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Who’s taking care of Superman?

Lynne Shallcross January 1, 2013

SuperCounselors are fond of telling clients that a drowning person can’t help others to get out of the water safely without first saving himself or herself, says Jane Myers, a professor in the Department of Counseling and Educational Development at the University of North Carolina at Greensboro.

But do counselors walk that talk? Not as often as they should, contends Myers, who, along with Thomas Sweeney, co-edited the book Counseling for Wellness: Theory, Research and Practice, published by the American Counseling Association in 2005.

“This is a matter of us taking our own advice,” says Myers, the executive director of the international counseling honor society Chi Sigma Iota and a past president of ACA. “When we experience challenges to our own wellness, when we are distracted with our own stress, anxiety and unresolved relationship issues, it becomes difficult or impossible to be fully present to our clients.”

Paul Hard, an associate professor of counseling at Auburn University at Montgomery who served on ACA’s Task Force on Counselor Wellness and Impairment almost a decade ago, agrees. The altruistic mindset that most counselors possess when coming to the profession, while certainly admirable, can also become their own form of Kryptonite, Hard says. Counselors often feel they should be Superman or Superwoman, he says, bearing the heavy responsibility of caring for others, while harboring the belief that life’s bumps and stressors don’t — or shouldn’t — affect them the way they do everyone else.

“Much of the professional literature suggests that counselors can see themselves as invulnerable to stress and impairment,” says Hard, who currently chairs the ACA Branch Development Committee. “We are client-centered. We are caregivers by nature, and this altruism may work against our self-interests.”

“At times, life situations, work and individual issues, and the counseling process itself can become overwhelming and challenging,” says Virginia Magnus, an associate professor in the counseling program at the University of Tennessee at Chattanooga (UTC). “Therefore, self-care is an essential component for counselors.”

Self-care becomes even more important when you take into account that counselors and counselor educators are often working with clients or students who are experiencing some kind of distress, says Magnus, who presented on self-care at the 2012 ACA Conference & Expo in San Francisco. “The very nature of counseling places [us] in a position to listen to others’ hurts, grief and distress. Therefore, self-care is necessary not only to function at full capacity but also to deliver competent services to clients and students alike,” she says.

The act of self-care requires that counselors regularly turn their attention inward and reflect on their own wellness, Myers says. “Counselors spend so much time working with and on behalf of others and thinking about others that it is easy to lose track of our own needs,” she says. “Sometimes we feel selfish when we are not available to persons in need because we are taking time out for ourselves. We are challenged to reframe the meaning of self-care as something we do to make sure we are always at our best in terms of our ability to be helpers. Just as we are intentional in learning the scope of knowledge required to practice counseling, we need to be intentional in learning and practicing the behaviors that allow us to approach each client with an openness and sense of hope and optimism. That sense of hope is for our clients’ ability to experience their strengths and choose to grow and change, and for our ability to help them see their strengths and develop a vision of themselves that will help them grow toward wellness.”

Maintaining equilibrium

Myers can think of many times she has needed to take self-care more seriously. “When I find I have lost my smile, that my mirth response is gone, I need to step back, take stock and something has to change,” she says. “That might be when I find myself at home with friends or family not fully listening or not being fully present [because] I am mentally recounting a client’s story and reconnecting with their predicament and their pain. When others around me are smiling and having fun, and I am ruminating and wanting to get back to the office or check out the Internet for some intervention ideas or to answer my emails, that is a time when I know change is needed. If I cannot leave my clients’ concerns at the office, I need an intervention for me. Typically, that would be supervision with a trusted counselor friend or colleague who can help me sort out my priorities and reconnect with my own self-care.”

Most people enter the counseling profession out of a sense of compassion for others and a desire to help, Myers says. “As we listen empathically to the stories of our clients, it becomes impossible not to enter their world and experience their pain. Empathy means feeling with others, and that carries the risk of what we call empathy fatigue or compassion fatigue. We enter so fully into the realm of our clients’ feelings that we have trouble separating ourselves and leaving those feelings at the office. Heading for home with a heavy heart and feelings of pain for the pain that our clients feel is not uncommon. To engage in self-care means to be able to put those feelings aside — to be compassionate when needed but to reclaim our own inner selves as we leave our offices behind and return home to others who need us in other ways.”

