Monthly Archives: December 2017

Nonprofit News: Burnout prevention for nonprofits

By “Doc Warren” Corson III December 13, 2017

Even the most compassionate, empathic and dedicated clinician has to work to prevent burnout and compassion fatigue. Where you work can often play a big role in the making or prevention of compassion fatigue and burnout. High-stress, high-volume work with little rest or downtime can be a major contributing factor to these issues.

As a nonprofit counseling professional, it is important to recognize the signs and symptoms of burnout in yourself and your staff members in order to prevent it. Taking small steps now can prevent or reduce the likelihood of losing some key members of your team. It is well worth the effort in the long run.

What follows are some warning signs of compassion fatigue:

  • Excessive blaming
  • Bottled-up emotions
  • Isolating from others
  • Substance abuse
  • Compulsive behaviors
  • Poor self-care
  • Legal problems
  • Apathy
  • Mental and physical fatigue
  • Being preoccupied
  • Being in denial about problems
  • Difficulty concentrating

If left unchecked, compassion fatigue can lead to full-scale burnout. Burnout is the physical and emotional exhaustion that caregivers can experience with increased workloads and stress levels. In extreme cases, burnout can lead to serious physical and mental illness. Thankfully, the signs are easily recognizable, preventable and treatable.

Signs of burnout:

  • Chronic fatigue
  • Quick to get angry or suspicious
  • Susceptibility to illness
  • Forgetfulness
  • Insomnia
  • Loss of appetite
  • Anxiety
  • Depression
  • Anger

There are four main stages of burnout.

Enthusiasm: Start work full of energy and with dreams of giant positive outcomes that may not be realistic.

Stagnation: Start feeling that your work is not matching your initial ideals, is always the same or is making little impact.

Frustration: Your anger and resentment over the state of your work grows. You feel you are wasting your time or accomplishing little to nothing.

Apathy: You no longer care. You are “punching the clock,” counting down to retirement, exploring options in other programs or changing careers.

Compassion fatigue and burnout can be quite difficult, especially for those in the helping professions. Many helping professionals report some level of compassion fatigue and burnout. Here are a few ways that caregivers can protect themselves.

  • Get educated on signs and symptoms
  • Practice self-care
  • Set emotional boundaries
  • Engage in outside hobbies
  • Cultivate healthy friendships outside of work
  • Keep a journal
  • Boost your resiliency
  • Use positive coping strategies
  • Identify workplace strategies
  • Seek personal therapy
  • Pace your work schedule
  • Vary your work as much as possible
  • Limit your work to 40 hours per week whenever possible
  • Take regular vacations or mini holidays to help recharge




Contributors: Lisa M. Corson and Jessica Gafaar


Nonprofit News looks at issues that are of interest to counselor clinicians, with a focus on those who are working in nonprofit settings.


Dr. Warren Corson III

“Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, and clinical and executive director of Community Counseling Centers of Central CT Inc. ( and Pillwillop Therapeutic Farm ( Contact him at Additional resources related to nonprofit design, documentation and related information can be found at







Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.


@TechCounselor: A better way to email, Part I

By Adria S. Dunbar and Beth A. Vincent December 11, 2017

Most of us have a love-hate relationship with email. Luckily, there are many software solutions to help counselors and counselor educators handle email more efficiently. Let’s begin by identifying the email issues you want to fix. If you choose more than one, don’t worry. We will take it one step at a time.


1) Which inbox issue are you trying to solve?

  1. a) I write emails during nonworking hours (e.g., 4 a.m., weekends, holidays).
  2. b) The number of emails I receive each day is out of control.
  3. c) I need to translate my emails into tasks on a to-do list.
  4. d) My email signature leads people nowhere.
  5. e) I write the same email over and over again.


We will spend the next few months addressing each of these types of email issues, one at a time. For those who chose “I write emails during nonworking hours,” we suggest an email add-on that might save you a lot of time and energy. It’s called Boomerang (, and it just might make your life with email a little easier.


Counselors, meet Boomerang

We are all trying our best to set boundaries with work and work-related tasks. Maybe you like to spend your Saturday mornings catching up on work, but sending an email on a Sunday evening or Saturday morning alerts people to the fact that you are available and working. Or perhaps you are a night owl who writes emails at 3 a.m. The meta-communication of when we send our emails says something to the recipients.

