Monthly Archives: May 2009

Looking in the mirror

Jim Paterson May 15, 2009

Society has long recognized the positive impact that a sturdy adult relationship can have not only on the individuals who have united to form a couple but on the emotional health of those in the couple’s sphere of influence. These relationships help define us and, some say, strengthen our society.

For nearly 80 years, the discipline of couples therapy has strived to solidify these relationships. But today, couples therapy has come into its own with what advocates say are stronger and more successful approaches as well as a growing reputation for providing its diverse clientele with popular psychoeducational supports.

In their exhaustive 2002 history of couples therapy for the journal Family Process, Alan S. Gurman, director of family therapy training at the University of Wisconsin Medical School, and Peter Fraenkel, director of the Ackerman Institute for the Family’s Center for Work and Family, note that although couples therapy has not occupied its own place in textbooks, it has been helping couples for decades. “Couples therapy is an area of psychotherapy practice that is long on history but short on tradition,” they wrote, adding that early marriage counseling centers set up shop in the early 1930s, generally manned by other types of professionals, including clergy and gynecologists.

There have long been differing views concerning whether couples therapy should fall under the family counseling umbrella, where Gurman and Fraenkel contend it languished without notice until the 1980s, even though it was a major part of what family counselors did. Until the 1960s, nearly all couples counseling took place in separate sessions with each individual partner.

“A couple is a unique system where one can find the most intimacy, friendship and comfort, as well as the greatest hurt, so couples therapy presents very specific challenges that require special expertise and a different viewpoint,” says American Counseling Association member Mark Young, professor of counselor education at the University of Central Florida and coauthor of Counseling and Therapy for Couples. He has witnessed couples counseling gain strength as an independent counseling specialty while growing in interesting new directions. However, there is more work to be done, says Young, who is also a member of the International Association of Marriage and Family Counselors, a division of ACA.

For example, in his recent book Infidelity: A Practitioner’s Guide to Working With Couples in Crisis, ACA and IAMFC member Paul Peluso notes that unfaithfulness has not received enough attention in the field despite its prominence as a cause for marital instability. “About 55 percent of couples seeking therapy either report immediately that infidelity occurred or eventually disclose it,” Peluso says. “Ninety percent are unhappy enough in the relationship that they say it might warrant an affair. But in a 1997 study, counselors reported it was the issue they were least prepared to deal with — and the hardest one to tackle.”

Even as couples therapy grew in popularity and gained its own stature, a nagging question remained about its effectiveness. “In fact, many people believe that it has often caused relationships to deteriorate,” says ACA member Nancy Buck, a developmental psychologist and specialist in human motivation. Relationship counseling might actually appear to make matters worse because it brings to light issues that already existed, she explains. In addition, Buck points out, clients often come to couples counseling only when their situation has deteriorated beyond the point at which it can easily be repaired. Still, she says, “I think that perception (that relationship counseling can actually be harmful) is changing — and for good reason.”

Among the significant evolutions in couples counseling has been the gradual move away from encouraging individuals to clearly voice their complaints and describe their own needs in an effort to change their partner’s behavior. Most couples theory now calls for the individual to take more personal responsibility for his/her actions and level of satisfaction in the relationship.

As early as the late 1960s, Virginia Satir, who wrote several popular books about marriage, not only identified structural problems that caused marital difficulties but also noted that development of the individual’s self-actualization and self-esteem should be an overriding goal. In announcing his ground-breaking work with the late Neil Jacobson in 1997, Andrew Christensen, professor of psychology at the University of California, Los Angeles, stated that traditional couples counseling was at best helping half the clients because it was “change focused.” In a UCLA news release, Christensen said, “The pressure to change is often a barrier to change rather than a facilitator of change.” Christensen and Jacobson claimed that their new “integrative” approach was showing a nearly 90 percent success rate at the time.

“The focus of integrative couples therapy is on having couples accept and tolerate the differences that often exist between partners rather than having them try to change their spouses,” the two colleagues stated in announcing their approach.

Today, theory about the individual needing to work on his/her own issues rather than focusing on a partner’s perceived issues is both accepted and trumpeted. In its April 2009 issue, Psychology Today interviewed leading couples counselors and offered this advice to its readers: “If you want to stay in a relationship, something has to change. In all likelihood, it’s you.”

Issues of semantics and identity have often clouded this specialized area of work. For example, should it be referred to as couples counseling or couples therapy? Is there actually a distinction between the two? If so, how can it be expressed clearly so that the general public (and, for that matter, counselors themselves) understand the distinction? How does it fit into or relate to the practice of marriage counseling and family therapy?

