Monthly Archives: May 2010

Shared wisdom

Lynne Shallcross May 15, 2010

The American Counseling Association is made up of approximately 43,000 members, representing a combined wealth of experience (and experiences), diversity and knowledge. Counseling Today wanted to tap into this deep reservoir of wisdom, so we contacted member practitioners from all over the country and asked them to share their “best lessons learned” within the counseling profession — whether revelatory “a-ha!” moments or instances of gradually obtained insight that exert lasting influence and continue to feed their professional growth.
Our hope is that some of this shared wisdom can be applied along the various pathways our readers are traveling, thereby enriching their journeys as counselors, counselor educators and students.

David Hof is an associate professor in the Department of Counseling and School Psychology at the University of Nebraska at Kearney and chair of the ACA Midwest Region.

“While working in private practice (recently) with an adolescent male, ‘John,’ I was again reminded of the power of relationship within the therapeutic setting. John was having trouble in school and was not getting his assignments done on time. As had become our ritual, each week I started off by asking him how school was going and if he was getting his homework done. He typically told me that everything was fine. This (time), I decided to push him a bit harder. I chose to challenge him on the honesty of his statements related to his success at school, reporting to him that I was struggling to believe him. He became tearful and dropped his head. As we talked, John looked up at me and said, ‘Dr. Hof, you are right. School isn’t always going well, and I don’t always get my homework done. But if you stop believing in me, then no one will. Because of you, I try harder.’ I seemed to have underestimated the power of our relationship and the impact my belief in him had on him.

“When I was a clinical director of an adolescent sex offender program some years ago, I had a similar experience. This program was token economy-based, and each of the young men there was working on a privilege system. One young man, ‘Paul,’ who had been there for some time due to his behavior and unwillingness to work on his issues, did indeed finally earn the privilege to go on an outing. In this particular small town where the program was located, one of the privileges was to walk down to the local grocery store with another young man who had also earned the same privilege. Since Paul had had such trouble, I watched him leave and return to the facility within the hour.

“As was the custom, the boys could buy things for other young men in the same program. Paul was asked to buy a Coke for a resident who was in an even worse spot than when he entered the program. This resident, ‘Tom,’ was picked on and often blamed for others’ behavior. Paul had returned into the program and given Tom his Coke. As I watched this, I was glad things had gone well, only to have Tom in my office minutes later telling me the seal on his Coke was broken. I could only imagine what had been done to his Coke, so I called Paul in to explain it himself. At this point, I can remember being very disappointed, and I expressed this to Paul.

Once again, I was reminded of the power of relationship and the need to believe in our clients. Paul looked at me with tears in his eyes and asked me to look under the bottle cap. As I did, I saw that inside the bottle cap read, “You win one free Coke.” Instead of keeping it for himself, he had switched his bottle cap with the cap on Tom’s Coke, giving Tom the free soda.

“I share these stories not only to remind myself, but also to remind (other ACA members) not to stop believing in the people you work with. For many of them, it takes our belief in their ability to be successful before they start to believe in themselves. Whether we are working with Johns or Pauls, they need us to have enough faith and belief in them that they can start believing in themselves.”

David Johns is a counselor at the Jefferson Center for Mental Health in Wheat Ridge, Colorado

“One of the best lessons learned since graduating from my master’s program four years ago happened, like most lessons, by a twist of fate. I had moved to the Denver metro area and started taking a yoga class. One of the instructors found out I was a counselor and introduced me to the executive director of a substance abuse agency. When the executive director and I met and I explained to him that I had a strong interest in spirituality, trauma, anxiety, depression, LGBT (lesbian/gay/bisexual/transgender) issues and group work, it was apparent that these interests would be helpful for the clients of the agency. For me, I would start a job with a full-time salary and health benefits. Little did I realize that I would expand my professional skills as well.

“I was intimidated by this new venture, as I had little experience working with substance users. I remember thinking as I met with the first few clients that my pre-practicum listening skills helped me to relate. I realized that although I had never interacted with people from these populations, our commonality was finding relief from psychological, emotional and physical pain. Listening with empathy and boundaries created strong bonds between us. The fact that I didn’t know the street names of the drugs the clients used or the places in the city where they had hung out was not a deterrent to a healthy clinical relationship. There were obviously some clients who immediately could not relate because I was not a former drug user; others simply respected me for the same reason. I found myself knee-deep in working with chronic mental health issues and substance abuse issues and experiencing the reality that a large majority of drug abusers also have mental health issues. I found myself utilizing the same principles of healthy counseling skills. Working at the substance abuse agency strengthened my diagnostic skills and counseling skills in unanticipated and exciting ways.

“It seems that throughout the U.S., the system creates a divide between mental health and substance abuse counseling. I find this disturbing because research is showing that treating the whole person is more effective. While working in the substance abuse field is challenging and rewarding, my concern is that qualified and skilled counselors shy away from the field because of their perception that the skills required to treat substance abuse are so foreign. I have come to the realization that a certain knowledge base is requisite and that the basic skills of counseling work in both arenas, and the added skills of substance abuse counseling increase effectiveness with mental health clients. I would encourage counselors who have the perception that substance abuse is entirely different to get some training and supervision in order to find the similarities in the two fields so that more clients will benefit from their expertise. My personal and professional life is more rich and satisfying, and I am glad that I stumbled into the substance abuse counseling field. Won’t you join me?”

Marilyn Powell-Kissinger, interim associate dean for the Walden University School of Psychology and director of the doctoral program in counseling psychology, maintains a private practice in Dallas.

“My life experiences teach me as much, midcareer, as my formal education did. I have learned that use of self in counseling is one of the most powerful tools to build connection. Since counseling cannot progress without connection and engagement in the process, this tool is a foundation to successful counseling. This is, however, where boundary work also really comes in. I learned from a very wise colleague how to decide what to share about myself and my experiences with my clients, particularly as we build relationships, and what to keep to myself and how to manage the ‘tipping point’ at which self-disclosure could hamper, rather than help, the process.