Regardless of your counseling role, email is a reality of the working world. Now that the majority of people have a smartphone, our emails tend to follow us everywhere — even when we are not physically present at the office. Everyone manages his or her connectedness differently, but as counselors, it can be challenging to set boundaries when it comes to responding to emails from clients, students or co-workers. Unfortunately, it can be easier to just go ahead and respond immediately rather than risking the sometimes unavoidable reality of forgetting to follow up at a later time.

Boomerang is a helpful tool that allows you to schedule when your emails get sent. What this means is that you can write and respond to an email whenever you choose — maybe that is at night after your children have gone to bed, or on the weekend when you said you weren’t going to be checking your email. Regardless, you can schedule the email to be sent to your client’s inbox at 8 a.m. on a Tuesday morning during normal “business” hours. This can help us as counseling practitioners or counselor educators to model better communication boundaries to our clients and students (i.e., suggesting that we are not instantly accessible) by limiting communication times and creating a culture of self-care.

In addition to setting boundaries, Boomerang allows you to schedule emails ahead of time, whether that is hours, days, weeks or months in advance. For example, perhaps you are planning a workshop or group event that is a month away, but you already have a list of attendees who have RSVP’d. Using Boomerang, you can write your email reminder now and schedule that email to be sent to attendees a week before your event takes place. This takes the pressure off of you to remember to send a reminder email.

Boomerang does come with some limitations. The tool is accessible both for Gmail and Outlook users. However, currently, you can schedule only 10 emails per month using the free version. Once you hit your 10-email limit, you are unable to schedule additional emails until a new month begins (unless you pay a monthly fee for the service).

In our view, there are definitely benefits to the paid services. For $5 a month, you can schedule messages to return to the top of your inbox at a set date, while also including a note to yourself with next steps or reminders. You also receive mobile access to the application. For additional fees each month, other features are available, including unlimited emails with Boomerang, recurring messages (e.g., weekly, monthly, yearly), a setting that allows you to pause email notifications and a setting to prioritize a VIP list of senders.

Whether wishing to disconnect a bit more, wanting to be more organized with your recurring messages or just needing reminders of the emails you sent that no one replied to, Boomerang can be a tool to help counselors reduce some of the mental clutter that we all experience because of our very full inboxes.




Adria S. Dunbar is an assistant professor in the Department of Educational Leadership, Policy and Human Development at North Carolina State University in Raleigh. She has more than 15 years of experience with both efficient and inefficient technology in school settings, private practice and counselor education. Contact her at


Beth A. Vincent is an assistant professor at Campbell University in Buies Creek, North Carolina, in counselor. She is a counselor educator, licensed school counselor and former career counselor who is driven to learn everything there is to know about innovative productivity software so that she can help counselors be their most present selves. Contact her at


Our Instagram is @techncounselor (




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Raising awareness of suicide risk

By Jerrod Brown and Tony Salvatore December 6, 2017

Suicides have increased steadily in the United States during the past decade. Suicide research has also grown, but pertinent findings are sometimes slow to reach mental health professionals and providers. Many misconceptions and gaps in the knowledge base remain. The role that mental illness plays in suicide is an area of research that both the public and many clinicians must better understand. This article touches on 10 aspects of the relationship between suicide and mental illness that mental health professionals should be aware of and should be able to share with others.

1) Serious and persistent mental health disorders sometimes contribute to suicidal behavior, but they generally are not the cause of suicides on their own. A suicide risk factor is a personal or demographic attribute found to be prevalent among suicide victims; a cause is a condition that brings suicide about. When suicide and serious and persistent mental illness are inappropriately linked, it can result in enhancing associated stigmas and misdirecting the focus of suicide prevention. Mental illness is sufficient to contribute to suicide but not absolutely necessary. Myriad factors and reasons, separate and aside from mental illness, can account for suicidal behavior. Keep in mind that antidepressants and other psychotropic medications may effectively reduce suicide risk only for the psychiatric disorder for which they are prescribed.

2) Many individuals who die by suicide do not have a diagnosed serious and persistent mental illness at the time of death. The Centers for Disease Control and Prevention’s National Violent Death Reporting System has found that just over 40 percent of those who die by suicide have a mental health diagnosis.

