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Why Your Students Need to Know about the Mental Health Field
By Phyllis Nasta, LPC, LMT

It's inevitable. At some point, wellness practitioners and fitness professionals all encounter clients who talk about their problems.  Clients may be up front about it by saying something like "I'm having trouble getting over my mom's death and it's been over a year" or they may weave it into the conversation by frequently complaining about their lives, or generalizing about groups of people, as in "my supervisor takes advantage of me but that's how all managers are." Or they may have an emotional release during the session and get in touch with memories or feelings that can be frightening to them.
    It's helpful for your students to have an overview of why they shouldn't take on the role of a counselor, and how to handle it when their clients express their with mental health issues. Students should learn to identify the boundaries between professional counseling and the kinds of communication that are appropriate in their field. Consider the following scenario.
    Brittany has a long-term client, Erica, whose son was stationed overseas. Erica worried that he would not come home safely but she worked on keeping her stress level down and her most effective method was getting weekly massage from Brittany. During the massages Erica would talk a bit about her worries and Brittany listened and gave supportive feedback or advice, but those talks never consumed the entire hour of the massage. However, after a year in Iraq, Erica's son was badly wounded and her daughter-in-law and grandson came to live with her while he was in the hospital. Erica began to have insomnia, and while on the massage table she sometimes talked obsessively, and couldn't quiet down. She kept reinforcing Brittany's involvement by saying "I couldn't get through this without you."
    Brittany was feeling uncomfortable. She worried about Erica between sessions and she felt overwhelmed by Erica's problems, but didn't know what to do.

    Brittany's situation is not unique. You can help your students learn to identify mental health symptoms and know what to do when they need to refer a client for professional help.

Fundamental Principles

People are likely to place an enormous amount of trust in professionals who provide one-on-one attention and care. This is especially true of treatments such as massage and acupuncture where client/therapist bonding is increased by the power of touch which  deepens relationships. Clients may open up about things that they don't talk about to anyone else. This can put an unrealistic burden on professionals, even when they consciously try to maintain good boundaries. Clients may avoid seeking mental health help because:
  • They know that they will be confronted on their own issues.
  • They may see counseling as an admission of weakness, or of being "crazy."
  • They may worry that counseling will bring up painful material.
Hence, it is easier to talk to the professional whose job is to make them feel good. However, if the practitioners allow themselves to migrate into a counseling role they may cause the client harm because that client doesn't seek appropriate treatment, and they expose themselves to legal vulnerability should anything happen to the client and it becomes apparent that s/he should have been referred for mental health treatment.

Practitioners' Responses
Practitioners should know themselves and their own tolerance for listening to clients
  talk about psychological problems. If they start to feel uneasy or overwhelmed, it's  time to limit their involvement. Or, if the opposite happens, i.e., they find themselves increasing their talk and analyzing problems,then they need to stop and look at the potential for hurting the client. How can they do this?
  • They can scale back their own verbal responses and thereby decrease the client's talking. This behavioral technique is called "extinguishing."
  • They can talk directly to the client and ask if s/he has considered counseling and tell the client that counseling might help the problem.  
  • They can be subtle about it and say something like, "when I've faced things like that I've gone for counseling and it has helped a lot."
If  clients express any of the following symptoms, the practitioner should be direct in letting the client know that mental health treatment is strongly recommended. In some cases it's appropriate to tell the client that they can't continue working together unless mental health treatment is initiated.
  • Suicidal or homicidal thought or express expressions.
  • Recall of sexual or physical abuse as a child, that has not been dealt with therapeutically.
  • Psychotic symptoms such as hallucinations, delusions or bizarre behavior, or severe mood swings.
  • Severe depression or anxiety that lasts for more than a few weeks and interferes with functioning.
  • Active addictions causing serious dysfunction in the client's life, or active domestic violence.
Providers and Resources
Professionals should have a cursory knowledge the types of mental health providers and local resources.
  • Psychiatrists are Medical Doctors who diagnose and treat mental disorders and often prescribe medication for depression, anxiety, and psychotic disorders.
  • Psychologists, Clinical Counselors and Clinical Social Workers all provide diagnosis and treatment of mental disorders, the treatment being psychological counseling (other services such as testing and consulting are also provided by these professionals). In a very few states, Psychologists can also prescribe medication for mental disorders.
  • Most every community has Crisis Help Lines for  counseling and suicide prevention.      
For Crisis Help Lines and Information and Referral simply go to your web browser, type in the term and the name of your city (e.g., Crisis Help Line, Tucson). 
  • Many health insurance plans provide coverage for mental health counseling. Suggest that the client call his provider and get the names of contracted therapists.
  • Anyone can go to an urgent care or emergency department for evaluation for suicidal or homicidal ideas and behavior.
  • Call 911 in the event of imminent danger to self      or others. For instance, if a client says, "I'm going to kill myself or someone else." If you have the address, you can even ask police to do a "˜welfare check' on someone whom you believe to be in danger of hurting self or others.
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Coming Soon! A 6-hour home-study course by Phyllis Nasta Ethics and Personal Growth: The Mental Health Angle The Who, What, Where, How and Why of Mental Health Providers.

