Anyone who has flown on an airplane and listened to the flight attendant before takeoff has been cautioned what to do in the event the oxygen masks fall from the ceiling: Put on your own mask first before trying to help someone else. Counselor wellness experts say that idea has mileage on the ground, too.
Helping yourself first is a principle that applies directly to counseling, says Sandra Rankin, a member of the American Counseling Association who runs a private practice in Austin, Texas. “If you’re gasping for air, you can’t help other people,” says Rankin, who is also earning her doctorate in health psychology from Walden University. “Counselors who neglect their own mental, physical and spiritual self-care eventually run out of ’oxygen’ and cannot effectively help their clients because all of their energy is going out to the clients and nothing is coming back in to replenish the counselors’ energy.”
Although most counselors are familiar with self-care — even preaching the concept religiously to clients — many find it a challenge to put the concept into practice in their own lives. Wellness experts say as life gets busy, counselors may tend to assume that they can, or even should, handle problems and stress on their own. But, these experts caution, counselors who ignore their own needs will find their outlook on the profession going quickly downhill.
“Wellness is one of the critical factors in being a healthy counselor,” says Stephanie Burns, an adjunct professor of counseling at Heidelberg University in Tiffin, Ohio. “We are asked as professionals to provide a tremendous amount of empathy to our clients. We often listen to very tragic and emotionally difficult stories. We are offering this empathy to the client and offering a place to share these stories, yet our profession is not meant to be a two-way street — the client is not there to provide us empathy. So, somehow, when you do that work on a daily basis, you have to have an outlet to receive things back. Otherwise, you end up depleting yourself and you don’t have anything more to give.”
Elizabeth Venart, a private practitioner in Ambler, Pa., who served on the ACA Task Force on Counselor Wellness and Impairment, says offering empathy is imperative in the profession, but this also opens the counselor up to feeling the client’s pain. “While vital, being emotionally attuned and available to clients increases our vulnerability in the work,” she says. “And, yet, we cannot be effective in our work if we are not emotionally attuned and available. Within the counseling relationship and within the moment-by-moment interplay of each session, this is the ultimate balancing act — finding ways to stay attuned to clients while maintaining a strong and deep connection with our own experience.”
The path to finding that balance begins with recognizing warning signs and not feeling ashamed of them, Venart says. “It is important for counselors to understand that there are risk factors inherent in the work and that noticing signs of stress or distress is a sign of health, not impairment. None of us is immune to the effects of the work. When counselors can view their emotional responses to their work as an expected part of empathic engagement rather than something they are doing wrong, they are more likely to seek support, talk about stress with colleagues and engage in self-care practices to support their overall wellness.”
Wellness is especially important because counselors are one of the primary instruments in their own work, says Gerard Lawson, associate professor of counselor education at Virginia Tech. “It’s impossible to separate who I am as a person from the work I do as a counselor,” says Lawson, who chaired the ACA Task Force on Counselor Wellness and Impairment. “If I’m not well, that’s going to get in the way of me being able to tune into the needs of my clients.”
Venart, who is also founder and director of the Resiliency Center, a community of private practitioners offering healing services, community education programs, professional development trainings for helping professionals and other services, echoes Lawson’s sentiment. “Counseling is a profession dependent upon our ability to be authentic and attune empathically because it is through this process of careful attunement that healing and growth occur,” she says. “Research consistently demonstrates that the quality of the therapeutic relationship is more predictive of counseling outcome than any other factor. Since the self of the counselor is an essential component of effective counseling, it is vital that we nourish our own wellness. When we are well, we are better able to connect with our clients, more attentive and creative in our work, and less likely to make clinical errors or violate boundaries.”
Counselors should make it a priority to walk the talk and model wellness for their clients, Lawson says. “It’s not to say we need to be perfect all the time, but we need to be aware. If you’re telling your clients to do it, do it yourself.”
Venart agrees. “We need to be aware of the messages we teach clients when we honor boundaries or neglect to set them, when we take a day off to nurture our health or come into work sick, or when we model joy and curiosity or unintentionally share the flat affect of our unresolved grief or depression.”
It’s important that counselors make a habit of checking in on themselves, Venart adds. “Because counselor wellness and impairment are on a continuum from well to stressed to distressed to impaired, it is critical that we continually monitor where we are on that continuum and address any early signs of stress so we don’t move further down the continuum. We are instruments of healing. If we don’t keep our own instrument tuned, we won’t be useful in promoting wellness in others.”
