counselors should encourage clients to continue using these supportive networks because it is imperative that they have trusted individuals to whom they can turn to discuss their experiences of race-based trauma.

Counselors should also reach out and form relationships with stakeholders in Black communities. Crumb and Avent Harris recommend partnering with community organizers, historically Black Greek-letter organizations, those involved with the juvenile justice system, law enforcement personnel and faith leaders.

Faith leaders are often both spiritual and political leaders in the Black community, Avent Harris says, so collaboration with them is crucial. "A lot of times, how [Black Americans] conceptualize events, crises, pain and suffering is coming from [their] spiritual beliefs systems," she adds.

In an article written for CT Online after the 2015 church shooting in Charleston, South Carolina, that took the lives of nine Black people, Avent Harris suggested that counselors could meet with Black pastors and offer to speak in their Sunday morning services, co-sponsor a mental health day or provide referral resources.

Counselors should also think of these partnerships as a preventive measure. Counselors need to be invested and involved with Black communities before crises happen, Avent Harris stresses. She challenges her colleagues to name five contacts they have a working relationship with in the Black community and could reach out to immediately. If they can't name five, she says, then they have some work to do.
Less talk, more action
The words diversity and inclusion have steadily gained prominence in the counseling profession, but Avent Harris believes this has allowed counselors to largely become complacent and not move past thinking of "change" as simply including and hiring diverse individuals.

"It's not just diversity and inclusion. It's how we're doing equity work, how we are doing anti-racism work," she emphasizes. "What are our actions behind the words that we say? And do our actions align with what we say and who we say we are as a profession?"

Avent Harris, like many other Black people, is exhausted from having the same conversation over and over again about what the Black experience is like. "It's time to move beyond that talk and really implement action," she says.

Taking action doesn't mean that all counselors have to hit the streets and protest, but they can commit to influencing the spaces they are in, Crumb says. Maybe that's writing an article. Maybe that's offering a training. Maybe it's working to inform policy. Maybe it involves working toward making positive change in their communities or within themselves.

Cartwright also suggests one small step counselors could take that would have a huge impact: making their services more accessible to communities of color by offering one pro bono slot a week or having a sliding scale.

Although 2020 hasn't been the year we wanted, it may be the one we need. Every day, we hear the global rallying cry, "Black Lives Matter." Behind that cry are Black people who are suffering and dying because of systemic racism. We hear the refrain: Trayvon Martin, Tamir Rice, Eric Garner, Philando Castile, Charleena Lyles, Atatiana Jefferson, Breonna Taylor, Ahmaud Arbery, George Floyd, Tony McDade, Rayshard Brooks, and countless others who have died.

These are the tragic killings that make the news. But how many others die daily without drawing widespread attention? How many more face daily injustices or discrimination?

Yes, their lives matter. And their mental health does too.
****
On June 22, the ACA Governing Council issued a statement on anti-racism. As this article was being written, ACA leadership was listening to a cross section of members and volunteers to develop an action plan that would give life to the statement. For more, see tinyurl.com/ACAAntiRacism.
****
Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.
**** Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

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Black mental health matters - Counseling Today

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Racial violence and discrimination are woven into the fabric of the United States. The way policies and laws are implemented. The weaponization of Whiteness and privilege. Disparities in education and health care. The horrible and senseless killings of Black people throughout our nation's history and into the present day.

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American Counseling Association. (2014). ACA Code of Ethics. American Counseling Association. https://www.counseling.org/docs/default-source/default-document-library/ethics/2014-aca-code-of-ethics.pdf

Mackey-Neorr, C. (2019. January). Adverse Childhood Experiences and Toxic Stress Among College Students. Prevalence, Risks, and Academic Success. Washington State University. Research Exchange. https://rex.libraries.wsu.edu/esploro/outputs/doctoral/ADVERSE-CHILDHOOD-EXPERIENCES-ACES-AND-TOXIC/99900581706901842

Sue S, Zane N, Nagayama Hall GC, Berger LK. (2009). The case for cultural competency in psychotherapeutic interventions. Annu Rev Psychol. 2009;60:525-48. Retrieved March 10, 2025 from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2793275/

VonTeese. D [@ditavonteese]. (2010, September 7). "You can be a delicious, ripe peach in the world, and there will still be people in the world that hate peaches." [Tweet]. X (formerly Twitter). Retrieved March 8, 2025 from: https://x.com/DitaVonTeese/status/23210190813