“For example, one life experience I have is that of being a parent. I have certainly had my own struggles in parenting. Some I have processed successfully to the degree I feel that examples from my life or a description of how I handled a certain challenge might help the right client at the right time. Some, however, are too new, too fresh, ongoing or midprocess, and I tend to err on the side of keeping those to myself — even, or especially, if the client is challenged by something very similar.

“But having the experience of parenting myself has in many ways enhanced my understanding and has given me yet another way to connect, when and if it might be helpful to the client. It is a tool in my toolkit as other skills and experiences are, both personal and professional. It has really changed the way I practice in that I can more confidently, but still selectively, pull from my experience to be more open and authentic in counseling, demonstrate my understanding of what it is like to struggle and have challenges, offer hope for successful resolutions for difficult times and share the experiences of being human. It is part of what makes counseling an art in addition to being a science.”

Susan Lester counsels part time at Bethany Pastoral Counseling Services in Collinsville, Connecticut, and is an adjunct faculty member in the Department of Counseling and Family Therapy at Saint Joseph College in West Hartford.

“I don’t remember the topic of conversation, but I remember the instructor’s words: ‘Every counselor’s most important question is “Am I enough?”‘ Earlier in my training, I would have thought this a counselor-centered, rather than client-centered, concern and dismissed my need for a sense of competence. Of course no one person is enough, but every counselor must be constantly reaching for more knowledge and skills in order to be as equipped as possible for every client.

“However, this moment in this class was after I had completed practicum, internship and a year of work as a counselor. I recognized that ‘Am I enough?’ was a question I posed to myself regularly before and during client sessions. I would search my files and the Internet for another new resource before a session, rifle through the stack of paperwork, double-check my knowledge of the case or rack my brain for theoretical language. Although those are valuable actions, the frantic spirit in which I carried them out sometimes deprived my clients of my full and genuine presence and caused me unnecessary stress.

“At that moment in class, I recognized the tension in myself between confidence and questioning. I made a very quiet decision to choose the confidence. If I am confident that what I bring, including my limitations, is sufficient to meet the purpose of each moment, I am free of unnecessary self-centered concern and able to focus completely on the client and his or her best interest. ‘I am enough’ does not mean that I should not prepare. In fact, to know it requires that I be diligent in all my preparations. However, it means that I can abandon the ‘should’ve’ and ‘could’ve’ concerns to leave room for my skills and good judgment to function.”

Cathy Malchiodi, president of the Counseling Association for Humanistic Education and Development, lives in Louisville, Ky., and is a professor at Lesley University in expressive therapies and counseling graduate studies.

“For the past 25 years, I have worked with child, adolescent and adult clients who have experienced some sort of traumatic event — death of a loved one, divorce, witness to or recipient of violence or abuse, or survivor of natural or manmade disaster. While I respond to trauma reactions in these clients, I know that grief is also part of what they bring to a counseling session. Trauma often involves loss, and grief is inevitably the end result of any loss, whether it is the death of a friend or family member or the destruction of a relationship, home or trust in life itself.

“As a mental health counselor and art therapist, I find that the most powerful lessons learned during my development as a helping professional have come from my own life. About a year ago, I experienced a series of traumas and losses that had a profound impact on my life in rapid order. A relative by marriage perished in a commuter plane crash. In addition to the emotional impact of his death, my family had to physically sort through wreckage to recover any of his personal effects. Around the same time, an ice storm struck our community. Our home was damaged, and we lived without electricity and heat in subfreezing temperatures for a week. And then, suddenly, like many Americans, I found myself without a job overnight from an organization to which I had faithfully devoted two decades of service, much of it as a volunteer. My husband’s job was also in jeopardy at the time but, fortunately, he was transferred to another department. Gratefully, we averted the frightening prospect of losing our health care, but we were traumatized nonetheless by how close we had come to financial disaster.

“These experiences put me in touch on a personal level with what my clients endure and dramatically increased my empathy for what they have survived and, most of all, what they are feeling. But the real lesson for this counselor came through my friends’ and colleagues’ messages to me in the days following these events. One well-meaning friend said of my job loss, ‘Bashert!’ That’s the Yiddish equivalent of ‘it’s meant to be’ or ‘predestined.’ Let me tell you, that is not what you say to someone who has just lost a job and (experienced) the death of a relative. No loss is just a ‘what will be, will be’ situation. Another colleague glibly lent this bit of wisdom: ‘When one door closes, a window opens.’ My first reaction to this cliché was, ‘What, to jump out of? It’s a good thing I don’t live in a high-rise building.’

“The irony of these statements is that they came from other mental health professionals. In retrospect, I know and accept that these individuals wanted me to feel better about my unfortunate circumstances at the time. But in truth, what they really wanted was to feel better about themselves by saying something self-comforting when faced with my personal pain. So, lesson learned? As counselors, our words do matter, especially during times of trauma, loss and grief. Our choices about what to say and how to respond can make all the difference in how we convey empathy, understanding and acceptance to our grieving and traumatized clients.”

Janet Allen lives in Idaho Falls, Idaho, and runs a counseling clinic with 11 employees.

“I think the most powerful lesson for me has been, ‘I am you, and you are me.’ In other words, challenges impact us all, and though we may feel separated by perceived differences, there is precious little difference in our collective struggles and the obstacles we must all learn to overcome. We are all so much the same.

“The concept, of course, doesn’t originate with me, but it’s so very real to me now that I have practiced for over 20 years as a mental health counselor. At the outset of my career, when I was green and inexperienced, I held all kinds of erroneous notions about people — assumptions about who they were and how they lived and why. For instance, I believed that people who suffered a divorce must somehow be ‘different’ from those who stayed married, that they were perhaps guided by a different set of goals and values. Early on, I didn’t want to work with clients who had been sexually abused — too traumatic for me to confront the reality of abuse in our society, especially of children — and I certainly didn’t want to work with perpetrators of sexual abuse.

“Experience has taught me that in spite of our many and varied experiences, people — all of us — are far more alike than we are different. In a sense, we are all victims, and we are all perpetrators. Sex offenders are people with stories of their own. Most, we now know, were once victims themselves. Divorced people want their marriages to work out just like the married folks and work just as hard.