Determining how “well” you are as a counselor can start with only a few clicks of the mouse, says Burns, an ACA member who has offered wellness workshops for counselors. She points to resources that came out of the Task Force on Counselor Wellness and Impairment, including handouts on risk factors, assessment tools and more, all available on the ACA website at counseling.org under the “Resources” tab. “It can be hard because of our work schedules and the fast pace of life to know how we’re doing,” Burns says. “All those resources are free, and counselors can download them 24/7. It’s a way for counselors to check in with themselves and figure out where they’re at.”
Leslie Kooyman, an assistant professor in the Counseling and Educational Leadership Department at Montclair State University, says mild feelings of resentment toward certain clients or feeling burdened by certain clients can be a subtle indicator that something isn’t right. Other indicators, Kooyman says, particularly for experienced counselors, are regularly feeling lost in terms of what direction to take with clients and sloppy logistics, such as starting sessions late or allowing sessions to go past their scheduled end time.
Unexpected events can throw a schedule off course, but that should be the exception, not the rule, says Kooyman, a member of ACA. “We all have good days and bad days, good sessions and bad sessions. You’re not always 100 percent, certainly.” But, he cautions, a pattern of such issues might signal the beginning of burnout.
Rankin says other warning signs include feeling irritated about clients, experiencing a low level of energy, having problems develop at home, viewing the world and the people in it as unsafe and losing your sense of humor. Paying attention to the physical and mental symptoms of stress is important, she says, as is taking action to alleviate those symptoms instead of ignoring them and simply hoping the situation will fix itself. “Unfortunately, many counselors use stress as an indicator of the quality of work they are doing, believing they are being ineffective if they experience even a hint of stress,” she says. “What counselors need to remember is that stress and the accompanying symptoms are indicative of how the work is affecting them.”
One of the ways Rankin keeps her wellness in check is by participating in a peer support group with a handful of other counselors. The group meets at someone’s office or goes out for lunch or coffee roughly once every other week, although group members meet more frequently when they feel the need. They are careful to go someplace neutral so whoever is having the worst week can get away from his or her work environment, Rankin says.
In one instance, a counselor in the group was experiencing explosive growth in her practice and was seeing between 40 and 50 clients per week. Some of these clients were outside of the counselor’s specialty and were not as enjoyable for her to work with. The counselor found herself exhausted and with precious little time left over for herself or her family. “When we as a group confronted her, she said it had happened before she knew it and [she] didn’t know how to get out of it,” Rankin says. “Being counselors, we probed into why she was ’suddenly’ overwhelmed with clients she did not want and was constantly working. Like our clients, she used every excuse in the book, including the very real ’If I don’t work, I don’t get paid’ argument.” The group helped her brainstorm options and potential solutions, and after she chose a few, the group gave her deadlines and held her accountable.
“She hired a local company to do her insurance reviews, started referring clients not in her specialty, set boundaries with her existing clients so she was not taking their calls at all hours of the day and night, and went for her own personal counseling to address issues she was using work to avoid,” Rankin says. “It took about a month for all of these changes to be put in place, but by the end of the second month, she was experiencing some relief and returning to her old self. It’s been over a year now, and she actually has more free time than ever.”
Making room for life
When Lawson worked as a counselor in an inpatient setting, he remembers rehashing each day in his mind during the car ride home from work. He would go over the clients he had seen, what he had done well and the things that hadn’t worked. “I was literally taking it home with me,” Lawson recalls.
That winter, Lawson repeatedly found himself getting sick, which previously had been a rare occurrence for him. It took a little while, but he eventually realized stress was taking a toll on him physically, so he determined to make a change. On his drive home, it was necessary for Lawson to cross a river. He decided that crossing the river would signify the end of his work day, at which point he would shut off and leave thoughts of the counseling office behind. “It sounds corny,” he says, “but it was a cleansing moment for me at the end of each day.”
A variety of ways exist to improve self-care, and Venart contends that self-awareness is the first step in creating lasting change. “Create and pay ongoing attention to the balance in your life — balance between work and play, giving and receiving, accomplishing tasks and doing nothing,” she says. “Learn simple strategies to nurture yourself within your day, including nourishing [yourself] with enough water, good nutrition and movement and exercise.”
Among Venart’s other recommendations are venting and problem solving with colleagues, taking a walk, journaling, practicing mindfulness and taking advantage of clinical supervision and peer support groups. Venart keeps herself motivated by maintaining a folder of thank-you notes and success stories from her work with clients. “I refer back to them regularly as a way to remind myself that this work really makes a difference, especially on those difficult days.”
