The newsletter of the
International Trauma Training Institute (ITTI)
Mike Dubi, Ed.D., LMHC, Editor
Jeanne Thomas, MBA, Associate Editor
Spring 2019, Vol. 2, No. 2

I'm looking forward to attending the annual conference of the American Counseling Association in New Orleans, March 28-31, 2019. I have been going to the annual conferences for the past 25 years and always look forward to making new friends and catching up with old friends, former students and colleagues. I am also on the lookout for new ideas and techniques. Please say hi in NOLA - I would love to chat.

If you enjoy traveling and would like to visit historic and beautiful Vienna (not far from Prague and Budapest!) as a presenter and/or attendee, why not plan on going to the annual conference of the European Branch of the American Counseling Association, September 27-28, 2019? You'll meet mental health professionals from all over Europe, many of them Americans working abroad. See call for presenters below for more details.

ITTI is in the process of developing a series of advanced-level trainings in Trauma, Forensics and Addictions. We are excited about these trainings and will keep you updated. Our goal is to be up and running with them by the summer.

Best wishes to you all,

Mike Dubi, ITTI, President
Digital Online Training Mentoring Learning Education Browsing Concept
beginning on
March 11, 2019.

To see course descriptions and to register, click this link:


Critical Thinking, Cultural Competence, Social Justice and You:
You Are What You Eat 

Charles L. Alexander, Psy.D.
This article focuses on the interesting and often times elusive concept of Cultural Competence. However, much of the discourse includes the topics of Critical Thinking and Social Justice. This is necessary because the contemplation and appreciation for the culture and life experiences of others requires critical thinking. However, the resulting increased awareness is not enough. The purpose of having Cultural Competence is for the person to employ their heightened awareness in the service of others. Typically, in America we think of or find the cultural other as a member of a marginalized group. Hence, the culturally competent individual is one who thinks critically about strengths and needs of the cultural other within an intolerant society that often punishes difference. In short, it is not enough to know. The Culturally Competent must advocate on behalf of the cultural other. They must work to secure equity, i.e. social justice, for the marginalized. This article is primarily intended for those who are employed or volunteer in the helping professions, such as education, criminal justice, human services, mental health, nursing, public health, etc. However, most of this information will be beneficial to anyone simply seeking to be a well-informed, culturally competent and socially engaged citizen.

First I will define a few terms. For the sake of this article let us think of Critical Thinking as self-guided, self-disciplined thinking which attempts to reason at the highest level of quality in a fair-minded way (Elder, 2007).

For Cultural Competency I rely on the definition set forth by the Centers for Disease Control which state:

Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. 'Culture' refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. 'Competence' implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.

Social Justice is a term that has been defined and employed in various ways since the 19th Century. The origins and original use are beyond the scope of this article, however, I will use the Adams et al., 2007, definition which is as follows:

“The goal of social justice is full and equal participation of all groups in a society that is mutually shaped to meet their needs. Social justice includes a vision of society in which the distribution of resources is equitable, and all members are physically and psychologically safe and secure.”

Having defined the contextual foundational principles, I now outline the skills of a helping professional. As I recall, basic helping skills include the following:

  • Empathy - accurately sensing the client's world and communicating that understanding
  • Genuineness - self-awareness, honesty and openness
  • Unconditional positive regard - accepting and valuing the client as a unique and worthwhile person, i.e. being nonjudgmental
  • Active listening - listening carefully, empathetically and attentively 
  • Reflecting - mirroring the thoughts and feelings to demonstrate active listening and encourage the client to continue speaking
  • Restating - repeating verbatim the main thought or feeling expressed by the client
  • Paraphrasing - stating, in your own words, the main thought or feeling expressed by the client
  • Summarizing - summarizing, in your words, a set of thought or feelings expressed by the client
  • Open-ended questioning - Asking questions that require more than a minimal or one-word response by the client.
  • Problem solving - assist with problem identification, options, strategies and implementation

Equipped with basic skills, as well as with contextual and foundational principles, we now need a circumstance or situation toward which they can be applied. For that, I will use an article I selected because it lends itself to a relevant illustration. Food Companies Spend More on TV Ads Targeting Black Shoppers . And before we continue, I want to add a couple more definitions: bias and stigma. For the sake of time I use Merriam-Webster’s definitions which define bias as:

  • An inclination of temperament or outlook, especially: a personal and sometimes unreasoned judgment (PREJUDICE)

  • An instance of such Prejudice is stigma as a mark of shame or discredit (STAIN)

  • STAIN is an identifying mark or characteristic specifically: a specific diagnostic sign of a disease

In short, the article states that whereas food companies are generally spending less, they are spending more money on ads directed at African American consumers. Note, I tend to use Black and African American interchangeably. This may not necessarily be the case with all persons with whom you come in contact. But I suggest you ask the individuals with whom you communicate how she or he identifies and prefers to be identified. OK back to the article. The authors go on to say “ chains and packaged food companies increased their spending for the demographic group during the period from 2013 to 2017.” And due to the increase, “Black teenagers saw more than twice as many ads for unhealthy foods compared to white teens in 2017,” which could contribute to the increase in rates of obesity, diabetes and hypertension.

As a helper, what is your first inclination when in front of you stands a chubby, pudgy, chunky, fat or obese Brown child, youth or adolescent in need of assistance? Well according to a study cited by the NIMH, if you are a health care provider, there is a high probability that you will “hold strong negative attitudes and stereotypes about people with obesity” and “such attitudes influence person-perceptions, judgment, interpersonal behavior and decision-making” which “impact the care they provide.” As a result, “Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity.” Hence contributing factors to health maladies.

Or what if you are a teacher and that same chubby, pudgy, chunky, fat or obese Brown child, youth or adolescent is in your class? Research suggests “Teachers perceive overweight students to be untidy, overly emotional, less likely to succeed at work, and more likely to have family problems compared with their normal weight peers”.

Perhaps you are a police office and that same chubby, pudgy, chunky, fat or obese Brown child, youth or adolescent is present but may or not be involved in a situation to which you are called? Well guess what? According to research conducted by American Psychological Association, “Black boys as young as 10…are instead more likely to be mistaken as older, be perceived as guilty and face police violence if accused of a crime”.

Or what if you are not a healthcare professional, teacher or police officer. What if you’re just a female undergraduate student? Based upon findings cited in the same APA article, you may consider “ children significantly less innocent than other children in every age group beginning at age 10” and/or “older and less innocent”. Granted the APA article does not expressly identify obesity as a factor in the thinking of the officers or students but it does say, consistent with multiple data sources, that Black children are perceived as “older” and it is not a stretch to assume that some portion of the bias thought process is impacted by the size (perception of body image) in addition to skin color.

But as a conscientious helper, at some point during or after your interaction with our previously described young person, you become aware that your biased and stigmatizing thoughts are incongruent with your self-perception of being empathetic and genuine. You recognize your thoughts inhibit your ability to demonstrate unconditional positive regard, so you begin to employ critical thinking. As a result, you consider that this young person’s physical presentation could be more a reflection of her or his geographic circumstance or a situational factor than any particular personal/internal or dispositional factor. For example, perhaps the youth lives in a family in which food insecurity is an issue. defines food insecurity as the disruption of food intake or eating patterns because of lack of money and other resources.

The United Stated Department of Agriculture divides food insecurity into two categories:

  • Low food security: “Reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake.”
  • Very low food security: “Reports of multiple indications of disrupted eating patterns and reduced food intake.”

According to data cited on “black non-Hispanic households were nearly 2 times more likely to be food insecure than the national average (22.5% versus 12.3%, respectively). As you dig deeper you may find that the geographic circumstance could be regional or a more proximal neighborhood issue (see ). Referring again to, you find that, “Predominantly black and Hispanic neighborhoods have fewer full-service supermarkets than predominantly white and non-Hispanic neighborhoods” and further that communities that lack “affordable and nutritious food” are known as “food deserts”. The USDA defines what's considered a food desert. To qualify as a “low-access community,” at least 500 people and/or at least 33 percent of the census tract's population must reside more than one mile from a supermarket or large grocery store (for rural census tracts, the distance is more than 10 miles).

Then as you are utilizing your active listening skills and making open ended inquiries to the young person (as well as to yourself) you realize this person resides in a food desert. Further intrigued you learn from multiple sources that although food deserts lack whole food providers, they are full of quick marts, liquor stores and fast food outlets offering whole food substitutes consisting of nothing more than sugar and fat.