Self-care involves learning how to manage stress, whether personal or related to work, making healthy decisions and participating in behaviors that help maintain equilibrium in daily life, says Magnus, a member of ACA. It is important to ensure that a self-care regimen includes physical, psychological, emotional, intellectual and spiritual aspects, she says.

Proper self-care also means drawing boundaries when necessary, Hard says. “We have to learn where our limits are. We have to learn to be able to say ‘no’ for no other reason than it’s going to be contrary to taking care of [ourselves], which, for a lot of us, is a challenge because we find it difficult to be selfish.”

Take, for example, the case of a counselor getting ready to take a vacation, Hard says. The counselor works doubly hard to cram clients into the schedule the week before leaving town. In doing so, the counselor isn’t truly getting a break from work. He or she is simply packing two weeks’ worth of work into a single week. Unfortunately, this might be a typical scenario because, according to Hard, counselors have trouble saying, “Work will be here when I get back, so I won’t make myself crazy trying to fit it all in before I leave.”

Myers agrees. “As a counselor educator, when I find myself telling the kids and grandkids to go to the movie without me because I need to finish an article or catch up with my email, that’s a time someone needs to hold up the self-care sign to remind me that work will always be there.”

Wellness as a lifestyle

Self-care is a favorite talking point for many helping professionals, and the concept is not complicated, but the counselors interviewed for this article say it takes intentional effort and real determination to turn that talk into action. “We have been hearing about self-care for decades and it sounds so simple, yet it is difficult to begin or to maintain a self-care plan because it requires time and resolve,” Magnus says. “We live in a world of instant gratification. Therefore, [we] expect self-care to be something that [we] can plan and implement and then consider it completed or accomplished. However, self-care is a lifelong journey and a consciously chosen lifestyle.”

It is easy for common life circumstances to interfere and quietly nudge counselors’ self-care efforts aside, Magnus says. “For example, we say to ourselves, ‘I am too busy this week’ or ‘Things at home are hectic right now,’ so [we] do not take the time for self-care. While that may be true, this is when we should be more aware of and dedicated to self-care. It is very easy for most of us to find reasons not to [go to] the trouble [of consistently practicing] self-care. Before we know it, our self-care plan has slipped away altogether. Let me reiterate here — self-care takes time and resolve.”

Hard thinks another reason more counselors don’t practice proper self-care is because of the way it is presented to them — as yet another add-on to their already lengthy to-do lists. For example, he says, in reviewing the litany of things that counseling students need to remember to best serve their clients, some counselor educators simply load self-care on top of the pile. The key to making self-care an integral part of more counselors’ routines, Hard believes, is to present it as part of a lifestyle, not simply as another add-on. It’s the difference between making time to incorporate wellness into your daily routine versus trying to squeeze a yoga class into an already packed weekend just because you feel you have to, he says.

The economy presents another hurdle to self-care, Hard says. He studied caseloads in community mental health settings in Alabama and developed a template for limiting caseloads to prevent counselor burnout while allowing counselors to effectively meet client needs. Hard acknowledges, however, that in a swamped community clinic or in a private practice in which the number of clients seen directly affects the bottom line, limiting counselors’ caseloads may simply not be possible, even if it would free up time to practice better self-care habits.

The reality is that incorporating self-care into an already busy life is never going to be easy, Myers says. Just because counselors know intellectually that self-care is important doesn’t mean they will automatically uncover ample time for self-care and magically achieve balance in their lives. Instead, counselors must embrace wellness as an intentional process, Myers says. “Taking talk into action requires a commitment, support from someone or ‘someones’ close [to us] to remind us of our promises to ourselves, effective time management and the ability to say no,” she emphasizes.

Myers suggests counselors find at least one “flow activity” — something that brings them such joy that they lose themselves and all sense of time while involved in it. “This could be reading, meditating, gardening, walking, playing a musical instrument — whatever we immerse ourselves in so deeply that nothing else matters but being in the moment with ourselves,” she says.