Despite methodological flaws, psychological autopsy studies that attempt to assign psychiatric diagnoses post-mortem through interviews of those who knew the deceased have routinely found that an overwhelming number of victims of suicide had a diagnosable, although perhaps not documented, mental illness. Nonetheless, this mode of research may sometimes exaggerate the role that mental illness plays in suicide. Mental health providers must understand that although mental health services are a critical component of suicide prevention, they should be only part of a comprehensive approach to deterring the onset or progression of suicide risk.

3) The rate of suicide and suicidal behavior has been found to be higher among people with a serious and persistent mental illness than in the general population, but the majority of those with a serious and persistent mental illness neither attempt nor complete suicide. Every mental health professional and provider organization must be sensitive to the potential for suicide risk and behavior in their clients regardless of their psychiatric histories. Retrospective studies of those who have died by suicide have found that not all of these individuals possessed discernible signs of any form of mental illness as identified by family members or friends. Therefore, outpatient providers must be careful not to minimize signs of possible suicide risk in the absence of mental illness.

4) Psychiatric hospitalization may stabilize and ensure the safety of people who are acutely suicidal. However, it does not in and of itself constitute long-term treatment or reduce the risk of suicidality in the future. Inpatient settings can reduce suicide risk through appropriate use of psychotropic medication when indicated. Psychoeducation about suicide and support groups should also be part of a treatment plan for a client who is suicidal. Community-based providers accepting referrals from inpatient facilities should review the attention given to a potential client’s suicidality while hospitalized and make sure that a predischarge suicide risk assessment was performed.

Suicide prevention must also be part of aftercare in the community. Outpatient providers should engage the client on this objective prior to discharge. Outpatient providers should be thoroughly familiar with the client’s discharge plan, and particularly those elements relating to ongoing suicide risk. If appropriate and with the client’s consent, the outpatient provider should consider a family conference to ensure that the client’s support system understands the individual’s ongoing suicide risk, the family’s role in managing it and what family members should do if the client shows signs of suicidality.

Most important, outpatient providers must maintain continuity of care and resume treatment as soon as possible. When short-term resumption of treatment cannot be accomplished, contact should be initiated by telephone or other means to support the client.

5) The first 30 days after discharge from inpatient psychiatric care is a period of high suicide risk irrespective of the reason for admission. Suicide risk has been found to be especially high in the first week after discharge. This must be acknowledged in outpatient discharge plans. Patients and families must be made aware of this risk, and providers must ensure that patients returning to the community engage quickly with outpatient services and adhere to medication regimens as applicable. Those leaving hospitals must be made aware of 24/7 hotline and crisis services that they can turn to if needed. The National Suicide Prevention Lifeline (at 800-273-8255) is one such resource.

6) Contracting for safety is a technique in which at-risk clients agree to notify their mental health providers or take other steps (e.g., calling a hotline or 911) rather than making an attempt on their life if they have thoughts of suicide. Many counselors, therapists and mental health practitioners continue to use this technique despite an absence of research supporting its efficacy. At best, safety contracts give mental health providers a questionable, if not groundless, sense of security regarding their clients’ potential risk.

Providers are better advised to use thorough suicide risk assessments and personal suicide safety plans with patients and clients. Providers and clients can collaboratively develop personal suicide prevention safety plans, and they have therapeutic value. These plans generally document factors such as warning signs, triggers, coping methods, supports, providers and sources of emergency help.

7) Many mental health providers do not have suicide prevention policies that mandate routine training or outline requirements for client and patient suicide risk assessment. In some instances, mental health providers lack guidance on what should be done in the event of the suicide of a client. This is a serious deficit given our exposure to potential client suicides. Agencies should have a formal suicide prevention policy stating the measures to be taken to prevent suicide and postvention actions to be initiated with staff affected by a client’s suicide. Providers should encourage licensed staff to include suicide prevention trainings among their required continuing education.

A client suicide is perhaps the most traumatic experience that a mental health provider can endure. Taking a risk management stance after a suicide is not sufficient and may be harmful to all concerned. Providers should supply grief support resources, such as Survivors of Suicide, to both staff members and to the deceased client’s family members.

