Addiction Counseling Licensure Issues for Licensed Professional Counselors

Sep 4, 2014 | Article, Volume 2 - Issue 1

Keith Morgen, Geri Miller, LoriAnn S. Stretch

This article addresses the obstacles of effectively integrating addiction counseling into a nationwide definition of professional counseling scope of practice. The article covers an overview of issues, specific licensure and credentialing frameworks (LPC, CADC, LCADC) in two U.S. states, and recommendations to effectively bridge the gap between professional and addiction counseling. Historical origins and an overview of addiction counseling are presented.

Keywords: addiction, licensure, credentialing, LPC, CADC, LCADC

The question of professional identity within the counseling profession, first considered during the founding of the American Personnel and Guidance Association (Sweeney, 1995), still exists today (Calley & Hawley, 2008; Cashwell, Kleist, & Schofield, 2009; Mellin, Hunt, & Nichols, 2011; Myers, Sweeney, & White, 2002; Nassar-McMillan & Niles, 2011; Remley & Herlihy, 2009). One possible reason for the continual debate around professional identity may lie in the multitude of specialty fields (e.g., addiction, career, and school) within counseling (Gale & Austin, 2003; Myers, 1995; O’Brien, 2010). Remley (1995) underscores that unlike psychology, psychiatry and social work, counseling is the only mental health profession that licenses specialty areas. Specialty areas such as career and school counseling only denote a practice area or population; whereas addiction counseling actually entails a DSM-IV-TR Axis I disorder (i.e., Substance Use Disorders; American Psychiatric Association, 2000). No other Axis I or Axis II disorder receives such attention.

Addiction is considered a part of professional counseling as implied by the latest CACREP standards (2009). However, a separate licensure track exists for the profession of addiction counseling. If the practice of addiction counseling really is a part of counseling (as implied by the latest 2009 CACREP standards), then the time has come to recalibrate the rest of the counseling profession to better fit an inclusive and unifying professional counseling identity that includes addiction counseling. Thus, the purpose of this paper is to start the dialogue regarding the mixed messages on the issue of counselor identity and specialization for addiction counseling (Morgen, Miller, Culbreth, & Juhnke, 2011; Tabor, Camisa, Yu, & Doncheski, 2011). The article is divided into an overview of issues, specific licensure and credentialing frameworks in two sample states (New Jersey and North Carolina), and recommendations in response to the concerns discussed.

Overview of Issues

Henriksen, Nelson, and Watts (2010) criticize the counseling specialty system by arguing that counseling specialties do not define counseling but merely denote a practice area, and that counseling specialty licensure/credentialing implies that only a small proportion of the counseling profession is qualified to work with this population. The addiction area is one such area of specialization that comes with a separate licensure/credentialing process. The authors believe that in regard to addiction counseling, the additional supervisory and training hours required for addiction licensure/credentialing (in addition to the supervisory and training hours required for licensure as a professional counselor) implies that addiction content falls outside the professional counseling scope of practice.

For instance, if the graduate counseling program does not possess an addiction track, a cursory review of curriculum at CACREP and non-CACREP programs found the typical option of one addiction course as an elective. However, curricular reviews of numerous programs find few to no electives on other DSM-IV-TR disorders (e.g., mood, anxiety). Thus, the authors argue this produces a confusing mixed message in that licensure as a professional counselor covers practice areas that typically receive minimal exclusive attention (e.g., one-week discussion on anxiety disorders in a maladaptive behavior course), yet an area where one (or more) electives are typically offered for in-depth study of a disorder (such as addiction) comes with an entirely unique and separate licensure process.

The presence of a separate licensure/credentialing process for addiction counseling seems antiquated considering the extensive training required for a graduate counseling degree. Furthermore, most states consider addiction work within the professional counselor scope of practice (Tabor et al., 2011). Thus, the pioneering issue this paper addresses is whether it is time to thoughtfully reconsider how addiction is conceptualized in professional counseling (beyond the inclusion in the most recent CACREP standards) and recalibrate the education and licensure processes accordingly. In order to begin this dialogue a brief review of the history of the licensure/credentialing process of addiction counselors needs to be provided.

Historical Origins of the Issue

Historically across most states, the advent of addiction counseling licensure/credentialing standards occurred parallel with the professionalization of the counseling field (i.e., the master’s-level state licensure laws). States mandated that graduate school-level professionals conduct counseling, leaving many long-time and effective addiction counselors (many of whom possessed only a high school diploma or GED) out of the counseling mainstream. Consequently, addiction licensure/credentialing boards were established to achieve two goals. The first goal was to professionalize the addiction counseling field in a manner similar to professional counseling via mandated supervised practice hours and education across a subscribed addiction curriculum. The second goal was to provide a mechanism to grandfather into the profession those addiction counselors who had long worked in the field and provided outstanding services. Without the grandfather clause, many of these addiction counselors would have lost their profession or would have needed to put their career on pause as they obtained the required education and/or training.

The professionalization of addiction counseling, including licensure and credentialing, strengthened the field and provided a higher quality of care to those struggling with addiction. Unfortunately, a system also was established that over 30 years reinforced the notion that addiction falls outside the scope of practice for professional counseling (i.e., the presence of a separate licensure and certification processes focused on addiction counseling). While the addiction counseling field did need professionalization, perhaps the original high standards (e.g. upwards of 3,000 hours of clinical practice with supervision) now require recalibration that takes into account a new era where counselor training for those engaged in addiction work extends far beyond a high school diploma or GED.

Professionalization or Deterrent?

The authors’ perspective in this paper is that imbedded in the current licensure and credentialing process for addiction counseling is the message that LPCs cannot or should not do addiction work. The message comes from a confusing mixed array of information. Using the graduate trainee (the next generation of counseling professional) as an example, it becomes clear as to how future LPCs may shy away from addiction work. For instance, in the classroom graduate students read about how counseling includes working in the addiction area (as per the latest CACREP standards). Graduate students are trained in a graduate counseling curriculum that offers advanced addiction course electives and the possibility of doing practicums or internships at an addiction facility. Many of these graduate students may even attend school in a state where addiction work is covered in the professional counseling scope of practice. But, these students also see professional counselors with separate addiction licenses (e.g., LPC and LCADC) and employment announcements requesting/requiring an addiction license. Even the National Board of Certified Counselors (NBCC) Master Addiction Counselor Credential (MAC) focused on this one DSM-IV-TR disorder class (with no other NBCC credential so narrowly focused on one DSM-IV-TR disorder). Because the student does not see an NBCC credential for mood disorders or sees a licensure for anxiety disorders, the imbedded message is strengthened.

The mixed messages coupled with the burdensome task of meeting the mandates for two professional bodies (professional counseling and addiction) may drive some new counselors from the addiction field. For example, at the end of a panel discussion on this topic at the 2011 American Counseling Association Conference (Morgen et al., 2011), a new graduate of a professional counseling master’s program said she would like to start accruing practice hours in a substance use disorders clinic as she had completed some internship hours there and took a course on substance use disorders. However, the facility where she wanted to work required her to obtain an addiction license in addition to her professional counseling license. She subsequently indicated that she did not have the time, money, or the energy to do both and was thus looking outside the substance use disorders field for employment. This anecdote clearly demonstrates how newly graduated counseling professionals (especially those working in the provisional licensure period) may be inhibited from entering the addiction counseling field.

