Tag Archives: Counselors Audience

Counselors Audience

Ch-ch-ch-changes: Leading by example

Bradley T. Erford October 1, 2012

I wish you all had attended the Institute for Leadership Training in our nation’s capital in late July. The institute is a gathering of current and emerging leaders from ACA divisions and state branches. We learned. We laughed. We charged up Capitol Hill to advocate for veterans, seasoned citizens, school-aged youth, counselors and the diverse clients we serve. We were inspired to lead and to promote positive changes in the increasingly complex world that our clients, colleagues and citizens are navigating.

What made this event special for me was the keynote address, “Countdown to Teamwork,” presented by Col. Mike Mullane, a retired astronaut who flew several space shuttle missions and has used his experiences in the Air Force and NASA to bring a powerful message about how to function as a high-performing individual and a higher-performing team.Col. Mullane came from very humble beginnings and was driven to space exploration in spite of many limitations, including persistent nausea and subpar vision that resigned him to the second seat in fighter aircraft. None of this dissuaded him from his ultimate goal of becoming an astronaut.

Col. Mullane showed us pictures from his high school yearbook. He was not an athlete, he was not a scholar, and he was not popular — in fact, only one other student signed his yearbook. By his own report, he was the wiry little geek shooting off model rockets in the desert. Still, his presence in our meeting room was larger than life, his effervescent spirit vibrant and enthusiastic. And his effect on the 140-plus participants was palpable. He received a standing ovation not only at the end of his presentation (at which time he left the institute), but also the next day and the day after that — even though he was no longer in the building!

To be sure, it helped immensely that Col. Mullane had the spiffiest multimedia presentation I have ever witnessed — full of humorous, poignant and, yes, tragic video footage and pictures from the NASA archives. But it was his developmental story that fascinated me, how he focused like a laser on his goal and persevered through numerous hardships and challenges to transition and change into an American hero.

As I sat enthralled by this presentation, the indefatigable David Bowie started playing in my head, reminding me that we all experience challenges and hardships as we grow and develop; that we all experience normative and nonnormative transitions and ch-ch-ch-changes. But many people do not have supportive adult and peer influences, or they are held to disadvantages because of various inequitable societal “isms.”

Col. Mullane highlighted two main roadblocks to success. Too often, we tolerate the “normalization of deviance.” For example, in the case of the Challenger disaster, the O-rings had failed to perform within tolerable limits on several previous flights, and numerous warnings were issued that these failures could have disastrous consequences. But nothing bad happened on those previous flights, so the deviation became the norm. “If we got away with it once, we can get away with it again” … until a tragic disaster occurred.

We sometimes normalize deviance in our daily lives. We might turn a blind eye to others who are experiencing unfair treatment and are in need of an advocate. As counselors, we see that our clients and students often normalize deviance by habituating to unhealthy thoughts and behaviors. My colleague, Lynn Linde, once overheard a student express this observation quite succinctly: “I am comfortable in my misery.” The unusual is experienced over and over and soon becomes the “new normal.”

The second roadblock Col. Mullane discussed was the failure of individuals to take personal responsibility. He told us that his plane crashed the first time he went up in a fighter. He was brand new, and the pilot he was with had a thousand hours of experience. So when the pilot said, “Let’s get that last target,” even though it would take them past their safe return zone, Mullane deferred to the experienced commander. Instead of saying, “But we’re running low on fuel!” he responded, “Sure.” He and the pilot ran out of fuel just short of the runway and crashed.

The lesson Col. Mullane was sharing was clear, and we have seen the related quote from Edmund Burke a hundred times: “All that is necessary for evil to prevail is for good [people] to do nothing.” Opportunities for us to take personal responsibility, to “walk the walk,” occur every day. So as we infuse empathy, compassion and the desire to be a team player into our work, families and relationships, please continue to ask two critically important questions:

  • Did we take personal responsibility for our actions?
  • Did we point out that deviations from excellence are occurring and that the inevitable result of these deviations is a growing tolerance of actions that do not represent excellence?

After all, ch-ch-ch-change is inevitable … but growth is optional!

Preparing for the final chapter

Lynne Shallcross

The adage is famously familiar: Nothing is certain in life except death and taxes.

Few counselors moonlight as accountants, and surprisingly few counselors address the subject of dying with clients, even though Thomas Nickel says they are well suited to do so. Nickel, the executive director for continuing education at Alliant International University (AIU), isn’t talking about helping clients who are grieving the loss of a loved one. He is referring to helping clients come to terms with their own mortality — a topic Nickel contends largely gets pushed to the background in our society.

Don’t believe it? Walk into a library and you’ll find entire shelves devoted to the subject of bereavement, but you’ll be hard-pressed to find more than a handful of books that focus on dealing with our mortality, says Nickel, who presented a workshop on preparing for end-of-life issues at the American Counseling Association Annual Conference & Expo in San Francisco earlier this year.

Medical advances during World War II introduced new possibilities for prolonging life through medical interventions, Nickel says. But as medicine and technology have continued to advance, “the human side [of the end-of-life process] has taken a backseat,” he says. Nickel calls this “the heart” of the matter as it relates to end-of-life planning, and he emphasizes that it is an element counselors would be wise to understand. “How the use of extreme technology at end of life has come to be the default approach is a matter of economics and national policy,” he says. “Counselors need to know [this] precisely because [the use of medical technology to delay death] is the default — what will automatically happen if nothing is in place to direct otherwise. Since many people ignore these matters or are in families that do not agree [on how to proceed], the default option — lots of medical technology — happens much of the time, whether people actually wanted it or not. Counselors can encourage people to think proactively as part of a wellness maintenance approach. It can increase anxiety at first to even consider end-of-life treatment, but if it’s done well, the end result is much less anxiety and a sense of self-efficacy and completeness.”

In Nickel’s view, the wellness aspect of end-of-life planning makes counselors uniquely suited for this niche. Because dying is a natural rather than a pathological process, counselors can help clients seek wellness and balance, even in preparing for their own death, he says.

“The way people maintain a sense of dignity and poise in [the dying process] is to focus on whatever areas of quality are still available. Not to deny the mounting list of bummers, but also not to dwell on it — to put more attention on appreciating what is still worthwhile about life. Counselors are trained to help clients find this balance and maintain it,” says Nickel, who has created an online course called “An Instructional Design for Dying” through AIU. The university offers both classroom and online courses on the topic for mental health professionals, as well as continuing education credits and a certificate in end-of-life preparation.

James Werth Jr., a professor of psychology and director of the doctoral program in counseling psychology at Radford University in Radford, Va., also sees the value of counselors addressing issues of death and mortality with clients. “Counselors typically have been taught to view people as whole beings, not just as a medical or psychiatric diagnosis. Thus, they naturally take into account that a person nearing the end of life may have physical and psychological concerns as well as interpersonal and spiritual issues, may be experiencing some societal influences on her or his decision-making, may have regrets about her or his career and so forth,” says Werth, a member of ACA who co-authored a literature review of end-of-life counseling for the Spring 2009 issue of the Journal of Counseling & Development.

