Tag Archives: Counselors Audience

Counselors Audience

Using a wider lens to conceptualize client problems

Heather Rudow April 18, 2012

(Photo: Wikimedia Commons)

One of the pillars of the counseling is empowering clients to achieve the goals they have set themselves. But over time, counselors have also placed greater focus on international issues and social justice counseling.

Manivong J. Ratts, president of Counselors for Social Justice, a division of the American Counseling Association, calls social justice the “fifth force” in counseling. According to Ratts, social justice recognizes that client problems cannot be understood solely through an intrapsychic lens.

“Social justice counseling calls on counselors to use a wider lens to conceptualize client problems by viewing clients in [the] context of their environment,” says Ratts. “When counselors are able to see clients in [the] context of their environment, they begin to see how larger social, political and economic forces influence client development. Moreover, counselors begin to see how oppressive conditions such as poverty, racism and homophobia negatively contribute to human development issues.”

One way that counselors can broaden their lenses, he says, is by getting involved with organizations that have social justice goals or missions. CARE (Cooperative for Assistance and Relief Everywhere Inc.) is one such nonprofit organization.

Founded in 1945 with the aim of fighting global poverty and focusing on poor women across the world, CARE often helps people who have gone through traumatic events that have seriously impacted their mental health. Richard Perera, CARE’s communications coordinator, says it is important for organizations such as CARE to provide psychosocial support systems for people who have experienced natural disasters, famine, violence, sexual assaults or poverty or have been displaced from their homes by war. He explains this “can mean direct counseling, but can also mean working through the community.”

For example, says Perera, in emergency camps for Somali refugees in Dadaab, Kenya, CARE provides training to the adult members of the camps so they can provide others with healthy ways of coping with traumatic experiences. Additionally, the knowledge they acquire helps them understand why some of the child refugees might misbehave.

“They don’t [think], ‘Oh, this kid is acting out because they’ve been through a traumatic experience.’ They [typically] just think they’re being bad,” Perera says. “Kids can be resilient, but they need a routine, and they need an environment where they can play and learn.”

Perera says CARE’s top priority is providing the people they help with a place where they feel safe and emotionally supported. He believes this is why the organization resonates with counseling professionals and the reason counselors might consider getting involved with the nonprofit’s endeavors.

“If there comes a time when the U.S. takes a stand [for or against an international issue],” he says, “counselors can be advocates for an enlightened foreign policy.”

One of CARE’s latest aims is supporting President Obama’s Fiscal Year 2013 request for the International Affairs Budget, which helps alleviate poverty, global hunger and famine, HIV/AIDS and maternal mortality. It also enables the United States to respond to humanitarian crises.

“I think of it as an investment,” Perera says of the International Affairs Budget. It doesn’t cost much in comparison to the rest of the budget, he says, and keeping children mentally, physically and emotionally stable in unstable countries helps the entire world to stay safe in the long run.

Ratts says it is important for counselors to take action and support organizations such as CARE as well as the president’s request for the International Affairs Budget because events that occur overseas also have an impact on the United States.

“Poverty is a global phenomenon that permeates all parts of the world,” he says. “More importantly, counselors need to understand that poverty is a global issue that affects us all. We cannot focus solely on local-level initiatives because we don’t live in a vacuum. The growth of technology has helped society to understand that we live in an increasingly global society where international politics can affect us at the local level. For this reason, counselor involvement in such initiatives as CARE to address global poverty is critical because it leads to quality schools, health care and employment. … Social justice-oriented organizations are important in helping to address equity issues that impact our world. These organizations help promote awareness of social injustices and serve as a way to systematically address the social ills of society. I think it is important that counselors be involved with at least one organization that addresses a social issue they are passionate about. Imagine how much better this world would be if all 50,000 members of ACA joined one organization similar to CARE. … As a collective, we would make this world more just and humane.”

In his view, Ratts doesn’t believe that counselor education programs have adequately equipped counselors with necessary social advocacy skills in part because counselor educators are not adequately equipped themselves.

“For the most part, counselor educators are not trained in community engagement and systems-level work,” he says. “Most have been trained under a paradigm that promotes the medical model and intrapsychic ways of helping. This problem is akin to the early days of the multicultural counseling movement when counselor educators were attempting to train graduate counseling students on becoming multiculturally competent but not having the training themselves. Unfortunately, the lack of social justice competence among counselor educators is setting a stage for future students to fail and for clients to leave counseling believing they are the problem when, in fact, their problems may be a result of larger oppressive conditions. “

Developing international and social justice competence would not only enhance the counseling profession, Ratts says, but also help make the world a better place for all citizens.

“Social justice must begin with us,” Ratts says. “Counselors need to develop competence as social justice advocates before they engage in advocacy interventions at the local, state, national and international levels. Counselors, even well-intentioned ones, can do more harm than good when they seek to help others but are not equipped to deal with the complexities of the world. Counselors need to first be multiculturally competent if they seek to address social justice issues. Cultural competence allows counselors to address sociopolitical issues in a culturally appropriate manner. Counselors also need to be cognizant of domestic and global politics. Understanding domestic and global politics can help counselors develop a better sense of whether individual counseling or environmental-level advocacy is needed. Counselors need to allow a community, whether it be domestic or international, to teach them what is needed. Oftentimes, we see counselors coming into a community thinking they know what is best for the community. We see this in higher education settings where well-intentioned faculty develop service-learning opportunities for their students but fail to take the diligence and time needed to truly understand the community. When this occurs, student learning occurs at the expense of the community.”

For more information about CARE’s mission and latest endeavors, visit its website.

For more information about Counselors for Social Justice, visit its website.

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

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Why aren’t they screaming? A counselor’s reflection on aging

Judith Gusky April 1, 2012

When I was younger, I often wondered how it was possible that elderly people weren’t consumed with fear of the inevitable. But Erik Erikson seemed to have a “good enough” theory to settle my inner turmoil. As an undergraduate back in the early 1970s, I surmised from Erikson’s theory that as we successfully move through each stage of development, our “reward” is our inauguration into the next stage. Each success in turn opens the next opportunity to successfully negotiate life’s challenges and conflicts until we reach the penultimate — an old age of peaceful integrity, not one of despair or fear of death.

Failure to meet challenges at any stage along the way can always be addressed by going back under the safe tutelage of the therapeutic relationship. If necessary, we might even go back to the beginning, to find that “good enough” mother and a sense of trust, autonomy, initiative, identity, intimacy or generativity — whichever it might be. The key, I found, is in our resiliency.

But I wonder, even still, does old age give us the time we need to renegotiate life’s failed challenges? And what about “late old age” (80-something or 90-something)? What are the challenges of a developmental stage that people rarely attained until recent times?

The ‘ninth stage’

The Eriksons made it. Erik was 91 at the time of his death in 1994, and his wife and collaborator, Joan, died in 1997 at the age of 95. What might they have had to say about old age as they were living it?

In a videotaped interview in 1993, while Erik was in a nursing home, Joan Erikson said she felt a responsibility to rethink their eighth and final stage of human development — integrity vs. despair. She thought they owed an apology to people for theorizing that wisdom and integrity were so great.