How many qualified, talented and motivated students are we turning away from the addiction counseling field due to these extra training requirements unique to working with the specific DSM-IV-TR Axis I Substance Use Disorder diagnosis at a time when there is an ever-growing need for services (e.g., addiction in returning veterans or the chronically unemployed)? Effective training of LPCs who work with addiction requires coordination between educational training institutions and actual practice that reflects reasonable experienced-based requirements for working in the area of addiction as well as respect for the graduate-level degree (e.g., master’s or doctorate) and training the counselor has already received. Such coordination varies from state to state and without a guarantee of such coordination the danger is that well-intentioned, well-trained counselors will enter the field technically qualified to counsel individuals, but philosophically lacking the integration of theory and practice necessary for treating addiction. This could mean, for example, that the counselor is more vulnerable to enabling the active addictive process and thereby not providing counseling in the best interest of the client.

In an effort to initiate the dialogue on how to perhaps recalibrate the system, it first seems warranted to review the professional and addiction counseling licensure laws and policies within two states. The authors intend to (over the next few years) review the state laws and policies for all 50 states. However, for the purposes of this initial paper, New Jersey and North Carolina will be discussed below.

Specific State Issues

New Jersey
New Jersey operates a professional counseling license (LPC) with a minimum education of a graduate counseling degree, a certified alcohol and drug abuse counselor credential (CADC) requiring a minimum education of bachelor’s degree, associate degree, high school diploma or GED, and a licensed clinical and alcohol and drug abuse counselor (LCADC) with a minimum education of a graduate counseling degree and qualification for the CADC. The LPC is governed by the Professional Counselor Examiners Committee (imbedded within the Marriage and Family Therapy Board), whereas the CADC/LCADC is governed by the Alcohol and Drug Counselor Committee.

According to the regulations for professional counseling, New Jersey defines counseling in part as “using currently accepted diagnostic classifications including, but not limited to the DSM-IV” (NJ Board of Marriage and Family Therapy Examiners, 2009, 13:34-10.2, p. 34-22). Substance use disorders fall within Axis I of the DSM-IV-TR, thus work with substance use disorders seems in line with the professional regulations of the LPC. Further evidence of this fact exists within the LCADC regulations (NJ Alcohol and Drug Counselor Committee, 13:34C-2.6, p. 34C-10) that states the following individuals are exempt from the LCADC licensure requirement:

A person doing work of an alcohol or drug counseling nature, or advertising those
services, when acting within the scope of the person’s profession or occupation and
doing work consistent with the person’s training, including physicians, clinical social
workers, professional counselors, marriage and family therapists, psychologists, nurses
or any other profession or occupation licensed by the State, or students within accredited
programs of these professions, if the person does not hold oneself out to the public as
possessing a license or certification issued pursuant to the Act or this chapter.

As long as an LPC does not advertise oneself as an addiction or substance abuse counselor, they are completely free to practice counseling with individuals presenting with addiction.

However, new counselors and LPCs who wish to accrue hours toward addiction licensure/credentialing face obstacles within the hiring process for addiction-focused positions. For example, despite the clear language in the LPC and CADC/LCADC regulations, advertised positions in the addiction counseling field in New Jersey typically include language stating “actively pursuing CADC/LCADC” or “must hold a New Jersey CADC/LCADC.” These requirements (which again, contradict the language of the New Jersey LPC and LCADC regulations) are typically in place due to a mandate of the program funding source (e.g., state or federal). Private practice counselors (who do not operate any funded programs with the above-mentioned requirements) are free to practice addiction work if qualified. However, most (if not all) of the addiction counseling positions where a new professional counseling graduate can accrue hours are housed in some type of treatment facility that very likely must adhere to the LCADC mandate, thereby limiting access to positions for those seeking to accrue LPC hours within the addiction counseling field.

In New Jersey, the typical master’s student who wants to accrue hours for licensure as an LPC must produce approximately 4,500 supervised counseling hours. This process comes immediately after the challenging two to three years of graduate study and passing the National Counselor Exam (NCE). However, to obtain the LCADC these students must complete an additional and separate 3,000 supervised addiction counseling hours, 270 clock hours of education focused on counseling and addiction, and 300 hours of supervised practical training in core counseling areas such as screening, intake, assessment, etc. The primary and most time-consuming problem lies in the need to accrue the supervised addiction counseling hours. Since the supervised counseling hours cannot be combined (e.g., there is no language in either the LPC or LCADC regulations permitting or denying the “double-dipping” of an hour for inclusion in both the LPC and LCADC hours accrual for licensure; this alone is confusing and indicates a need for clarification), the trainee working towards licensure who wishes to work in an addiction facility must accrue thousands of extra hours or opt to only work towards the LCADC. No other DSM-IV-TR disorder class comes with this burdensome extra mandated training requirement.

Recent efforts to integrate the mental health and addiction licensure processes in New Jersey are in motion, but still in an early phase. Much of this work is coming from a project sponsored by the New Jersey Division of Mental Health and Addiction Services designed to train the next generation of dual-licensed and trained (mental health and addiction) practitioners. However, this need to streamline the process is only present because of the dual licenses already in place. Furthermore, the premise of the program (though an excellent contribution) still propels the notion that addiction falls outside the scope of LPC practice and there needs to be a process to merge the two together. Despite the benefits of this new initiative, the end result is still the same: two different licenses. Again, this is the only DSM-IV-TR disorder that receives this treatment.

North Carolina
North Carolina has a well-coordinated system for addiction counselors. All professionals who want to be licensed to work in the addiction counseling field need to go through the same board, the NC Substance Abuse Professional Practice Board (the Board), which is “recognized as the registering, certifying, and licensing authority for substance abuse professionals” (Practice Act, 2005, Senate Bill 705, North Carolina General Assembly, § 90 113.32). One board eliminates competition between boards and the related issues that arise. In fact, the Licensed Professional Counselors Act (LPC law) specifically exempts substance abuse counselors from the counseling law by declaring that nothing in the LPC law “shall prevent a person from performing substance abuse counseling or substance abuse prevention consulting” (NC Board of Licensed Professional Counselors, 2009, § 90-332.1.d). Having one board brings together individuals from various professions in a concerted effort to address the issues related to addiction counseling and to advocate for the field at a state level. This framework has the strength of cooperation between different professional groups and the absence of competition within a state.

This cooperation is enhanced by a tiered system (licensure and credentialing). Individuals may apply for licensure as a Licensed Clinical Addictions Specialist. With regard to entry at the licensure level, there are four main routes or criteria (Criteria A, Criteria B, Criteria C, and Criteria D). Although initially the system may be confusing to determine the criteria under which one fits, the advantage is that there is greater flexibility for the individual applying for licensure. This flexibility is the result of minimum requirement variation in the areas of education, training, experience, and supervision (Criteria A, B, & C), as well as professional discipline (e.g., psychology, social work, counseling—Criteria D). For specific guidelines and clarification of this summary, the reader is referred to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_90/Article_5C.html.