8) Care of individuals who are suicidal has been delegated to the mental health system for evaluation and treatment. This has resulted in many at-risk individuals being assigned one or more diagnoses from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. These diagnoses often become the focus of subsequent care, which may overshadow the person’s ongoing suicide risk and the need to address his or her suicidality. The mental health field has access to some evidenced-based therapies that can assist in reducing suicide risk and deterring future suicidal behavior, but more research and education are needed.

Those who survive a suicide attempt have an elevated short-term suicide risk and a continuing lifelong suicide risk. It is imperative for treating mental health professionals not only to provide therapeutic services but also to connect these clients with available community resources to reduce the likelihood of subsequent suicide attempts. Support groups made up of survivors of suicide attempts are optimal, but these groups are appearing only slowly in communities. In the absence of peer groups or provider-led support groups, consideration should be given to warm lines, chats and other online resources, or to videos and texts created by survivors of suicide attempts.

9) Effective treatment of serious and persistent mental health disorders may lessen suicide risk among impacted individuals. However, treatment for these disorders may not be the only answer. It is imperative for mental health professionals to also address other issues such as substance misuse, traumatic loss, shame, social disconnectedness, feelings of hopelessness or the belief that one is a burden to others when present. Suicide risk should be assessed whenever clients experience any adverse life events, regardless of clients’ adherence to therapy or counseling regimens. Assessing for risk of suicide may require ongoing attention throughout the entire treatment process.

10) The intense and persistent desire to die is experienced by some individuals with serious and persistent mental illness. However, by itself, desire to die is insufficient to bring about a potentially fatal suicide attempt. The person in question must also have overcome the inherent resistance to lethal self-harm. The mitigation of this resistance can occur through life experiences such as abuse, a history of violence, self-injury or traumatic grief, any of which individually can create a capability for significant self-harm up to and including suicide.


Certainly, some individuals with serious and persistent mental illness die as a result of suicide. Nonetheless, suicide is preventable. Mental health treatment providers are well-positioned to minimize the impact of suicidality after onset and to address any ongoing suicide risk. Several steps can be taken to accomplish this.

Every provider should have a suicide prevention policy that outlines measures to identify suicide risk in clients and appropriate responses to such risk. Such a policy should detail what must be done in the event of a client suicide. A suicide risk assessment should be considered as part of new client intake depending on prescreening responses. This involves both clinical judgment and an evidence-based risk assessment instrument.

All staff need to be able to recognize possible warning signs of suicide in clients. We recommend requiring all clinical staff to complete a continuing education course on suicide prevention on a regular basis. Providers might also consider participating on suicide prevention task forces at the city, county or state level. Participation may provide additional access to suicide prevention experts and other resources.

Finally, clinicians must adopt what might be called suicide prevention literacy. They must rely only on evidence-based reports about suicide from researchers in their disciplines and related fields. They must be able to assess these sources and use them to develop evidence-based treatments and programs. Suicide prevention literacy means employing these skills to make suicide prevention a practice reality. It goes beyond participating in suicide prevention walks and runs, conferences and trainings to create a provider mentality that is prevention-oriented. It means using what is available to try to mitigate suicide risk and amplifying suicide protective factors in clients and in the community — not just talking about it.




Jerrod Brown is the treatment director for Pathways Counseling Center Inc., which provides programs and services for individuals impacted by mental illness and addictions. He is also the founder and CEO of the American Institute for the Advancement of Forensic Studies and the editor-in-chief of Forensic Scholars Today and The Journal of Special Populations. He holds graduate certificates in autism spectrum disorder, other health disabilities and traumatic brain injuries. Contact him at

Tony Salvatore is the director of suicide prevention at Montgomery County Emergency Service, a nonprofit crisis intervention and psychiatric emergency response system in Norristown, Pennsylvania. He has a particular interest in post-psychiatric hospital suicide prevention and has served on a number of suicide prevention task forces at the state and county levels in Pennsylvania.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.


Grief, loss and substance use

By Susan Furr and Derrick Johnson December 5, 2017

Andrew’s mother was so happy that he had finally agreed to enter treatment for his drinking problem. He had been an excellent college student until his hard partying began to take over his nights, leading to missed classes and incomplete assignments. He still managed to get a decent job that involved a lot of travel and client dinners. Andrew’s mom thought these responsibilities would help him settle down. What she didn’t realize was that he would begin using stimulants to keep up the hectic pace. When combined with his socially sanctioned business drinking, Andrew’s performance soon suffered.