Classroom Caper
Classroom Caper
Title: Mental Health Boundaries

Objective: Students explore the impact of mental health issues and identify resources.

Procedure: Have students write about a time when they had a client who talked a lot about his/her psychological and emotional problems. If they can't think of a client, suggest that they think of someone else, such as a co-worker, friend or family member who did the same thing.
    Next, ask them to write down how it made them feel when it first occurred, and then as time progressed. What did they notice about their own reactions?

Small Group Discussion: Students share their experiences. Include questions, such as: What did they do about the situation? What did they want to do? With hindsight, do they wish they'd done anything else?

Full Class Discussion:
What were some of the key points from the small group discussions? What did you learn from how others dealt with their situations? What resources would have been helpful?

Materials Required:

Approximate Time Required:
30-60 minutes.

Source: Phyllis Nasta
Title: Who's Who in Mental Health

Objective: Students explore the impact of mental health issues and identify resources.

Procedure: Divide students into 4 groups. Have each group look up their state's definitions, rules and laws that pertain to one of the following mental health professionals: Licensed Professional Counselor, Licensed Social Worker, Licensed Psychologist, Psychiatrist. Also have them identify the training, degrees, and supervision required to become licensed. When done, each group reports their findings to the class.

Note: This can be done as a homework assignment instead of in class.

What did you learn from this activity? Where are the areas that overlap? How can you assemble a referral list of appropriate mental health professionals?

Materials Required:
Computers and internet access.

Approximate Time Required:
30-60 minutes.

Source: Phyllis Nasta
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Current Survey Results from Last Months Survey
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Does your school provide in-service training on teaching skills?

How many hours does your school allot for teaching Ethics?
< 10 - 25.8%
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51-60 - 6.5%
61-99 - 3.2%

Total number = 31

Cherie was elected to the Alliance for Massage Therapy Education Board of Directors. She is very excited about contributing to the profession, particularly in the area of developing standards that guide and inform the effective teaching of massage therapy. The Alliance is the voice, advocate and resource for the community of massage therapy schools and educators. Please join us!
Mental Health Resources
American Psychiatric Association
This organization of psychiatrists works together to ensure humane care and effective treatment for all persons with mental disorders, including mental retardation and substance-related disorders. It is the voice and conscience of modern psychiatry. Its vision is a society that has available, accessible quality psychiatric diagnosis and treatment.

Healthy Minds"”Healthy Lives
The American Psychiatric Association's online resource for anyone seeking mental health information. Here you find information on many common mental health concerns, including warning signs of mental disorders, treatment options and preventive measures. 

American Psychological Association
A scientific and professional organization whose mission is to advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives.

National Association of School Psychologists   
NASP represents school psychology and supports school psychologists to enhance the learning and mental health of all children and youth.

American Counseling Association  
This not-for-profit, professional and educational organization is dedicated to the growth and enhancement of the counseling profession. Its mission is to enhance the quality of life in society by promoting the development of professional counselors, advancing the counseling profession, and using the profession and practice of counseling to promote respect for human dignity and diversity.

National Association of Social Workers   
This organization works to enhance the professional growth and development of its members, to create and maintain professional standards, and to advance sound social policies.

American School Counselor Association    
The ASCA supports school counselors' efforts to help students focus on academic, personal/social and career development so they achieve success in school and are prepared to lead fulfilling lives as responsible members of society. It provides professional development, publications and other resources, research and advocacy to school counselors around the globe.

Innovators Guide
This site provides links to each state's professional licensing requirements.
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