In terms of similarities for the individual applying for licensure, there are two aspects that remain the same under Criteria A, B, and C: the submission of three letters of reference (there is some variation allowed for the individuals who can write these letters) and a passing score on a master’s level written examination administered by the Board. The variations under these criteria are as follows. In the area of education, Criteria A and B require a minimum of a master’s degree with a clinical application in a human services field from a regionally accredited college or university. In addition, in terms of training, Criteria A requires 180 hours of substance abuse specific training from either a regionally accredited college or university, which may include unlimited independent study or from training events of which no more than fifty percent (50%) shall be in independent study. Criteria C combines the education and training requirement in the minimum requirement of a master’s degree in a human services field with both a clinical application and a substance abuse specialty from a regionally accredited college or university that includes 180 hours of substance abuse specific education and training. In the area of experience, Criteria A requires two years postgraduate supervised substance abuse counseling experience, while Criteria B requires the applicant to be certified as a substance abuse counselor. Finally, regarding supervision, Criteria A requires documentation of a minimum of 300 hours of supervised practical training and provision of a board-approved supervision contract between the applicant and an applicant supervisor, while Criteria C requires one year of postgraduate supervised substance abuse counseling experience. Criteria D simply requires that the applicant has a substance abuse certification from a professional discipline that has been granted deemed status by the Board (i.e., possession of a certification to practice addictions work under another discipline, such as social work, and that certification is recognized by the counseling board).

Note that the Board also offers numerous credentials through certification for non-master’s-level professionals. These include the Certified Substance Abuse Counselor (CSAC), Certified Substance Abuse Prevention Consultant (CSAPC), Certified Criminal Justice Addictions Professional (CCJP) and the Substance Abuse Residential Facility Director (CSARFD) credentials. In terms of the CSAC and the CSAPC, the applicant needs to be of good moral character, not be (or have been) engaged in any practice or conduct that would be grounds for disciplinary action, have a minimum of a high school diploma or a high school equivalency certificate, sign a form attesting to the intention to adhere fully to the Board’s ethical standards, and submit a complete criminal history record check.

Additionally, a CSAC who completes a clinical master’s degree program in a human services field can seek the LCAS via Criteria B as outlined above. This criterion recognizes the fact that the CSAC has already completed a 300-hour supervised clinical practicum and has substance abuse specific work experience. In addition to submitting proof of one’s master’s degree, all one has to do to obtain the LCAS via this criteria is to submit three letters of reference from LCAS’s and/or master’s level CSAC’s and pass the LCAS examination.

This tiered system allows the counselor to enter the field with or without a masters’ degree and allows the master’s=level counselor to have an accelerated process if they acquire clinical application experience enhancing the possibility they are both technically and philosophically prepared to work in the addiction counseling field. The requirement of the clinical application experience may be a barrier for some counselors, but the intent is to serve the best interests of the public.

Finally, there is collaboration between the Board and specific university degree programs regarding the type and quality of the courses, thus increasing the chance that counselors are effectively trained to work in the addiction counseling field. While there is not “board approval” on the content areas, programs are approved for addiction counseling. Students who graduate from these master’s degree programs may seek the LCAS license via Criteria C (outlined above). The Board maintains a current list of school programs approved for application under Criteria C on its website: http://www.ncsappb.org/certificationssteve/criteriaschools2.htm.

While North Carolina’s tiered system of licensure and credentialing allows for greater flexibility for the individual applying to work in the addiction counseling field, the system can be overwhelming and does contribute to the perception that addiction counseling is a separate profession with separate education, training, supervision and practice. Kaplan and Gladding (2011), King (2011), and Gladding, Kaplan, Linde, Mascari, and Tarvydas (2011) have advocated along with others about the importance of a unified counseling identity with common skills, training and practice (particularly among counseling specialties).

Recommendations

Overall, there appears to be a need for a recalibration of the experienced-based training required for LPCs at a national level that will enhance their entrance into the field of addiction counseling. Currently, states that do not allow for multiple entries into the field have a tiered system of entry, or an approval mandate of the type or quality of the addiction training program, that may inhibit LPCs from practicing in the addiction counseling field. In states where there are significant barriers, professional counselors (fully licensed or in-training) entering the addiction counseling profession with a graduate degree may be required to complete additional training requirements that were created during a time when the addiction counseling professional possibly possessed no more than a high school diploma or GED, and such credentialing requirements (e.g., thousands of supervised hours) were imposed as a mechanism to professionalize the field. Considering the graduate counseling degree (and associated supervised counseling hours) held by a LPC or counselor-in-training accruing licensure hours, these mandates currently seem excessive and possibly even redundant. Presently, the North Carolina system may be one of the few in the United States that provides the fewest barriers for LPCs entering the addiction counseling field.

In the following section, two remedies for the licensure/credentialing problems are presented. Although myriad issues complicate the process (e.g., counselors are called different titles in different states and different state requirements are present for licensure/credentialing as an addiction counselor), the following suggestions in some conceptualization may spur more tangible action. Any formal action should likely come from a national committee set up through the American Counseling Association (ACA) and in conjunction with the ACA addiction division, The International Association of Addictions and Offender Counselors (IAAOC), as well as CACREP, and national bodies such as the National Association of Alcoholism and Drug Abuse Counselors (NAADAC) and the International Certification and Reciprocity Consortium (IC&RC). Committee representatives from these parties could examine the coordination of experience and training. Such a committee could develop guidelines for balancing these concerns for states to use in their individual recalibration of requirements.

Possible Solution #1: Nationally Recognized Tiered System of Addiction Counselor Credentialing
One of the difficulties in terms of the current state of addiction credentialing in the U.S. is the absence of uniform national curriculum training standards in the addiction field. Also, there are two main national credentialing groups: NAADAC and the IC&RC. Issues arise because affiliation with one of the two main credentialing groups and credentialing variations between these organizations can result in issues in terms of competition and the nature of the boards and exams required for credentialing. Miller, Scarborough, Clark, Leonard, and Keziah (2010) recommend the following with regard to addiction counseling: (a) portability of credentials, (b) competition reduction between credentialing groups and state boards, (c) national standards for addiction education and training, and (d) a standardized national licensure/credentialing process. Unfortunately, these recommendations have not yet been fully implemented.

One possible solution is to develop a tiered system of addiction counseling credentials at a national level that takes into account professional experience as well as educational training. There needs to be a balance between the idea that anyone with a general counseling degree can do addiction counseling and the idea that only a few select counselors can do the work. Furthermore, this balance should be firmly based upon the ACA Ethical Code that indicates that counselors only practice within their area(s) of competence (2005).

For example, graduates of professional counseling programs (e.g., those working towards LPC status) who have taken a nationally-approved addiction counseling curriculum and have completed practicum/internship experiences could be designated as having addiction credentials in addition to the LPC (i.e., a nationally approved addiction concentration). Therefore, graduate counseling coursework that includes addiction counseling education and practical experiences would enable new graduates to move seamlessly into the addiction counseling profession without the need for additional supervision hours or educational components (i.e., beyond the required supervised counseling hours and educational components required for the LPC). The system would eliminate the need for a professional counselor to acquire an additional and separate addiction license/certification. In addition, the national standards could promote portability of credentials. This compromise works to maintain the licensed/certified addiction counseling credentials in each state while also providing the LPC with the documented expertise required for many addiction facility positions. This tiered system also could facilitate enhanced training during the process of accruing hours for licensure by better focusing the training hours upon the interface between addiction and other mental health issues as opposed to the current parallel and disparate relationship between addiction and other mental health issues.