Andrew managed to cover up the cracks in his professional veneer for several years before finally passing out one evening from a combination of exhaustion and alcohol. Thankfully, his company supported his entry into treatment, a move that encouraged his mother.

During one of the family visiting days, Andrew’s mother was thoroughly confused by his anger over giving up his substance. He had believed that treatment would help him “dry out” and then return to his previous life. “I don’t know why they expect me to give up people, places and things associated with my drinking,” Andrew lamented.

Andrew’s mother wanted to scream that this was such a small price to pay for Andrew to regain his life before it was too late. What she didn’t realize was that she had just encountered the first glimpse of Andrew’s grief related to recovery. Many other layers of grief would need to be uncovered and processed in the weeks and months ahead.

Confronting losses

You do not have to be an addictions counselor to encounter the grief related to substance use. I (Susan) worked for many years in a college counseling center and encountered students struggling with losses related to family members who were addicted. Substance use had taken away the parent they longed for.

For other students, siblings who were addicted created a range of issues, from trying to engage the student in substance use to wanting the student to “cover” for them. In the extreme, counselors may connect with students whose sibling overdosed while they were away at college, adding to their guilt because of a false belief that they could have prevented the act.

Given that college students are engaging in their own developmental issues around identity, they may be in a place to face these issues for the first time. Many college students begin to recognize some of the harmful effects created by the environments in which they lived.

Perhaps the most difficult case I encountered was a young woman who was beginning to address childhood sexual abuse perpetrated by her father. During our work together, her father contacted her to apologize for any harm he might have done, although he professed that his memories were cloudy because of his substance use. He was now in recovery and trying to make amends. Although his confession reaffirmed my client’s own memories, she was left grieving for the father she never had.

Groups such as Adult Children of Alcoholics evolved to support those whose lives have been upended by the addiction of someone else. In examining your client’s history, gathering information on any substance use issues in the family may go a long way toward helping the client understand the evolution of his or her current emotional challenges.

The loss of identity

Grief is often a forgotten aspect of recovery. Out of necessity, the need exists to focus on the physical aspects of addiction to alcohol and other drugs (AOD). These physical aspects of addiction are much more challenging than acknowledged by a “just say no” culture. Think about giving up that first cup of coffee each morning — for the rest of your life. And then multiply that impact manyfold.

Treatment programs have developed protocols to help clients navigate this process on a physical level, and support groups such as Alcoholics Anonymous (AA), Narcotics Anonymous and SMART Recovery help deal with the abstinence aspect of recovery. However, the idea of grieving the loss of one’s substance may seem contradictory to treatment. After all, giving up a destructive substance is a good thing — right? Regardless, any change, no matter how positive, often creates a sense of loss.

One way to think about this issue is to focus on the identity the client forms with the addictive substance rather than just thinking about giving up the substance. Clients often develop a positive view of self in terms of their substance, such as being able to “hold one’s liquor” or a female being able to “drink like a guy.” They gain a positive status for their drinking or drugging prowess; in other words, the user gains a sense of belonging and significance.

As substance use becomes a core value, social networks form around the experience of “using.” For example, one’s knowledge base and interest revolve around being aware of the best microbreweries or having a refined wine palette or even knowing the best place to buy meth. Identity begins to form around using and being with other users. The use of mobile apps that help “connoisseurs” identify and cross off “must-have” finds further increases the social lure of drinking and using substances. These items combine to develop an identity for the user and the onset of a relationship between the substance and the user.

More profound is the discovery of the purpose of substance use. Does it relieve anxiety in social situations or loosen inhibitions with potential relationship partners? How does the substance help the client cope with painful emotions caused by other losses? It is not uncommon for people to cope with a painful situation by going out for a drink, but for some, the substance becomes the go-to solution for any life stressor. I recall a bar that gave out a free drink for every job rejection letter that one of its patrons received. On the surface, this was a way to lighten the mood, but on a deeper level, it was just another way of teaching poor coping strategies — in this instance, managing loss through the use of substances.