Having considered the world of the youth, the who, where, when, what and the why, that defines her or his particular circumstance, you have an amazing epiphany and you realize as stated by Jennifer Harris, lead author of the aforementioned research:

“They’re really focusing on products that can harm kids’ health, and they’re focusing on black networks…Given higher rates of obesity, diabetes and hypertension in black families, they’re basically contributing to those diseases.”

As a result of a change or an expansion in the information you consume, your thinking becomes more in-depth, intentional and informed, i.e. critical. Thus, you realize your cultural reference points are also broadening and your appreciation for the experience of the individual before you is growing. At this time, you have another revelation. This chubby, pudgy, chunky, fat or obese Brown child, youth or adolescent is not so because she or he is labile, unmotivated, violent and dumb. It is highly possible and quite likely, depending upon where this interaction occurs, that she or he may be obese because she or he is being targeted by Food companies and the victim of “TV marketing aimed at black Americans”, and as a result, she or he is constantly bombarded with ads for unhealthy foods. Then as you reflect on all you have heard and seen, you scratch your head in fear, shame and doubt as you acknowledge that this is an example of exploitation in the service of corporate greed and governmental indifference and therefore a matter of social justice. With more clarity and insight, you are better equipped to initiate the problem-solving process. 

So, just as our health is dependent upon consumption of nutritious food, exercise and healthy living, our ability to help is predicated upon consumption of factual data that informs critical thinking that fosters cultural competency and prepares us to be advocates for social justice.

3.       Adams, M. (Editor), Bell, L. A., (Editor), Griffin, P. (Editor). Teaching for diversity and social justice. Published April 7, 2007, Routledge
4.       Phelan, S. M.; Burgess D. J.; Yeazel M. W.; Hellerstedt, W. L.; Griffin, J. M., and van Ryn, M., Impact of weight bias and stigma on quality of care and outcomes for patients with obesity 2015 Apr; 16(4): 319–326. Published online 2015 Mar 5. doi: 10.1111/obr.12266
5.       Neumark-Sztainer D., Story M., Harris T. Beliefs and attitudes about obesity among teachers and school health care providers working with adolescents. J Nutr Educ 1999; 31 (1) :3-9.
6.       Goff, P. A.; Matthew, C. J.; Allison, B.; Di Leone, L., “The essence of innocence: consequences of dehumanizing black children,” Journal of Personality and Social Psychology. Published Feb. 24, 2014

About the Author
Charles Larson Alexander, Psy.D., is a licensed clinical psychologist with a record of success in program development and implementation in clinical, educational and organizational environments. A skilled clinician, he is an equally talented therapist and diagnostician. Dr. Alexander has a solid background in planning and executing organizational goals. He is a hands-on manager with highly developed negotiation skills and experience cultivating strategic partnerships. Further, Dr. Alexander is a persuasive communicator with well-developed presentation and engagement skills that enable him
to develop productive relationships with colleagues, clients and staff
at all levels.
Currently, Dr. Alexander provides psychological consultation in diverse settings, such as community medical centers, elementary schools, psychiatric hospitals as well as the Department of Children and Family Service (DCFS). Apart from the hospitals, Dr. Alexander works extensively with families to enhance quality of life in the home, community, career and school. Dr. Alexander is committed to addressing the clinical needs of traditionally underserved populations. This is evident by the fact that 95% of his adult and child clientele are recipients of Medicare and/or Medicaid. In keeping with his value of community service, Dr. Alexander seeks and welcomes opportunities to do the most for those who have the least. 
Cheryl Paulhus, Ed.D., LPC, CETP, RYT, has been working in the Mental Health field for the past 30 years in numerous capacities clinically and administratively. Dr. Paulhus holds a Doctorate in Counseling Psychology from Argosy University, American School of Professional Psychology, Sarasota, Florida. She is licensed to practice in the state of Texas. She is a Certified Expert Trauma Professional through the International Association of Trauma Professionals.

In addition to mental health expertise, Cheryl has a professional dance background and has created Dance and Movement programs for Community Mental Health and Psychiatric Inpatient settings over the span of her mental health career. She holds a Bachelor of Science in Dance from Skidmore College, Saratoga Springs, New York. She was classically trained by members of the New York City Ballet Company, American Ballet Theatre and had extensive training with the Martha Graham Company and members of the Paul Taylor Company, Jose Limon, and Bill Evans Company. She has received extensive training in Pilates, Yoga and Qigong (a holistic system of coordinated body posture and movement, breathing and meditation) while training as a dancer.

