Below is a summary of my interview with a Licensed Professional Counselor, Heidi, that I conducted for CNS 771: Clinical Mental Health Counseling (Assignment 6.3). During our talk, we discussed her likes and dislikes in the field, as well as what is needed for the future of counseling. Heidi mentioned the importance of advocating for more research funding and more research in general in the field of counseling. This is something I also hope to advocate for as I move forward in the field. This shows my commitment to using my counseling training to affect change on a national and international level. Click here to download a PDF version.
Interview with Clinical Mental Health Counselor
Overview of Mental Health Counselor and Work History For the purpose of this assignment, I interviewed a local counselor, Heidi, who has been working in the field for over seven years and became licensed this year. The first step in her journey toward licensure was attending a private university and obtaining a Master of Arts in Community Counseling. During the internship portion of her college program, Heidi interned at a setting that provided services to low-income adults with chronic mental health illnesses, and another where she worked with college students. She also completed an internship at a residential eating disorder treatment center. Upon graduation, she began her career working at a state-funded community agency where her clientele was primarily low-income clients seeking outpatient services for anxiety, depression, and substance abuse. After five years at that community agency, she transitioned to a private practice group which gave her the opportunity for her to conduct intensive in-home therapy. At this practice, Heidi was able to complete her hours for licensure.
Last year, she sat for the National Clinical Mental Health Counseling Exam and passed. She is now a Licensed Professional Counselor in the state of Virginia. Heidi hopes to obtain additional credentials in Dialectical Behavioral Therapy and as a Certified Eating Disorder Specialist. Through the various settings mentioned above, Heidi has worked with individual clients of all ages and socioeconomic and ethnic background. She has also worked with groups and families in both rural and urban settings. Heidi shared that the range of these experiences have truly allowed her to hone her counseling skills and be able to adapt to working with clients of all different backgrounds. It also allowed her to pinpoint that she prefers working with adolescents and their families in an outpatient setting.
Most recently, Heidi has been working as an outpatient therapist at a private practice eating disorder treatment center. Although the primary concerns of her clients at this site are eating disorders, she also seeing many clients with co-occurring anxiety, depression, attention deficit disorder, and bipolar disorder. She described the majority of her client base as being high-functioning, over-achieving, and perfectionistic. However, she also said that the common thread is that most of her clients are struggling deeply and working very hard to conceal their struggles from everyone, including friends and family members. At this site, she primarily utilizes a combination of Cognitive Behavioral Therapy and Dialectical Behavioral Therapy. In her current role, she runs intensive outpatient program groups as well as partial hospitalization program. She also conducts individual sessions.
Other counselors at the site offer parent support groups, yoga therapy, music therapy, and equine-assisted therapy. The practice’s primary owner is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist. Another staff member is certified in Maudsley Family Therapy, which is a well-respected and extremely specialized treatment modality for eating disorders. Several of the other counselors are Licensed Professional Counselors, while others are still in their pre-licensure residency. Other staff members include a psychiatrist who does medication management and several registered dieticians. At this point, the practice is well-established and so many client referrals come from word of mouth and doctor recommendations. However, Heidi mentioned that the business owner does utilize social media and a website as marketing tools, but that they are primarily meant to engage with current and past clients as opposed to getting new ones in the door. In comparing her current private practice setting to community agency settings, Heidi expressed that there are advantages to her current site due to the clients’ higher abilities to create change in their own lives. However, Heidi said she did feel like she was meeting vital, unmet needs when working with underserved populations in community agency sessions. While there are pros and cons to all settings, Heidi chooses to stay at her current setting due to the supportive team environment.
Insights into the Field One of the things Heidi mentioned during our discussion that stuck with me was the importance of validating all of a client’s emotions as long as they are genuine. She said that one of the things that she finds most special about the counseling profession is the opportunity to sit with clients through everything from laughter to tears. On the other hand, Heidi expressed that her biggest struggle as a counselor is working with clients who do not buy into the therapeutic process. Especially working with teens, many of her clients do not seek counseling by choice and are doing so solely based on familial expectations or doctors’ orders. She mentioned that many of these clients are very set in their disordered thinking and behaviors and do not have a desire to change. As a counselor, Heidi said one of the challenges is that clients can lash out at her when their struggles are identified or their patterns are challenged.
Additional Benefits and Challenges of Counseling Another one of Heidi’s main challenges as a counselor is dealing with the difficulties associated with the business side of things, such as billing and insurance. She said she was surprised to learn how slow the reimbursement process goes. She also expressed some guilt and internal conflict over the fact that many clients cannot receive adequate mental health treatment due to lack of insurance or inability to pay out of pocket for services. Her current workplace is out of network with all insurances except for one, which prevents many clients from coming to her. Because of this, most clients at her current site pay out of pocket. The site does occasionally offer sliding scale services to clients who have high-acuity eating disorders but are unable to pay full cost for services. They also offer one annual scholarship for a client to complete the entirety of the intensive outpatient program over the course of three months. All billing is done through a business manager who works full-time to communicate with insurance companies.
Heidi said that she certainly had moments where she thought about leaving the counseling profession all together due to the stress, but that overall the connections she is able to make with clients make it all worth it. She said that at this point, she actually loves being a counselor even more than she thought she would and that she cannot imagine being in any other line of work. Counseling, to Heidi, is a way to keep herself focused on “honesty, authenticity, vulnerability, and humility.” Like many of my Wake Forest professors, Heidi emphasized many times the importance of consultation and collaboration. She said that especially outpatient counseling with individuals can be an isolating experience. In those moments, Heidi’s advice is to reach out for advice, brainstorming, and reassurance. She said that having a team that you trust who supports you is one of the most important parts of maintaining your ability to be a good counselor. We talked about how this can help prevent burnout as well.
When discussing the future of the mental health field, Heidi emphasized how important she thinks continual research will be. Specifically, she hopes that more research will be done on how eating disorders manifest across cultural groups and genders. In addition to more research, Heidi hopes that insurance will begin to cover more mental health services so that access to treatment will be more attainable.
Personal Reactions I was personally encouraged by the fact that Heidi has worked in such a wide variety of settings. I made the choice to split my internship semesters across three different settings so that I could try different client populations and see where I saw myself thriving as a counselor. While I knew this was best for me, I doubted the decision when I watched my classmates who stayed at the same site over the year develop longer term relationships and treatment plans with clients.
Overall, I appreciated Heidi’s candor and this discussion helped me gain more insight into the nuances of the counseling field. It emphasized the importance of finding a setting that fits well with my theoretical orientation, values, and personality. It also reminded me that while all counseling settings have their challenges, there are also great rewards to being a counselor. I look forward to enjoying and growing in this role as Heidi does every day.