Despite the need to address these issues, Nickel says counselors probably haven’t run across many clients seeking their help in this area. “People don’t tend to go to counselors saying, ‘I’m having trouble with my mortality,’ and it’s not easy to bring up the subject,” he says. “People say they know they need to talk about and plan for end of life, but most don’t get around to it.”

However, Nickel says, that situation is ripe for change, at least in part due to the aging of the baby boomer generation. Baby boomers have a “tendency for high involvement,” Nickel says. He suspects that might translate into more counseling clients wanting to take an active role in their end-of-life planning in the coming years. Nickel thinks counselors who seek specialized training in this area will be well positioned to fill an emerging niche.

Regrets and possibilities

People typically begin thinking about their own mortality at two main points, Nickel says — when they receive a life-threatening diagnosis and when someone close to them has died or is in the process of dying. As the front end of the baby boomer generation moves through its 60s, many of its members are experiencing their own medical diagnoses even as they watch their parents aging and dying.

Large-scale tragedies can also spur people to face their mortality, Werth says. “After 9/11, all of a sudden people started saying, ‘Wow, you never know what’s going to happen. That could have been me.’ That can lead people to thinking, ‘Do I have everything in place?’ After 9/11, we saw that fairly frequently.”

Topics clients deal with when thinking about their eventual mortality range from the emotional to the practical. Regrets and possibilities are the main focus for many clients, says Werth, whose book, Counseling Clients Near the End of Life: A Practical Guide for the Mental Health Professional, is due out in December from Springer Publishing Company. He says counselors who can work through those issues with clients can help them gain peace of mind.

“In my work with people with chronic and terminal illness and their loved ones, I often heard them say, ‘What if I had …’ or ‘If only I had …’ or ‘I wish I would have …’ The focus was frequently on regrets or things that they had not done, so instead, I tried to help them refocus on what was still possible and what could be done,” he says. “That way, they had a chance to say everything that they wanted to say before it was too late. Of course, we focused on the fact that they only had control over themselves, not over how others responded to them, but at least they wouldn’t be on their deathbeds saying, ‘I wish I would have tried to mend fences with my son,’ or after a parent’s death, a child wouldn’t say, ‘I wish I would have told Mom how much I loved her.’”

In Nickel’s experience, people confronting their own inevitable death are often seeking two things: a sense of completion, often tied to interpersonal relationships, and relief from their anxieties about death. “Counselors can help people achieve the sense of completion that they’re seeking by assisting them in coming to terms with the life they have lived, their disappointments and achievements, and, if necessary, in saying or doing something to help heal important relationships,” he says. “Sometimes, not always, things that people have struggled for years to say can finally be said at the end of life. End of life is an exceptional time. Normal patterns of behavior can change. There is great potential for resolving issues that have endured for long periods of time. Counselors can be present to listen and to remind [clients] that things can be done to address these issues, such as reaching out to someone to apologize. The goal would be to help clients acknowledge their regrets without guilt, which people tend to be more able to do as they approach the end and face their own mortality.”

Other people experience anxieties related to what the dying process might be like, Nickel says. For instance, some clients are scared they might feel unbearable pain. Nickel says counselors can remind these clients that pain involves subjective interpretation of nerve signals, so it is something the mind can influence. Counselors can help clients learn a variety of mental techniques, including meditative methods, that may reduce or eliminate pain in many cases, he says. Having skills they can practice and build on beforehand in case they do experience pain as they are dying reduces anxiety for some clients.

For others, the prospect of dementia is frightening. Nickel says counselors can help clients who are still fully competent to explore how they feel now about being kept alive at certain stages of dementia in the future. “Counselors might have clients describe a point at which they might rather begin a natural dying process,” Nickel says. “One organization, Caring Advocates, has even developed a set of illustrated cards depicting a range of cognitive and emotional conditions specifically to help counselors and clients consider these issues in depth. The work that is done can be saved and used to produce a living will, which carefully documents a client’s wishes. In other words, by planning now, a legal foundation can be created to avoid unwanted measures later for extending life.”

Making decisions in advance

The topic of when a person might want to begin a natural dying process is where advance care directives, which can include living wills and powers of attorney, come into play. Both Nickel and Werth say counselors can seek training in order to help clients create these directives for themselves. According to the U.S. National Library of Medicine, advance care directives “allow patients to provide instructions about their preferences regarding the care they would like to receive if they develop an illness or a life-threatening injury and are unable to express their preferences. Advance care directives can also designate someone the patient trusts to make decisions about medical care if the patient becomes unable to make (or communicate) these decisions. This is called designating ‘power of attorney (for health care).’”

“There are no right or wrong [answers],” Nickel says about creating a living will. “The important thing is to cut through some of the anxieties, get in touch with what you want and make sure that it’s legally written down.” A living will should not be completed hastily, Nickel says, but instead approached carefully, both by counselors and by clients. In addition, the directive should be reviewed periodically to make sure the client still feels the same way about end-of-life decisions.

If clients decide to designate a power of attorney, Werth says, counselors should suggest that the clients talk with the chosen power of attorney about their wishes, as well as inform their family of those wishes. “It’s important to have the conversation with other family members that ‘I’m asking Jean to do this, and this is what I want,’” Werth says. The counselor might invite a client and the client’s family into session to discuss the person’s decision, or the client might choose to have that conversation with his or her family in private, Werth says.

Even the topic of inheritance can come up in a counseling session, Nickel says. “It’s not really about who’s going to get Grandma’s table; it’s about a lot more than that,” he says. If clients desire it, counselors can invite families into session to have those discussions as well, Nickel says.

Facilitating sticky conversations such as those about end-of-life decisions or inheritance is what counselors are trained to do, and each counselor will have his or her own approach, Nickel says. “In general, all counselors will know techniques like setting rules for the discussion, making overall agreed-upon goals [and] having an outside facilitator such as the counselor present,” he says. “The art is in applying the right approach the right way at the right time. Questions around inheritance and helping families in this area can involve putting out fires that are already spreading. It’s important to make a distinction at the start [whether] a counselor is present as someone’s therapist or as a neutral facilitator — there to help the family communicate about difficult topics.”

Tools to help

Many counseling approaches can apply when clients are struggling to come to terms with their own mortality, Nickel says. A “counselor might help a client identify a few important relationships to start with and then to very clearly state what is needed in order to feel complete with each one,” he says. “The strategic part is then to help the client describe something that can be done to represent that act of completion. It might be symbolic [or] it might be sacrificial.”

Cognitive behavior therapy and solution-focused approaches can be helpful because they focus on the present instead of the past, Nickel says. “I don’t personally think that a lengthy analysis of one’s past is really what’s called for,” he says. “We need to act on [any issues] to get beyond [them].” He says the completion process might also involve getting rid of trauma, which may call for trauma-processing therapies such as eye movement desensitization and reprocessing or exposure therapy.

Narrative forms of therapy can also be beneficial, Nickel says. “[That] would focus more on having clients tell stories to create the record they want to leave and to pass along messages about what they feel is important,” he says. “Parts of what clients do would be in session, but a lot would not have to be.”

Meditation is yet another tool to offer clients. “Meditation tends to reduce emotional reactivity, which can help some people tolerate the negative emotional reaction to the thought of their own death,” Nickel says. “Meditation can [also] play a role in pain reduction, which is what many people say they fear most about end of life.”