In retrospect, she found that other people might see wisdom and integrity in an old person, but that’s not what that old person was feeling. “We shouldn’t have made it up,” she admitted. “We hadn’t been there yet. Maybe we should have talked to a lot of old people.”

The Eriksonian “ninth stage” emerged from her reflections. In a second interview in 1995, a year after Erik’s death, Joan conceptualized the newer, final stage of development by way of a metaphor — that of a woven fabric. She called it the Woven Cycle of Life. Erikson saw the warp, the lengthwise threads attached to a loom before weaving, as a person’s “indomitable core.” Throughout life, everything that was in utero is there — all our potential.

The weft, the thread that is woven back and forth to complete the fabric, represents life’s experiences and the challenges and conflicts along the way. When our strength wanes, the fabric’s color becomes grayer, colorless. But our strength keeps coming back, and when it does, our fabric’s colors are bright.

Erikson believed that the strength, the warp, is always there. Nothing is ever completely cut off. “You can always go back,” she said. You can make up for it anywhere along the line. This is the resiliency of human beings.

Providing a little more meat to the metaphor, Erikson theorized that the ninth stage is where we begin to see things from the other point of view. The eight stages of development are always presented in a syntonic-dystonic order (trust vs. mistrust, autonomy vs. doubt and shame, integrity vs. despair and so on). In old age, the order is reversed. The dystonic takes precedence. For example:

Mistrust vs. trust: When you get older, you realize there are certain things you cannot do. You may become mistrustful. But you have to draw on the trust, forgive the weakness (the failing memory, the slowing gait) and trust the rest.

Guilt vs. initiative: You may become insistent about taking on a particular project or challenge. You make people do things your way. You overestimate your physical competence. Your decision turns out to be wrong. The guilt comes not only because you didn’t have the physical capacity but also because you shouldn’t have made the choice in the first place.

Role confusion vs. identity: When you become dependent, when others are taking care of you, you question who and what you are.

Isolation vs. intimacy: In old age, isolation comes first. If you are isolated, you may yearn for intimacy.

Stagnation vs. generativity: How far do you go along with the stereotype of yourself as an old lady or an old man? To what extent will you choose to go on being a productive, contributing human being? To what extent will you withdraw?

In short, all of life’s conflicts and challenges are reexperienced in old age. From Erikson’s point of view, success in the ninth stage of life allows the older person to assert the Self by saying, “Don’t take away from me what I have. Let me choose.” It is all about maintaining our indomitable core.

Is it gerotranscendence?

Joan Erikson remained productive even in the last few years of her life. Among other things, she devoted the last chapter of her 1997 revision of Erik’s book The Life Cycle Completed to the concept of gerotranscendence.

Swedish sociologist Lars Tornstam coined the term gerotranscendence in 1989 in part to revive an interest in the “disengagement theory” of aging. This psychospiritual theoretical concept posits an alteration of consciousness in old age, a redefinition of the Self in relationship to others and a new understanding of fundamental existential questions, including:

  • Increased feelings of a cosmic communion with the Spirit of the Universe
  • Redefinition of the perception of time, space and object
  • Redefinition of the perception of life and death and a decrease in the fear of death
  • Decreased interest in superfluous social interaction
  • Decreased interest in material things

I’m not sure this is exactly what Joan Erikson was thinking about when she wrote about the ninth stage of human development. It would be nice to believe that, provided we can hold on long enough to our physical and cognitive health, we might have this tidy little process to look forward to. I think life is perhaps a bit too messy. But some may be so blessed to experience good aging and a “good death.”

What good can counseling do?

I love Ann Orbach’s 1996 book Not Too Late: Psychotherapy and Ageing. Orbach is a British psychotherapist, now retired. I relate closely to her account of herself as a 50-something therapist working with aging adults. The difference, of course, is that I am just at the beginning of this career, while she was already a well-seasoned psychoanalyst when she saw her first elderly client.

Each chapter in the book is like a literary adventure, and it offers a challenge to the ageism inherent within Western society and the counseling profession. For example, we laud the “wellness” model of mental health as counselors but tend to return to the medical model and pathology when working with aging adults.

Orbach’s perspective is personal and humane, inspirational and refreshing. She has helped me look at myself as an aging counselor and the aging clients I counsel in a different way.

One of her chapters, titled “Why Aren’t They Screaming?” begins: “For someone who is young and healthy enough to expect long years ahead, it is almost impossible to grasp what it would be like to have to accept a shrinking future in which there will be little further change or achievement or drama.”

As counselors, we want to help each client to live more fully and to pursue the same life-enhancing goals we desire for ourselves. But inevitably, Orbach tells us, the aging adult’s life is diminishing, and the ultimate goal will be that of facing death.

Facing such a reality is not easy, regardless of whether our clients enthusiastically embrace the existential challenge. As counselors, we might be as uncomfortable (or even more uncomfortable) as our clients are with the topic of death and dying. And so we resist, offer moral support and encouragement, and turn a blind eye to pharmacological dependency when challenge and rigor may be what is called for. Orbach is mindful that what we resist looking at in our clients is likely what we resist examining in ourselves.

Most counselors are not trained in long-term psychoanalysis. Brief, solution-focused therapy predominates in the field. Yet, why should the elderly regularly be singled out for short-term therapy? Is it the element of time, the stereotypical belief that perhaps it is simply too late to expect significant change?

Most elderly clients today probably are seen by mental health professionals for depression and anxiety, which is usually diagnosed by a primary health care provider after the older adult has lost a spouse, battled an illness or struggled with physical or cognitive incapacity. The medical model seems the only reasonable model to follow. So, we leave much of the work of counseling the elderly to those in the social work profession who dominate mental health care in the arena of nursing homes, hospitals and hospices.

Yet, if we entertain the notion, as did Joan Erikson, that personality and identity continue to evolve and develop even in the very advanced stages of life, then we owe the elderly much more.

Old age is an important stage of development. The strengths a person has achieved and demonstrated throughout the life cycle will be challenged as that person encounters a decline in physical and mental abilities in old age. But in this stage of life, whether we label it a ninth stage or gerotranscendence or something else, whether our clients look backward or forward, a successful outcome is possible. This outcome is one in which the final years can be lived to the fullest, in harmony with one’s past life and without fear of death, or at least with the acceptance of life’s existential limitations.

In one of her final interviews, Joan Erikson said she was uncertain of how to advise people concerning what to do as they reached old age. If nothing else, she said, the thought that came to her was that they should go on “becoming.”

It was a very existential response for a developmental psychologist. It reminded me of Viktor Frankl’s admonition that there is meaning in life, available to everyone, and that life retains its meaning under any condition and until its final moment. We owe this much to each elderly client who crosses our path.

 

Judith Gusky is a licensed professional counselor in Pennsylvania who came to counseling as a midlife career changer. Contact her at judithgusky@gmail.com.

Letters to the editor: ct@counseling.org

 

Working through ambivalence with adolescent substance abusers

Matthew Snyder & Lynn Zubernis

As practicing counselors, we all have clients who are “easier” than others. The easy clients are motivated toward change, take action on established goals and internalize feedback readily. The other side of that coin is that we also have clients who are more difficult. They are not motivated toward change, do not perceive the need for change and are ambivalent toward counseling. We have all encountered the person who has experienced a heart attack but continues to smoke, or the person who keeps abusing alcohol despite DUIs, failed relationships and repeated hangovers. Why do some people change, while others continue to engage in self-destructive behaviors?