Possible Solution #2: Nationally Recognized Addiction Counseling Concentration Curriculum
There are issues regarding standardization of training that need to be addressed within the context of academia. In essence, what are the theoretical and practical skills required of an addiction counselor nationwide? There are numerous initial places to look into the process of establishing a nationally recognized addiction counseling concentration, such as the 2009 CACREP standards for addiction counseling and the Center for Substance Abuse Treatment’s (2006) Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice. By using these (and other) standards, all counseling programs (regardless of CACREP accreditation) can follow a standard recommended education experience for students who desire the addiction credential discussed in the first possible solution. Curricular issues would likely include standalone addiction courses, infusion of addiction content into other courses, faculty expertise in the addiction area and practicum and internship hours focused on addiction counseling practice.

In addition, the NCE and National Clinical Mental Health Counselor Examination (NCMHCE) would require some recalibration to take into account the curricular changes to a professional counseling education that includes the addiction counseling concentration. One caution is that any discussion of these and other training issues may produce opposing forces within academia, the counseling profession, the addiction counseling profession, state licensing/credentialing boards (both professional counseling and addiction) and individual counselor education professors and college/university departments. Again, that is why a national committee comprised of all involved parties is necessary to navigate this challenging process.

Concluding Comments

Two students graduate with a master’s degree in counseling. Both took elective courses in their area of interest; one in mood disorders, the other in addiction, and both did an internship in a counseling setting focused on their interest area. Upon graduation, the student with an interest in mood disorders can easily be brought onto the clinical roster of a mood disorders clinic and immediately start accruing hours towards licensure. Their provisional license is all that is required during the training period. Unfortunately, the graduate with an interest in addiction may face competing licensure and/or credentialing requirements between professional and addiction counseling, mandated extra training coupled with thousands of extra supervised hours, and/or the possibility of a denial of employment without the appropriate addiction credential.

The purpose of this article is to start the dialogue on how to effectively incorporate addiction counseling into the scope of practice and accepted role of the professional counselor. We firmly believe that effective counseling focused on addiction issues requires specific and rigorous counselor training. However, we also believe the current national practice of training and credentialing for addiction counseling must change. State-by-state, burdensome (and in some instances outdated) rules and regulations are keeping countless qualified, capable, and motivated counselors from entering the addiction field. The time has come to recalibrate the rest of the counseling profession to better fit an inclusive and unifying professional counseling identity that includes addiction counseling.

References

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Keith Morgen, NCC, teaches at Centenary College, Geri Miller teaches at Appalachian State University and LoriAnn S. Stretch teaches at Walden University. The authors thank Anna Misenheimer, Executive Director of the North Carolina Substance Abuse Professional Practice Board, for serving as a reader of the early drafts of this paper. Her feedback was critical in our sharpening the preliminary focus of the paper. Correspondence can be addressed to Keith Morgen, Centenary College, 400 Jefferson Street, Box 403, Hackettstown, New Jersey, 07840, morgenk@centenarycollege.edu.

Wellness in Mental Health Agencies

Sep 1, 2014 | Article, Volume 2 - Issue 1

Jonathan H. Ohrt, Laura K. Cunningham

Burnout and impairment among professional counselors are serious concerns. Additionally, counselors’ work environments may influence their levels of wellness, impairment and burnout. This phenomenological study included the perspectives of 10 professional counselors who responded to questions about how their work environments influence their sense of wellness. Five themes emerged: (a) agency resources, (b) time management, (c) occupational hazards, (d) agency culture, and (e) individual differences. Implications for professional counselors and future research are discussed.

Keywords: professional counselors, agencies, wellness, burnout, impairment

Wellness promotion focuses on individual strengths and emphasizes holistic growth and development. For example, Myers, Sweeney and Witmer (2000) defined wellness as:

A way of life oriented towards optimal health and well-being in which body, mind, and spirit are integrated by the individual to live life more fully within the human and natural community. Ideally, it is the optimum state of health and well-being that each individual is capable of achieving. (p. 252)

The authors’ definition of wellness alludes to one’s overall well-being. Counselors often advocate holism, exploration of self and self-actualization for their clients (Cain, 2001). Such aspirations may be achieved through a holistic wellness approach (i.e., attending to intellectual, emotional, physical, occupational and spiritual well-being; Witmer & Young, 1996). Therefore, counselors view wellness as an important aspect of overall human functioning. Although this fundamental view has historically been applied to clients, professional counselors themselves now recognize that they also may benefit from a wellness focus (Maslach, 2003).

Professional counseling organizations (e.g., American Counseling Association [ACA]; American Mental Health Counselors Association [AMHCA]; National Board for Certified Counselors [NBCC]) specifically emphasize the importance of counselor wellness and impairment prevention. For example, counselors are ethically required to recognize when they are impaired. The ACA (2005) ethical standards state that “Counselors are alert to the signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing professional services when such impairment is likely to harm a client or others” (Standard C.2.g). The AMHCA (2010) ethical standards further state that counselors:

recognize that their effectiveness is dependent on their own mental and physical health. Should their involvement in any activity, or any mental, emotional, or physical health problem, compromise sound professional judgment and competency, they seek capable professional assistance to determine whether to limit, suspend, or terminate services to their clients. (Standard C.1.h)

Furthermore, the NBCC (2005) ethical standards indicate that certified counselors discontinue providing services “if the mental or physical condition of the certified counselor renders it unlikely that a professional relationship will be maintained” (Standard A.15).

The Governing Council of the ACA states that “Therapeutic impairment occurs when there is a significant negative impact on a counselor’s professional functioning which compromises client care or poses the potential for harm to the client” (Lawson & Venart, 2005, p. 3). In 2003, this council became proactive in addressing the issue of counselor wellness by creating a task force on counselor wellness and impairment. The task force seeks to educate counselors about impairment prevention, promote resources for prevention and treatment of impaired counselors and to advocate within ACA and its division to address the broader issue of counselor impairment. As a result, they have distributed information on risk factors, assessment, resources and wellness strategies. Thus, a wellness focus is essential for professional counselors to prevent impairment and provide effective counseling services to clients (Witmer & Young, 1996).

Unfortunately, professional counselors encounter multiple factors that threaten their wellness (Lawson, 2007). For instance, counselors are at a particularly high risk for burnout due to the intense and psychologically close work they do with clients (Skovholt, 2001). Although there are many definitions of burnout, Pines and Maslach (1978) described it as “a condition of physical and emotional exhaustion, involving the development of a negative self-concept, negative job attitude, and loss of concern and feelings for clients” (p. 233). Additional consequences of burnout may include low energy and fatigue, cynicism towards clients, feelings of hopelessness and being late or absent from work (Lambie, 2006). When counselors fail to address burnout it can lead to impairment. Counselors also may experience occupational hazards such as compassion or empathy fatigue and vicarious traumatization (Figley, 2002; Lawson, 2007; Stebniki, 2007). Stebniki (2007) defined empathy fatigue as a state wherein counselors are exhausted by their duties because of their constant exposure to the suffering of others, which induces feelings of hopelessness and despair. Similarly, vicarious traumatization occurs when a counselor becomes emotionally impaired due to being exposed to an accumulation of traumatic stories from multiple therapy sessions (McCann & Perlman, 1990). Therefore, the actual nature of counselors’ work is a potential threat to their ability to be well.