Werth points to the effectiveness of dignity therapy, especially with clients who are going through the dying process. “Dignity therapy was designed by Harvey Chochinov and colleagues to provide dying people an opportunity to shape their own legacy for others,” Werth explains. “The therapist asks the ill person a series of questions in order for her or him to talk about the important parts of her or his life, key memories and people, and so forth in order to prepare a document for loved ones to have after the person dies. The research has indicated that this can be helpful to reduce the distress and suffering of dying people.”

Meaning-centered group therapy is another potential approach. “William Breitbart and colleagues developed meaning-centered group therapy from Viktor Frankl’s work discussing the importance of having meaning and purpose in life,” Werth says. “It was originally done in group format but has been adapted for individuals too. There can be a link to spirituality in the work, which helps to ensure that this important part of people’s lives is not inadvertently left out of the discussion. The focus is on helping people live their lives to the fullest in the time they have remaining.”

Werth adds that existential therapy can also make sense for these clients because of its link to finding meaning. “Frankl’s work on meaning is considered existential,” Werth says. “In addition, [Irvin] Yalom’s discussion of existential therapy focuses on four ‘ultimate concerns of life,’ all of which are clearly related to end-of-life matters: isolation, meaning/meaninglessness, freedom and responsibility, and death. By helping people address each of these areas, especially their fears, we can help them be active participants in the dying process instead of feeling powerless and out of control.”

Getting prepared

It is crucial for counselors to focus on their own self-care before seeking to work with clients who are facing issues surrounding mortality, Werth says. “Many counselors like to see change,” he says, “[but] when someone’s dying, we can’t change that. Hopefully we can help them have a better quality of life, but it can be overwhelming to hear what’s happening to [them].”

Staying mindful of how working with this population can affect them, counselors might choose to strike a balance between seeing clients who are dealing with issues of death and mortality and those who are not, Werth says. Counselors immersed in these issues should also be careful to maintain a good support system, take time off, engage in hobbies and be intentional about appreciating what they have in life.

Counselors also need to develop an awareness of the topics likely to push their buttons before working with this group of clients, Werth says. “If [clients] start talking about lung cancer and my grandmother died of lung cancer, and then that’s all I’m thinking about, I’m
not being of much help,” he says.
Getting consultation after beginning to work with these clients can prevent additional personal issues from cropping up, Werth says.

Counselors are already equipped with many of the skills needed to work with these clients, but Nickel says additional training specific to end-of-life issues is necessary. For example, counselors should seek training in advance care directives, he says. “Some very simple care directive forms may be sufficient for some circumstances, but not for all,” he says. “The more you document, the more you reduce uncertainty. I believe that counselors working with clients at the end of life should know about a range of care directive approaches and be able to recommend a few options that best suit each individual and family.” Nickel suggests counselors consider looking at the Physicians Orders for Life-Saving Treatment, a national initiative adopted by many states, as well as Natural Dying Living Wills, an approach by Stanley Terman of Caring Advocates that also addresses Alzheimer’s and dementia.

Learning how each of the major religions views the end of life is also helpful, Nickel says, as is learning different cultural expectations and traditions. For example, if an Asian American mother has just been given a cancer diagnosis, it would help to know that many Asian cultures are more collectivistic in nature, Nickel says. This means the counselor might need to focus on the whole family rather than assuming that the mother will be the sole or primary decision-maker concerning end-of-life issues.

Werth says counselors also need to be aware of the ethical and legal issues involved in this area of counseling and points out that the ACA Code of Ethics addresses end-of-life care for terminally ill clients (see Standard A.9.). Counselors should also become familiar with any legal requirements regarding confidentiality after a client dies. Werth also suggests including any legal and ethical statements concerning confidentiality related to end-of-life care in informed consent documents.

Although Nickel says baby boomers may one day change the landscape, clients aren’t currently beating down counselors’ doors and asking to take proactive measures to prepare for their end-of-life experiences. If counselors secure some training in advance care directives, though, Nickel thinks it might open new doors of opportunity to help people prepare for end of life, both emotionally and practically. Counselors could let their current and former clients know that they have the necessary training to help create advance care directives, Nickel says. “It’s a good, concrete thing,” he says. “A lot of things come out once you start the process, but that’s a good way to begin.”

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

Where East meets West

Lynne Shallcross

Cliff Hamrick was meditating long before he became a counselor, having found the practice useful for treating the depression he had experienced some years before. Now a private practitioner in Austin, Texas, Hamrick integrates Eastern and Western approaches to counseling because he believes it benefits his clients.

Partway across the country in Connecticut, counselor Deb Del Vecchio-Scully also combines Eastern and Western approaches when working with clients. She discovered guided imagery and meditation almost three decades ago while seeking ways to manage her pain after multiple back surgeries.

As technology continues to “shrink” the world and as the counseling profession steadily expands its global presence, it is not hard to predict that an increasing number of counselors will join Hamrick and Del Vecchio-Scully in further breaking down barriers and intermingling Eastern and Western approaches to counseling.

Isabel Thompson, an assistant professor with the Center for Psychological Studies at Nova Southeastern University, has researched and presented on this topic. She has also integrated Eastern contemplative approaches into her work with clients and says Eastern and Western counseling approaches have similarities in that they both focus on relieving human suffering and helping people feel better. But they also differ, she points out. Generally, Western approaches place more focus on psychopathology and rely on a medical model of alleviating symptoms, Thompson says. Although Eastern approaches can also be applied to psychopathology and the alleviation of symptoms, their primary focus tends to be on flourishing and achieving optimal human development through leading an ethical life, says Thompson, a member of the American Counseling Association.

Fred Hanna, a professor in the Department of Counselor Education at the University of Northern Colorado, says Western approaches place more emphasis on correction and on mitigating feelings and symptoms. Eastern approaches, on the other hand, are more aimed at liberation and “setting [people] truly free so they can be in charge of their feeling states and so they can control their thoughts,” Hanna says. “This can be done through Eastern meditation techniques as well as direct Eastern-derived psychological techniques.”

In traditional Western thought, emotional problems aren’t viewed as affecting the body, Del Vecchio-Scully says, whereas in traditional Eastern thought, it is all interactive. “Everything that happens in the body affects the mind and emotions, and vice versa,” says Del Vecchio-Scully, a certified yoga therapist and Reiki master who is also the executive director of the Connecticut Counseling Association, a branch of ACA. Del Vecchio-Scully often sees that mind-body interaction play out among her clients, who are referred to her through the neurology group for which she works, Associated Neurologists of Southern Connecticut.

“I find that Eastern thought is rooted more in the integration of mind-body and energy,” says Serena Wadhwa, an ACA member who works in a hospital outpatient group practice and runs a private practice in Chicago. “Western thought tends to separate body and mind, although there is much progress [being made] in this area. We see the approaches of yoga, tai chi, Ayurveda and Chinese medicine, to name a few, that also focus on utilizing the body’s natural healing systems and restoring balance. Western thought usually involves a ‘quick fix’ medicinal approach.”