“To be sure, this lesson has helped me approach counseling with significantly fewer assumptions. But far beyond that, I have cultivated a genuine appreciation and affection for people of all walks of life. Over the years, I have developed a kind of humility and openness to people who are suffering, who want to heal and change their lives. I have an abiding respect for all of us — for the courage and resilience we demonstrate as we encounter the various challenges of our lives. Being a counselor and coming to understand this great lesson in life, I am more open, less presumptuous, more appreciative and, in the end, I care more sincerely about my clients and others in my life. Hence the lesson, ‘I am you, and you are me.'”

Sharon Peters works in private practice as a family coach in Brooklyn, N.Y.

“I believe respecting the power of the parent-child relationship to resolve concerns is vital. Helping a parent have a closer and calmer relationship with a child can resolve countless issues. Having a relative stranger, even a professional, see a child alone usually takes longer and produces less thorough results.”

Carolyn Rollins, an associate professor in the Department of Counseling and Educational Leadership at Albany State University (Ga.), is president of the American Rehabilitation Counseling Association.

“As a grad student, I was reasonably sure I wasn’t ‘getting it.’ Memorizing the theorists and the key features of each modality for tests and papers was easy enough, but I always questioned whether I was applying them correctly, whether I’d identified the most appropriate one to use for each client’s situation or whether the theorist may not have gotten it right. At that time, no one was discussing issues related to multicultural competence. All I knew was that the people they talked about did not fit the people with whom I worked. If, at that time, I had learned the things that I know now, I could have relaxed and enjoyed more of my early career.

“Clients have taught me that when I have a genuine interest in their well-being, I am more effective than if I focus on technique. Empathy helps me hear what is truly important for a person and allows me to address their needs rather than the agendas of their employers, parents or teachers. In an environment that often dictates to people how they ‘should’ live their lives, having a therapist who respects their culture and individual uniqueness and who supports their goals is sometimes the only relationship that models trust and helps clients develop a sense of worth and stability.”

Len Gomberg is a counselor at the Soldier and Family Assistance Center in West Point, N.Y.

“One of my colleagues and I discussed (the topic of lessons learned), and he came up with a wonderful idea — namely that it’s the little things that sometimes count the most. Our media culture and, as a result, many supervisors and helping professionals, are attuned to the larger issues affecting people in pain.

“My colleague and I work with the wounded warrior population, many of whom are afflicted with post-traumatic stress and other behavioral difficulties in addition to their physical injuries. The Army’s intent is to process these folks either back to military service or out of the Army, and (it) concentrates on the medical side. However, many of these soldiers have what may appear to be minor problems, such as losing access to their military e-mail or military pay account, that if not dealt with promptly, contribute to increased stress that could negatively impact their medical situation. These minor issues are not given as much attention as the medical processing by the soldiers’ chain of command, and all it usually takes is an informal conversation to learn about such minor difficulties that nonetheless need to be handled. Once handled, the soldier can then concentrate more effectively on healing.”

Don Ward, a professor and chair of the counseling committee in the Department of Psychology and Counseling at Pittsburg State University in Pittsburg, Kan., is president of the Association for Specialists in Group Work.

“My first position upon completion of my Ph.D. in 1973 was a dream come true for a working-class Midwesterner who had never left the country or even applied for a passport. I was employed by the Department of Counseling Psychology and Guidance Services at Ball State University. Ball State had contracted with the Department of Defense to provide master’s degree programs on U.S. Air Force bases in Europe to members of the Air Force and their dependents. I was hired to teach for the fall and winter quarters on Air Force bases near Cambridge and Oxford.

“I was lucky enough to be assigned to teach a theories of counseling course and a group course — my favorite teaching areas to this day — during my first semester to approximately 30 bright and eager students, most of whom were Air Force officers. Students did well in my classes, and I was very pleased with the way my professional career had begun. Before we returned to the Ball State campus for the spring and summer quarters, I received an invitation to return to Europe again the next year to teach at the same base in England as well as at a base in Madrid, Spain, during the winter quarter. I agreed quickly.

“As I began teaching at the same base with the same students to whom I had taught theories and group work a year before, I found they had learned and matured professionally a great deal. I was very pleasantly surprised that one of my brightest and nicest students the prior year, Mike, was now seen as a major force in counseling services in the Advanced Practicum I was teaching and supervising one year later. Students had to find their own clients for the practicum experience, and this student, despite seeming to be more of a student than a counselor in the earlier classes, had developed into a skilled clinician who drew people in need to him and was therefore able to refer prospective practicum clients to his classmates.

“I was thrilled with Mike’s development but somewhat puzzled by the extent of his progress. In one of our supervision sessions, I asked him if he recognized how much he had changed beyond my initial impressions of his interests and style. He did not hesitate to inform me that he certainly recognized the extent of change and growth he had undergone, and he thanked me for being instrumental in bringing that change about. I was pleased but surprised with this attribution of credit to me and inquired further about what I had done to bring about this metamorphosis. He replied that he had experienced an epiphany from a very important statement I had made in our last theories class the year before. I could not think of any statement I had made in any class that was profound enough to have this kind of an impact on a student, so I asked him to clarify. He stated, ‘I vividly remember when you said to us, “An essential element of working as a professional counselor and providing real help to troubled people is to ignore your own needs and expectations and to focus entirely upon the needs and experiences of the client.” That changed my entire perception of being a counselor and of my own role as a people-helping person.’

“Although I understood that I might very well have said something similar to what Mike had indicated at some time during the class, it certainly was not a major point in my outline of theories lectures. However, if it worked for Mike, I was pleased. Still, I was somewhat disconcerted by how this kind of impact had occurred and whether it was a positive part of teaching counseling students. As I processed the situation, I came to the conclusion that these kinds of important informational statements have a very significant place in teaching and learning, both between counselor educators and their students and between professional counselors and their clients. The judicious and occasional repeated use of such cogent organizing principles, many of which are not clearly articulated in formal theories and textbooks, are often extremely valuable to stimulate exploration, processing and growth in both students and clients. The results may not be immediate, but if the principles expressed are sound and stated with emphasis, they can have a major stimulating effect on student and client learning and development.