In many settings and with many populations, ambivalence is more the rule than the exception. Clients who are mandated for treatment by an administrator or judge, who are “forced” into counseling by concerned parents or loved ones, or who are simply “going through the motions” may exhibit high levels of ambivalence, and this can be a major impediment to positive change. So how, as counselors, do we best help these clients?

If we look at James Prochaska and Carlo DiClemente’s “stages of change” model, many of these ambivalent clients are in the precontemplation stage. In other words, they are not at the point in the change process in which they are able to make insightful conclusions. They do not see their behaviors as problematic, or if they do, they are most likely blaming an external entity or third party for their problems. When we have clients who are at an early stage of the change process, we want to help them begin to feel or think that they are ready, willing and able to make a positive change. To achieve this, clients must recognize that their current behavior is a concern, think that they will be better off if they change and believe they are able to change.

So, how do we get them from this initial defensive stance to a place in which they are internally goal driven and actively seeking solutions? William Miller and Stephen Rollnick (1991) and Thomas Bied, William Miller and J. Scott Tonigan (1993) established that certain critical conditions must be present for change to occur. These conditions include empathy, feedback regarding personal risk associated with current behaviors, emphasis on personal responsibility for change, clear goal options and the facilitation of client self-efficacy. Following this work, Robert Stephens and Roger Roffman (1996) found that brief treatments can be effective for substance use clients and can establish these critical conditions for change.

Building on these areas of critical research, which have been continued and expanded through the past two decades, this article will briefly discuss how to work effectively with ambivalent clients and provide some useful techniques and strategies for doing so. Because most of us work within the constraints of managed care, organizational constraints or merely the financial realities of the current economy, we will focus on brief treatments that empirical studies have demonstrated to be effective. The framework and interventions we present feature eclectic ideas from a variety of theoretical approaches to counseling, including humanistic, cognitive behavior, solution-focused and motivational interviewing paradigms.

Substance abuse is a serious problem among adolescents, who face significant stressors in competition for academic and job success, a lack of support from overstressed parents and school systems, and the challenges posed by formal operational thinking and rampant social comparison (including cyberbullying). It is widely accepted that both risk taking and resistance are developmentally appropriate parts of individuation. Thus, the approach outlined here can be particularly effective in helping teens and young adults to accomplish positive change.

The initial sessions

The first counseling session is always important. Ideally, it establishes rapport and sets the groundwork for client change. With ambivalent or unmotivated clients, the initial session is even more critical.

The goals of such a session are first to express empathy, then to develop discrepancies between what the clients want and the behaviors they are engaging in and, finally, to support the belief that clients can make positive change. Rapport is critical and hinges on the counselor’s expression of real interest in clients’ views. This means not being dismissive or making assumptions based on one’s own beliefs about what is “best” for clients.

We often tell our graduate students that counseling is not like putting together a barbecue grill — there are no printed instructions or one-size-fits-all approaches. Instead, a counselor has to listen, long enough and hard enough to “get it.” But how can counselors really know that we get it? When we do, clients’ behaviors and coping strategies will make sense — not in a general way perhaps, but in the context of their specific circumstances. Their behaviors may be kicking them in the backside, but somewhere, a reinforcement contingency is present that is keeping them dependent on this behavior. Oftentimes, clients also have a realistic fear of giving up the only coping strategy they have been able to find.

One important caveat is to avoid increasing the client’s resistance, which will result in the client tuning you out — and very little actual change. Try to steer clear of taking any kind of argumentative stance. This will help you avoid power struggles, including adolescents’ typically knee-jerk response to anything that sounds as if an adult is telling them what to do. Drawing from what humanistic psychology teaches us, the counselor should listen and reflect rather than judging or telling clients what to do. From a motivational perspective, it is important for all clients — but especially for adolescent clients — to make choices for themselves and to experience that choice as being internally motivated.

During the initial session(s), it is expected that adolescents will be ambivalent regarding change. Start from this premise and try not to expect otherwise. After the counselor accepts this and listens closely enough to understand the context of the client’s behavior, the next step is to develop discrepancies. These usually involve a client’s behaviors not matching his or her verbalized goals or affective expression. No matter how ingrained the coping behavior, even the most defended clients are aware on some level that there are costs to the behaviors they have adopted.

However, it is just as critical for the counselor to remember that clients likewise perceive benefits to their behavior. If the behavior is continuing, something is reinforcing it, and the perception of the client is that the reinforcements are currently outweighing the costs. As we often emphasize to our graduate students, every behavior has a reason — you just need to keep digging to figure out what that reason is. Beginning counselors commonly fear acknowledging the “positives” that clients associate with their addictive behavior, whether it be substance abuse, an eating disorder or self-harm. But the counselor gains credibility and the client feels as though the counselor “gets it” when both costs and benefits are discussed openly.

Having acknowledged the positives, we then want to examine the negative outcomes and make concrete comparisons between the two. We follow this with a systematic exploration of the feelings associated with these behaviors and outcomes. Change does not happen in an intellectual, rational vacuum. If the emotional costs of change are perceived as too high, clients will remain where they are — this makes perfect sense, because no one wants to incur emotional suffering.

The next step is to move forward to the future, examining how these behaviors affect the client’s long-range goals. The reinforcing impact of many coping behaviors such as substance abuse are limited to short-term pain reduction, and clients avoid awareness of long-term negative impact. It is human nature to prioritize stopping immediate pain over some future deferred benefit. Change will occur only if adolescents perceive a discrepancy between where they are and where they actually want to be, while also having the emotional regulation skills and substitute coping strategies to tolerate some discomfort in getting there. In other words, it makes sense to change only when the client (not the counselor) comes to believe that the good things about the problem behavior are outweighed by its adverse consequences.

A good way to get clients to express their ambivalence, as well as their awareness of some of the potential costs of their behavior, is through reflective listening. For example, a client who talks about feeling less anxious and more sociable when using marijuana but is also motivated to do well in school and concerned about the cognitive impact of use is expressing both positive and negative aspects of using. A typical reflective statement that points out one of these discrepancies would be “So, you are saying that you really enjoy the feeling of getting high, but at the same time you are afraid of losing brain cells.” If a client says, “Maybe I should start cutting down on my marijuana use a little bit before I lose my job or get suspended from school,” the counselor could follow with “So you see a connection between your drug use and problems you are having at school and work.” In making such a statement, the counselor is acknowledging and reinforcing the client’s insight, which naturally leads into more directive goal setting.

It may sound counterintuitive, but we want clients to become more distressed about their usage. People are motivated to change something when they’re in distress, so clients need to experience that distress. By first understanding and then challenging their defense mechanisms and pointing out the discrepancies, counselors can use this distress as a motivating factor toward change.

The early sessions should also be designed both to increase client motivation to address issues of concern and to empower clients for change by educating them about cognitive behavior approaches and the triggers to their substance abuse. It is important in these initial sessions for clients to start expressing motivational statements. These statements can be in the cognitive, affective or behavioral realms. For example, a client might say, “I guess maybe this is more serious than I thought” (cognitive recognition of the problem) or “I’m really worried about what’s happening to me” (affective expression). Motivational statements also include implied or stated intention to make changes, such as “I’ve got to do something!” or “I know I can do it if I put my mind to it.”