In a broad sense, there’s also a difference in the locus of control, says Hamrick, a member of ACA. With many Eastern approaches, it is assumed that people will fix themselves, often by paying close attention to themselves and their surroundings, he says. In the West, that control tends to be externally located, he says, with the expectation being that the “right” technique or intervention will fix the client. Hamrick says those differing ideas likely took root in the respective cultures. Buddhist and Hindu traditions teach that each individual person has a soul or god residing within them, whereas Western European thought suggests that individuals should rely on an external, all-knowing God or someone else to help them and guide them along the way. In the West, that often translates to the counselor being viewed as the “expert” and outcome success hinging on the counselor’s advice and interventions,
he says.

Hamrick believes there is room for both views. He likes for his clients to feel that they possess the power within to handle and solve their mental and emotional issues, which is based more in Eastern thought. But on the Western side, he says, an abundance of good scholarly work is being done that he can pass along as knowledge to his clients, such as new research in neuroscience and positive psychology.

Although Eastern and Western counseling techniques traditionally come from different vantage points, Wadhwa says it is important for counselors to recognize that the underlying concepts are often the same. For example, the idea that our thoughts have an impact on us is fairly universal, says Wadhwa, who is originally from India and has presented on Eastern treatment considerations in working with Asian populations. “So I use both cognitive restructuring and mindfulness in my work, and depending on how I introduce these techniques, the individual I am working with may be more open to exploring how it may work for them.”

Wadhwa says she discusses with clients how thoughts may cause suffering and explains the idea behind both approaches. “I explain how cognitive restructuring works by providing strategies to cope with the thoughts and how mindfulness practice works at detaching from the thoughts and focusing back on the present moment. I also explore how coping with the thoughts may be initially more relieving than mindfulness, as mindfulness takes practice. Most clients are open to learning how to cope with their thoughts and then how to detach from them.”

Taking control

In a counseling session that he supervised, Hanna remembers a client diagnosed with borderline personality disorder who had cut herself habitually and reported that she had attempted suicide 160 times. Hanna and his doctoral student asked the client to bring to mind the feeling she would have just before she started to cut or attempt suicide. “Then what we did was have her go directly into that feeling,” says Hanna, a member of ACA. “It was sort of a therapy-assisted meditation of exploring those feelings.”

Hanna and the counselor-in-training asked the client to imagine she was in an elevator made of thick, clear glass that she could take straight down into her feelings. They told her she couldn’t feel the pain or anxiety inside the elevator but that she could see what was deep down inside those feelings. In her mind, the client took the elevator, little by little, all the way to the bottom. She reported that it was like a lake, and at the bottom of it all, there was really nothing to be afraid of. After reaching the bottom and thoroughly exploring her feelings, the client filled the lake with earth and put a house on top of it in her mind. “After those sessions, the client reported a marked decrease in her borderline symptoms,” Hanna says.

Hanna created the approach that he and his doctoral student used with the client. He calls the approach “internal control therapy,” which he describes as a blend of yoga psychology, Buddhism and a few Taoist ideas. “Using that object-oriented approach, [the client] was literally taking control over those feelings … that were before in control of her,” Hanna says. Internal control therapy makes use of a client’s powers of creativity to generate positive feeling states and unbuild negative ones, he says.

From a yoga psychology perspective, the mind is an object that can be manipulated, akin to an ordinary physical object, Hanna says. His internal control therapy taps into that perspective. “If [clients have] a strong image in their mind of someone who hurt them and they carry that image around — I wouldn’t want their image hanging in my living room, would I? But we carry those images around in our minds. … If you treat [that image] as an object, you take it down and throw it away.”

Although yoga psychology is a traditionally Eastern approach, Hanna thinks its application can benefit Western psychology by offering an alternate view of psychopathology. Whereas the Diagnostic and Statistical Manual of Mental Disorders (DSM) presents classifications for disorders in an attempt to explain and treat mental illness, Hanna says yoga psychology offers the idea that there are five points that lead to suffering and dissatisfaction with life: ego and self-centeredness; cravings beyond what we need; resisting something; ignorance; and fear of death. In this view, when people get overly bogged down with any of the five points, it can result in suffering and psychological problems.

Hamrick gravitates toward a different Eastern-based approach — mindfulness meditation — introducing it to almost every client with whom he works. “Usually in the first session, I will spend about five minutes walking a new client through a sitting meditation just to show them how the technique works and demonstrate its usefulness,” he says. “My clients with anger, depression and anxiety find it particularly helpful [as a technique] to … control their emotions, stop ruminating on the past and prevent worrying about the future. Clients learn that racing thoughts can be stopped or slowed down with practice.”

Mindfulness-based therapy is akin to mental training, Hamrick says. “My clients learn how to train their mind so they can think about what they want to think about, when they want to think about it and how they want to think about it,” he says. “[Clients] wouldn’t tolerate their right arm suddenly going off and flailing around without their control. So why would they tolerate their brain doing the same thing? Mindfulness teaches clients to focus on the here and now rather than on the there and then and on what they can control rather than on what they cannot control.”

Hamrick also uses the Buddhist concept of impermanence, especially with clients dealing with depression, anxiety or substance abuse. “This concept emphasizes that nothing lasts forever,” he says. “It gives hope to the hopeless. There is no reason to believe that the client will always be in the same situation [he or she is] in now. Depression can be treated and overcome. A panic attack never lasts forever. And plenty of people have overcome addictions of all kinds. Once we’ve established that the situation can be overcome, then I find using solution-focused techniques will help clients develop a plan to overcome what’s facing them.”

Counseling and contemplation

Thompson has long nurtured an interest in contemplative practices, a broad term, she says, that includes both formal seated meditation practices and practices such as walking meditation and yoga. She says contemplative practices are “activities that are used to cultivate the mind and the heart.”

According to Thompson, the act of contemplation helps shift us out of a current mode of thinking to a broader, more open mode of thinking that increases our ability to understand issues. “When we are stressed out, or if a family system is under extreme stress, [our] brains are firing for survival,” she says. “Contemplation helps one relax so that the brain reorients to a more reflective and calmer place — a place where problems can be solved more easily because there are more resources available to draw from. The foundation of any contemplative technique is to focus on relaxation first, then gain stability of concentration and then advance to vividness/intensity. The West tends to focus on intensity first without understanding that … intensity is unstable” unless relaxation is also emphasized.

Both Eastern and Western mental health approaches use a form of contemplation, Thompson says, but the East has a longer history of developing those techniques. “This stems from the two different modes of inquiry that the East and West have emphasized,” she says. “The West and its modes of inquiry have generally relied on exploring reality from a ‘God’s-eye view’ or an objective standpoint through science, while the East’s more contemplative approach starts with subjective experience and phenomena, then moves out from there. This approach still asks empirical questions, but the answers are more rooted in subjective experience.”

Both the counseling profession and Eastern philosophy share a respect and appreciation for the client’s subjective, internal experiences, Thompson says, which makes them a good match for the integration of contemplative approaches. Contemplative approaches are typically present-focused, Thompson says, adding that studies have linked a contemplative mind to lower cortisol levels, lower rates of depression, fewer heart attacks and lower rates of cancer.

For clients presenting with a concrete situation that they need assistance changing, a Western approach might work best, Thompson says. For example, a Western-based counseling approach might be a better fit for a family seeking help with a child’s school-related issue, such as bullying or poor academic performance. “A contemplative approach may be more useful for issues related to the long term, more related to lifestyle or a chronic condition — for example, working with habits, chronic anger or chronic pain,” she says.