Holding each other accountable

Counseling students at UTC learn about self-care and develop a wellness plan the first semester they enter the program, according to Magnus. The topics of self-care and wellness are discussed throughout the program, she says, with the hope being that the continual emphasis will carry over once students graduate and become professionals.

This past semester, Magnus and her nine internship students developed a group plan for self-care, setting a goal as a group to walk or run 500 miles by the end of the semester. “No specific number of miles was set per person per week,” Magnus says. “Each week, we logged how many miles each person had completed. Some students accumulated more miles than others did, but rather than make those of us who had not done as well feel defeated, it spurred us on to do better the next week. As a result, we completed the 500 miles with a few to spare.”

Setting goals, writing them down and collaborating with others in an effort toward wellness — all of which the UTC counseling students did — are a few ways self-care can become more achievable, Magnus says. She also emphasizes that goals should be realistic.

Hard wishes more graduate counseling programs would replicate UTC’s commitment to self-care. He would like to see self-care incorporated into the curriculum and into supervision more widely. “Supervisors and mentors in the field need to place a focus on self-care to make it an expected aspect of the profession rather than an afterthought,” he says.

All counselors could play a role in furthering the practice of self-care by teaming up and holding one another accountable to put the focus back on their own wellness, Hard says. As the clinical director of a community mental health center in northern Alabama a decade ago, Hard experienced the death of a client by suicide. In the wake of the client’s death, Hard tried to carry on as normal, but in reality he was struggling. Fortunately, one of his colleagues came into Hard’s office, shut the door and asked how he was doing. “She refused to accept the easy response,” Hard remembers. Instead, she took responsibility for Hard’s wellness, both as a colleague and as a friend. Hard believes this is an example that more counselors should follow in watching out for one another.

When looking out for his colleagues’ wellness, Hard pays particular attention to those individuals who are coming in on weekends to do extra work or extending their client hours and those who seem needy for client approval. Peer supervision circles can also be helpful in self-care efforts, Hard says, because they encourage peers to keep each other accountable.

Staying alert and self-aware

Counselors who don’t take self-care seriously are putting more than their own well-being at risk. “Lack of self-care can lead to exhaustion/fatigue, negatively affect an individual’s work and colleagues, [and] affect the overall functioning of an organization and the quality of services provided to clients and/or students,” Magnus says. “It can influence the way a counselor acts and interacts with clients, family and friends.”

It isn’t always easy for counselors to recognize when they are in need of more concentrated self-care, Magnus says, but a variety of assessments are available. She also provides a partial list of possible indicators that self-care has been compromised:

  • Feelings of powerlessness or helplessness
  • Skepticism
  • Irritability
  • Loss of meaning, purpose and hope
  • Lowered concentration
  • Impatience
  • Somatic complaints
  • Low morale or motivation
  • Anger
  • Guilt
  • Anxiety

In his own work, Hard, who runs a very limited private practice, says he stays alert for feelings such as wishing certain clients wouldn’t show up for their next session. “That’s danger territory,” he says, explaining that those and similar thoughts can indicate that impairment is creeping in and that a counselor hasn’t been attending to self-care.

Every counselor should keep a list of his or her own self-care needs and triggers, Myers suggests. “We each need to know the signs that tell us we are out of balance,” she says. “A wheel out of round does not roll smoothly. When we are out of balance, there are lots of little signs that tell us we need a course correction: ‘I have too much on my plate. I wish I had said no.’ For me, it is when I fail to smile and someone tells me. It is when I am asked to spend time with others and I say, ‘No, I have work to do,’ that I have to stop myself and ask, ‘When I look back, what [would] I like to be able to say about how I used the gift of this day?’”

The goal is incorporating self-care into a daily routine, these counselors say, although that often means navigating a host of challenges. Waiting until the weekend or the next vacation or the end of the semester to incorporate wellness and self-care into life doesn’t work, at least not for Myers. What does work is making time each day to practice the behaviors that Myers says keep her well, such as spending time alone or with her favorite people, focusing on breathing, enjoying a good meal or spending time in nature. “I have learned that I cannot feel centered, calm or present to others unless I take time daily to remind myself of who I want to be and practice those things that help me be that person.”