Later sessions

After the initial session(s), in which counselors have highlighted some discrepancies and clients have been able to verbalize some motivation statements, there are many techniques you can use to help clients progress toward goal setting and positive change.

Often, young adults who are abusing substances have a limited repertoire of alternative coping skills, so they are understandably reluctant to give up the ones they do have. Skill deficits should be explored and remedied, and new behaviors should be taught and practiced. This can be achieved through role-play, scripting or cognitive restructuring.

A functional analysis can also be very helpful at this point in the process. It will help clients explore and understand that there are antecedents and consequences that influence their usage patterns, and that their responses to these environmental contingencies are entirely understandable. Change the antecedents and consequences, and the behavior changes.

An understanding of the way in which their use is influenced by external factors, in combination with an emphasis on the client’s ability to change these, can be motivating and empowering. This approach also avoids pathologizing clients. Self-efficacy is an important component to later sessions. From this point, you can help clients come up with alternative behaviors and cognitions that will in turn alter their ultimate consequences.

Once clients have gained an understanding of how their behaviors are negatively affecting multiple aspects of their lives and have gained motivation toward change, the next step is goal setting.

Warning signals and how to navigate around them

Resistance is common when working with ambivalent clients. It should be expected but not ignored. Resistance might take the form of a client contesting some factual information or something the counselor has said. It might take the form of frequent interruptions to change the subject or be of the “yes, but …” variety. These should serve as red flags for the counselor, indications that you’re pushing too hard or trying to go too fast. Clients didn’t develop this coping strategy overnight, and it’s unrealistic to think they’ll discard it quickly either.

When you sense resistance, drop back and “roll with the resistance.” Repeat clients’ statements in a neutral, nonjudgmental tone, letting them know that you’re hearing them and that you realize what they’re saying is important. Express empathy with their statements, perhaps by reframing them toward the positive. Emphasize what clients are already doing that’s helping them move toward positive change. Shift focus away from obstacles that seem immovable to barriers that these clients have already been able to surpass.

Rather than arguing with clients, it can be helpful to try a paradoxical approach, siding with the problem instead of challenging it. Exaggerating what clients have said can sometimes help them to see the downsides of their coping strategies more clearly. For example, if a client has said that alcohol makes him or her more sociable, you can take that side by expanding the statement: “You can only talk to people and get to know them if you’re drinking, and it’s really helping you get to know people better and form some close relationships.”

Other motivational interviewing techniques are also useful in minimizing resistance. Asking open-ended questions (“What do you think about your alcohol use?” instead of “Do you know what drinking does to you?”), using reflective listening and validating the client’s worldview are all good approaches to use in helping the counselor to “get it” and helping the client to feel “gotten.”

Clients are more likely to attempt change and to persevere after relapse if the counselor has taken the time to get to know them and shared positive affirmations with them. Engaging in the helping process when dependent on a coping strategy that will be challenged takes a tremendous amount of courage. Reflecting that courage back to the client can be the starting point for real change.

“Knowledge Share” articles are adapted from sessions presented at past ACA Annual Conferences.

Matthew Snyder is an assistant professor and graduate coordinator in the Department of Counselor Education at West Chester University. Contact him at msnyder@wcupa.edu.

Lynn Zubernis is an assistant professor in the Department of Counselor Education at West Chester University.

Letters to the editor: ct@counseling.org

Not content to ‘ride off into the sunset’

Lynne Shallcross

When Hilda Davis Carroll turned 60, she was between counseling positions following a layoff. As she watched the sun rise on the morning of her birthday, she thought to herself, “OK, I’m 60. Where do I go from here, and what am I going to do with the rest of my life?”

The answer for Carroll, a member of the American Counseling Association, was to open a private practice in her hometown of Nashville, Tenn. Not so long ago, that choice would have struck many as surprising because 60 generally signaled the point to start ramping down a career and making preparations to settle into a quiet retired life. But as Carroll reached that milestone age, she found herself happily anticipating at least 20 more years of work. As a member of the baby boomer generation, Carroll isn’t unique in choosing to rev up her career instead of slow down.

Nancy Roth, a counselor at Philadelphia FIGHT (Field Initiating Group for HIV Trials), says baby boomers are thinking differently about aging than previous generations. “Boomers were the generation that said, ‘Don’t trust anyone over 30.’ As they age, they’re now the ones saying 60 is the new 50 and 50 is the new 40. Older generations were OK to say, ‘Now I’m hitting a certain age, and I’m content to retire or ride off into the sunset.’ Boomers are saying, ‘OK, now I’ve hit this great age, and I’m going to reinvent myself.’ They’re seeking more. They’re not just content with what [the norm] was before.” Roth, a member of ACA, is among that contingent, noting that she reinvented herself at age 50 by going back to school to study counseling.

It is important for counselors to take notice of this attitude shift because of the sheer number of potential clients who are baby boomers, Carroll says. She also points out that baby boomers represent the largest population in U.S. history to be reaching retirement age. As boomers age and look to make meaning of their remaining years, Carroll believes counselors can assist in multiple ways. This includes offering understanding that boomers might feel a little disoriented or overwhelmed and might even confront some level of grief when thinking about the reality that they have less time ahead of them than behind them to live.

Aside from simply being a very large generation, these counselors say baby boomers possess some general characteristics that set them apart from both previous and ensuing generations. “Baby boomers are accustomed to challenging authority,” Carroll says. “Baby boomers are accustomed to things changing because we make them change. Counselors can utilize that for helping boomers push the limits of what might be expected of retirement. Tap into that strength and resilience that carried them through the tumult of the ’60s, societal changes in the ’70s and the [financial] collapse in the ’80s. [Tap] into boomers’ history of being able to make change and change themselves.”

Roth agrees. “It’s not surprising that a generation that was challenging all those social norms would also be challenging the received wisdom about what it means to grow older,” she says. “From clinical experience, I would say that boomers tend to be more confident that they can change — that they can change themselves or can change the world — than I see in the generation that came before or the generations that came after.”

On the basis of her observations, Carroll says clients in younger generations can at times be more concerned both with how they’ll be perceived and with social standards. Boomers are less concerned with those things, which can be a strength, she says, because it allows them more room to focus on how they will make a difference, find fulfillment and leave a legacy.

Catherine Roland, professor and director of the doctoral program in counselor education at Montclair State University in New Jersey, says the baby boomer generation is not particularly accustomed to depending on others for help. For that reason, she says, it’s imperative that counselors treat these clients with the utmost respect and ask them how the counselor might assist them rather than telling them what to do. That independence can also make baby boomers reluctant to go to counseling in the first place, but once they take that step, Roland says they tend to be very committed to the process, from keeping their appointments to writing entries in their journals or following through with other treatment exercises.

Although no one particularly likes to think about aging, it’s something everyone goes through, so it is imperative that counselors examine the process so they can better assist clients, says Roland, the Association for Adult Development and Aging’s representative to the ACA Governing Council and a past president of the ACA division. Aging decreases or takes away some abilities and activities, such as the ability to run perhaps, but Roland points out that it also restores or gives us new perspective on other abilities, such as being able to bask in the glory of being a fast walker at an older age.