A benefit often exists to blending Eastern and Western approaches as well, Thompson says, such as when working with a client with severe depression. “I have found that addressing the depression first using a more Western counseling approach is beneficial,” she says. “For example, I might start with a person-centered approach to build a therapeutic relationship with clients and then integrate elements of cognitive behavior therapy (CBT) to help clients see the connection between their thinking patterns, behaviors and moods. I also might include psychoeducational components to help clients understand their symptoms and realize that they are not alone in healing from depression. When someone is suffering from severe depression, many things, even contemplative practices, can become tools of self-recrimination. Therefore, helping a client to break the downward spiral of depression characterized by guilt, regret and self-blame is a starting point. Then, a foundation for a positive spiral, characterized by acceptance, gentleness and self-compassion, can be laid.”

In cases such as these, Thompson says, she would gently integrate Eastern approaches at a pace that is right for each client. This gives her time to ensure she is being sensitive to the needs of the client and allows her to gain a solid understanding of the client’s worldview and beliefs. “For me, Eastern approaches emphasize returning to gentleness and self-compassion as foundations for future change,” she says. “Sometimes clients suffering from depression have a greater sense of compassion for others than they do for themselves. Helping them to see their own worth and recognize that they deserve compassion as much as others begins the process of cultivating self-compassion and acceptance.”

Treating trauma and pain

Many of the clients Del Vecchio-Scully sees are dealing with posttraumatic stress disorder (PTSD) and chronic pain. A blended approach of Eastern and Western techniques tends to yield the best results for these clients, says Del Vecchio-Scully, who is certified in integrative yoga therapy, a specialized form of yoga that can be used with clients with medical conditions.

For chronic and acute pain, Del Vecchio-Scully says relaxation and meditation techniques are key. From the Western side, she says, that can include CBT, guided imagery and dialectical behavior therapy (DBT). From the Eastern side, her chosen approaches include mindfulness, yoga breathing, Buddhist meditation, Tibetan chants and mantra. The aim of these techniques is to reduce clients’ anxiety, which can frequently accompany pain and the human tendency to guard against the pain, Del Vecchio-Scully says. “For example, if I have a sprained ankle, I will avoid putting weight on it for fear of pain,” she says. “This phenomenon actually creates more pain by creating additional tension in the muscles and tissues. When a person in pain can release this tension through relaxation, their pain decreases.”

As it relates to PTSD, Del Vecchio-Scully says counselors must have a toolbox of coping skills to help clients effectively manage and heal their trauma. Clients with PTSD often experience a cluster of arousal symptoms, she says, including insomnia, nightmares, irritability, anger outbursts, hypervigilance and an exaggerated startle reaction. These clients are often experiencing a stress response that is stuck on “on,” she says.

“The most effective approach to arousal is calming and soothing,” Del Vecchio-Scully says. “How this is accomplished is where a blend of East-West skills can be applied. Each of these symptoms taken on its own could have its own treatment approach. Insomnia, with difficulty falling asleep, could be treated with CBT and sleep hygiene as well as sleep meditation [and] self-hypnosis. Many times, trauma survivors have insomnia because they are afraid to go to sleep. In this case, identifying ways to foster safety — guided imagery, visualization, hypnosis, expressive therapies and art therapy, which can be either Eastern or Western in how they are applied — can be helpful. It truly is individualized to address each person’s unique presentation.”

Clients who have experienced trauma might present with hypervigilance and dissociation, which together can form a vicious cycle, Del Vecchio-Scully says. But teaching these clients to be present to their feelings can help them feel less afraid and threatened, she says. A Western approach of psychoeducation can be useful in addressing hypervigilance because it teaches clients about the nature of trauma, she says. Del Vecchio-Scully might then follow that up with Eastern techniques that provide restorative, calming experiences, including yogic practice and breathing, mantra meditation, affirmations and safety totems, such as hope stones that clients can carry with them.

“Another way of blending [Eastern and Western] approaches,” she adds, “is through the use of trauma-informed art therapy, which utilizes expressive arts therapies [including] yoga, art-making [and] mindfulness to stabilize mood and dysregulation often experienced by trauma survivors.”

Del Vecchio-Scully again blends East and West in addressing the dissociative piece of trauma, using Western-based progressive muscle relaxation and Eastern-based basic centering/grounding and additional yogic techniques.

One client who came to see Del Vecchio-Scully was dealing with a history of PTSD and bullying, while also struggling with fibromyalgia and chronic fatigue. Once again, Del Vecchio-Scully found a blended approach worked best. “She benefited from medication to improve her sleep and reduce pain; meditation — guided imagery, visualization and mantra — to calm and soothe herself; and psychoeducation regarding the nature of PTSD and the many ways it can present — for example, anxiety and hypervigilance, chronic pain, insomnia. In this case, medication alone would have helped her sleep without changing the cause of her pain syndrome and anxiety. She has found the meditation particularly useful in reducing her anxiety, improving mental clarity and fatigue.”

Del Vecchio-Scully also uses Reiki, a healing tradition that originated in Japan, with some of her counseling clients. The idea is that every living thing has an energetic vibration, and Reiki is one way of experiencing that life-force energy. “There are many ways to share Reiki with another,” Del Vecchio-Scully says. “It can be given through a light touch or by placing your hands close to a person’s body. It can also be shared through intention. For example, in my counseling session, I activate my Reiki vibration, which can help the client feel calmer and settled. Reiki and other energetic-based techniques help clients to assess their own well-being [and] can reduce anxiety and chronic pain. I use psychoeducation to identify [clients’] own energies and teach them methods to do so [themselves].”

Finding the client’s comfort zone

Although Eastern and Western approaches tend to come from different perspectives, these counselors say there are benefits to be gained in session by blending them according to each client’s needs. “The blending of Eastern and Western healing work is a philosophy of how I, as a therapist, approach counseling,” Del Vecchio-Scully says. “My counseling training taught me how to identify psychopathology, which is invaluable in identifying a client’s symptoms and classifying them. It gives me the starting-off point for therapy. However, the healing process begins with normalizing their behaviors, feelings and experiences as often normal reactions to abnormal situations. This clearly doesn’t include psychosis, delusions, hallucinations, intention for self-harm or harm to others. My philosophy is holistic, incorporating the mind and body, emotions and spirit using the best of the traditional Western approaches and perhaps nontraditional — though I believe this is changing — Eastern approaches. Both have value when
used with clinical skill for the client’s greater good.”

For example, Del Vecchio-Scully says, if she is using basic CBT techniques such as cognitive restructuring, cognitive reframing and challenging limited beliefs with a client, at the same time, she will ask that client to take a moment to stop and breathe. Teaching people how to be in the here and now is a basic Gestalt concept, but yoga and mindfulness practice are also steeped in that philosophy, so a lot of overlap is present, she says. “I weave mindfulness into any intervention I am doing,” she says. “It’s always about, ‘Take a breath. Let’s see if we can slow down the pace of what’s going on inside.’”