Career-sustaining behaviors are often unrelated to work itself, Lawson points out. Aim for a rich life outside of work, which might include taking vacations or “staycations,” spending time with family or a significant other and making time to meditate or pray. Lawson sometimes asks counselors what they do for leisure outside of work, and he routinely hears responses such as volunteering with the American Red Cross or hospice care. “Those are wonderful things to do but very similar to the rest of their professional lives,” he says. “At some point, you need to do something with another part of your brain, not something where you’re caring for others or putting others’ needs ahead of your own.”
Kooyman advocates integrating relaxing activities such as yoga, deep breathing and listening to music after sessions but says counselors should protect their well-being in session, too. “Wellness is also about being able to take care of yourself in the moment,” he says, “and that’s a little more challenging.” He provides the example of counselors being honest about the days they’re available to be in the office instead of stretching to accommodate a particular client.
Another example is setting limits when negotiating fees with clients. Kooyman, who worked in private practice for 10 years, did pro bono work but was also realistic about having to make a living. At times, he says, counselors can be too client-centered and end up giving more than they should. “If we’re not really comfortable with what we’ve decided, it’s going to eat away at us,” he says.
Maintaining boundaries is a crucial element of self-care, Rankin says. “A lack of professional boundaries can create feelings of being overwhelmed, bitter and angry. Too many counselors have not learned what boundaries are, so they meet with or take calls from clients outside of office hours, do not set office hours or work overtime when there is no real need. Basically, they put clients before their own family, friends and self.”
Setting boundaries means taking vacations and holidays, Rankin adds. That can be a tough decision, especially for private practitioners who aren’t bringing in income if they take a day off, but getting away from work is extremely important, she says. “Long or unusual work hours, large caseloads, caseloads with a high amount of trauma, no vacation or off days and no holidays all contribute to counselors becoming unhealthy in mind, body and spirit and therefore impacts the quality of care provided to clients.”
Keeping up with the literature in the field can also promote wellness, Lawson says. When counselors read the latest research and understand new aspects of a concept or problem, it can remind them to view clients as people rather than the problems they represent. Reading the professional literature can also help counselors guard against taking cookie-cutter approaches with clients, Lawson says. Also a proponent of journaling, Lawson says research has shown that people who journal on a regular basis are less susceptible to illness.
Rankin points to research showing that personal therapy and/or clinical supervision can help counselors stay happy and healthy in their work. However, she says, many supervisors are unaware of the importance of self-care, and many counselors don’t seek supervision beyond their internships. “For example, many counselors I have worked with, as well as counselors I have had as clients, do not understand the difference between emotional attachment and empathy. Learning the difference while in clinical supervision would have decreased their risk of compassion fatigue and burnout. Those that were my clients may not have needed therapy had they learned the difference.” If clinical supervision is not an option, Rankin recommends finding a peer consultation group.
Venart recommends that counselors sort their to-do lists into tasks that are truly essential and those that are not. She recalls a counselor in one of her peer consultation groups who told a story about resenting her husband’s ability to relax and informing him there were no days off in their household. “While believing this assertion wholeheartedly as she was expressing it to him, she had to laugh at herself as she was recounting the story aloud in our group,” Venart says. “She realized it wasn’t OK with her for him to have a ’day off’ because she had never considered the possibility that she, too, might be entitled to regular downtime. We explored the undercurrent of beliefs that drive so many of us to push hard without resting, to put others before ourselves and to deny our basic needs for rest, nourishment and pleasure. Yes, some of the tasks of work and parenting and taking care of a home are essential, but some are not. Counselor wellness is sustained when we take an ongoing inventory of what’s truly important and make sure we’ve made ourselves a high priority on our running list of things requiring care.”
In the process, Venart adds, don’t forget to appreciate the lighter side. “Infuse a sense of play into your life. A sense of play can help you and your clients remember that life need not always be so serious. I have a playful little wire figure of a girl sticking out her tongue that reminds me that humor is healing. Clients love this little figure and have commented that her silly irreverence inspires them to speak their mind and see the humor in situations.”
Not second nature
If wellness is ingrained in the foundation of counseling, why doesn’t self-care come more naturally to counselors? First and foremost, Lawson says, people who end up in the helping professions are naturally inclined to take care of others. Plus counseling, by design, is a one-way caring relationship. At times, Lawson says, counselors let that work mentality “leak over” into the rest of their lives, allowing every relationship to become a caretaking relationship.
“Those drawn to work in counseling may have learned at an early age to become other-focused rather than self-focused,” Venart confirms. “As a result, they may not feel they need or deserve the same nurturing [that] they accept others need and deserve. They may have exceptionally high standards for themselves and yet be compassionate and forgiving of the shortcomings, mistakes or inconsideration of others.”