ACA and IAMFC member Jon Carlson, Distinguished Professor of psychology and counseling at Governors State University and the author of several counseling books, offered the following view: “Counseling seems to me to be different from therapy. Counseling seems to be interested in helping a wider range of couples concerns. Counselors are concerned with prevention and education as well as remediation, while therapists focus on problems and remediation. However, the distinction between therapy and counseling does not seem to be a big deal among practitioners. The difference between marriage and couples seems to be more of a political/philosophical issue. Marriage therapy is for those who are legally bound in marriage. This seemed to discriminate against gay and other committed couples who were not legally ‘married’ but nonetheless a couple.”

Peluso adds that, today, couples counseling is more often viewed as being “unique and separate from family counseling. Prior to this, the emphasis was on family therapy, and the marriage and couples part was seen as more of an adjunct. The reality is that couples counseling deals with some complex dynamics that family therapy does not.” He acknowledges, however, that the two fields have areas that overlap.

A brief history

According to Gurman and Fraenkel, couples counseling has passed through four overlapping phases as it has stutter-stepped forward.

Phase I — Theoretical marriage counseling formation (1930-1963): Within this phase, four stages were identified — the field was born, became established, was legally recognized and began to develop its own literature and studies. Interestingly, the first marriage counseling clinical institutes emphasized premarital education, hinting at the psychoeducational-preventative efforts that are increasingly popular today.

Phase II — Psychoanalytic experimentation (1931-1966): A “rebellious” group of therapists began to experiment more broadly as the field gelled, though the focus continued to be on working with partners individually in separate sessions. “I am not primarily involved in treating marital disharmony, which is a symptom, but rather in treating the two individuals in the marriage,” wrote influential therapist C.J. Sager. Because of its link to family therapy, which avoided psychoanalytical and psychodynamic interpretations, couples therapy remained somewhat static during this phase, according to Gurman and Fraenkel.

Phase III — Family therapy incorporation (1963-1985): Pioneering therapist Jay Haley was hugely influential, suggesting that family dynamics were key to the happiness of everyone, including the primary couple. “Marriage counseling did not seem relevant to the developing family therapy field,” he said. Gurman and Fraenkel note that “Family therapy had now not merely incorporated, merged with or absorbed marriage counseling and psychoanalytic couples therapy; it had engulfed, consumed and devoured them both.”

Phase IV — Refinement, extension, diversification and integration (1986-present): The couples counseling field would develop its own identity in the 1960s but remained somewhat stagnant until the early 1980s. This period saw feminism’s and multiculturalism’s influence on couples counseling grow, as well as the roots of new approaches such as integrative therapy begin to develop.

An integrative approach

During that final phase, Behavioral Marital Therapy (BMT) developed. The therapy was based in clinical research and initially focused on couples identifying desired changes in behavior and then talking about those new actions. Couples made agreements or contracts and learned new communication and problem-solving skills. But in the mid-90s, BMT grew into what is today one of the more popular approaches to couples therapy — Integrative Behavioral Couples Therapy (IBCT), in which the concept of acceptance became a primary part of the couple’s work.

To a large degree, this new line of thinking developed because approaches based in training couples to change proved not to be very effective, particularly in difficult marriages. Gradually, self-regulation on the part of both partners to achieve mutual satisfaction in the relationship was embraced as a key component to what was increasingly called “couples counseling” rather than “marital counseling.” The name was meant to be inclusive of those who were not married but were involved in a serious relationship, particularly same-sex couples.

Kathleen Eldridge, an associate professor at the Pepperdine University Graduate School of Education and Psychology, has written about and presented on IBCT, including at the 2008 ACA Conference in Honolulu. She explains that IBCT replaces couples counseling’s former emphasis on improved behavior and new skills with “cognitive change that suggests a difference isn’t a deficiency or right or wrong in a partner; it is just a difference.” The other partner’s response, including an awareness of his or her emotions, is key.

“Based on research about couples’ ability to make behavioral changes and maintain them long term, we have learned that only about 50 percent are able to make and sustain changes after traditional forms of couples therapy. So we need to help couples learn to accept those things that are less amendable to change,” says Eldridge, a member of ACA.

However, she notes that acceptance by one partner often ends up fostering the desired change in the other partner. What’s more, she says, this change comes about “more naturally” than with traditional therapy, in which one partner typically identified a problem in the relationship, while the other partner was “encouraged” to change. “These self-motivated changes are more likely to last,” she says.