In addition, environmental factors in counselors’ work settings also may be detrimental to their wellness (Ducharme, Knudsen, & Roman, 2008; Knudsen, Ducharme, & Roman, 2006; Vredenburgh, Carlozzi, & Stein, 1999). In a survey that included 501 professional counselors, Lawson (2007) found that those working in community agencies experienced higher levels of burnout and compassion fatigue and vicarious traumatization than those working in private practice. Agency variables that are associated with burnout include: work overload, low remuneration, lack of control over services, unsupportive or unhealthy work peers and ineffective or punitive supervisors (Lloyd, King, & Chenoweth, 2002). For example, low remuneration is a specific concern in many Southeastern states. Lambie and Young (2007) offered the following example of a work environment in a specific agency: “an employee assistance program in this area requires its counselors to conduct sessions for 35 clients a week…the counselor in such an organization faces stresses and work hours similar to a first year lawyer in a large firm, without the mitigating effects of financial compensation” (p.101). Additional stressors stem from nonprofit agencies’ dependence on government and state funding sources to operate. Agency compliance with government and state policies to maintain funding often require administrations to focus on the “bottom line,” sometimes to the detriment of client services and employee wellness (Rupert & Morgan, 2005). Counselors who experience such stressors are at serious risk for burnout. Nevertheless, counselors are ethically expected to avoid burnout because it ultimately reduces the quality of services provided to clients, compromises client care and creates potential for harm to the clients (Lawson & Venart, 2005).

Leaders in the counseling profession strongly encourage counselors to be proactive in maintaining their own wellness and self-care. Counselors need to “fill the well” of their own sense of well-being continually, so they can “pour it out” for their clients (Shapiro, Brown, & Biegel, 2007). For example, Lawson (2007) reported that counselors who endorsed 15 highly valued career sustaining behaviors scored higher on compassion satisfaction and lower on burnout. However, despite individuals’ efforts to maintain a wellness lifestyle, the work environment may have a significant role in impeding or supporting wellness efforts. If the work environment does not allow for rejuvenation, or if wellness is not valued, employees (counselors) may become distressed and impaired (Maslach, Leiter, & Schaufeli, 2008). Witmer and Young (1996) suggested that counselor education programs promote and model wellness for their students so they can prepare themselves to make lasting changes in their life to reduce the risk of impairment. Further, if counselors create an individual sense of wellness, they can advocate for their personal well-being in the agency and redirect energies towards organization wellness (Lambie & Young, 2007).

Previous authors suggested that the agencies in which counselors work can help to create wellness environments that contribute to counselors’ overall functioning. For example, Witmer and Young (1996) posited that counselor education programs, employing organizations and regulatory boards should develop systemic preventative wellness protocols to prevent counselor impairment. Their recommendations to agencies included equally distributing the most difficult cases, providing employee assistance programs that include family counseling, adequate peer support, and supervision and team building exercises. Stokes, Henley, and Herget (2006) offered some concrete suggestions to increase wellness including healthy food options, on-site exercise facilities, smoke-free environments, break stations away from the work areas, wellness challenges, support groups, social activities, health risk assessments, self-care information, employee counseling, financial incentives for long term employees and conflict resolution training for supervisors. Further, Lambie and Young (2007) recommended that mental health agencies reduce stress and promote wellness among their employees (counselors) by reducing paperwork and cutting “red tape,” adopting a collaborative management style, improving interpersonal relationships and teamwork, developing ways to reduce role stress, helping counselors grow on the job (e.g., professional development) and improving environmental conditions.

Although the potential hazards related to counselor’s work have received some attention (Gaal, 2009), there is limited research about how counselors conceptualize their wellness in relation to the influence of their work environment. Thus, the purpose of this exploratory study was to gain a greater understanding of how counselors experience wellness and how their work environment influences their sense of wellness. A qualitative phenomenological approach was the most appropriate method to implement because we were seeking to understand the participants’ lived experience of the phenomena (Creswell, 2007). Following the phenomenological tradition, we sought to uncover the central underlying meaning of their experience by reducing data, analyzing specific statements, searching for all possible meanings and creating meaning units (Creswell, 2009). Thus, we developed two research questions. The first question was, “How do you relate to the concept of wellness as a professional counselor?” and the second question was, “How do you perceive your agency influences your sense of wellness?” The first open-ended question was designed to gain information on each of the counselors’ thoughts about wellness and how they interpret the concept. The second question was designed to obtain information about how they believe their work environment affects their sense of wellness.

Method

Research Team
The research team consisted of two counselor educators who at the time of the study were doctoral students at a university in the southeastern U.S. The first author is a Caucasian male and the second author is a Caucasian female. The first author has previous work experience in a residential treatment setting and in a secondary school setting where he experienced a high level of turnover and burnout among the staff. The second author has previous work experience in a variety of agency settings and experienced different levels of emphasis on wellness in each agency. She became interested in researching in this area to assist counselors in the field. Both authors believe a wellness focus is important for professionals in the helping professions. Furthermore, the authors believe that one’s work environment affects each counselor’s ability to be well.

Procedure
Prior to facilitating the interviews and focus groups, we obtained approval from the Institutional Review Board (IRB) to conduct the study. Next, we recruited the 10 participants through a mixture of criterion-based and snowball-sampling strategies (Teddlie & Yu, 2007). The criterion included contacting counselors or agency directors who were currently or very recently employed at mental health agencies in a southeastern state. The snowball strategy included contacting individuals from the first and second authors’ previous employers, e-mailing invites on group servers for counselors who are alumni from a university that educates counselors and through following up recommendations from other counselors. After we secured participants for the study, we obtained informed consent and confirmed dates for the interviews and focus group.

Participants
The sample included seven female and three male professional counselors whose ages ranged from 25 to 53. Seven of the counselors were Caucasian, one counselor was of Indian descent, one was Latino, and one was of Middle Eastern descent. Two participants were employed by an agency that provides palliative care by way of in-home visits. One participant was a clinical director of an adolescent residential unit. One was previously a clinical director of a domestic violence shelter and a community counseling clinic. One participant worked in a behavioral hospital while another participant worked in an inpatient facility and previously in a residential setting. Three of the participants worked in a university-based clinic. Three counselors were present in the focus group interview and seven counselors were interviewed individually on separate occasions. See Appendix for pseudonyms and demographics.

Data Collection
Demographic questionnaire. Participants completed a demographic questionnaire consisting of questions about their age, race/ethnicity, socioeconomic status, gender, years in the field and work setting prior to participating in the interviews.

Individual interviews. The second author facilitated individual, semi-structured interviews with seven of the participants. Each interview lasted between 60 and 90 minutes. The interview started with the interviewer explaining the purpose of the study and then posing the first question: “How do you relate to the concept of wellness as a professional counselor?” Once this area was completely explored between the researcher and the interviewee, the researcher posed the second question: “How do you perceive your agency impacts your sense of wellness?” The researchers used follow-up, open-ended questions to elicit significant depth for each of the questions.

Focus group. The focus group included three counselors at a university-based counseling clinic and was facilitated by the second author. Prior to the group, the researcher reminded the interviewees about confidentiality and its limitations. The group lasted approximately 90 minutes and followed the same protocol as the individual interviews.

Data Analysis
After completing the interviews, we transcribed the audio-recorded sessions. All identifying information of the participants and location of employment were altered to maintain confidentiality. Next, the first and second authors read through transcripts to find initial categories. We employed inductive coding to devise categories that represented the overall essential message that was being conveyed in each interview and the focus group. The coding categories that emerged were recorded as well as thoughts about possible relationships between the categories (Glesne, 2006). Next, using the qualitative research software ATLAS.ti (Muhr, 2004), we loaded the documents and reduced the data using a chunking method, which requires the researcher to highlight sections of the transcription and assign codes or categories. Finally, we numbered the code list and noted connections among the interviewees’ coded chunks. This procedure consists of the researcher reviewing the codes to determine if a pattern, theme or relationship occurs (Glesne, 2006).