Wadhwa, who is also the program coordinator for an addictions counseling concentration at Governors State University in University Park, Ill., often allows the client to choose the best route. “I will usually introduce Eastern approaches [by saying], ‘One approach that exists is …’ This seems to work well for my clients. They ask questions, and we discuss the topic.”

For example, Wadhwa has seen clients who were dealing with transgenerational issues. “When clients recognize some pattern from generation to generation, I’ll offer the transgenerational thought of how things may be passed down,” she says. “I’ll introduce the approach of karma and how one approach believes that one generation works out the karma of the previous generation and that maybe what my client is experiencing is the cumulative effect of that karma. If this is something that resonates with the client, then I’ll offer some options on assignments geared toward this. If not, we’ll explore what elements of these different approaches fit better for the client and what [he or she] thinks may be helpful in resolving or healing this particular issue.”

These counselors acknowledge that some clients are hesitant to try techniques that incorporate elements of a traditionally Eastern approach. If Hamrick encounters a client who is unsure about meditation, he raises the point that meditation is a form of mental training. “I explain how meditation has been shown in scientific research to be beneficial in the treatment of depression and anxiety, and [how] scans of the brains of people who have practiced meditation, even for short periods of time, have shown real changes in the structure of the brain that allow for better emotional control,” he says. “When put in these concrete terms, clients typically want to try meditation.”

Thompson looks for approaches that are relatable to the client. For example, she has worked with individuals who were turned off by the idea of meditation because they thought it ran counter to their closely held religious beliefs. “It [didn’t] connect with their experience of the sacred,” Thompson says. “I want to be helpful to them in the worldview that makes sense to them, so I might ask them instead about what Scriptures provide them a sense of peace [or] what brings them calm.”

Radical acceptance, which also has Eastern themes, is another approach Thompson sometimes uses, particularly with clients struggling with perfectionism and self-judgment. At times, however, these clients resist the idea of acceptance because they have come to counseling with the idea of “fixing” themselves, she says. At that point, Thompson might switch to the technique of motivational interviewing. “Have you achieved your goals with self-criticism?” Thompson asks clients. “What would it be like to accept that this is where you’re at?”

Regardless of where counselors fall on the spectrum of Eastern versus Western approaches, Thompson believes meeting clients where they are and using techniques they are comfortable with is most important. “In order for a transaction to occur, the therapist must meet the client in his or her worldview and understanding of change and contemplation,” she says. “It takes so much courage to come to a counselor, and I want to demonstrate to my clients that I honor their courage. I want to help them alleviate the suffering that spurred them to come into counseling. Therefore, gathering information about clients, their cultural backgrounds, their family backgrounds, their worldviews and spiritual and/or religious beliefs is essential. The question ‘How would you like to try … X?’ is helpful. If the client is not interested, then I do not pursue it.”

“Most clients agree that relaxation in one form or another is helpful, so I like to start from there,” Thompson continues. “It can easily move to progressive relaxation, full body awareness or simply cultivating the wish for happiness and to alleviate suffering. A useful question related to mindfulness is, ‘What do I need to do and what do I need to stop doing in order to be happy?’ What is surprising is that answer can frequently range from mundane tasks such as doing more laundry to completely changing how one engages with reality. Contemplative approaches have something for everyone.”

Although not a common occurrence, Del Vecchio-Scully recalls one client who was concerned that yoga might run counter to her Christian faith. “I talked it through with her and supported her decision,” Del Vecchio-Scully says. “The only path is to honor and respect their feelings toward something and move on in another direction.”

Del Vecchio-Scully says she doesn’t present approaches as being Eastern versus Western with clients. “We discuss what may be helpful to them and then try to identify the right interventions for them based on personality, openness and willingness to try,” she says. “I reinforce that if one thing doesn’t work for them, there are always many options.”

Maintaining counselor identity

As more counselors begin promoting the benefits of Eastern-based approaches such as meditation, mindfulness and yoga, the public may question what counseling has to offer that meditation centers or yoga retreats don’t.

“In a meditation center, the only focus is on meditation,” Hamrick says. “In counseling, the focus is on the client feeling better. In counseling, I might use meditation as a tool to help my client, but I have many more tools in my toolbox. I think the biggest benefit that clients can get from counseling that they can’t get at a meditation center is the opportunity to talk about painful and possibly embarrassing topics with an unbiased and confidential professional.”

Counseling remains more clinically oriented as well, adds Del Vecchio-Scully. “I’ve made a diagnosis and formulated a treatment plan that includes multiple interventions based on the diagnosis,” she says. “There are different types and styles of meditation and yoga that garner different outcomes. This is where the blend of my clinical training and Eastern specialties is a distinct advantage. Within the guided imagery field alone, there are many approaches for clinical issues, and [they] are based on the written script. A nonclinician isn’t going to have this expertise. Also, [counseling clients] are getting one-to-one attention to their issues, and techniques can be modified based on their needs. This isn’t going to happen in a group setting [led] by a nonclinician.”

With the influence of globalization, Del Vecchio-Scully predicts the counseling profession will continue to experience a shift toward eclectic practice, including the incorporation of Eastern-rooted approaches. The complementary nature of Eastern and Western approaches will further facilitate that movement, Thompson adds. “Both Eastern and Western approaches share the common goal of helping people,” she says. “Eastern approaches can provide tools to help clients work with their minds and emotions to build on the changes they have made through Western approaches.”

Thompson, who has pursued trainings focused specifically on integrating contemplative practices into counseling, says many training options are available to counselors who want to blend Eastern approaches into their work. However, she says, there is no one “best” training, just as there is no one best approach to counseling.

Regardless, it is imperative that counselors have personal experience in whatever practice they might ask their clients to engage in, she says. “Do your own yoga, seek out meditation on your own,” Thompson says. “Personal exploration and practice are essential. If you want to share meditation with your clients, pursue contemplative training and practice it first. If you want to integrate mindfulness attitudes and practices into your work with clients, again, find ways to integrate them into your own life through training, retreats and personal practice. In addition, finding a community of counselors who incorporate Eastern/contemplative approaches is extremely helpful. There is a community of counselors in my area who incorporate Eastern approaches — specifically mindfulness — into clinical practice. This has been a wonderful resource and inspiration for me. Also, for clinicians working on licensure, finding a supervisor who incorporates Eastern approaches would be an excellent means of getting support.”

Hamrick agrees that personal experience is the best starting point. “Eastern philosophy is based on the individual experience,” he says. “You can read a pile of books and have a beginning understanding of Buddhism, Hinduism or Taoism. You can learn the steps of meditation and teach them to others. But if you really want to incorporate Eastern approaches into your counseling, you need to start practicing them first. Once you’ve really experienced the changes they can bring to your life, then you’ll really be ready to present them to your clients.”

“The first thing to do is put down this magazine and look around the room,” he says. “Really look without thought and without judgment and without analysis. Simply sit, look and be. That’s a good start.”

 To contact the individuals interviewed for this article, email:

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

ACA keynote speakers view counseling process from different angles

Heather Rudow

The keynote speakers for the American Counseling Association 2013 Conference & Expo in Cincinnati (March 20-24) are well known in their respective fields. The circles in which they are famous and the perspectives from which they view the counseling process are quite different, however.