In today’s multicultural society, counselors are more likely to see partners who have very different values, tendencies and traits, Eldridge notes, so acceptance may be an even more critical component. Others have noted that multiculturalism and feminism helped change modern thinking about couples counseling because they pointed to the differing perspectives partners can bring to a relationship.

In IBCT approaches, counselors help clients learn to accept rather than criticize their partner’s behaviors, while also developing constructive communication and conflict-resolution techniques. Couples are taught unified detachment, which allows them to step back from emotional responses (particularly hard, “blaming” responses) to identify patterns and better understand their positions. The goal of the therapy isn’t necessarily to change the behavior but the response to the behavior, without always expecting complete change, Eldridge says.

Emotions are key

Another important development, Peluso says, is the attention now given to the emotions that couples in relationship bring to conflict. In particular, he credits the groundbreaking work of John Gottman as well as Emotionally Focused Couples Therapy (EFT), championed by Sue Johnson, author of Hold Me Tight: Seven Conversations for a Lifetime of Love.

On her website, Johnson says clients must “recognize and admit that they are emotionally attached to and dependent on their partner in much the same way that a child is dependent on a parent for nurturing, soothing and protection. EFT focuses on creating and strengthening this bond and identifying and transforming the key moments that foster an adult, loving relationship.”

Johnson, who recently authored an article on the approach in Psychology Today, says certain steps can transform relationships:

  • Couples must identify negative and destructive remarks to find the root of the problem and understand their partner.
  • Each partner must look beyond immediate, impulsive reactions.
  • Couples should revisit a difficult moment to provide a platform for de-escalating conflict, repairing rifts and building emotional safety.
  • Injuries may be forgiven, but they never disappear. They need to be “integrated into couples’ conversations as demonstrations of renewal and connection.” Forgiveness strengthens a couple’s bond.
  • Couples find how emotional connection creates great sex, and good sex creates deeper emotional connection.
  • Couples must understand that love is a continual process of losing and finding emotional connection; it asks couples to be deliberate and mindful about maintaining connection.

Johnson dismisses thinking that says partners’ dependency on each another is improper or shows weakness. She claims we have a “wired-in need for emotional contact from significant others” and believes that therapy can help couples find ways to meet those needs for bonding and attachment, which creates relational harmony.

Gurman and Fraenkel say EFT reconnects couples therapy to the experiential work of Carl Rogers and Fritz Perls, explaining that it “sees marital conflict and harmony as dependent upon the degree to which the marital partners’ basic needs for bonding or attachment are satisfied.”

Gottman’s approach

High praise for Johnson’s book has come from Gottman, whom several leading experts cite as the key force in modern thinking about couples therapy. “He is a must read for any couples counselor,” Peluso says.

Gottman, a mathematician by training, developed techniques for predicting whether couples will break up. These breakthrough techniques included analyzing both the literal responses and the tone of those responses in interview settings, as well as reviewing body language and facial expressions.

“The assessment process is more extensive than any other I’ve used,” says Lisa Lund, a marriage and family therapist and Gottman specialist in Santa Rosa, Calif. “I especially like the information I get from the oral history interview, where the couple shares with me the story of their relationship from the first time they met up to the present moment. I learn a lot in these interviews about how they go through life together.”

Gottman has written several books with his wife, Julie, a clinical psychiatrist who is cofounder and clinical director of the Gottman Institute, which offers seminars and various self-study guides for couples as well as in-depth training for therapists.

Like Johnson, Gottman views emotions as a primary concern, along with the patterns in a relationship. He stresses avoidance of what he calls “the four horsemen of the apocalypse” in a relationship: criticism, contempt, stonewalling and defensiveness. He also suggests that therapists help couples to identify the strengths and positive aspects of their relationship in addition to their “life wishes.”

Gottman advises couples to seek help early on in their relationship, to avoid critical thought, to soften the start-up to a difficult discussion, to accept influence from each other and to have high standards, refusing to accept hurtful behavior. He also says couples should learn to exit a disagreement and repair damage before an argument gets out of control, even backing down from a strongly held position if no harm will be done. Each of these are central ideas in his well-known book The Seven Principals for Making Marriage Work.

“In a happy marriage, while discussing problems, couples make at least five times as many positive statement to and about each other and their relationship as negative ones,” Gottman says on his website. “A good marriage must have a rich climate of positivity.”