Squeezed in the middle

Baby boomers are sometimes referred to as the “sandwich generation” because many find themselves caring for their aging parents, while simultaneously still trying to provide support for adult children, some of whom have returned home to live with them. With clients who are in this situation and feeling overwhelmed, Roland, who also runs a private practice, conducts a family overview and asks if anyone else in the family can assist in any part of the caregiving. Considering the independent streak many baby boomers possess, Roland will often hear these clients exclaim, “My sister doesn’t want to help, so the heck with it. I’ll do it myself.” But there comes a time to ask for help, which is sometimes the advice that Roland offers her clients.

With baby boomers who are experiencing these pressures, Roth often first urges them to take care of themselves, then shifts attention to taking care of parents and children. Carroll also emphasizes a primary focus on self-care and echoes Roland in asking these clients whether another family member can provide some level of assistance. If not, she suggests resources such as AARP and the client’s area Council on Aging as possible starting points for finding professional respite care.

At times, Roland has even suggested that clients consider assisted living for their parents. As heartbreaking as that decision can be to make, she says it is sometimes the one that most benefits everyone involved. If the situation grows too dire otherwise, she says, both the aging parents and their baby boomer children can find themselves vulnerable to accidents, higher health-related costs and stress-related issues. “Having that conversation is one of the most difficult situations to talk about as a counselor,” Roland acknowledges.

Counselors should also prepare themselves to address some amount of anticipatory grief among baby boomer clients, Carroll says. She explains that these clients are likely to experience grief associated with watching their parents age and lose vitality, while also dealing with anxiety related to anticipating that the same scenario will play out for them in the future.

Issues concerning romance may also surface during counseling sessions with baby boomers, Carroll says. Whether these clients are navigating their relationships with longtime partners or seeking new relationships after the death of a spouse or a divorce, questions surrounding how to find a mate or how to stay attractive to a mate are common, she says. Carroll, who writes a blog, says one of her recent posts was titled “KY Jelly and People of a Certain Age.” “We’re grown-ups,” she says. “We can talk about sex.” Baby boomers weren’t accustomed to thinking about sexually transmitted diseases and HIV/AIDS in their younger years, but now it’s imperative that counselors discuss those topics with them, Carroll says.

Roland says it isn’t uncommon to see baby boomers enter counseling after their relationship of 25 or 30 years has ended, often because their partner decided to leave. “It’s a tremendous loss and blow to the ego,” she says. Counselors can offer help to these clients by carefully processing what happened and the history of the relationship, she says. Through the review process, Roland says, clients often see that the breakup wasn’t altogether surprising. Sometimes, in fact, they discover that they were equally unhappy in the relationship and can identify many ways that it might be freeing to move on without the other person.

Of course, aging is not something that people always want to face or embrace, Carroll says. She points to the lucrative markets for plastic surgery and drugs such as Viagra as proof of the pushback against aging. Carroll admits it’s a struggle even in her own life. “One minute I’m glad to be 62,” she says, “and the next minute, I am in jeans and three-inch heels pushing age out of my mind. How do we manage and balance those?”

But Carroll tells her clients that the grief sometimes attached to getting older won’t disappear with a facelift. Even as they prepare for the future, she advises them not to agonize over what might happen and what things will change with age. Her advice to clients: Rein those thoughts in, breathe and stay present in the moment.

Although the economy’s recent struggles have presented challenges for each generation, the timing has been particularly bad for baby boomers. Many were or are approaching the point where they expected to retire, Roth says, but instead they have found that their house is under water or their retirement account isn’t what they expected. “That forces people to make decisions they hadn’t planned on making,” including possibly learning new skills and seeking a new career, Roth says. In other instances, boomers have adult children and aging parents depending on them financially, adding another hurdle to their ability to retire.

In these situations, counselors can evaluate and work on coping skills with clients, Roth says. “How do you manage your feelings? How do you cope in positive ways so that you’re not turning to drugs, alcohol, overeating or some less helpful way of coping? Can we increase your frustration tolerance? Can we help you regulate your mood, even though things aren’t going the way you want them to, so that you can continue to find joy even though your life isn’t the way you had planned? In many ways, that’s a lot of what we do with clients because we just can’t control everything.”

When baby boomers are able to fully retire, they’re often quite surprised to discover that they feel somewhat isolated and that their sense of self-worth was tied to the work that they did, Roth says. Counselors can minimize the difficulty of this transition for clients by discussing with them what they will do with this new free time, how they might choose to continue to use their skills and how they plan to stay connected to the world, she says.

Roland agrees that the time after retirement can be unsettling for some people. “Everyone doesn’t have three children and eight grandchildren who all live close by,” she says. “Many times they regret retiring or feel sad. It’s a tremendous loss of identity. One of the things you need to say [to them] is that it’s not about retirement — it’s the absence of the everyday position. That’s why there’s a loss of identity.”

Roth encourages clients who are struggling with their identity in retirement to look at the good things that have occurred since they retired. She also suggests these clients consider volunteering their time and skills or, if finances are still a concern, pursuing a part-time job.

Roland says it’s also important to remind clients that when it comes to aging, there are many positives worth focusing on. For example, she says, there is power in growing older and not caring as much about what people think of you. If you’re retired, there is no boss to report to or tiptoe around. Financially, you’re likely to be better off in retirement or preretirement than you were in your younger years. “Every year that you live, you become wiser for yourself in your life than you were the year before,” Roland says. “You’re just more savvy.”

Effective interventions

Boomers are a great group of clients with which to use strengths-based interventions, Roth says. “They may be at a time in life where they’re feeling uncertain, but they come to the table being able to say they’ve done X, Y and Z in the past,” she says.

Many of the HIV/AIDS clients with whom Roth works at Philadelphia FIGHT are baby boomers who have lived on the streets or in poverty and are not well educated. Still, Roth says, they are a group with enormous capacities and strengths. Their past experiences have taught them significant coping skills, and they’re consistently able to learn more, she says. “Even when we’re working with very challenged individuals, they have enormous strengths that we can build on,” Roth says. “I have found that to be less true of some of the younger people I’ve worked with.”

Roth also finds a psychodynamic approach effective. “It’s helpful for people who are at that middle-age point to be able to look back on their lives and look at patterns that have developed and how those help or hinder them moving forward,” she says. A structural family approach is also helpful for those boomers who find themselves active participants in the sandwich generation, she adds.

Life review is another appropriate intervention for baby boomers, according to Roland, with the concept being to have clients identify the positive things in their past. For example, if a client was an avid runner, Roland might ask her to talk about her experiences as a runner. “It’s important for them to understand the successes they’ve had,” she says. “When something is taken away from us, we tend to forget the good that we’ve done. I want them to remember their great accomplishments.”

With most baby boomers, Roland uses a combination of client-centered and cognitive-behavioral techniques. “They don’t want to sit and nod,” she says. “They want to know, ‘If these are the issues, give me some things I can do.’ Their eyes light up when they get homework. [Counseling] has to be action-oriented, not analysis.”

Spirituality is another factor that can help boomers face the challenges of aging and being part of the sandwich generation, Carroll adds.