To contact the individuals interviewed for this article, email:

In working with clients, listening to their stories and empathizing with their situations, counselors put themselves at risk for vicarious trauma and threaten their own wellness. Counseling Today asked Victoria Kress, professor and coordinator of the clinical mental health and addictions counseling programs at Youngstown State University, to explain the nature of vicarious trauma and how counselors can combat it. Kress, the president of the international counseling honor society Chi Sigma Iota, has both presented on the topic of vicarious trauma and written about it for the Journal of Counseling & Development. To contact Kress, email victoriaekress@gmail.com.

 The other side of empathy

What is vicarious trauma?

Vicarious trauma (VT) involves reactions that counselors have secondary to exposure to clients’ traumatic experiences. VT involves changes in core aspects of the counselor’s self and can include disruptions in the cognitive schemas of counselors’ identity, memory system and belief system.

Why are counselors specifically at risk for experiencing VT?

VT is often rooted in the open engagement of empathy or the connection with clients that is inherent in counseling relationships. These repeated exposures to clients’ traumatic experiences can cause a shift in how counselors perceive themselves, others and the world around them. These shifts in the cognitive schemas of counselors can have significant effects on their personal and professional lives.

What are some of the detrimental effects of VT, both professionally and personally? How does it actually affect the counselor?

Counselors experiencing VT may feel there is no safe place or haven against real or imagined threats to personal safety. Higher levels of fearfulness, vulnerability and concern may be ways in which this disruption in safety needs is expressed. Counselors suffering from VT may be overly cautious regarding their children or take extra measures related to being physically safe.

The exposure to repeated client trauma shakes the trusting foundations on which the counselor’s world rests. Counselors experiencing VT are vulnerable to self-doubt and inhibited self-trust, often prompting them to question their ability to judge and effectively help clients.

Counselors experiencing VT may feel inadequate and question their own abilities to help others. Esteem for others can be compromised as counselors are faced with the ability of people to be cruel and for the world to be unfair.

VT may cause intimacy issues and cause a counselor to push away or become increasingly dependent on significant persons in his or her life.

How can a counselor work to actively prevent VT?

  • Maintain a diverse caseload and be aware of not being overwhelmed with many clients with trauma issues.
  • Training focusing on traumatology is important for trauma counselors and can decrease the impact of VT.
  • The impact of VT can be decreased when counselors maintain their wellness and balance.
  • Research suggests that counselors with a greater sense of meaning and connection are less likely to experience VT. Maintaining a healthy sense of spirituality and understanding what we can and cannot control can prevent VT. We all need to connect with our sense of spirituality in our own unique ways. Organized religions, meditation and yoga, and community service are just a few examples of activities that may deepen our sense of spirituality.
  • Peer supervision and regular consultation can help prevent VT and normalize VT experiences.

Are certain types of counselors more at risk?

People who work with victims of interpersonal violence are especially at risk, for example, those who work with child and sexual abuse victims or victims of interpersonal relationship violence and sexual assault.

Why is this an important topic to talk about and address?

  • Not addressing VT can result in serious ethical violations, which may harm clients.
  • Disruptions in cognitive schemas may lead to counselors compromising therapeutic boundaries. For example, counselors may forget appointments, not return phone calls, have inappropriate contact, [consider] client abandonment, and [risk] sexual or even emotional abuse of clients.
  • Counselors may begin doubting their skills and knowledge and potentially lose focus on clients’ strengths and resources.
  • Counselors may avoid discussion of traumatic material or be intrusive when exploring traumatic memories by probing for specific, unnecessary details of the client’s abuse or pushing to identify or confront perpetrators before the client is ready.
  • Counselor irritability, decreased ability to attend to external stimuli, misdiagnosis and attempts to “rescue” the client [are possible].

Read an online exclusive Q&A with Mark Stebnicki, professor in the East Carolina University Department of Addictions and Rehabilitation, on the topic of empathy fatigue.

 
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