Lund says she has more than 50 interventions at her disposal through Gottman’s approach, including labeling and replaying the “four horsemen” and replaying a fight in which the argument is slowed down and evaluated step-by-step so the participants will better understand each other and what the disagreement was really about. “What appears to be a dumb argument about taking out the trash may actually be about something else entirely,” Lund says. Using Gottman techniques, the counselor coaches the couple in speaker-listener exercises so they will learn to ask open-ended questions in a way that “deepens their understanding of each other’s gridlocked position,” she says.

Making choices

William Glasser’s Choice Theory has long been associated with individual and school counseling, but a strong contingent of counselors are also putting his ideas to work with couples. Choice Theory encourages each partner to take personal responsibility for the relationship, set aside differences and work on current issues without necessarily expecting his/her partner to change, says ACA member Kim Olver, a speaker, author and relationship coach who has worked extensively with Glasser’s theory. The theory’s emphasis on relationships as a key to happiness seems to make it a natural approach for couples counseling.

“(Glasser) says the most destructive thing in a relationship is people trying to control one another,” says Buck, a senior faculty member at the William Glasser Institute. She explains that both partners must think about whether what he/she is about to do or say will improve the relationship. “You then support those things that work,” she says. “The brain tends to focus on what is wrong, and couples have to identify what is right.”

Olver says couples must be trained to treat the relationship as a third entity that, with attention from both partners, will help to meet each of the individual’s needs. “You may think you are going to get a couple into the counseling office and get them to change, but it doesn’t work,” she says, noting that partners can only control and take responsibility for their own actions and gain real rewards internally.

As Olver explains, Glasser recommends that counselors work on couples’ “deadly” habits — criticizing, complaining, blaming, nagging, threatening, bribing and punishing — while also promoting good “caring” habits such as listening, empathy, support, encouragement and trust. Counseling begins, she says, by asking both partners if they are committed to working on the relationship. In succeeding sessions, the couple talks about ways in which their relationship is working or not working and instances in which controlling behavior tends to rear its head. Olver also asks couples to do something intentionally every day for a week to improve their relationship and then to report back about the process. This step often leads to a dramatic change in the couple’s attitude, she says.

Glasser advises counselors to get clients to “focus on what counselees can do directly — act and think,” Olver adds. This means the couple should spend less time on things they cannot do directly — namely, change their feelings and physiology. Feelings and physiology can be changed, but only if there is a change in the acting and thinking, Olver says.

Glasser says the goal of his reality therapy is to “help people reconnect” with a specific plan and to focus on the present instead of symptoms and complaints. “Encourage people to judge all they are doing by the Choice Theory axiom: Is what I am doing getting me closer to the people I need? If the choice of behaviors is not working, then the counselor helps clients find new behaviors that lead to a better connection,” Glasser says on his institute’s website. His most recent book is Eight Lessons for a Happier Marriage.

Solution-focused and brief counseling are also being used extensively today in couples counseling. Like Glasser’s therapy, these approaches focus on the present, what the couple is doing right and how the relationship can move forward rather than dwelling on past wrongs or requiring behavior changes.

When there is an affair

Another trend in couples counseling is specific work on infidelity as a primary cause of relationship problems. The causes and effects of infidelity have been more closely studied in recent years, both in serious clinical studies and in the popular media.

Peluso, whose book on the topic provides chapters by key figures in couples counseling and therapy, says many counselors acknowledge that infidelity is an issue they are ill-equipped to handle, even though studies suggest 55 percent of couples eventually report an affair has occurred in their relationship.

He believes the topic of infidelity was previously undervalued in couples counseling for a variety of reasons. First, he says, for many years, the topic was simply viewed as taboo. Counselors were also unsure of what approach to use in helping couples heal from infidelity, questioning whether counseling should be trauma-, grief- or attachment-based. In addition, many counselors remain wary of the topic’s emotional aspects. “The emotions are so raw and intense with infidelity,” Peluso says. “It really stuns a lot of counselors. It becomes difficult to offer effective counseling and maintain a neutral stance in the face of that.”

Peluso recommends that counselors recognize the underlying dynamics of infidelity and assess the reasons for its happening. He adds that responsibility for the act of infidelity rarely lies solely with the partner who had the affair.

Peluso has developed a process for working with couples confronting infidelity in their relationship. The process begins by dealing with infidelity and its effects as a crisis that must be handled with the equivalent of medical triage, treating the vital concerns and stopping further damage. The partners must then decide whether they can still live together and how they will discuss the issue. Other steps include minimizing the damage and guiding the couple beyond their bitterness over the affair. This involves getting the couple to recognize that the act of infidelity is not the primary issue; rather, it is evidence of greater issues within their relationship that they must address.