To provide better services to baby boomer clients, counselors should take workshops focused on working with older adults, Roland says. “If you were trained awhile back, you might not have had human growth and development classes,” she says. “So … go back and take some new classes.” Counselors also might want to consider getting a gerontology certificate from a university or visiting a hospice for older adults, Roland says.

To strengthen their knowledge base further, Carroll recommends that counselors read the AARP The Magazine and listen carefully to the people they know who are boomers to learn about them. In addition, she urges counselors to join AADA and attend its conferences and participate in other workshops focused on the topic of counseling baby boomers.

Because baby boomers have some unique characteristics, these counselors offer a few recommendations for working with this population:

  • Don’t stereotype, Carroll says. Do be open to who is in front of you.
  • Check your personal temperature concerning how you deal with older adults, Roland says. If you have a problem in your family and you really don’t like being around Aunt Tilly, then don’t work with older adults right now, she says.
  • Don’t assume that baby boomers are planning on retiring, moving to a retirement community and disengaging from life in the greater world, Roth says.
  • Don’t assume that because a client is of a certain age, he or she does not still desire a romantic relationship, Carroll says.
  • Make sure your office is accessible, comfortable and possibly brighter than you would keep it for other clients, Roland says.
  • Allow clients to grieve in their own way about their aging process and everything they’re experiencing, Carroll says.
  • Don’t assume that baby boomers don’t have an additional chapter left to write in their lives or that they can’t take on something new and challenging, Roth says.
  • Offer concrete support, Carroll says. It’s good to listen, but also provide specific means of help, including resources in the community.
  • Find out what medications clients are on and help with medication management, Carroll says. Don’t rush these clients, Roland says. You may be the only person an older client is speaking to that day for any length of time.
  • Be aware of what you bring to the equation as a counselor, Carroll says. Pushing clients too hard or not pushing them hard enough might be reflective of the counselor’s own feelings rather than what the client needs.

Looking ahead, Carroll predicts that the sensibility around aging will evolve as baby boomers continue to age. “It will be change in a positive way because the boomers are the people who gave us the Internet, civil rights, women’s rights,” Carroll says. “That same energy will be poured into aging.”

To contact the individuals interviewed in this article, email:

Hilda Davis Carroll at hrdaviscarroll@aol.com

Catherine Roland at rolandc@mail.montclair.edu

Nancy Roth at nlroth77@gmail.com

 

Lynne Shallcross is a senior writer for Counseling Today. Contact her at lshallcross@counseling.org.

Letters to the editor: ct@counseling.org


Bringing work home

Lynne Shallcross

It’s Monday of a three-day holiday weekend, and I’m sitting on my couch at home, staring at my laptop, trying to write a story about how work affects life. Ironic? Certainly. And as for you, Counseling Today reader, you’re likely skimming this story after a long day of work with clients or students, looking for ways to improve yourself as a counseling professional even as you simultaneously stir a pot on the stove for dinner. Regardless of how we might feel about it, the line between work and our lives outside of work is getting harder and harder to distinguish.

According to the Center for American Progress, 86 percent of men and 67 percent of women in the United States work more than 40 hours per week. A recent story from The Fiscal Times points to studies suggesting that the “extra work is negatively affecting our health, family lives and effectiveness at work.” One such study published in 2008 in the Journal of Occupational and Environmental Medicine indicated that anxiety and depression are increased among people who work the most overtime. A 2007 study from the American Psychological Association showed that 74 percent of employees regard their work as a significant source of stress, while 20 percent admitted to missing work due to stress.

But even when we’re home, we remain more connected to work than ever before. In 2008, research from the Pew Research Center found that 22 percent of employees are expected to respond to work email even when they’re not at work, half of all employees check work email over the weekend and a third check work email while on vacation. With the economic downturn resulting in fewer employees shouldering more of the workload at many companies, it stands to reason that those percentages have only grown during the past four years.

New research published earlier this year in the journal PLoS ONE by the Public Library of Science again indicated that working extended hours could substantially increase a person’s risk of depression. Those putting in an average of at least 11 hours per day at work were two and a half times more likely to experience depression than those who put in seven- or eight-hour workdays. Researchers took into account factors including job strain, support in the workplace, alcohol use, smoking and chronic physical diseases, but the connection between depression and lengthy workdays held up.

Over the course of our lifetime, we spend most of our waking hours at work, points out David Blustein, a professor in the Department of Counseling, Developmental and Educational Psychology at Boston College. The only thing that competes with work in terms of time spent is sleeping, he adds. Although many studies focus on the negative side of work, Blustein says at its best, work provides people with a sense of self-determination and a means of social connection. It can also serve as a source of fulfillment or compensation for problems people might be experiencing in other areas of their lives, such as a failing relationship, he says. And, of course, stripped to its most basic function, work is the means by which people support themselves financially.

Charles P. Chen, a professor in the counseling psychology program at the University of Toronto, adds that work also assists in creating personal identity. When two people meet for the first time, Chen says, they often start the conversation by asking what the other does for a living. What we do in our careers often gives others a sense of who we are as people, he points out.

“Work is essential in our lives, both in terms of the time that it occupies as well as the psychological meaning to us,” says Blustein, a member of the American Counseling Association, a member of the Board of Directors of the National Career Development Association, which is a division of ACA, and an NCDA fellow. “In many ways, people locate significant parts of their identities in their work lives.” Work provides us with a source of intellectual stimulation, he says, as well as an arena for expressing our interests and values in a context in which we can be rewarded and affirmed.

Understanding clients’ complex connections to their work lives is essential for counselors, says Blustein, adding that vocation is not only part of the counseling profession’s foundation but also central to clients’ identities and mental health. “Work is one of the main theaters of life, and it is a place where we manifest both our dreams and disappointments,” he says.

A different kind of calling

Imagine this scenario. An angry caller is on the other end of the phone. He is yelling at you about the mortgage he’s having trouble paying and the government loan modification program he was told he qualifies for. He is audibly angry and likely scared of losing his home, so he curses at you and calls you a few unsavory names. But listening to this caller — and others like him — is your job. You can’t correct him, you can’t ask him to stop cursing and you can’t hang up on him. All you can do is try to help him — in polite a manner as possible.

Sound stressful? It is, says Melissa Sanderlin, an employee assistance provider who works with, among other clients, employees of a mortgage call center in Monroe, La., when they are referred to her practice through their insurance. “[The callers] are irritated, stressed and they take it out on the person answering the call,” Sanderlin says.

Not surprisingly, the day-in, day-out routine of fielding these high-stress phone calls can take a toll on the call center employees. “[The employees are] often dealing with anger issues, depression and anxiety,” says Sanderlin, a member of ACA. “If they were completely healthy, they might not have those issues, but the work environment definitely makes it worse. They might be functioning on a pretty normal level until they go work there.”

The mortgage callers aren’t the only ones who ramp up the anxiety levels of some of Sanderlin’s clients. Managers who aren’t always trained very well in people skills sometimes add fuel to the fire, she says. Some of her clients report that their managers aren’t always professional and appropriate, sometimes even berating call center employees in front of their co-workers. Recently, a client came to Sanderlin and said the criticism she was receiving from her manager at work was having a negative impact on her home life, her relationship with her husband and her interactions with her children. “It stays on her mind constantly,” Sanderlin says. “She thinks about it all the way home, she thinks about it at home and it wakes her up in the middle of the night. These are common complaints” among Sanderlin’s clients from the call center.