“It is also interesting to note the parallel process operating in addition to that between counselor educator and student and student and client. It is the reverse effect of student to counselor and between client and student. Therefore, over 35 years later, I say to Mike, thank you. By sharing your reaction with me, you stimulated my exploration and insight into the complex process of interpersonal influence and learning to learn a lesson that has influenced my work with students and in supervising students with their clients for these many years.”

Sandra Wills works in private practice and part time as a school counselor for a private Catholic college in Nashville, Tennessee

“I think the most important thing I learned is that most clients need to be given hope and a sense of empowerment. I believe that it is my duty to help them find out how to get to that place where they can trust themselves to make appropriate decisions or take appropriate actions. So many times, the focus is on what’s wrong instead of what’s right. Often, what’s right can be totally pushed aside. I often work with clients in determining what their strengths are and what they can control, and from there we can put together a strategy to work on their problems.

“I often use a business analogy. I ask a client, ‘What does it take to run a successful business? What has to be taken care of so that the business doesn’t fail?’ I play out a scenario with my clients by saying that they are the CEO of their own life, which is their ‘business.’ What do they have to do to keep the business running, healthy and successful?

“We brainstorm about their skills, their habits, what needs to change and what kind of ‘business plan’ they can put together. As homework, I ask them to write a ‘mission statement.’ It is often an eye-opening experiment for both the client and myself. I often praise clients for making the step of asking for help. It is not a sign of weakness but a self-awareness that something needs to change.”

Pat Schwallie-Giddis, an associate professor and department chair of counseling/human and organizational studies at George Washington University in Washington, D.C., is president of the National Career Development Association.

“Never, ever, ever, ever give up. As a brand new elementary school counselor, I was eager to meet the needs of every individual child in my school. Toward that goal, I provided classroom guidance, small-group experiences and individual counseling when needed. Soon after the school year began, a second-grade teacher came to my door. She began to describe a challenging situation with one of her young students. She told me how two years before, a young boy named Timmy kissed his mother goodbye and headed off for his new adventure on the first day of kindergarten. He returned home at the end of the first day of school only to discover that his mother had left home and was never to return. The following day, Timmy went back to school but became totally silent. From the moment he saw the school until he left school in the afternoon, he remained completely mute. Now, two years later, having completed kindergarten and first grade, he was beginning second grade and had never uttered a word. The teacher was totally frustrated and baffled as to how to help this bright but silent student.

“After much discussion with Timmy’s teacher, other teachers, the school psychologist and Timmy’s father, we came up with a plan. I created a weekly ‘circle’ session with five little boys that included Timmy and four of his classmates. Each week, we met and talked about our feelings, focusing on one specific feeling — ‘a time I was happy,’ ‘a time I was sad,’ ‘a time I was scared,’ etc. Each week, everyone shared but Timmy, and each week, we continued to go over the rules of the circle session: one person share at a time, everyone gets a turn and no one has to speak if he doesn’t want to. The group went on for at least two months, and I was beginning to get discouraged. Timmy continued not to speak when it was his turn, and I began to think that this plan was not going to work.

“Then one day, I began by saying, ‘Today we are going to talk about a time when I felt left out.’ The first little boy shared a time when his friends gathered in his neighborhood to play and didn’t ask him to join them. He explained that he felt left out and very sad. The second little boy shared a time in class when his teacher recognized students who had done a great job on a project and didn’t mention his name, even though he had been a part of the group. Then it came Timmy’s time to share. As I always did, I asked Timmy if he’d like to share, and suddenly he blurted out, ‘On my first day of school, my mommy left and she never came back, and that makes me very sad.’

“All four of the other boys jumped up, clapped their hands and shouted, ‘Timmy spoke! Timmy spoke!’ Suddenly, Timmy realized he had broken two long years of silence. He gave a huge sigh of relief and began to clap and cheer along with the other boys. All five boys returned to the classroom shouting out, ‘Timmy talked! Timmy talked!’ His teacher immediately knelt down and hugged Timmy, and the entire class cheered. From that day on, Timmy became a part of the class, participating like everyone else.

“Word spread quickly, and by the end of the day, the entire school had heard about Timmy. The next morning when I arrived in my office, there was a beaming father waiting for me with a huge bouquet of flowers. He exclaimed, ‘You have made me the happiest father in the world. For two years I wondered what would happen to Timmy if he never spoke again.’

“That day, I knew that as an elementary school counselor, I had made a difference in one child’s life. The lesson I learned has served me well throughout my career. Never, ever, ever, ever give up on a child.”

Gary John is a professor and coordinator of human development at Richland College in Dallas.

“My most significant story would be what I call ‘Words of Wisdom’ for my last session of any graduate class. A brief one would be, ‘Good counseling always upsets the client’s expectations.’ Example: A wife or husband manages to get their significant other to come to counseling so the counselor can ‘fix’ them — and it turns out that they also need counseling!
“Most of us have a hard time seeing our own shadow. Some of my most difficult work over 40-plus years as a counselor (has been) working with other counselors. They are so well-defended and often can’t ‘see’ their own shadow. Many refuse to even think they need counseling.”

Lynda Gobright, who lives in Wyomissing, Pa., is in her second year of retirement after more than 30 years as a school counselor with the Reading School District in Reading, Pa.

“I find it challenging to choose a single lesson. I’m more inclined toward a concept — that being, sharing my gifts as a counselor. I never thought of working as a counselor as much as being a counselor. It is truly who I am as a person, not just what defines me in a particular job setting. I was always so proud of my mentees when they took the skills and knowledge I shared with them and applied it to their own successful pursuits.

“I was blessed to begin my counseling career under the direction of a caring and capable director of pupil services. We enjoyed a wonderful working relationship for many years, and when it came time for him to retire, I wanted to do something special to honor him. Along with my team of talented colleagues, we put together a night to remember for him and his family. When I received a lovely note of thanks after the festivities, I was touched to read that one of his greatest moments was when he saw the ‘counselor’ in me years back and that I had never disappointed him. We remain friends to this day.