Throughout the process, the counselor must be forceful, Peluso says. “The people involved are overwhelmed, and they want strong guidance from a counselor,” he says, adding that firm direction provided by a professional is often key to the relationship’s survival and future success.

Learning the art of the relationship

Society has long recognized the positive impact that a sturdy adult relationship can have not only on the individuals who have united to form a couple but on the emotional health of those in the couple’s sphere of influence. These relationships help define us and, some say, strengthen our society.

For nearly 80 years, the discipline of couples therapy has strived to solidify these relationships. But today, couples therapy has come into its own with what advocates say are stronger and more successful approaches as well as a growing reputation for providing its diverse clientele with popular psychoeducational supports.

In their exhaustive 2002 history of couples therapy for the journal Family Process, Alan S. Gurman, director of family therapy training at the University of Wisconsin Medical School, and Peter Fraenkel, director of the Ackerman Institute for the Family’s Center for Work and Family, note that although couples therapy has not occupied its own place in textbooks, it has been helping couples for decades. “Couples therapy is an area of psychotherapy practice that is long on history but short on tradition,” they wrote, adding that early marriage counseling centers set up shop in the early 1930s, generally manned by other types of professionals, including clergy and gynecologists.

There have long been differing views concerning whether couples therapy should fall under the family counseling umbrella, where Gurman and Fraenkel contend it languished without notice until the 1980s, even though it was a major part of what family counselors did. Until the 1960s, nearly all couples counseling took place in separate sessions with each individual partner.

“A couple is a unique system where one can find the most intimacy, friendship and comfort, as well as the greatest hurt, so couples therapy presents very specific challenges that require special expertise and a different viewpoint,” says American Counseling Association member Mark Young, professor of counselor education at the University of Central Florida and coauthor of Counseling and Therapy for Couples. He has witnessed couples counseling gain strength as an independent counseling specialty while growing in interesting new directions. However, there is more work to be done, says Young, who is also a member of the International Association of Marriage and Family Counselors, a division of ACA.

For example, in his recent book Infidelity: A Practitioner’s Guide to Working With Couples in Crisis, ACA and IAMFC member Paul Peluso notes that unfaithfulness has not received enough attention in the field despite its prominence as a cause for marital instability. “About 55 percent of couples seeking therapy either report immediately that infidelity occurred or eventually disclose it,” Peluso says. “Ninety percent are unhappy enough in the relationship that they say it might warrant an affair. But in a 1997 study, counselors reported it was the issue they were least prepared to deal with — and the hardest one to tackle.”

Even as couples therapy grew in popularity and gained its own stature, a nagging question remained about its effectiveness. “In fact, many people believe that it has often caused relationships to deteriorate,” says ACA member Nancy Buck, a developmental psychologist and specialist in human motivation. Relationship counseling might actually appear to make matters worse because it brings to light issues that already existed, she explains. In addition, Buck points out, clients often come to couples counseling only when their situation has deteriorated beyond the point at which it can easily be repaired. Still, she says, “I think that perception (that relationship counseling can actually be harmful) is changing — and for good reason.”

Among the significant evolutions in couples counseling has been the gradual move away from encouraging individuals to clearly voice their complaints and describe their own needs in an effort to change their partner’s behavior. Most couples theory now calls for the individual to take more personal responsibility for his/her actions and level of satisfaction in the relationship.

As early as the late 1960s, Virginia Satir, who wrote several popular books about marriage, not only identified structural problems that caused marital difficulties but also noted that development of the individual’s self-actualization and self-esteem should be an overriding goal. In announcing his ground-breaking work with the late Neil Jacobson in 1997, Andrew Christensen, professor of psychology at the University of California, Los Angeles, stated that traditional couples counseling was at best helping half the clients because it was “change focused.” In a UCLA news release, Christensen said, “The pressure to change is often a barrier to change rather than a facilitator of change.” Christensen and Jacobson claimed that their new “integrative” approach was showing a nearly 90 percent success rate at the time.

“The focus of integrative couples therapy is on having couples accept and tolerate the differences that often exist between partners rather than having them try to change their spouses,” the two colleagues stated in announcing their approach.

Today, theory about the individual needing to work on his/her own issues rather than focusing on a partner’s perceived issues is both accepted and trumpeted. In its April 2009 issue, Psychology Today interviewed leading couples counselors and offered this advice to its readers: “If you want to stay in a relationship, something has to change. In all likelihood, it’s you.”