Actor, humanitarian and mental health advocate Ashley Judd will present the conference’s opening keynote on March 22. Allen Ivey and Mary Bradford Ivey, counselors with a strong background in neuroscience, will follow on March 23 with a keynote titled “What Counselors Need to Know About the Intersection of Neuroscience and Counseling.”

Brain-based counseling

The Iveys have been researching neuroscience and its implications for the counseling profession since the 1970s. Allen is distinguished university professor emeritus at the University of Massachusetts, Amherst and courtesy professor at the University of South Florida (USF). He is a life member and fellow of ACA and the originator of the influential microcounseling framework and developmental counseling and therapy. He has authored or co-authored more than 40 books and 200 articles, and his work has been translated into 20 languages.

Mary is a national certified counselor, a licensed mental health counselor and courtesy professor at USF. Her areas of expertise include writing, independent consulting, school guidance and applying her consultation skills to school and management environments. Mary was one of the first 13 individuals honored with ACA fellow status.

“We feel honored and excited that we will present a keynote in Cincinnati on the relevance of neuroscience to counseling,” Allen says. “The basis for our presentation is the scientific finding that counseling changes the brain and that virtually all that we are doing [as counselors] is now backed up by neuroscience research. Neurogenesis, the development of new neurons and neural connections, occurs throughout the life span, even among the most aged. This possibility for human growth never ends.”

“Counseling has always been on the right track with its emphasis on wellness and client strengths,” he says. Attendees of the Iveys’ keynote can expect to hear the phrase brain-based counseling, which, Allen says, “means that all our efforts are making distinctive differences in the client’s brain.”

The topic of neuroscience has gained much momentum in the counseling profession since the Iveys first presented on it at the 2008 ACA Conference in Honolulu. “We had a moderate response in Hawaii, but interest in neuroscience has multiplied extensively, and we feel lucky that many more counselors are now seeing its potential,” Allen says. “A lot has happened since that early presentation, and we have seen many new breakthroughs that increase our understanding of the counseling process and how we can help clients more effectively. We are eager to share some of our discoveries of the past few years. At issue is using this knowledge so that we can more effectively reach clients and help them achieve their goals.”

The Iveys will highlight empathy in their presentation as an example that counselors’ methods have been on the right track from the early stages. Says Mary, “Empathy has long been basic and central to our profession and to our personal identity as counselors. Carl Rogers has shown us the importance of empathy and seeing the client’s world as he or she experiences it. Counseling could be described as the empathic profession. Now, empathy can be identified through observation of brain activation through functional magnetic imaging. One of the more interesting studies [investigated] brain patterns of a client and a counselor in a real interview. Moments of highly rated empathic communication between the two showed in parallel brain processes.”

The Iveys emphasize that ACA members already understand the importance of working with their clients’ strengths and focusing on wellness in their practices. However, Allen adds, “knowing the power and influence of the limbic emotional system enables us to become even more aware of the need to facilitate positive emotions and effective decision-making.”

He cites strategies such as cognitive behavior therapy and stress management as “key part[s] of our practice, for we are indeed seeking to help our clients manage their thoughts, feelings and behaviors more effectively.”

Another part of the Iveys’ presentation will explain how using Therapeutic Lifestyle Changes (TLC) as a treatment option can help clients manage their thoughts and behaviors effectively.

“TLCs are all oriented toward a positive wellness approach to body, mind and human development,” Allen explains. “We have spent far too much time on repair, when a reorientation to building on existing and future strengths will move us to health and wellness.”

In their keynote, the Iveys will cover the “big six” TLCs, which include the improvement of social relationships. Allen points out that this is what much of counseling has traditionally been about. All six TLCs strengthen client cognitions and emotions, he says, leading to better mental and physical health.

Mary states that prevention activities and social justice action are also strongly supported by neuroscience research and writing. “Evidence is clear that poverty, hunger, trauma — for example, neighborhood shootings — and abuse can actually slow or even destroy brain growth,” she says. “On the other hand, children and adolescents are resilient, and counselors can facilitate normal growth, and we do much to prevent these problems in the community.”

“Thus,” Allen says, “one of our central messages is that counselors have a responsibility for neurogenesis and neural growth in our clients and in their communities. We can only do this with a positive wellness approach to human change. Through TLCs, stress management and social action, our profession can and will make a significant difference for our clients.”

The Iveys will discuss these and other topics in more detail during their keynote in Cincinnati.

The other side of the coin

Ashley Judd can speak to that “significant difference” from a different perspective. In 2006, Judd, who has starred in 30 films and multiple TV shows in her career, spent time at an intensive inpatient treatment program at Shades of Hope, an addictions center in Buffalo Gap, Texas, to help her cope with a long-standing struggle with depression.

At the time Judd checked in to Shades of Hope, her sister, country music star Wynonna Judd, was being treated for an eating disorder at the same center. Ashley told Esperanza that after the counselors witnessed her acting out symptoms of a compulsive disorder, such as constantly tidying up her sister’s room, they suggested that she check into the center herself. She agreed.

“What I said was, ‘I’m so tired of holding up all this pain. I’m so glad to come to treatment,’” Judd told Nightline in an interview about her time in treatment. “God saved me from being angry, and it impairs my ability to be of service to another human being.”

Judd wrote in her memoir, All That Is Bitter & Sweet, that her depression, which began at age 8, stemmed from a childhood filled with abuse and loneliness, as her mother and sister, the famed country music duo, The Judds, would leave her at home when touring across the country.

Esperanza reports that Judd went to 12 schools in 13 years, and this insecurity, coupled with feelings of loneliness, fed into her depression as well as a fear of the unknown. “I remember what it was like for me … when I was living in a perpetual state of anxiety,” she told the magazine. “It feels like you can’t breathe properly. Every thought you have brings more stress, and for me, the most frustrating part was that I felt powerless to change it. The really frustrating part is that a part of you recognizes that you are doing it to yourself. But there’s this inexorable force pushing you down, and what’s really [messed] up is that you end up hurting your own feelings. I’m good at creating these dead ends for friends and loved ones where it makes it impossible for them to help.”

Judd acknowledges acting out through fits of rage and cleaning frenzies in an attempt to cope with her feelings of depression and anxiety.

But according to Judd, her treatment experience at Shades of Hope was both successful and life changing. Following her positive experience, she became an advocate for the therapeutic process. She will be speaking about that experience during her keynote at the ACA Conference.

In 2010, Judd graduated from Harvard University with a degree in public administration and has found new meaning through charity work and spending time as a political activist and humanitarian focusing on issues such as AIDS, poverty and women’s issues.

She is a global ambassador for YouthAIDS, a global health organization targeting malaria, HIV and reproductive health, and has been a member of its board of directors since 2004. Judd has traveled with the organization to places affected by illness and poverty such as Cambodia, Kenya and Rwanda.

In 2011, Judd joined the Leadership Council of the International Center for Research on Women and is involved with other organizations such as Women for Women International and Equality Now.

In April, Judd wrote a piece for The Daily Beast slamming the media for speculating over what they called her “puffy” appearance and incessantly commenting on the appearance of women and girls everywhere. “The assault on our body image, the hypersexualization of girls and women and subsequent degradation of our sexuality as we walk through the decades, and the general incessant objectification is what this conversation allegedly about my face is really about,” she wrote.