Verification Procedures
We implemented multiple verification procedures in order to ensure the trustworthiness of the study (Creswell, 2008). First, we performed member checks with participants to verify that the themes developed captured the essence of their experience. We addressed the threat of subjectivity through revealing our positionality and attempting to view information as objectively as possible. Additionally, we employed a peer-debriefer who continuously asked the primary author questions about the study, reviewed the relationship between the data and the research questions and reviewed the accuracy of the data analysis in comparison to the transcriptions.

Findings

In this study, we conducted seven individual interviews and a focus group to explore wellness for professional counselors in various mental health agencies. From the two research questions, “How do you relate to the concept of wellness as a professional counselor?” and, “How do you perceive your agency influences your sense of wellness?” five themes emerged: (a) resources, (b) time management, (c) occupational hazards, (d) agency culture, and (e) individual differences. We discuss each theme with thick, rich descriptions.

Agency Resources
Resources within the agency appeared to be a common theme that influenced participants’ sense of wellness. Participants consistently discussed areas such as salary, staff coverage and workloads as barriers to wellness. For example, participants discussed how financial compensation affected their feelings of being valued as well as their means to do things to maintain wellness. One participant, Anne, explained, “I am a 37-year-old woman who has to live with a roommate… I’m paid half of what nurses [at the same facility] are paid for the same amount of time.” When asked how she handled being paid less than other helping professionals, Anne responded, “I commiserate with other people in the field about being underpaid and undervalued. I can’t beat my head against a wall.” Another participant, Brian, discussed how his salary often impeded his ability to engage in wellness activities:
One of the struggles I had at the beginning was pay. Because it didn’t afford me, literally, the chance to do things to take care of myself, that I wanted to do to take care of myself. So if I had a weekend I couldn’t take a trip to the beach for the weekend. It had to be a quick jaunt and back because I couldn’t afford a hotel.

Resources also included counselor workloads, specifically in terms of how many clients each counselor had to see a day to maintain reimbursement policies. Brian discussed the lack of funding and explained that agencies must work “bare bones…skeleton crew basically.” One participant, Helen, commented on her caseload:

Money can drive a lot of things. Like the choices that you could make [before reimbursement] were more about the clients and what was needed, or what you wanted to try, and then you know Medicaid or other external forces enter, and then decisions have to be made on a different basis. The number of people you would even take would change. [before Medicaid]… There was a lot of flexibility, there was no external pressure to take a certain amount of clients and then there were great conversations and the ability to envision what you should do, and there was the time do it, and there was opportunity to review what you have done, and build the relationships and get feedback on your work, and whereas now, you have put in the time and you have to make the numbers and you lose the time to create relationships or talk about what you are doing.

Similarly, Brian discussed how large caseloads and working with clients back-to-back affected his performance when stating:
Basically, it took away from the services I was able to offer. But most of all it took away from me. You know my energy level, and just across the board I wasn’t able to do all of the things you would like to do as a quality counselor like planning…often it was sort of on the cusp.

Participants described the various resources within their agencies that influenced their sense of wellness. They identified the lack of resources as a barrier to their wellness, which also affected the quality of client care and enthusiasm for their work.

Time Management
Participants discussed time constraints as barriers to their wellness and their ability to maintain optimal performance with clients. They mentioned heavy caseloads as well as administrative duties and paperwork requirements as obstacles to their wellness that also reduced the quality of client services. Additionally, they believed that there was not adequate time for other important aspects of their development, such as supervision. One participant, David, discussed his frustration with not being able to sufficiently prepare for sessions, stating, “there was kind of this disconnect with how long it took to prepare for a session to do it right, or how long it would take to do a group, and to do it right.” He further proposed that the problem may be lessened even without reducing the caseload; “maybe it’s not about the number of clients as much as, maybe it’s just about a scheduling thing too, if you could just spread these clients out, thin enough.”

Participants also discussed administrative duties such as paperwork as wellness barriers that take away from the true meaning of their work. For instance, David stated that, “what was most stressful wasn’t working one-on-one with clients, it was just the amount of paperwork and catch up. You literally feel like you’re running a marathon when you walk in the room.” Brian described the draining effects of paperwork by stating, “I found myself very disenchanted because the work that I wanted to do was with people and often I found I was just doing documentation.”

Finally, participants discussed the importance of making time for appropriate supervision and consultation in maintaining their wellness. For example, when comparing an agency where she felt greater wellness to her previous agency, Fatin stated that the difference is:
The support and the peer consultation, and the time to do that. The level of respect is much higher. There is respect for the administrator; you can approach her with feedback. [There are] high ethical standards and consulting, and the open-door policy. Just makes it so you never feel worried that you will make a mistake, because a lot of people are holding you up.

When talking about the need to differentiate client staffing from clinical supervision, Brian explained that supervisors often, “don’t do supervision with their employees…or supervision is staffing. It’s the same.” He further explained, “Ideally, you have a sit-down with a person and do supervision. So they have a chance to talk about how they’re feeling, the problems they are having, in a safe place to do that.” He conceded that time constraints often hinder this process because, “there’s a lot of crisis and things come up at any given moment. So, you have a schedule, but something trumps it very quickly.” David discussed the benefits of having a positive supervisor who made time for clinical supervision with him, stating:
It was a really important part of me so when I was getting close to burnout or when I was stressed out or in a funk or whatever, I could talk to him and that kind of supervision process which was more than just once a week for an hour. It was more of an as needed kind of a thing and was very, very helpful. It was more than just clients, so it was very helpful for personal growth and so I was totally happy to have that.

Participants described time constraints as significant barriers to their wellness and consequently their ability to provide the best care to clients. However, they also discussed how access to human resources (e.g., supervisors) can positively influence their sense of wellness and development.

Occupational Hazards
A second theme that emerged was occupational hazards. This theme involved the psychologically intense characteristics of the work itself that threaten wellness and included concepts such as empathy fatigue, vicarious traumatization, depersonalization, lack of meaning and wounded healing. Participants discussed the challenges of helping difficult clients while attempting to maintain their own wellness.

One participant, Peter, discussed his struggle to not personally take on too much of the clients’ concerns. He stated that:
I think the biggest challenge that I’ve faced, and I can’t say this challenge is gone to this day, is that I took on a lot of my clients’ stuff. You know, you hear as a counselor you develop empathy for your clients with their challenges and their stories and experiences can be very traumatic and you know can be very impactful. So I think the biggest thing that I had that was impactful is I feel I would take on a lot and I would feel a lot more of what others struggled to face, as opposed to be there in the moment and then walk away from it… That was something, if you think about wellness as this bubble around me and that bubble keeps me from taking on too much of people’s stuff and keeps me mentally and personally safe, then my wellness was gone, the bubble was gone.

Another participant, Anne, discussed the burden that builds when occupational hazards are ignored by the agency and/or supervisors:
A lot of vicarious trauma, grief trauma left unprocessed. When a patient dies it is like—okay next. My administrator actually said that we assume you are coming in with the clinical skills and you will take care of yourself with that. There is no facilitative process or it is not acknowledged in our agency—that it could be happening to us as counselors. We are not given a moment to have that time. [The administrators say] be sure your taking care of yourselves out there—it is sort of you take care of yourself out there.