There’s also a deeply rooted idea that as Americans, we should be self-sufficient and pull ourselves up by our bootstraps, Lawson says. “I would argue it’s good practice to say, ’I need help.’ Asking for help isn’t a sign of weakness. It really is a sign of the commitment to the work that we do.”
The work itself can stand in the way of wellness, Rankin says. “Many counselors struggle just to get through the day, so self-care takes a backseat to limited time and fatigue. Plus, some work environments make it difficult for therapists to engage in self-care because of unusual or long work hours, large caseloads and little or no support.”
In addition, like most people, counselors can grow “comfortable” in their discomfort. Even when their work environments are filled with stress, fatigue, anger and resentments, it can still feel “safe” simply because they know what to expect, Rankin says. Trying to change that work environment, even if for the better, can move counselors out of their comfort zones. “But, as I tell my clients, while you’re helping others, who is helping you? Your work should be only a part of your life,” Rankin says. “Boundaries, including a commitment to self, must be in place so there is a balance and distinction between your work life and your personal life.”
Counselors who have children can feel as though there’s even less time to think about personal wellness, Venart notes. “Counselors who are parents may struggle with feelings of guilt for not being more emotionally or physically available for their children,” she says. “As a result, they may tell themselves they must devote all their nonwork time to their children and that it would be wrong to take time away from the kids to nurture themselves. Yet, when we pay attention to and nourish our own needs, it is far easier to be mindfully present with those we love.”
Although counselors may be full of wellness tips for others, knowledge doesn’t always translate into action for themselves. “We are not so different from our clients when it comes to this,” Venart says. “There is often a gap between what we know in our heads to make sense and how we live our lives.”
“Counselors may have more information about effective self-care practices, but they are as vulnerable to internalized negative messages that discourage or discount self-care as their clients,” she continues. “In addition, counselors may have a false belief that they should be able to heal themselves, that their training as a counselor somehow means they don’t need outside support and that the wellness practices that work for everyone else are somehow too simple for them or just not necessary.”
How can counselors infuse what they know into their day-to-day lives? There’s no easy fix, Burns says, but it can be done. “It’s just like we tell our clients: If we want to see a change occur, we have to take ownership of what we want to see happen and do it. We have to make a choice, take ownership of it and then act on it.” Set a goal, but make it an attainable one, Burns recommends. “We can overwhelm ourselves [if we think] that we have to implement all of these things instead of just focusing on one thing and taking it from there.”
Taking a step toward wellness doesn’t equate to doing everything perfectly from here on out, Lawson says. “I don’t really care that you’re doing it just right,” he says. “I’m more concerned that people are paying attention and making efforts toward it.”
Having a supportive environment can help immensely in improving counselor wellness, says Lawson, who recommends that counselors talk with colleagues about their personal needs and struggles and solicit support for the changes they are trying to make. At Virginia Tech, Lawson came up with a rule to support wellness and life balance: No shop talk over meals. “It’s a small thing, but it can make a huge difference in a work setting,” he says. “But you need someone else to buy in as well. It’s awfully hard to do alone.” Start by finding one person to make changes with, but don’t be surprised if two people turn into a trio and then a culture of wellness catches on, he says.
Venart concurs that peers can make all the difference. “Peer support can be incredibly effective in improving self-awareness and supporting positive growth and wellness,” she says. “Creating personalized wellness goals and committing to them in the company of colleagues can support counselors in turning plans into reality.”
Shedding the day
A foundation for wellness should be built before counselors even enter into their professional lives, Lawson says. “In counselor education, we don’t do as good of a job teaching about risks and how to avoid them or manage them if you bump into them,” says Lawson, who makes an extra effort to talk with his students about wellness in the hopes the message will stay with them when they become professionals.
To help establish this mind-set, Lawson encourages his students to change their clothes after they return home from their internships at the end of each day. “You’re [figuratively] shedding the day, and you can move on to the evening with your family,” he says. “It’s a tiny ritual, but it’s those sorts of things that help us separate our professional life from our home life. The ritual becomes a habit and, over time, that habit becomes part of maintaining your own wellness.”
Kooyman, who teaches school and community counselors, often asks his students to make a list of activities they enjoy doing and then to be deliberate about incorporating enough of those activities into their daily lives. Burns also brings up wellness with her students, asking them how they give attention to the many facets of their lives. Creating a supportive atmosphere for counselor wellness in graduate school is crucial, she says. “That’s a good sandbox. If it can be incorporated there, then those skills can be transferred over when they’re working full time as a counselor.”