Social networks can revolve around a culture of using. Stopping by the neighborhood bar after work may evolve into hanging out with the guys until closing time — dinner missed and a partner outraged. After awhile, users seem to prefer the company of fellow users over that of the distraught family. These gathering places often become part of a ritual, providing a structure that may normalize the damaging behavior. Recall the old TV show Cheers, “where everybody knows your name.” The act of walking in, seeing familiar faces and sharing a favorite drink creates a comforting routine that overshadows the underlying harm caused by abusing substances.

The grief aspects of recovery

To be successful in recovery, the client has to let go of all of the comforting aspects of using. These things must be grieved in order for the client to move forward.

Entering treatment means leaving behind the familiar and facing the unknown. On a cognitive level, giving up immediate gratification for future gains may make sense, but the actual experience of change also results in losses that need to be acknowledged.

Clinicians who understand the role that loss plays in recovery have devised activities, such as writing a goodbye letter to one’s substance, which recognize that even the loss of something that is ultimately negative needs to be grieved. It was through my work in grief and loss counseling that I first became aware of the loss associated with giving up one’s substance. Kathryn Hunsucker, a graduate student at the time, began applying the concept of loss to recovery and found that this concept resonated with her clients. We began working together to use some of the existing grief theories to conceptualize recovery in a way that made sense to clients. Derrick Johnson, an addictions counselor in Charlotte, North Carolina, has teamed with us to extend this approach to families. The theories of both J. William Worden and Therese Rando have been instrumental in helping us conceptualize the grief aspects of recovery.

Grief and loss show up in other phases of recovery too. Clients not only grieve giving up their substance and fellow users, but they also begin to examine losses throughout their lives. Once clients are engaged in ways of maintaining their abstinence and perhaps working through the steps of AA, they begin facing the choices that they made while using. In this phase of recovery, clients may begin to recognize that the consequences of their choices often involved a loss.

The underlying loss may be about the loss of the person the client once was or aspired to be. Some clients lament the loss of meaning in their life and their disconnection from spiritual or existential values. Often, however, there are more concrete losses that may include jobs, family, freedom and home. It is common to see the recognition of these losses emerge as clients address steps No. 8 and No. 9 of the Twelve Steps. Acknowledging those who have been harmed and making amends forces clients to see how they might have created their own losses.

The realization that this time can never be recaptured may trigger new waves of grief that can dampen the sense of hope that treatment initially fosters. Creating space for grieving is necessary to help cushion against relapse. This space is created by the counselor’s willingness to address the issue of loss directly. Clients often are surprised when the counselor asks them about the grief they experience in giving up their substance, but they are typically quite open to sharing what they will miss about using. If we pretend that no sense of loss exists, our clients will continue to avoid facing the losses that they will encounter in recovery.

Throughout the recovery process, clients often fight against memories of painful and traumatic experiences that may initially have contributed to their substance use. Counselors may be drawn to pursuing issues such as childhood sexual abuse early in treatment because the core nature of these events is linked to their clients’ emotional pain. However, until skills to maintain abstinence are developed and more recent losses have been grieved, it may be more productive to focus on the skills needed to contain these feelings. Kathryn Hunsucker, who is now an addictions specialist in Morehead City, North Carolina, suggests “bookmarking” these issues and returning to them at a later date — ideally when clients have formed the strength to encounter the pain associated with these losses.

Metaphors and other creative approaches

Derrick Johnson saw his practice change after adding grief counseling as part of his approach in treating addiction. Of specific interest is his use of “love” as a metaphor.

Derrick has clients think of a romantic love or someone very special to them whom they lost due to the person’s death. Derrick then asks his clients to list both the positive and negative aspects of their relationship with this person. After examining these relational attributes, Derrick next asks, “Did you stop loving that person the moment you said goodbye?” Of course, the reply is “no.” The use of this metaphor creates understanding and generates recognizable feelings and thus becomes a cognitive tool for clients to make the connection to their experience of giving up a substance.

Another example could be the termination of an intimate relationship. Again, although saying goodbye leads to a newly defined relationship status, it does not mean that love immediately stops. Through group discussion, members are able to understand that just because they love someone does not automatically qualify it as a healthy relationship. Similarly, love of or use of a substance does not equal compatibility. This parallels AOD abuse/dependence, which is not compatible with successful life engagements and life fulfillment. Through this metaphor, clients are able to draw parallels between giving up a substance and the loss of a relationship.