Changing managers was not an option for this particular client, so she and Sanderlin worked together on improving her coping skills and finding a way for her to stop taking the interactions personally. Sanderlin takes a similar course with clients who come to her because of the stress they feel interacting with the mortgage callers. She works with these clients on separating their self-worth from what they experience on the job, on developing anger management skills and on establishing or maintaining a healthy lifestyle consisting of exercise, proper eating habits and adequate sleep. Sanderlin also focuses on relaxation skills with these clients, some of whom have reported experiencing panic attacks when pulling into the parking lot at work.

Creating a boundary between work and home is important as well, Sanderlin says. To avoid bringing the stress of work home with them, she advises her clients to consider options such as playing music, making a phone call to a friend or family member, or even taking a different route home so they have to think about where they’re going instead of constantly replaying in their mind what happened at work. Even visualizing closing the office door or car door and leaving the day behind can help separate work from home, she says.

Blaise Morrison, a vocational rehabilitation counselor and mental health counselor for an agency in Bowling Green, Ohio, says a good first step when engaging on the topic of how work impacts life is to assess the relationship between the client and his or her job. Similar to a relationship between two people, Morrison says the worker and the place of employment both have certain needs, and if those needs aren’t being met, the relationship becomes dysfunctional.

When the job isn’t meeting the client’s needs — be they financial needs or the need to fully utilize his or her skills — the work situation can become stressful, Morrison says. “It decreases self-confidence, decreases their view of their own competency, brings on frustration and distress, and they might bring that home with them,” says Morrison, a member of ACA. “So, the counselor can look at the situation and see if the client’s needs are being met. If they’re not, this will be a barrier in the client’s mental health.”

If clients’ needs are not being met at work, Morrison says counselors can help these clients to better understand their expectations of a job, gain insight into their interests and then evaluate their skills to see if they might be better suited for a different position.

With clients who think they are in a dead-end job or otherwise feel their current work doesn’t meet their needs, Christopher Adams, an assistant professor in the Department of Behavioral Sciences at Fitchburg State University, says he would have a discussion to determine whether they think it is important to explore other options. Among clients who want more out of their careers — whether money, responsibility, prestige or challenge — he would assist them in exploring available options as well as factors that influence their ability to change jobs. In some situations, he says, clients might wish to remain in their current jobs while simultaneously pursuing alternative avenues outside of work for making extra money, being stimulated intellectually or otherwise finding fulfillment.

Many of Sanderlin’s call center clients aren’t planning to make a career out of working there, so she collaborates with them to identify goals and develop a plan for career change. Envisioning a way out often helps these clients to feel less trapped, she says, which can contribute to reducing their stress levels. “Get them to remember what they were passionate about to begin with or to learn a new passion,” Sanderlin says. “Clients will realize they have things that they’re interested in that they could make a career out of. So, when they go back to work [at the call center], they feel like they have an end to work toward.”

Work, balance and relationships

Among the most difficult work-related circumstances for clients is when they are unemployed or underemployed, Blustein says, because they are not using the full extent of their skills and abilities at work. “In a nutshell, when people lose work or lose the opportunity to work in a job that is consistent with their talents and training, they are likely to experience a sense of loss of meaning, access to relational resources and access to the means to survive,” he says. “Considerable research has documented the impact of job loss on mental health, and the data underscore these points.”

On the other side of the spectrum, Morrison says when clients are using their skills and competencies in the workplace and their job correlates with their vocational interests, balance is often achieved and there is a positive effect on relationships outside of work. “If a job helps clients to personally grow, helps them to explore themselves more and provides positive challenges, it provides the client with a positive, reaffirming career identity, meaning the client is fully aware of their competencies, skills and vocational interests,” he says. “To have that self-awareness in vocation also allows them to have greater self-awareness in other parts of their life, greater clarity [regarding] what they expect of relationships and healthier boundaries.”

Adams, a member of ACA, says that another positive outcome of clients finding fulfillment in their jobs is that the feeling can spill over into life outside of work. From the other direction, if people are struggling with relationship problems or feelings of loss or loneliness outside of work, Blustein says developing relationships at work and deriving meaning from work can help them to compensate.

But just as they do at home, interpersonal conflicts can crop up at work. However, unlike situations in which clients choose a romantic partner or a friend, it’s rare to get the opportunity to pick one’s co-workers. People with different communication styles, work ethics and personalities get put together, which naturally leads to moments of friction. When tensions flare between co-workers or bosses and subordinates, Sanderlin talks with her clients about empathy and encourages them to consider that perhaps the other person is dealing with problems of his or her own.

Other times, Sanderlin says, clients have come to her because they formerly dated a co-worker and, after the relationship went sour, began having difficulties seeing and interacting with that person at work. In such cases, Sanderlin says, the solution often involves helping clients to process the relationship and its ending so they can grieve the loss and once again be around their former dating partner without negative feelings bubbling up.

Balancing life with work inherently involves sacrifices, Adams says, and getting clients to grasp that concept can play a role in reducing their stress. Adams tries to help his clients be realistic and accept that a fixed amount of time exists in their schedules each week, which naturally means that they can’t do absolutely everything for everyone. “Sometimes people try to fight that, thinking, ‘If I only worked harder, I could squeeze more time into the week.’ It creates stress because they feel they should be able to do more,” he says.

Adams encourages clients to think about their values and what is most important to them. “They might say, ‘I’m going to have to accept the fact that I won’t see my kids do this or that because my career is important,’” he says. “If they make the decision to want to spend more time around family, that might mean they won’t get paid a super high salary or they may be limited in terms of the jobs they can take. I help them understand the reality and then understand that there is a sacrifice involved in any decision. Once they understand and accept that, I’ve found that clients aren’t always happy about it, but there is less stress instead of them feeling like they should be able to do everything.”

“I often try to talk to them about having a fixed amount of physical and mental energy as well as time,” Adams continues. “I also try to explain to them that if they put 100 percent of their energy or time into work, they won’t have any left over for other parts of their lives [such as] family. In my experience, it’s not uncommon for clients to experience a sense of loss when they finally accept this. I think to some degree it is difficult for clients to accept this, given the American mindset that ‘I can do it all as long as I just work hard enough.’”

But clients can benefit from learning to accept that they can’t be everything to everyone, Adams says. “Sometimes people expect themselves to be the best spouse, the best parent and the best worker,” he says. “If, for example, being a good parent and spouse is important, then maybe it’s OK not to be 100 percent at work.”

A stressed-out workforce

The nature of work means that stress can crop up at any given time, but new research published in the journal Occupational Medicine indicates that work-related stress is drastically increased during a recession and that stress leads to an accompanying rise in employee absenteeism. After looking at tens of thousands of civil servants in Northern Ireland, researchers found that as many as 25 percent of workers struggled with stress on the job during an economic downturn.

A recent study from the University of Hawaii also shows that work stress is contagious, suggesting that we soak up the emotions of our co-workers and that stress can make its way around the office like a common cold. Stress can also spread to loved ones at home, Chen says, explaining that when people feel overloaded and stressed at work, they are more likely to bring that stress home with them. For example, he says, when a family member asks how our day was, just the tone in our voice can carry negativity. “So that stress can have a detrimental impact in other aspects of life,” says Chen, a member of ACA and NCDA.