Cheryl specializes in the field of Trauma, with advanced clinical training in both the treatment of trauma and in assessing forensic issues. She has experience in high profile cases and court testimony. Cheryl has a special interest in human development and attachment patterns in children and adolescents. She conducted original research in Attachment Theory with 118 Adolescents from a New England High school for her Doctoral Dissertation.

Cheryl is currently the Behavioral Health Director for Central Counties Services in Central Texas. Throughout her career she has worked in Community Mental Health Settings, Child and Adolescent Psychiatric Inpatient Units, Juvenile Rehabilitation for Washington State, Emergency Services for the City of Alexandria, Virginia, Public Education in NH and as an Administrator in Central Office for the State of NH. She also has been a private practitioner working with a multi-disciplinary team offering specialized services for trauma.

Cheryl brings a unique set of skills in blending behavioral health treatment, mind/body techniques, mindfulness and traditional therapy. As part of her practice she infuses dance, exercise, movement, theatre, and improvisation into aspects of a mental health treatment program that addresses mind, body, and soul.

She has performed throughout the Northeast and West Coast as well as choreographed, taught and directed shows such as “The Triumph of the Human Spirit”, a collaboration of Artists in Olympia, Washington bringing their talents together in honor of people who suffered from Trauma and Childhood Abuse. The program brought talent from across the state to perform original works of music, dance, and theatre pieces to the Capitol Theatre.

Cheryl has a passion for creating innovative programs where the need exists and most notably created an After-School Dance and Activities Program for the state of NH that served over 125 youth and adults.  She formed the “RESCUE” Program (residents for environmental and social change in a united effort)  with several of her colleagues in the State of Washington while working for the Juvenile Rehabilitation Division. The RESCUE Program was an innovative program for Gang related Youth. She developed programs for the Intensive Management Unit youth in Washington State. Program development included components related to Mental Health, Gangs, Trauma, and the Sexual Offender Program.

In her capacity as the Behavioral Health Director for Central Counties, Dr. Paulhus is passionate and committed to the realization of the values, principles, and goals of Integrated Care. This type of care will emerge from a wide-ranging team of behavioral health and primary care professionals, working together with stakeholders, the community, clients and their families, embracing the values of holistic care.

EB-ACA (European Branch - American Counseling Association
Vienna, Austria, Sept 27-28, 2019
Greetings, colleagues and friends!
On behalf of the European Branch of the American Counseling Association (EB-ACA), we are pleased to announce that we are currently accepting presentation proposals for the 60th Annual EB-ACA Conference, which will be held September 27-28, 2019 at Webster University in Vienna, Austria.

This year's conference theme is Counseling Around the World: Reaching Beyond Borders , a reflection of the past, present, and future of international counseling issues and a celebration of the 60th anniversary of EB-ACA. We are accepting proposals for 50-minute content sessions and for student poster presentations. We welcome diverse proposals that address a variety of issues in counseling; however, preference will be given to proposal submissions that reflect this year's conference theme. Each presenter may present up to two sessions. Proposals are due by Friday, April 5th, 2019 by 11:59 p.m. EST. Proposal determination letters will be e-mailed within four weeks of the submission deadline.

Go to to submit a presentation proposal. Submission deadline: Friday, April 5th, 2019 by 11:59 p.m. EST.
Conference registration will open within the next two weeks. Please stay tuned for more information and do not hesitate to contact us at if you have any questions or comments.

We hope you will consider presenting at the 60th Annual EB-ACA Conference in Vienna, Austria!

Best regards,
Elizabeth Crunk, Ph.D.
EB-ACA President-Elect and Conference Coordinator
Assistant Professor of Counseling, The George Washington University

Mercedes Ballbé ter Maat, Ph.D., LPC, ATR-BC
EB-ACA President
Professor, Department of Counseling
Nova Southeastern University

All courses are NBCC approved
(ACEP# 6674)

March 11 - April 21, 2019


March 11 - May 5, 2019

For additional certification requirements go to,