Acknowledging that it is OK to grieve the loss of the substance is essential to helping clients move through that initial fear of giving up or losing something. It is no different than acknowledging the passing of a loved one or the end of a relationship. Would counselors take that away from a client who is mourning? Of course not.

Engaging in creative approaches to help clients visualize their losses can also be valuable. Kathryn often uses an activity that starts with a handout, “What Baggage Do You Carry,” illustrated with different types of suitcases. She asks clients to fill the bags with the losses they carry around with them because of their addictions. Clients then explore what it would mean to take items out of their bags to lessen their loads. Emotions related to giving up the items are then examined. This is one concrete way for clients to increase awareness of the losses they may need to grieve.

Another awareness activity Kathryn uses is “Life Event Bingo.” In this activity, group members are given bingo cards featuring different life events in each square. Group members are instructed to mingle to try to find someone who has experienced a particular life event in the past year and to learn what coping techniques worked best for the person in that situation. Group members then record the person’s name and coping strategy in the appropriate box. The goal is to find a different person for each box so that group members make connections with others and explore different ways to deal with life challenges.

It is important to allow clients to discuss and make a list of those things that they miss about using. Though contrary to intuitive treatment protocol, it is important to remember that people use substances to alter their feelings, which means that the complete spectrum of feelings must be explored. This process involves careful one-on-one work between the client and therapist that can uncover a multitude of clues about why a client uses substances.

For example, when Derrick worked at a 90-day intensive outpatient facility, the identification of engagement and belonging was a key factor in uncovering the etiology of one client’s substance dependence. Specifically, this binge drinker identified fall and winter as “just my perfect time.” Upon closer examination, Derrick discovered that attending NFL football games and tailgating prior to the games provided this client with a keen sense of belonging. Thus, giving up drinking also meant saying goodbye to his ritual and way of belonging. This client had to grieve the loss of his ritual and what the loss represented as it related to his identity.

Closing thoughts

Grief and loss issues are essential to explore when working with people living with addictions but, frequently, this focus is left out because of the many competing issues that arise. Although those who are in treatment gain a new understanding of what it means to grieve the loss of their substance of choice, this process may be confusing to those in their support networks. The family just wants the person back whom they lost to addiction. We need to be sensitive to the losses faced by families who have their own grief to explore. They, too, have lost hopes and dreams that were shattered by addiction. Even with effective treatment, the person who returns to them has been changed by the addiction experience and will need to continue to work on personal abstinence.

Families may need additional support as they work to reintegrate their family member returning from treatment. Groups such as Al-Anon can provide needed encouragement and understanding. But as is the case with all losses, grief must be faced and experienced as part of the healing process. Often, the lessons learned from the loss can lead to an enriched way of living, both for the family and the person in recovery.




Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Susan Furr is a professor in the Department of Counseling at the University of North Carolina at Charlotte (UNC Charlotte). She had 16 years’ experience working at the university’s counseling center before moving to teaching. Her interests include grief and loss counseling, crisis intervention and counselor development. She is an active member of the International Association of Addictions and Offender Counselors (a division of the American Counseling Association), where she is the editor of IAAOC News. Contact her at

Derrick Johnson is a doctoral student at UNC Charlotte with research interest in the association of grief, loss and addiction. He is senior clinical addiction therapist at Legacy Freedom Treatment Center and also has a private practice in Charlotte.






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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.


Giving children a voice in addiction recovery

By Bethany Bray December 4, 2017

When treating clients struggling with substance abuse, Lindsey Chadwick would like her fellow counselors to keep in mind the toll that addiction takes on children. Addiction affects the whole household. Children feel the effects differently — but as acutely — as adults, says Chadwick, a licensed professional counselor and manager of the children’s program at the Betty Ford Center, part of the Hazelden Betty Ford Foundation, just outside of Denver, Colorado.

“Simply being aware [of the fact] that kids are affected by addiction is a huge piece of the advocacy work that we do,” says Chadwick, a member of the American Counseling Association. “Even if a counselor is working [in addictions] with adults, be thinking of the kids. They are a big part of their grown-ups’ recovery. They matter. Take into account what the kids have to say.”

Chadwick and her colleagues run a program for children, ages 7 to 12, who come from addicted homes. The child’s “grown-up,” a parent, relative or caregiver, receives treatment simultaneously through the Betty Ford Center’s programming for adults. The children come for an intensive, four-day workshop that focuses on coping skills and education on what addiction is, and – most importantly – that it’s not their fault, says Chadwick.