“My proudest moments were when I ‘saw the counselor’ in those I worked with and mentored. I would describe it as sort of a ‘pay it forward.’ My life as a counselor has taken me on a rewarding journey of finding meaning through purpose and contribution. I continue to share my counseling gifts and hope to make a positive difference in the lives of others.”

Emily Parodi is a private practitioner in Jersey City, N.J.

“The two most valuable lessons I have learned thus far:

“One, theory and practice are very different. As a naive graduate student, I had all the confidence that I would know what to do when working with ‘real’ clients. After all, I had spent years studying which theories and interventions work best to alleviate the symptoms of most disorders. However, once I began working, I quickly realized that most clients are unresponsive to textbook interventions. This is, of course, when the real counseling begins.

“Two, be concerned with acting ethically, not about being sued. When I first started out, I was too concerned about being sued. I found myself worrying too much about how to protect myself from malpractice lawsuits — I was not being an effective counselor. Then a lawyer told me that I could be sued for any reason, but that does not mean the lawsuit has validity. He stressed that knowing and upholding the state rules and regulations that govern counseling licensure, (knowing) the ACA Code of Ethics and (knowing) how to navigate the conflicts between such rules and ethics codes was the best way to protect myself from a malpractice lawsuit. Today, I concern myself with acting in the best interest of the client, using the ethical decision-making guidelines within the boundaries of the law and, of course, documenting everything.”

Sonia Harris is a private practitioner in North Versailles, Pa.

“As a clinician, I have a governing mission, which is to help individuals realize their true worth and value. On a day-to-day basis, I purpose to create a nonthreatening, relaxed and safe environment in which all clients can see themselves as competent and feel assured that I’m invested in their well-being. I also have a spiritual approach that I use, without pushing religion, to understand the need that has one in treatment. I believe both (approaches) have contributed to my effectiveness in therapy.

“When with clients, I always purpose to be present with them so that they know that they have my undivided attention. Over the years, I have learned not to fear flowing with the moment, which has allowed for the development of treatment plans that are personalized despite the commonality of the symptoms they may present with. As I reflect, what stands out is that ‘I do therapy on purpose.'”

Elliott Ingersoll, professor and coordinator of counseling and counseling psychology at Cleveland State University in Ohio, is president of the Association for Spiritual, Ethical and Religious Values in Counseling.

“There are many lessons I’ve learned in my 25 years as a counselor but, serving as president of ASERVIC, one that stands out is the balancing act between nurturing individual development and trying to engage in state and national organizations. My experience at times has been that these two things exist in a creative tension that is usually not fully appreciated in the official positions of professional organizations.

“I’ve learned that most counselors I know, including myself, went into the work because it offered a chance to practice in one of the healing professions. Most people were not drawn by ideas of ‘counselor identity’ as much as they felt they wanted to lessen human suffering, and counseling provided one route, perhaps a convenient one, toward that end. In many cases, my experience with state and national professional organizations is that they attract those interested in mammalian political behavior, which can seem antithetical to the healing impulse just described. As a result, many counselors avoid professional organizations.

“I’ve also learned that the only way to infuse one’s values in an organization is to play a role in it, try to engage it and try to bring it closer to the ideals that motivate one personally and professionally. What I am learning from that engagement is that it takes more than one person to change an organization. So counseling mirrors the dynamic Erich Fromm noted wherein people strive to evolve as individuals, and this is in tension with their desire to be accepted by and influence those they hold in high regard, or in this case, those in their professional communities. There is no end point in this journey — just the hope of striking a creative tension that is gratifying enough to keep one on the path of learning.”

Thomas Scofield, an associate professor, clinical supervisor and community counseling program coordinator in the Department of Professional Counseling at the University of Wisconsin Oshkosh, is president of the Association for Counselor Education and Supervision.

“One of the greatest lessons I learned in counseling was that conceptualization of the client’s presenting concerns, although a necessary function of professional practice, creates a precarious proposition — much like walking with feathers in the palm of the hand in a strong wind.”

Terry Kottman has a private practice in Cedar Falls, Iowa, and runs a training center where other counselors can learn Adlerian play therapy.

“The gist of (my) lesson is about being real with clients — that your personality and who you are is your most important tool in counseling. It was taught to me by an 8-year-old girl, who was my first play therapy client.”

Janis Booth is associate professor and clinical training coordinator at Mississippi College in Clinton, Mississippi

“When I first began to think of a single most important lesson in counseling, I thought of the general principles which guide my life professionally and personally — and many other people’s, too, for that matter. Things like William Shakespeare’s ‘To thine own self be true’ and St. Francis de Sales’ ‘Nothing is so strong as gentleness, nothing so gentle as real strength.’ Then I realized I found it rather depressing that my lessons seemed to all have come from someone else — important thinkers, mind you, but not from me. I realized that while I may not have some earth-shatteringly, devastatingly astute and unique lesson that I can share, I have learned an attitude toward life through my counseling profession.

“I have had the pleasure of having two counseling professional careers, the first as a director of counseling for more than 20 years and, now, in my ‘middle years,’ as a professor teaching counseling graduate students. I think that the most important lesson I’ve learned professionally is taught to me continuously by my clients and now students. And I teach them the importance of that lesson in return, since it can be reciprocal. It is that if one keeps one’s mind and one’s heart open to the lessons others and life experiences have to teach, life becomes the most amazing place in which to live. And one can become quite wise in the process, too. The hurts are still painful, but there is a point to them that can lead somewhere better.

“I have learned so much from my graduate students as I teach them — about social problems I wasn’t fully aware of while counseling at a private college and growing up in a small town; about different views of multiculturalism and our attempts to teach it when everyone is so wonderfully unique; about gifts that others bring from their experiences into our profession; and about new ways of accomplishing counseling goals.”

Victoria Sherk is a therapist and intake specialist at a community mental health agency in Washington, D.C.