Yet another participant, David, discussed how the quick client turnaround in the inpatient facility led him to question the value and meaning in his work when he stated:
It was a lot of treat and street, so in other words they come in, you’re basically working on discharge paperwork from the first day you meet them, so you are already thinking about where they need to go…I mean they had lost everyone else in their lives and they felt isolated and alone, so the relationship was incredibly crucial and I think most people would agree that the relationship is the most important part of the counseling process, and you can’t build a relationship if basically when they are coming in you are looking at the chart trying to get the form filled out and trying to get them out the door because either insurance won’t pay or it’s a bed that needs to be emptied out so it can be filled with someone who can maybe last longer.

David went on to discuss his resulting emotions:
There is almost like this shame/guilt you are kind of feeling or struggling with where you feel like you can’t seem to get anywhere, or I am not doing anything, or what am I doing…Am I helping?…Does this matter? And I think that once you have lost that meaning in your work, that passion for what you are doing then it just kind of all, it’s a sinking ship at that point and wellness is just kind of out the window, you just get frustrated.

Participants also discussed the potential setbacks that can occur when professional counselors over-identify with their clients (e.g., wounded healer). Helen comments on how unfinished business unfolds in an agency:
It isn’t quite a straight line. In other words, it is whatever the underlying energy of the agency that draws people in. If people come and then they go, they may not relate to it, but those people who stay for a while, for [more than] three years, that is an issue. You have to constantly reflect back ‘why am I here?’ What is it about this job that has pulled me here and what is it that I need to learn. I think you could stay in the field and never reflect or heal from anything.

One participant, Romie, who also does clinical supervision, discussed the importance of processing empathy fatigue and often spends her time processing the “heaviness of the work.” She responded that “managing the occupational hazards is a matter of keeping the counselors happy…if they are happy and they feel good, and if they feel rewarded in their work they are going to produce and stay.”

Participants discussed that intense and emotionally close work they do with clients is a potential barrier to their wellness. They alluded to the need to set personal boundaries while still finding meaning in their work. Additionally, participants discussed needing time to process the emotions that may arise.

Agency Culture
The next theme that emerged was agency culture. The participants expressed that the messages the administration convey as well as the morale of the agency often influence their sense of wellness. Participants discussed wanting to feel valued and respected by their agency. Sarita stated that she felt valued by her agency. When she was asked how that message was conveyed to her, she replied:
I have been made to feel okay about my developmental level, just…you know…. normalizing my learning level. Everyone can speak up about what their opinion is, even if they are new, you feel part of the team. You know you have been selected for a reason to work here. They have confidence in you and they remind you of that.

Romie paralleled Sarita’s statement:
I happen to believe that wellness comes from the agency itself through feeling valued as an employee, [when] someone hears you in the company and that you have a voice. Having a sense that you say things and that they are respected. Feeling like that if there is anything that the company could do to help, they would. People feel happier, more rewarded and better. What that is in an agency I think is different for each one. It is more of a relationship and personal style.

Brian discussed the value when agencies respect the employees’ need to take care of their family:
Most of the programs that I’ve been in—they are more than willing to let you take care of your family as long as you are doing your job. That’s been the biggest piece I think from a wellness standpoint is the understanding of that from the top.

Participants also discussed how the overall morale of the agency and coworker relationships influence their sense of wellness. For example, Helen commented on how one of her previous places of employment communicated messages of wellness through promoting coworker relationships:
A lot that has to do with the attitude with the people running the place, what they valued, that fact they were invested in relationships. They realized we have to have connection with each other in order to give support to do the work here.

Similarly, Peter discussed how he believed staff cohesion plays a role in wellness:
My experience is that when there is a sense of cohesion, a sense of togetherness and teamwork, I think that people get along better and there’s a natural well, not well, but a natural happiness that goes along with it. My experience, where I’ve had the most stable or happy wellness have been places that encourage staff meals or having staff getaways, or doing events that brought the staff together to enjoy one another…not to work, but just to be around one another and enjoy one another and support one another.

Participants also discussed how agency directors and supervisors directly advocate for self-care. Catherine commented about self-care and wellness:
There is an encouragement for self-care. It is double-binded, you have to get your stuff done, but you know it is like it is Friday, let’s go home. They encourage each other to work less and have fun. Other places (agencies) had more pressure to get it done. There is a consciousness of balance.

Peter also discussed positive feelings when his supervisor supported his self-care efforts, “There was one day there was an accumulation of things, a combination of feeling sick, but also in the middle of a stressful time…he said go home, have a great day. So he was in support of wellness.” Peter continued, “he understood the job is not always easy and can bring on a lot of stress and he was willing to let us take care of ourselves if we needed to.”

Overall, when the agency promoted the respect and value of professional counselors and encouraged counselors to have a voice and affect change, it promoted the counselors’ own sense of wellness. Furthermore, sensing an investment in work relationships and promoting a work-life balance influenced the wellness of these counselors.

Individual Differences
The final theme that emerged involved the different perspectives of the participants and how that influenced their feelings of wellness. Two participants from the same agency held very different feelings about how their agencies influenced their sense of wellness. Jill felt very positive about her agency and spoke of the many financial incentives and freedoms allotted and that the agency’s independent scheduling fit her. Anne also mentioned the same financial incentives, but believed that she received negative mixed messages and that her wellness was being negatively affected by the same agency. Conversely, Jill, who felt positive towards her agency, noted, “No one had to tell me to take care of myself.” David also expressed that wellness is often left up to the individual; when speaking about one of his agencies he stated, “it wasn’t really like it was a place of wellness. Wellness is something that happened, or self-care happened long after you left.” Romie responded about her intentionality with wellness:

Personally, what I do is many things. I exercise; I make sure I get plenty of sleep. I take time for myself when I need to. I will do yoga and meditate and do a lot of reading and I am highly spiritual. I have a wonderful home-life, a very supportive love-mate in my life. I am really in a good place.

Throughout the interviews, the participants discussed very different values in terms of their wellness. Some of the participants mentioned spiritual practice and journaling as being important in maintaining wellness. Others expressed time with family as being most important, whereas others discussed setting clear boundaries or finding meaning in their work.

Other participants discussed how wellness initiatives within their agencies often seemed inconvenient to them. When talking about a discounted gym membership that was offered, Brian viewed the offer as superficial, saying “in my experience, most of what they offer in terms of wellness is, in my experience, is somewhat superficial.” He further stated, “Very few people are able to utilize the gym membership because of the hours they work and where it’s located and the cost is still too high for the employees.” Peter discussed the positives and negatives of a wellness initiative:

The book was a 40 week-by-week event where you learned about wellness…physical, mental, spiritual; all these different components. The problem was they had these events that took place scattered all over the district and so for anyone to attend them, they would have to drive half an hour to 45 minutes to attend them and which if you’re trying to have a good basis for wellness, then having people drive 45 minutes after a long day of work is not a good place to start for that.

However, Peter acknowledged that this may be only his view, stating:

The planning of the events I felt could have been better. And of course, not to say other people didn’t go to them and find them successful, but it was just my experience of do I go home or drive 45 minutes then attend a 2-hour meeting on nutrition. I felt like going home was more beneficial for me at that time.