Judd also advocates for more public acceptance of mental health issues in society. “Unfortunately, there’s still a huge stigma around all kinds of mental illness, and depression in particular,” Judd told Esperanza. “It’s odd. We don’t stigmatize people with epilepsy, which is another debilitating disease. I think the disease element of depression needs more traction. People need to understand that depression isn’t just a matter of being sad. It’s a condition and a real illness. It’s actually a full-blown public health issue. But right now … talking about depression is like coming out. And … I don’t mind being one of the first to talk about my so-called little secret.”

For more information on the ACA 2013 Conference & Expo, visit counseling.org/conference.

Heather Rudow is a staff writer for Counseling Today. Contact her at hrudow@counseling.org.

Letters to the editor: ct@counseling.org

Q & A with a counselor: Teri Nehring

Heather Rudow September 28, 2012

Teri Nehring is an American Counseling Association member who works with individuals from all walks of life — from trauma victims to the Oneida Tribe of American Indians. As reiki master, certified breathworker and shamanic practitioner, Nehring says what she has found to work best with all of her counseling clients is an infusion of both Eastern and Western counseling approaches. Nehring says she truly believes that the utilization of both of these practices combined with energy work is the new wave of contemporary therapy. For more on Eastern and Western approaches to counseling, read Counseling Today’s October cover story, “Where East meets West.”

What techniques do you specialize in?

I specialize in mental health/drug and alcohol issues with an emphasis in trauma work and empowerment training. I have been able to blend reiki, breathwork, chakra clearing meditation, mindfulness and shamanic energy-based work in conjunction with traditional strength-based and talk therapy. I have developed my own model of working with clients using all of these tools called Luminous Energy Therapy — “luminous” meaning working with our energetic light or medicine body.

 How did you first get involved in Eastern techniques?

I became very interested in Eastern and shamanic energy healing seven years ago when I started to see an influx of clients who were trying to work through chronic pain, fatigue, trauma issues, depression and anxiety, to name a few. Traditional talk therapy combined with constant pain medications was not working to benefit the clients.

Describe a typical session with your clients.

A typical session starts with a dialogue about what the client would like to have more of in their life, and then energetically, I track with the client where the blockage around the core issue is in their energy body. I am looking for the chakra that is nearest to where they identify feeling the issue in their body. When we desire more of something in our life, we have to find the energetic block and identify the core issue or negative messages that we give ourselves. If the client wishes to give detail about the situation they can, but it is not necessary. I then ask the client to close their eyes and to hear and visualize the negative message and where do they feel it in their body. I work with the client to simplify the message.

For example, a client may say, “I never seem to feel confident in myself,” or, “I am always worried that others will not like me.” A core issue statement usually starts with the words “I am not” and then we narrow down what resonates with the client. In the example I used, the core issue may be “I am not good enough” or “I am not enough.”

Sixty percent of the time, people will tell me they feel it in their belly because energetically the belly is where feelings and emotions are energetically held. The other chakra many people feel those negative core issues in is the chest or heart chakra.

I work with the client to begin a connected breath. I also breathe with the client until they have established a steady breathing pattern. The breath is our life force. It is the fuel that powers the body, the amazing vehicle that allows our spirit to live and move around in. Cells have memory and they remember and record every event in our lives that we experience, so when we breathe, we are able to release the negative energy and take a new message and positive energy into the cells through oxygen. Oxygen is the fuel for the cells and through the connected breath we can begin to create a new cellular memory and message.

I use the technique of journeying to help the client identify a place that they feel is safe and that they love being. The client is allowed to bring anything with them except another living being into the sacred and safe place they create for themselves. I often will journey or go with people to their sacred space to do the connected breath work. People feel more relaxed and are able to begin to get in touch the core issue and negative feelings that surround the message.

When the connected breathwork begins and the chakra is opened, energy automatically begins to move along with the emotions connected to it. I coach people to continue to breathe as the emotions begin to arise and move through and out of the body. It is important that people continue to breathe because often when we feel negative emotions, we stop breathing and then the body holds the negative energy. When the energy is held it usually finds the weakest area and our body and locks itself in. This often becomes the origin for chronic pain and fatigue along with a host of other physical ailments.

Once the client begins to release the energy, I continue to track with the client what are they feeling in their body and where. Energy can sometimes become stuck, so I work to open other chakras as the energy moves so it can be released through that chakra.

Once the energy is released, many times there is inner child work that needs to take place. I will again journey with the client to their sacred place or sanctuary to begin working with the child within through a dialogue that starts the process of nurturing and restoring what the inner child most needs to feel safe and loved.

If the inner child work needs to done, I work with the client to develop his or her own new positive core message starting again with “I am.” I have the client repeat the new positive message out loud three times while holding their hands on top of their heart. This helps them bring awareness and a new message in to the cells and is received on a soul level.

This is the spiritual piece of the work, which then unites and completes the integration of mind, body and spirit, which most traditional therapies cannot help our clients to do. All the chakras that were unwound and opened are then closed as they are now clear of any negative energy.

The client is given a notecard to record the new message or affirmation on and is directed to keep the notecard in a place where they will see it several times a day. Every time they see the card they are asked to say the affirmation out loud to themselves.

An assignment that creates action and meaning connected to the session work that has been completed is given to help the client nurture themselves. This allows the client to honor the sacred and powerful work they have completed and to continue to help integrate the new positive message on an energetic and cognitive level.

When we begin to understand that the body is more than just physical, that is has several subtle energetic fields that surround it, we can then begin the process of helping clients to heal and restore on all levels.

In this work, I find that I can help a client to resolve and to restore themselves on all levels 50 percent faster than traditional talk therapy. A typical client can create a meaningful and strengths-based resolution in three to five sessions. Clients also are given tools that allow them to practice the process outside of the therapy session.

What kinds of clients do you see?

I see clients [ranging from] teenagers to adults with mental health, alcohol and other drug abuse, and trauma issues. I also am a personal trainer and work [with] clients who want to take part in personal/business empowerment and transformation by understanding their authenticity, speaking their truth, owning it and stepping into themselves.

Why do you believe it is important it to integrate Eastern and Western approaches to counseling?

I believe that many of the Western modalities only address mind and body. When we begin to understand the principles of the Eastern practices, then we begin to come from a place of integrating the spiritual pieces that complete our healing on a soul level.

What kinds of misconceptions arise — if any — surrounding your techniques?

Fear is the biggest obstacle that stands in the way of understanding and progress. We are creatures of habit and this rings true even in the counseling field. We all have our favorite modalities that we are confident in working with. Sometimes it is difficult to allow oneself to get out of the box and experience something that may be outside of our comfort zone.

What sort of counselors do you recommend trying Eastern approaches?

I believe Eastern modalities should be encouraged for all types of counselors to look at the potential of how they can integrate these approaches and tools into their practice for the benefit of their clients.

Where should counselors look for more information about the subject?

Counselors can find information all over the Internet and in bookstores. Keywords are energy therapy, holistic approaches to healing, reiki, shamanism and breathwork.

Heather Rudow is a staff writer for Counseling Today. Email her at hrudow@counseling.org.

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