“I began my work in Washington, D.C., postgrad as a case manager at my current community mental health agency. I learned that I felt so strongly, politically and personally, about the LGBT community in a supportive, human-rights type way, that I couldn’t provide them clinical services effectively. I was working with a transgender person and was so caught up in my awe of and enthusiasm toward the difficult choice she had made to alter her gender that I was failing to assist her in addressing the real challenges she was facing that were not related to her sexual orientation or gender. I hope to overcome that transference eventually, but for now, I know to avoid or be extra cautious when engaging that community. It was a real learning experience for me.”

Dwight Hurst is a substance abuse therapist in Clearfield, Utah.

“My greatest lesson would probably be related to individuation of emotion and finding reward in the doing of the work, rather than becoming enmeshed with clients’ outcomes. It’s not so much forgetting about outcomes, but rather not allowing the counselor’s feelings to become enmeshed in the client’s feelings.”

Elliott Connie is a private practitioner in Keller, Texas.

“I work as a solution-focused therapist, and I would have to say that my greatest lesson learned is to stick to what the client wants.”

Lynn Bowling is a private practitioner in Mount Sterling, Ky.

“After I received my master’s (in counseling), I got a job as a mobile intervention therapist. Then my husband decided what he wanted to do with his life after nine years in the military and was accepted into pharmacy school at Samford University in Birmingham, Ala. At that time, I needed a job that would support the two of us since he was going to school full time. I decided to take a job working for a managed care company.

“I lasted at this job for one miserable year. I hated the fact that I was not a part of the client’s face-to-face treatment. I was mainly behind the scenes. I love to talk to people, and I felt out of the loop and did not feel that I was helping anyone. My husband realized how miserable and depressed I was and told me that I needed to find another job. I worked as a senior in-home therapist/clinical team leader for a mental health center in Birmingham and then moved to Kentucky, where I was a school-based therapist for a community mental health center in Mount Sterling.

“Now I have my own private practice, and I continue to do what I really love — talk and help people. I realize that there are so many areas that a person with this degree can go (into), but I have learned that where I am really needed and where I feel that I can make a difference is being one-on-one with people. That’s what I enjoy!”

Robin Shefts runs a holistic-oriented counseling and mediation practice in Deep River, Connecticut

“One (lesson) that was really significant for me was in May 2000 when I volunteered to become one of 20 multiethnic/religious delegates for the Compassionate Listening Project sponsored by the MidEast Citizen Diplomacy organization. Our mission was to travel to Israel/Palestine and support the peace process between the Israeli and Palestinian people by listening compassionately and nonjudgmentally to their personal, horrific stories.

“As an American exposed to the media and propaganda of this nation and other Western civilizations, I naturally had certain images and expectations of the people from these two diverse cultures. I had an abrupt awakening when I experienced the truth about the situation. I had the opportunity to witness the situation from an insider’s view. The inequities and prejudice I witnessed were blatant and systemic. It was shocking.

“When I was able to listen to the personal stories of the Israeli and Palestinian women, I realized they needed and wanted the same things for their families — namely food, clothing, shelter, safety, loving relationships and quality education. All these items related to survival needs. These women would make many personal sacrifices to provide these basics to their families.

“As an American citizen and a professional counselor who believes in equal rights for all people, it was difficult for me to stand by and accept these inequities. I had to remind myself repeatedly that I was a visitor in a foreign nation and committed to the mission I had agreed to as a delegate. When I arrived home, I shared my experiences with my colleagues, friends and family. Since my experiences have made me more skeptical of the news media, I try to investigate the subject matter before I form an opinion.

“Although many people would agree with the following life lessons (I intellectually knew them before my trip to Israel/Palestine), they came to life for me in a significant way during my experience as a delegate:

  • All people basically have the same needs and possess more similarities than differences.
  • People in modest financial circumstances and difficult living conditions appreciate what they do have, especially the love and support of their families or clans.
  • It is prudent, and a moral obligation, to investigate both sides of an issue before assuming the media is broadcasting the ‘real’ truth.”

Lynne Shallcross is a senior writer for Counseling Today. Contact her at lshallcross@counseling.org. Letters to the editor: ct@counseling.org

No easy answers

Lynne Shallcross May 14, 2010

If you were really lucky … you had a grandmother like mine. She was your best friend,” Helen Hudson writes in Kissing Tomatoes, a book about the years she spent caring for her grandmother. “The wall above my desk is filled with photographs of my Granny Jo, taken during the 13 years she lived with my husband and me. Granny moved in with us in 1982, when we were newlyweds. Along with her suitcases, she also brought Alzheimer’s.”

Hudson, a member of the American Counseling Association, didn’t have much choice when it came to learning about what it means to have a loved one with Alzheimer’s disease. But she believes Alzheimer’s is an epidemic of which all counselors should take note. This year alone, 250,000 people in the United States will be diagnosed with Alzheimer’s, Hudson says, and by 2040, an estimated 11 million Americans will have the disease. “There aren’t enough nursing homes for all of us,” says Hudson, who is working on finalizing a publishing deal for her book. “We need to care for those closest to us at home for as long as we can.”

With the increase in diagnosed cases and more caregiving responsibilities being assumed at home, Hudson says it’s imperative that counselors educate themselves about Alzheimer’s. Especially as baby boomers age, counselors are increasingly likely to see clients afflicted with the disease themselves, clients serving as caregivers for ailing loved ones or both. Of course, Alzheimer’s may also hit home for counselors in a more personal way, as it did for Hudson and her grandmother.

With Alzheimer’s, plaque builds up in the brain, destroying nerve cells and synapses and attacking the part of the brain that gives us our human qualities, Hudson explains. The disease was discovered in 1906, but heavy research didn’t begin until the 1980s. Today, there is still no cure. “Alzheimer’s is not a clear-cut disease with a linear downward progression,” Hudson says. “It is fluid, constantly changing and unpredictable, which means that for the counselor or caregiver, there are no consistent, easy fixes.”