Issues of semantics and identity have often clouded this specialized area of work. For example, should it be referred to as couples counseling or couples therapy? Is there actually a distinction between the two? If so, how can it be expressed clearly so that the general public (and, for that matter, counselors themselves) understand the distinction? How does it fit into or relate to the practice of marriage counseling and family therapy?

ACA and IAMFC member Jon Carlson, Distinguished Professor of psychology and counseling at Governors State University and the author of several counseling books, offered the following view: “Counseling seems to me to be different from therapy. Counseling seems to be interested in helping a wider range of couples concerns. Counselors are concerned with prevention and education as well as remediation, while therapists focus on problems and remediation. However, the distinction between therapy and counseling does not seem to be a big deal among practitioners. The difference between marriage and couples seems to be more of a political/philosophical issue. Marriage therapy is for those who are legally bound in marriage. This seemed to discriminate against gay and other committed couples who were not legally ‘married’ but nonetheless a couple.”

Peluso adds that, today, couples counseling is more often viewed as being “unique and separate from family counseling. Prior to this, the emphasis was on family therapy, and the marriage and couples part was seen as more of an adjunct. The reality is that couples counseling deals with some complex dynamics that family therapy does not.” He acknowledges, however, that the two fields have areas that overlap.

Jim Paterson is a writer, editor and school counselor living in Olney, Md. He is a frequent contributor to Counseling Today. Contact him at jamespaterson7@gmail.com. Letters to the editor: ct@counseling.org.

 

From burning bright to simply burned out

Chris Morkides May 14, 2009

Sharon cares.

The 26-year-old counselor cares for the clients she leads in two groups composed of individuals with substance abuse and mental health problems. She cares for the few individuals she has time to see when her groups aren’t meeting three times per week, three hours per session. She even cares about doing a good job on the mounds of paperwork that clutter her desk.

It turns out, though, that Sharon may not be spending as much time caring about the person who matters most — herself — while she tends to the needs of others at the community mental health center where she works.

“Last week, I felt that I definitely was burning out,” says Sharon, who asked Counseling Today not to reveal her last name. “I felt that I had symptoms of generalized anxiety disorder, of post-traumatic stress disorder. I dreamed of getting shot.”

So Sharon decided to shift gears. “The newest belief I’ve adopted is that I’m doing a job and not doing therapy,” she says. “If I look at it that way, I can cope with my stress better.”

Counselor burnout. With increasing caseloads, managed care headaches, mounting paperwork and the ever-present stress of listening to other people’s tales of despair all day before going home to play with the kids at night, it is an issue that many in the counseling profession take very seriously.

“It can’t be overstated,” says Gerard Lawson, an assistant professor of counselor education at Virginia Tech and coleader, along with Jane Myers, of the American Counseling Association’s Wellness Interest Network. “Everyone in the helping professions, especially counseling, wants to help people. But it’s all meaningless when the instrument — you — isn’t OK.”

When Lawson chaired the ACA Task Force on Impaired Counselors from 2003 to 2007, he and Beth Venart wrote a paper titled “Preventing Counselor Impairment: Vulnerability, Wellness and Resilience.” They defined counselor impairment as something that 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.”

Impairment, Lawson and Venart wrote, includes substance abuse or chemical dependency, mental illness, physical illness and personal crisis. The term “burnout” was included under the personal crisis category.

But what is burnout? What leads to it? How can it be treated? And, perhaps most important, how can counselors avoid it?

Counselor burnout is defined by its symptoms: feelings of exhaustion, detachment and dehumanization when dealing with clients, in addition to feelings of depression and inadequacy. And then there is burnout’s close cousin, compassion fatigue, when the helper is traumatized by her efforts to be compassionate with the individual suffering from the initial trauma.

“We find that 5 percent of people in the helping professions suffer from burnout and 10 percent suffer from compassion fatigue,” Lawson says. “That should give us pause. It’s not a huge number when we look at the 95 percent who aren’t suffering from burnout, but what do we do with the 5 percent, and how do we make sure that the 95 percent doesn’t slide into the 5 percent?”

Few protections in place

Graduate school would be an obvious place to stem the tide before people enter the counseling profession. Or so it would seem.

“It’s not attended to enough,” says Myers, a professor in the University of North Carolina at Greensboro Department of Counseling and Educational Development and a past president of ACA. “We focus on professional development as part of the curriculum, but we don’t have any training on burnout.”