These statements reveal that professional counselors may value different things related to wellness. Other counselors in Brian or Peter’s agency may have appreciated the wellness initiatives.

The participants responded differently in terms of wellness values. One cannot overlook how different individuals will react to the stress of being a counselor. Knowing what type of atmosphere is the best fit for the counselor’s personality and interests can factor in overall well-being. Romie commented, “It is good to know what kind of atmosphere is the best fit for you, if you love it, then that is your wellness, if you don’t, then nothing you do will ever click.”

Discussion

The findings in this study suggest that the environment in which the participants work may play an important role in their overall wellness. This finding is consistent with previous research that suggested agencies directly affect well-being and satisfaction of counselors (Knudsen, Ducharme, & Roman, 2006; Lloyd, King, & Chenowith, 2002; Maslach, 1982, 1986). Participants in this study discussed lack of resources as potential barriers to wellness including unsatisfactory salaries, large caseloads, heavy paperwork and lack of supervision. This finding is consistent with previous research that maintaining caseloads above 15 per week increases chances of occupational hazards (Trippany, Kress, & Wilcoxon, 2004). Additionally, counselors have reported increased salaries as directly relating to their wellness (Bell et al., 2003), and comprised a major setback for counselors in this study. Further, our findings support previous research that poor supervision, little to no peer-to-peer conversations, low salaries, heavy paperwork, lack of control over services and managed care influences are all correlated with decreased wellness and increased likelihood of burnout (Ackerly, Burnell, Holder, & Kurdek, 1998; Gaal, 2009). Clients deserve to receive the best care possible in agencies; therefore, funding sources should be aware of what counselors specifically need to function at their best. However, it is the responsibility of all counseling professionals to organize and advocate for gains such as salary increases, caseload limits, qualified supervisors, and funding for wellness activities. Advocating through joining local, state and national organizations is one way to work toward these goals, as organizations stay abreast of current legislative changes and locate opportunities to improve the counseling profession.

The finding in this study that occupational hazards influenced counselors’ wellness is consistent with previous literature (Skovholt, 2001; Stebnicki, 2007). Additionally, participants in this study discussed the importance of supervision and processing time in order to work through such hazards. This finding reinforces the importance of supportive environments where counselors can obtain peer support and adequate supervision. Consequently, counselors’ wellness may be increased when agencies have consistent treatment-team meetings and supervision sessions, where counselors have an opportunity to process their work with others and obtain consultation. Additionally, supervisors should have appropriate training in supervision to ensure that a quality supervision experience occurs.

Participants in this study expressed that the culture of the agency influenced their sense of wellness. Factors that positively influenced them included feeling valued by administrators, feeling that they had a voice, being respected and feeling cohesion with coworkers. Agencies may assist in counselor wellness by developing employee committees that provide a forum for counselors to express concerns and provide recommendations to the agency. This may help to foster a sense of value among the counselors when their perspectives are heard. Additionally, employee committees may serve to organize wellness activities and professional development opportunities for the staff, encourage peer support and cohesion, and organize advocacy efforts.

Implications for Professional Counselors

The findings in this study suggest that one’s wellness is very personal and is heavily influenced by personally salient values. In this study, the participants mentioned different wellness values. Individually, counselors can develop holistic wellness plans and gain self-knowledge concerning what aids them in performing at their best, while considering the realities of their work environment and resources that are available to them. Counselor educators can model wellness activities and highlight the resilience that stems from a comprehensive wellness plan so new professionals are prepared to attend to wellness when they enter the field. Counselor educators also should educate counselor trainees as to the realities of agency work (e.g., caseloads, paperwork, difficult clients) so they can prepare themselves mentally to enter the system. Counselors and clinical directors can vocalize ways to enhance the well-being of the atmosphere in the agencies by advocating for reasonable caseloads and encouraging wellness days for the staff (e.g., days where the entire staff rejuvenates together through team building or other enjoyable workshops or activities). Given that funding is often mentioned as a factor that influences wellness, agencies and individual counselors may benefit from learning how to secure various types of grants to assist with resources (e.g., additional staff, technology, wellness initiatives). Additionally, agencies may benefit from developing ad-hoc committees that will evaluate processes and procedures (e.g., paperwork, documentation) to potentially reduce workloads and ensure that counselors’ time is used efficiently. Finally, counselors should be proactive in seeking out further training in wellness, self-care and burnout prevention through conferences (e.g., ACA, AMHCA) or other professional development opportunities, and should advocate that their agencies provide these types of trainings.

Limitations and Future Research

Despite the depth and richness of information obtained in this exploratory study, there are multiple limitations. First, we did not spend prolonged time in the field in order to gather further data about wellness practices through observation or document analysis. Future researchers may benefit from direct observations of wellness practices in the natural setting. Additionally, we only utilized one source of data for interpretation (i.e., interview/focus group) which may have affected the depth of information obtained. Finally, although generalizability is not a major goal of qualitative research, readers should be mindful that the findings may not be representative of other counselors in different settings.

Future researchers could explore wellness experiences of more diverse racial/ethnic groups and those at various income levels. Additional studies may include more prolonged engagement in the field by the researcher in order to make observations about wellness practices as well as multiple data sources (e.g., observations, questionnaires, reflective journals). Other studies may include agencies that are currently implementing specific wellness practices in order to evaluate their effect on counselor wellness. Finally, future researchers may benefit from identifying particular agencies that maintain effective wellness practices and exploring them through in-depth analysis.

Conclusion

Counselor wellness is an important aspect of ensuring effective and ethical services to clients (ACA, 2010; NBCC, 2005). The findings in this study provide some initial information about the various aspects of wellness that may be influenced by professional counselors’ work environment. Although agencies may not be able to immediately change all aspects of the work environment (e.g., salary, caseloads, work hours), other aspects such as agency culture and adequate supervision are easier to address. Counselors and clinical directors may benefit from evaluating their current wellness practices through staff questionnaires, focus groups, or needs’ assessments. Attending to professional counselors’ wellness needs may help to improve the morale in the agency, help counselors avoid burnout, and ensure more quality care for clients.

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Jonathan H. Ohrt is an Assistant Professor at the University of North Texas. Laura K. Cunningham, NCC, is an Assistant
Professor at Argosy University. Correspondence can be addressed to Jonathan H. Ohrt, University of North Texas, 1155 Union Circle #310829, Denton, TX 76203, jonathan.ohrt@unt.edu.

Appendix
Participant Demographics

Name (pseudonyms were assigned) Type of Facility Gender Age Race Experience in Field Interview Method

Anne
Palliative Care Facility
Female

37

Caucasian

11 Years
Individual

Jill
Palliative Care Facility Female 40 Caucasian 2 Years Individual
Helen

Clinical Director for Domestic Violence Shelter and Community Counseling Center Female 45 Caucasian 13 Years Individual

Romie

Clinical Director of an Adolescent Residential unit
Female 53 Caucasian 20 Years Individual
Fatin
University Counselor
Female 27 Caucasian/Middle Eastern 1 Year Focus Group
Catherine

University Counselor
Female 28 Caucasian 9 Months Focus Group
Sarita
University Counselor
Female 33 East Indian 1 Year Focus Group
David Behavioral Hospital Male 29 Latino 3 Years Individual
Peter Inpatient & Residential Male 28 Caucasian 3 Years Individual
Brian Adolescent Residential Male 38 Caucasian 13 Years Individual