“Most of all, we try and help them have fun and be a kid. They are often caught up in very grown-up situations at home,” says Chadwick.

Children from homes where  addiction is present often  take on roles they’re too young to play, such as caring for younger siblings or being a peacemaker or mediator in the home, she

Lindsey Chadwick at work in the children’s program at the Betty Ford Center just outside of Denver, Colorado.

explains. At Betty Ford, Chadwick and her colleagues do a lot of role-play, sharing activities and psychoeducational games with the children, as well as non-therapeutic games, snacks and swimming at a nearby pool.

“For the most part, on the surface, our kids look like any other kids,” says Chadwick. “But we see a lot who are struggling with anger toward their grown-up or family members. We see a lot of very anxious and nervous kids who have taken on a lot of adult roles because they needed to.  Some of our kids have also experienced abuse and neglect. Addiction is an equal-opportunity disease, so we see it in all kinds of families.”

Children who come through the program often struggle with perfectionism, an extreme focus on maintaining control and “not making waves,” says Chadwick. Also, children who come from addicted homes often experience loneliness and guilt or feel like their family is not as good as others.

Many children feel like the addiction is somehow their fault – a message they focus on reversing, says Chadwick.

“We teach them that many people go through what they’re going through,” she says. “We want them to really learn their strengths. Despite the addiction, it doesn’t mean that they can’t love their family, or that other things [in their life] aren’t going well.”

In households with addiction, feelings and problems are not usually talked about or addressed. This unwritten “rule” of not talking about struggles or emotions is passed from older to younger generations, Chadwick says. At Betty Ford, they work to undo those patterns, teaching children to express what they’re feeling – with an aim to keep them from falling into addiction when older.

“A lot of our kids don’t have the language [to express the struggles of addiction]. We try to give them the language to talk about what’s going on, to identify what’s wrong and tell someone,” says Chadwick. “… We give them the space to know that they matter, and it’s OK to let things out.”

In addition to talking to express themselves, they teach the youngsters nonverbal ways to let out their emotions, such as drawing, physical activity and other self-care activities. They also identify who is safe to talk to (i.e., a counselor, trusted adult or peer) and when. “Addiction sometimes confuses that for them,” explains Chadwick.

“We have kids who come in, and they’re angry, sad or mad, and they don’t want to be here,” she says. “On the last day [of the program], they’re happy and smiling – they’re a kid again. It’s such a wonderful transformation to be a part of.”

Psychoeducation activities at the Betty Ford children’s program also involve a cartoon character named Beamer. He stars in a series of books that the Betty Ford Center uses in their children’s program.

Both of Beamer’s parents struggle with addiction, and one is in recovery, and the other is not, explains Chadwick. Beamer navigates the ups and downs of living in a household coping with addiction in each of the books.

“Kids really love Beamer because they’ve never really seen a character that’s going through the same things as they are,” Chadwick says. “It’s very validating to learn that they’re not alone. They relate to him. A lot of the situations he’s been in, they’ve been in – his struggles at school and interactions with family. It gives them a vehicle to talk about it as well, and helps them feel more comfortable.”

Betty Ford counselors sometimes encourage the children to write Beamer letters as a therapeutic tool, adds Chadwick.

All families who go through recovery programs at the Betty Ford Center are referred for therapy in their local area. They are also invited back for weekly follow-up programming and support groups.

Chadwick has worked for nine years at the children’s program at the Betty Ford Center. In addition to Chadwick’s program in Colorado, Betty Ford also offers children’s programming at centers in Dallas and Rancho Mirage, California.

“I grew up in a family where addiction was a problem for multiple generations. I saw things that I shouldn’t have as a kid. I’m happy to give back to these families,” says Chadwick. “It’s so amazing, as a therapist, you get to work with the kids on their level and have so much fun throughout the day, but also help focus on recovery … It’s really amazing to watch these families heal. The adults in the [Betty Ford Center] program really want what’s best for their families, and it’s wonderful to be part of that process.”






Find out more about the Hazelden Betty Ford Foundation’s children’s program at

More information on the “Beamer” character and materials can be found at





Bethany Bray is a staff writer for Counseling Today. Contact her at


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