Likewise, according to the task force Lawson chaired in 2003, state licensing boards don’t deal with the issue adequately. The task force found that few intervention programs existed to assist counselors and only a few states — Minnesota, Michigan and Virginia — had good impairment programs that defined impairment to include stress, substance abuse, mental illness and physical illness.

So graduate programs turn out counselors who gladly dive into the deep water. Helping people is their goal, and burnout is generally the furthest thing from their minds. They often start out at community mental health agencies because they can work there before getting licensed. This is where they are given freedom to see clients — individually and in groups — pretty quickly. And this is where clients with the most serious mental illnesses await.

“If you want to burn people out,” Lawson says, speaking of community mental health agencies, “we have the perfect recipe.” Namely, new counselors seeing clients with not-so-new problems.

“A lot of our graduates talk about the severity of their caseloads,” Myers says. “It’s very difficult when you’re treating the severely impaired. If I feel I’m not a success as a counselor, there’s a good chance I am going to burn out.”

Battling against burnout

Burnout certainly isn’t restricted to recent counseling graduates or workers at community mental health centers, however. Still, Lawson acknowledges that private practice offers greater control, and control mitigates against burnout.

Balance also is a key to the prevention of burnout, whatever the age of the counselor. “Meditation, exercise, vacation, dedicating time to your family … Folks that tend to these aspects of their life fare better with burnout,” Lawson says. “There’s a significant improvement with work when you do wellness activities.”

“There’s a crossover between our professional and private lives,” Myers adds. “We’re more prone to high stress if there are problems at home. It’s easy for our clients to become secondary when we have problems in our private lives.”

Myers also emphasizes the importance of engaging in non-counseling activities. “On a scale of one to 10, I’d say that’s about a 15,” she says. “You have to have balance. You have to do things that renew you in other areas of your life.”

Counselors can also benefit from practicing what they preach, including seeking counseling themselves. “I think counselors can be reticent to see other counselors,” Myers says. “When you’re a counselor yourself, you might not think another counselor will be effective dealing with you. … (But) the best theorists and clinicians in our field, starting with Alfred Adler, have stressed the importance of having someone else hear our stories and help us gain new perspectives.”

Adds Lawson, “Going to counseling contributes to the counselor’s development in that it improves interpersonal skills and flexibility to meet the needs of clients, insulates clients from the influence of the counselor’s own unresolved issues and bolsters the counselor’s ability to manage stresses related to counseling work and to renew themselves. From our research, we know that 83 percent of counselors have been in counseling at some point in their life, including 18 percent who indicated that they were currently attending personal counseling.”

Good supervision is another key to preventing burnout. “It’s the No. 1 way to mitigate burnout and compassion fatigue,” according to Lawson. “And good supervision should, in my estimation, include more than discussion of cases. It should include a supervisor asking, ‘How are you doing?’”

“One of the challenges of the burned out counselor is that she/he is likely to be unaware of the impact of the burnout,” Myers says. “Burnout creates, to a greater or lesser extent, an impairment of our ability to be fully present to our clients. Although we can often overcome the effects of burnout with time, a rapid return to wellness is best and most quickly achieved if we truly believe in and are willing to practice the power of our art. So I strongly encourage counselors experiencing burnout to seek both professional peer supervision of their work and personal counseling to help them move beyond impairment to wellness and to follow a self-reinforcing path to a high level of wellness.”

Still, even with these safeguards in place, counselors can experience burnout. Bills pile up. Paperwork piles up. Clients with serious mental health problems don’t get better overnight. Left unchecked, burnout can make a counselor who was once so eager to help others equally as eager to leave the profession altogether.

“One of the components of people who get into this profession is that they are passionate about what they do,” Lawson says. “They want to help. There’s a great potential for burnout, especially when they don’t see the payoff until way down the line.”

Finding renewal

Things weren’t paying off five years ago for Cathy Woodyard, an ACA member based in McKinney, Texas. She was teaching at Texas Woman’s University, seeing clients individually and experiencing signs of burnout.

“I gave up my job as a counselor educator because I found it was depleting me,” Woodyard says. “I gave myself a week in a cabin. I took movies. I took scrapbooks.” And she came away with a feeling of renewal.

Woodyard and Connie Fox, a friend and counselor Woodyard had met at an ACA Conference, decided to put together retreats for counselors. The counselors, mostly from Texas and Oklahoma, go on weekend retreats twice a year. One of the retreats in Oklahoma City included a talk by a therapist who specialized in dream work. Another retreat incorporated psychodrama. A retreat in Santa Fe, N.M., last fall included a visit from a shaman. A massage therapist was featured at another retreat.