As a whole, counselor education programs must do more to promote and teach counselor wellness strategies, Venart says. “While current programs or individual professors may discuss the importance of self-care, I believe it is vital that this focus be interwoven throughout graduate training programs and that students and professors alike be challenged to engage in wellness practices and modify behaviors that clearly impair their functioning, including workaholism. I have a friend currently enrolled in a holistic nursing program where practitioner wellness has been integrated into every aspect of their training. The importance of self-care is overtly discussed and modeled by faculty, and the curriculum of each course includes an emphasis on self-assessment and reflection as well as the development and implementation of concrete wellness plans and practices.”
Venart reminds students and professionals alike that although self-care can appear large and looming at times, the process begins with just one step. “As we see with clients, it doesn’t usually require a heroic effort or a complete life makeover to generate really positive results. Sometimes the smallest changes can make the biggest impact. Never underestimate the power of a restful eight hours of sleep, exercise and good nutrition throughout the day. Lunch with a friend can lift our spirits, and taking a Sunday off to rest and play can help us recharge for the week.”
Lynne Shallcross is a senior writer for Counseling Today. Contact her at firstname.lastname@example.org.
Letters to the editor: email@example.com
Roadblocks to wellness
Burnout, vicarious traumatization, compassion fatigue and impairment are terms often mentioned when discussing counselor wellness and self-care. But what distinguishes one from the other? Counseling Today asked counselor wellness experts to weigh in.
Burnout: Gerard Lawson describes burnout as a slow degradation of a counselor’s ability to empathize with clients over time. Elizabeth Venart says burnout often arises from an accumulation of work-related stress, resulting in feelings of hopelessness and helplessness. “It is typically created or exacerbated by the nature of the work and workplace. As a result, a change in work environment can dramatically improve one’s experience of burnout,” she says.
Vicarious traumatization: The symptoms of vicarious traumatization, or secondary traumatic stress, are much the same as those associated with post-traumatic stress disorder, Sandra Rankin says. Counselors can acquire vicarious traumatization in as little as one interaction when they are affected by the trauma they hear about through clients, Lawson says.
Compassion fatigue: “Charles Figley originally coined the term compassion fatigue [as] an experience in which exposure to the suffering of clients coupled with an inability to rescue them from this suffering results in feelings of depletion, anxiety, depression, resentment and/or emotional withdrawal,” Venart explains. “Counselors experiencing compassion fatigue may deny clients’ traumatic experiences, overdiagnose and pathologize clients, and become increasingly less attuned and empathic.”
Impairment: Venart says the ACA Task Force on Counselor Wellness and Impairment found that impairment “occurs when there is a significant negative impact on a counselor’s professional functioning which compromises client care or poses the potential for harm to the client.” Lawson adds that impairment, which doesn’t always equate to unethical behavior, can lead counselors to tend to their own issues at the expense of clients’ issue. For example, a counselor with grief issues might steer clients away from their own grief or loss issues because the counselor can’t handle talking about them.
— Lynne Shallcross
When counselors are isolated, whether working in rural areas or working as sole private practitioners, maintaining wellness can pose an even bigger challenge. Without other colleagues to learn from, vent with or lean on for support, stress is more likely to build unimpeded. Experts say finding a support system, whether through formal supervision or an informal network of other professionals to meet with for consultation and camaraderie, is vital.
Technology can also help bridge the gap. “With the Internet, e-mail, Facebook and the phone, you can still connect with other people,” says Sandra Rankin, who works in private practice in Austin, Texas. Adds Elizabeth Venart, a private practitioner in Ambler, Pa.: “Post questions and participate in online forums for counselors through sites like LinkedIn and Psychology Today. Join interest networks (electronic mailing lists) through ACA where you can connect with counselors in other geographical areas who share your professional interests.” Find out more about ACA’s interest networks by scrolling to the bottom of counseling.org and clicking on “Interest Networks” under the “Get Involved” tab.
Counselors also recommend checking out local, state, regional and national associations for networking possibilities and attending professional conferences to meet other helping professionals. Leslie Kooyman, an assistant professor at Montclair State University, says counselors also might want to consider consulting. When he worked in private practice, Kooyman split his time between counseling clients and doing consulting work with nonprofit organizations and school systems. Not only does consulting offer a team of people with which to work, he says, but it can also help generate revenue.
Research others in your geographic area who are doing similar work, Venart recommends, then contact them and schedule a time to talk in person. “Even if your ’local’ colleagues end up being three counties or two hours away, they can be a resource for you,” she says. “Perhaps organize quarterly in-person meetings to supplement more regular phone calls and teleconferences. There are several free teleconference services where the only fee is the price of
the phone call through your local phone service provider. One I have
used successfully in the past is freeconference.com.”
— Lynne Shallcross