Like Hudson, Susan W. Eig knows all too well the intimate details of Alzheimer’s and the absence of easy answers. Eig, a counselor in private practice in Washington, D.C., and a member of ACA, helped care for her father, who suffered from Alzheimer’s for 16 years. “One of the things I became keenly aware of was how few resources there were for people who were caring for a family member,” says Eig, who took it upon herself to create CaregiverSupportLink, a website (caregiversupportlink.com) and support service that she runs out of her Washington office.

Eig understands that it’s not always easy for caregivers to get out of the house to attend support groups or go to therapy, so she removes some of the obstacles. Through CaregiverSupportLink, clients can call in and take part in group or individual therapy sessions over the phone. Eig also offers another service through CaregiverSupportLink for families jointly caring for a loved one with Alzheimer’s across a long distance. She conducts phone sessions with the entire family, both to problem solve and to ensure that each family member feels as though she or he is doing something to help.

Eig believes her unique experience on both sides of the Alzheimer’s issue helps. “I am able to offer to family members a dual perspective — that of the professional as well as that of the family member.”

Counseling support for an insidious disease

Plaque starts building in the brain five to seven years before a person begins exhibiting symptoms of Alzheimer’s, says Hudson, who presented the Education Session “There’s No Place Like Home: Caring for the Alzheimer Patient at Home” at the ACA Annual Conference & Exposition in Pittsburgh in March. “In the early stage, Alzheimer’s presents as forgetfulness. The person forgets where they are going when they get in the car. They put food on the stove and forget to either turn it on or off. They forget to pay bills — or pay the same ones over and over.”

“The reason it can be tricky to catch is because people can hide it well, particularly if one’s contact with them is brief,” Hudson continues. “If the person is in close contact with family, friends or neighbors, they are more likely to be diagnosed more quickly. However, if the person lives alone, as was the case with my grandmother, it can take months and months to become apparent.”

The insidious nature of Alzheimer’s often catches people off guard. While losing the car in a parking lot or making a wrong turn might not seem significant at the time, Eig says her caregiver clients are often able to recall all those instances and connect the dots after a loved one is diagnosed. “You don’t really notice initially, but as the disease progresses, you become that much more aware,” she says. “Once the diagnosis is in place, you really do become aware of the changes and the losses that have been occurring.”

Counseling can go a long way with families or individuals who have learned a loved one has Alzheimer’s, Hudson says. “Most families feel suddenly paralyzed as to what to do,” she says. “In many cases, they actually overreact. The key is for them to keep their cool and take it step by step. A good counselor is crucial in this, both in allaying the fears of the family and then helping them navigate to the next step.”

Counselors working with caregiver clients should first educate themselves about Alzheimer’s and any available community resources and then focus on using their counseling skills to help, Eig says. Grief is one significant issue that can arise after a diagnosis of Alzheimer’s is made. “You have the shell, but the person you knew and cared for isn’t really there,” she says. “It’s a series of ongoing losses for the caregiver.” The counselor can help the client deal with the loss or, if necessary, refer to a colleague trained in working with grief.

Eig also advises counselors to be good listeners and to never make assumptions. “Your client will be your greatest guide as to what they need,” she says. Reflecting on her own journey, Eig adds that it is also helpful to encourage clients to seek out support groups or others in the community who are facing the same situation. When her father was struggling with Alzheimer’s, Eig says, community support groups weren’t prevalent. Perhaps thanks to her counseling background, Eig sought out her own. She found people in her community going through the same struggle and set up weekly meetings. “I think it was life-giving for all of us to know we were not alone,” she says.

Hudson offers six “human” techniques counselors can work on with clients who have taken on the role of caregiver.

  • Patience. Help clients avoid jumping to conclusions, she says. “For as soon as they think they’ve ‘got it,’ they inevitably won’t have gotten it at all. After nights of Granny wetting her bed, I insisted she wear diapers. Then one day, while we were shopping at Macy’s, she removed the diaper, placed it outside her dressing room and announced loudly, ‘I don’t need this thing. I would like to use the ladies room, please.'”
  • Humility. Counselors can help clients embrace a new perspective when it comes to potentially embarrassing episodes with their loved ones, Hudson says. “When your loved one starts kissing tomatoes in the produce department instead of putting them in the bag, a smile is an important thing to put on.”
  • A sense of humor. “When your loved one stands up in the middle of the congregation during the minister’s sermon and announces, ‘He’s boring. Let’s get out of here!’ another smile will come in handy.”
  • Acceptance. Help clients accept what is, not what was or what “should be.”
  • Persistence. Assist clients in finding the strength to stay the course, even when they feel like giving up.
  • Empathy. Counselors can encourage clients to imagine themselves in their loved ones’ shoes, Hudson says. “When your loved one sits absolutely mute and unmoving at the end, when they have no clue who you are, remember this: You knew them once, and though the disease has taken them away, it has not taken you.”

Could counseling prevent Alzheimer’s?

A March 2008 Counseling Today article, “Untapped potential,” explored whether wellness counseling might hold the key to reducing the number of future Alzheimer’s dementia cases. To access this article — or any other CT article going back to January 2006 — visit the Counseling Today section of the ACA website (counseling.org) and follow the link near the top of the page that says, “Click here to download complete issues in PDF format.” Access to the electronic archives is a benefit reserved for ACA members.

A terrifying time

For counselors who find themselves working directly with a client who has been diagnosed with Alzheimer’s, Hudson recommends contacting family and friends to begin navigating care for the client. The counselor can also open the dialogue about what may lie ahead for the caregivers and put family or friends in touch with Alzheimer’s organizations, she says. (Be aware that the ACA Code of Ethics, Standard B.1.c., Respect for Confidentiality, says, “Counselors do not share confidential information without client consent or without sound legal or ethical justification.”)

Unfortunately, Hudson says, there are no counseling-specific techniques to help a client with Alzheimer’s. “While I personally prefer a combination of Rogerian client-centered therapy mixed with reality therapy and sprinkled with a bit of Salvador Minuchin, the truth is this: Most counseling techniques are formed on the supposition that the client can think with a certain amount of both logic and self-perception. With Alzheimer’s, the book is thrown out. The counselor is completely at the mercy of his or her own wits and personal resources. Every single one of them will be needed at any given moment.”