Woodyard plans to expand her retreats to include individuals from other professions. Meanwhile, the counselors who attend Woodyard’s retreat talk about themselves. They talk about cases. But mostly, they engage in renewing activities.

“I couldn’t counsel if I didn’t do something like this,” Woodyard says. “My therapy would turn into problem-serving. It wouldn’t be about growth. I don’t trust a counselor who doesn’t work on themselves.”

A counselor herself for nearly 20 years, Woodyard sees individuals, runs four groups and conducts a monthly experiential workshop that primarily focuses on self-exploration and dealing with fear. From her perspective, what are the top three factors contributing to counselor burnout? “Lack of self-care, a schedule that is too full and seeing a population that is too demanding,” she says.

On second thought, make that four factors. “I think you need a variety of clients,” she says. “If I worked with all children, I think I’d burn out. If I worked only with an older group, I think I’d burn out. When you’re working with a tougher population especially, there’s something refreshing about seeing different types of people.”

Woodyard’s husband, Jim Bray, is in a different profession altogether, working as an electrical engineer. “I’m so glad he’s not a counselor,” Woodyard says. “It forces me to remember that there’s a different world out there. He’s into antique cars. When he’s talking about that, it brings me out.”

Meanwhile, Sharon is trying to bring herself out of her funk. Sometimes, to protect herself, she calls what she is doing “a job,” not therapy. She also has another name for what she does. “I look at myself as a drive-through therapist,” she says. “You pull up, and you get a kernel of something that can help you.”

But what can help Sharon?

“I care immensely about these people,” Sharon says. “But there are moments of frustration that I can’t fight through.”

ACA member Chris Morkides is a psychotherapist in private practice in Swarthmore, Pa. Contact him at cmorkides@aol.com. Letters to the editor: ct@counseling.org.

The journey begins

Richard Yep May 1, 2009

Richard Yep

Each year, many of you experience a very special passage that results in exchanging your “student” descriptor for one that reads “new professional.” Some of you will walk across a stage to accept your graduate degree in counseling. Others will simply walk off campus and begin the journey — a journey that comes as the result of hard work, dedication and self-exploration. And, of course, some of you have decided to go for yet another advanced degree.

To all of you finishing up your studies this year, I say simply, congratulations. You have earned a very special place in society as a professional counselor. You are an advocate for those seeking help for life’s challenges. You will experience exhilaration, fulfillment and, yes, at times, disappointment. But you will all be performing incredibly important work, and I am in awe of what you have chosen to do.

If you have been a student member of the American Counseling Association, you now have the opportunity to become a “new professional.” This means that, at a deeply discounted rate, you will be afforded all the rights and privileges given to those seasoned professionals who have been practicing, teaching and mentoring for several years. Why? Because we know many of you have student loans that need to be repaid or you have agreed to take a lower paying job to begin your career. Every single member of the ACA Governing Council remembers what it was like to “start out” in the profession. So even as you make the transition from student to new professional, your membership rate remains the same. Consider this our “graduation gift.”

There will be some of you who still question whether continuing your membership is really worth the expense. You might even tell yourself that once you are on your feet and established in your practice, you will “re-up” with ACA. Let me appeal to you to maintain your membership in ACA if at all possible.

For less than 25 cents per day, you, as a new professional, need the resources, information and networking opportunities that membership in ACA can provide. In addition, as you start out in your chosen career, you are bound to have questions about ethics; ACA is here to help answer all of your questions as a member of our association. There are numerous other benefits to maintaining your membership in ACA, so if you have questions, please call us at 800.347.6647, and we will be happy to respond.

And now, I address those of you who have been the support system for the newly graduated. Whether you are a partner, professor, mentor, parent, child or friend of a recent graduate, you can take pride in knowing that the student in your life will soon be helping others in their own lives. In many ways, these new professionals in counseling are doing what they are doing because of the encouragement, support, care and love you have provided.

So, graduates, don’t forget to give that extra hug or handshake to all those who helped you get through graduate school. They, like you, are very special people.

Once again, to the Class of 2009 — as well as to those who supported, nurtured and prepared this latest group entering the counseling profession — thanks and congratulations to all of you. The ACA staff and leadership look forward to being here for you and appreciate the chance to serve as your professional partner for many years to come.

Please contact me with any comments, questions or suggestions that you might have via e-mail at ryep@counseling.org or by phone at 800.347.6647 ext. 231.

Thanks and be well.