Wang X, Lu C, Niu L. (2023, October 5). Body image construction and mental health levels among college students: a data survey of Chinese university students. Front Public Health. https://pmc.ncbi.nlm.nih.gov/articles/PMC10585169/#sec20

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2014 ACA Code of Ethics

ASCA Code of Ethics:

https://www.schoolcounselor.org/getmedia/44f30280-ffe8-4b41-9ad8-f15909c3d164/EthicalStandards.pdf

ACA- Practitioner's Guide to Ethical Decision Making

https://www.counseling.org/docs/default-source/ethics/practioner-39-s-guide-to-ethical-decision-making.pdf?sfvrsn=f9e5482c_10

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Title IX Legal Manual- US DOJ Civil Rights Division

https://www.justice.gov/crt/title-ix#:~:text=Title%20IX%20prohibits%2C%20with%20certain,in%20education%20programs%20or%20activities.&text=The%20clearest%20example%20of%20federal,award%20or%20grant%20of%20money.

Texas Administrative Code: Title 22 Part 30 Chapter 681

https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=22&pt=30&ch=681

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3. Pre-Award Authority of Recipients vis-a-vis Subrecipients

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Disclaimer: Pursuant to Executive Order 14168, issued January 20, 2025, references to “gender”should instead be read to reference “sex” consistent with the Executive Order. This manual shouldbe read consistently with Executive Order 14168.

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EMDR Basic Training:

https://www.emdr.com/us-basic-training-overview/

Motivational Interviewing Training:

https://motivationalinterviewing.org/list-events

Graduate Cert in Applied Sports Psychology

https://www.uws.edu/course-registration-at-uws/#program-planners

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Right now, as I am learning and not certified, the process for referral is to our Dean of Student Services who is also a licensed counselor.

From there referrals would be made to an appropriate additional service provider as needed.

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The American Counseling Association Code of Ethics (2014) makes cultural competence required by stating counselors must honor and respect diversity while being "aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors."

Outside of ethical requirements, developing cultural competence is a pathway to better understanding and direction from counselors, therapeutic outcomes for clients, and movement towards ending generational trauma. (Sue, et al. 2009)

What I think is important to note is that the most important aspect I have come to learn about cultural competency is that it is not about how much knowledge I necessary possess beforehand. It is important to stay informed of broad issues, barriers, statistics, or trends with marginalized group. However, that information is constantly changing, is incredibly vast, and is not always applicable on an individual level.

Because of this, cultural competency in service provision for me, is more of an attitude and belief system. It is being appropriately curious, flexible, and intentional rather than judgmental, rigid, and bias motivated. It is approaching care with generally established outcomes and culturally flexible methods. It doesn't require that I know everything as much as it needs me to admit I don't know everything.

I also believe that in addition to practicing cultural competence, a counselor can also be a leader in creating spaces and conversations that encourage healthy cultural awareness and acceptance.

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Mental Health:

Center for Life Resources- 325-646-9574

Crisis Hotline: 800-458-7788

Oceans Behavioral Hospital- 325-399-6101

Substance Abuse:

Serenity House- 866-795-4673

Victims of Crime- DV, SA

Eastland County Crisis Center- 254.629.3223

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My Purpose: When Possible, Make Life Better for Others. 

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I have learned that my purpose, placement, and plans are not the same things.

My life’s purpose is an overarching calling, placement is the location and time the purpose is to be used, and plan is the organization of the purpose for that moment in time. Purpose remains while placement and plans shift according to circumstance. In the form of a simple analogy that has come to define this perspective: A peach tree’s purpose, regardless of where or when it is planted, is to produce peaches.

If my purpose is the fruit of my life, then I need to remember a tree must be healthy to produce good fruit for others. And its care is not dependent on its own fruit production, but instead on the sun, water, nutrients from the soil, pollinators from other trees, and its use of those resources to care for itself through the seasons.

My self-care is about having routines that provide daily care for my whole life. It is honest, kind, and intentional about my influences, life balance, education, flaws, experiences, choices, and relationships. It is vulnerable to the right people in times of need and recognizes the difference between who is there to tend the tree and who is there to eat the fruit. In the presence or absence of gratitude, reward, or recognition, it reminds me that my purpose is not for me and is separate from my own worth, because as Dita Von Teese tweeted in 2010, "You can be a delicious, ripe peach in the world, and there will still be people in the world that hate peaches."