Possibly the most important role a counselor can play with these clients, Hudson says, is to encourage them to maintain strong social networks and to stay active. “In the last 20 years, science has proved beyond a doubt that staying socially and physically active not only slows the progress of the disease but vastly improves the quality of life for those with Alzheimer’s.” She advises counselors to be proactive in researching outlets for clients and their families, creative in helping clients find things they can still do and assertive and firm with families to ensure that they follow through. “It’s a whole lot easier just taking Grandpa home and dumping him in front of the TV set,” Hudson says.

Simply being there for those clients struggling with dementia or Alzheimer’s is key, Eig says. “It’s a very terrifying time for the patient. It’s a time when a trained counselor can be there to be supportive. Certainly never to say everything’s going to be OK, but to be there to listen to the pain and the struggle. The greatest gift is to be able to listen and to be able to hold the anxiety that this patient is dealing with or struggling with.” Counselors can also assist clients in writing things down and recording memories for their children or grandchildren, says Eig, who has helped clients diagnosed with Alzheimer’s to write their life stories and make videos for their family members and friends.

“By helping them to record memories that they can pass down to their families, it allows the patient to feel that he or she is making a contribution to his family and loved ones. He’s leaving a life history for his family,” Eig says. “It’s a real gift to the family member to receive the stories and to hear about the challenges from the patient’s perspective.” Oftentimes, clients want to shield loved ones from the pain or fear that they’re experiencing, Eig says, but they may be willing to share these feelings with the counselor. “The professional becomes the person who can hold the story and help them do something constructive with it. When they’re losing so much ground, the notion that they can be contributing something is hugely important.”

Counselors who haven’t previously been exposed to Alzheimer’s might be surprised at how tricky the disease can be, Hudson says. “One day, the client may be totally ‘with it’ and seemingly in control. The next, they may think that Teddy Roosevelt is president.” It’s also worth noting that people with the same diagnosis of Alzheimer’s can act very differently, Hudson adds. “Some will become childlike and lovable. Others will be bitter and raging. Still others may vacillate between the extremes.”

Mystery still surrounds the underlying causes of and potential cures for Alzheimer’s. But, says Hudson, one thing is certain — counselors have seen only the tip of the iceberg when it comes to Alzheimer’s among their client base. “(Counselors) are going to see this kind of client with increasing frequency,” she says. “I predict that within the next 10 years, there will be so many afflicted with Alzheimer’s that there will be counselors who are solely devoted to those with the disease.”

Interested in learning more? Contact Susan Eig at seig@caregiversupportlink.com; visit Helen Hudson’s website at helen-hudson.com or read her blog at helenhudsonhere.wordpress.com.

Sixteen suggestions for Alzheimer’s caregivers

The following is an excerpt from Kissing Tomatoes, a book about the years that ACA member Helen Hudson spent caring for her grandmother.

  1. Try to keep your loved ones in their own surroundings as long as possible. Change confuses them.
  2. When they can no longer care for themselves alone safely, move them in with you. Try and recreate the bedroom they knew. The more familiar you can keep their environment, the less confused they will be.
  3. Keep their lives simple but organized. Even their clothing should be easy to put on and take off.
  4. Give them chores to do that they can handle at each stage. In the beginning, Granny’s chores were to fold the laundry and retrieve the mail from the mailbox. At the end, she had only to get out of bed and dress — with our help of course.
  5. Watch their diet closely, being sure they get small amounts of protein throughout the day. Many elderly people, especially those who eat alone, gravitate toward soft, sweet foods that are easy to consume but not always healthy. Too much sugar can exacerbate already confused thoughts.
  6. Encourage them to participate in some form of exercise daily, even if it is simply walking to the mailbox. It will set the tone both for their physical stamina and for their mental outlook.
  7. Remember that people with Alzheimer’s grow more childlike and helpless as time passes. Treat them as the person they are now, not the one you remember.
  8. Just as you would not park a child in front of the TV set all day, do not let your elderly loved one do so either. They will soon become part of the furniture and have little to offer.
  9. Take them everywhere you go as often as you can for as long as you can. Even if they have no clue as to where they are going, it keeps them connected to both you and the world. It is also good for others to see our elderly included as opposed to excluded.
  10. Sing with them often. There is nothing wrong with a chorus of “Jingle Bells” in July. Surprisingly, many Alzheimer patients who can’t tell you their own names can still sing entire verses from songs they learned as children.
  11. Engage them in conversation as often as possible. Encourage them to talk and express themselves even if you have to hear the same story over and over every day for years. It is their story.
  12. Offer them something new whenever possible: whether it is to try a new food or read a new book, take up painting or piano lessons, or perhaps, if they’re physically able, even tennis. Remember that it does not matter how well they do something as long as they are doing something. Do not let them vegetate if you can help it! Nothing kills the mind and spirit faster.
  13. Remember that every Alzheimer patient, like every person, is different. They can run the gamut from docile to violent. If at any time they become more than you can handle, don’t be a martyr. Get help. There is no shame in asking for help. Most people like to be of service, but you need to ask. In the beginning, I enlisted teenage babysitters, our next-door neighbors, the pool man, the mailman, our minister and complete and total strangers.
  14. There will come a time, though, when you will need real, professional help. Whether it is a respite care, live-in facility or hospice, there will be a time when you need it. Fortunately, with the advent of the Internet, there are countless organizations at your fingertips now. Some of these include the Alzheimer Association, AARP, Alzheimer Foundation of America, the National Family Caregivers Association, the National Respite Locator Service, the Family Caregiver Alliance, Eldercare Advocates and Aging With Dignity: Five Wishes. These are only some, and by the time (her book) is published, there will likely be many more.
  15. Keep them warm because one day, they will not even know that they are cold. Even if they shiver and a blanket is nearby, they will not make the connection and cover themselves.
  16. Love them often. Hugs and kisses are better medicine than anything you will ever buy in a bottle.

Lynne Shallcross is a senior writer for Counseling Today. Contact her at lshallcross@counseling.org.
Letters to the editor: ct@counseling.org