Depression and anxiety are not uncommon in the workplace, Adams notes. In fact, 2010 statistics from the Centers for Disease Control and Prevention put 9 percent of adult Americans in the category of clinically depressed, and the most recent data cited by the National Institute of Mental Health indicate that slightly more than 18 percent of U.S. adults have an anxiety disorder. Anxiety and depression can lead to a host of effects at work, Adams says, including decreased productivity, restlessness and feelings of being overwhelmed, low energy levels, compromised immune systems and detrimental impacts on relationships with co-workers.

Morrison agrees, adding that depression and anxiety can impede concentration, organization and the acceptance of constructive criticism. And, he says, a stressful atmosphere at work only worsens the impact of depression and anxiety.

“I don’t know that I can say that counselors view work as causing depression or anxiety,” Adams says. “These problems seem more complex than stemming from one cause. However, we do know that stress can contribute to depression and anxiety, and some research indicates that work stress may contribute to these. On the other hand, some people truly enjoy their work and find it to serve as an outlet for stress. For example, if things aren’t going well at home, they may be able to focus on their work in order to cope. As such, work may serve to buffer some people from stress.”

What can clients do to manage the stress? “I think they need to consider several things,” Adams says. “First, how much do they enjoy their work and how much stress does it cause? Second, what can they do to manage their work stress — can they delegate responsibilities, take on less work? Last, I always try to get clients to step back and put things in perspective. At the end of the day, work is often a means to an end for many people — it provides a way of supporting oneself and family. Consequently, clients may not need to get so worked up or overstressed by work, particularly if other parts of their lives are more important to them. Of course, they need to balance that with the demands of the job.”

It appears that partners at home also play a role in how we handle work stress. Researchers at Florida State University looked at more than 400 working couples in blue- and white-collar jobs and found that strong partner support led to a variety of positive effects, including a 33 percent greater likelihood of positive relationships with co-workers, a 30 percent lower likelihood of experiencing guilt associated with home or family neglect, a 30 percent lower likelihood of being critical of others at home, a 25 percent higher rate of concentration at work and a 20 percent higher level of job satisfaction.

Among workers struggling with depression, a recent Tufts University study points toward the effectiveness of counseling. The researchers anonymously surveyed 79 Maine state government employees diagnosed with depression. During a two-month period, those workers took part in a program offering telephone sessions with a counselor. Sessions included work coaching, coordination of care with the patients’ doctors and cognitive-behavior therapy strategies. The outcome of the phone counseling program included improved depressive symptoms, increased productivity and fewer missed workdays.

Workaholics and bullies

Not all clients can blame being overworked on a hard-driving boss or the daily demands of the job. Some clients resist unplugging from their jobs because they’re “workaholics.” Workaholism can take root for any number of different psychological reasons, Chen says. For example, in some instances, clients are avoiding issues at home, he says. In other cases, clients have perfectionist tendencies and push themselves unnecessarily. Others think that working excessively is the only way they can prove their value to their bosses, Chen says. And still another cause, he says, is when people are externally driven by the rewards they experience from working.

Chen suggests that counselors explore those feelings and motivations with clients. For example, if clients insist that they have to work to a certain level to be a top performer, Chen might analyze the situation with them to see if that perception meets reality. In some cases, it’s possible that they would remain top performers even if they worked a little less.

“It’s not uncommon for people to use work as a way of sublimating other things,” Adams says. “An example might be a person who has an unsatisfying relationship with a partner. He might not want to admit that [because] it might be culturally unacceptable to get a divorce. So he might channel [those feelings] through work. Being a hard worker is more socially acceptable.” These individuals not only spend more time at work to avoid going home, but might also dive into work again upon returning home, which allows them to erect a socially acceptable wall between themselves and their partners, Adams observes.

When engaging with workaholic clients, Morrison advises counselors to proceed at the clients’ pace but to assist them in understanding what they’re trying to avoid or make up for by working more. “Help clients gain insight into their own behaviors. Help them understand what they are substituting work for,” he says. “And then the counselor’s role is to help them develop healthier coping mechanisms.” Morrison acknowledges, however, that sometimes workaholic behavior truly represents an effort to make ends meet financially.

Blustein echoes that sentiment: “It can also reflect the reality that many people are afraid of losing their jobs and are working harder than ever to become indispensable to their organizations.” For that reason, he says, the optimal solution for each client will be nuanced and unique.

Another workplace issue gaining prominence is bullying. “Workplace bullying is a major crisis, and it’s now getting the attention it deserves in research and counseling practice,” Blustein says. Workplace bullying usually comes in the form of verbal abuse in which a co-worker or superior yells at a colleague or focuses only on that person’s faults. “It’s an adult version of childhood and adolescent bullying,” Blustein says. “I think it’s always existed. We’re just now giving it a name.”

The dynamics involved in workplace bullying can make it even more difficult to resolve than schoolyard bullying, Blustein says. If the bully is your boss, he points out, financial considerations and legitimate concerns about finding another job are likely to restrict the worker’s ability to retreat from the situation. “Unlike other parts of life where we can often walk away from bullies, in the workplace, we are often forced to engage with bullies indefinitely, and often with little recourse,” he says.

Blustein says counselors can assist bullied clients by helping them set boundaries and limits and learn to be assertive with their workplace bullies. Counselors can also help clients by exploring company policies that address workplace bullying and the potential consequences, which might mean contacting human resources, Blustein says. The counselor might also explore alternative job possibilities with clients, he says.

Morrison sees the effects of workplace bullying among many of his clients, who must have a mental health disability to be eligible for his agency’s services. Many times, he says, his clients are taken advantage of professionally by their co-workers or supervisors because these clients have difficulty being assertive or expressing their needs. As a counselor, Morrison sees his role as assisting these clients with communication and assertiveness training, teaching them about healthy boundaries and perhaps engaging with them in role-plays so they can try out their new skills.

A question of values

Helping clients reach the proper work–life balance is a difficult challenge but well worth the effort, Blustein says. “Clients can talk with their families about how the work–life balance is working for them,” he says. “They should find ways of setting limits on the ways in which work creeps into their lives. For example, with all of the new technology like smartphones, iPads, etc., it is increasingly hard for people to fully orient themselves to their home lives. At the same time, life issues may creep into our work lives, which will require careful planning and the development of clear boundaries, except of course in emergency situations, when our need to care for our families needs to take precedence.”

Self-care is a key element in making life and work run in sync, counselors say. “Self-care is critical, although it’s often easier said than done,” Adams says. “I try to help clients understand the effects that work and life stress can have on them mentally and physically — [for example], increased health problems and marital stress — and try to encourage them to consider what they want. In some ways, it’s a discussion of their values. Some clients really value their careers and are willing to sacrifice their health and time with family, friends, etc. Others aren’t willing to accept this and understand that they need to set boundaries and take time to care for themselves.”

The more stressed people get at work, the less they tend to take care of themselves, according to Sanderlin. They stop participating in activities they enjoy, stop interacting with friends and family, stop eating properly and start sleeping too much or experiencing insomnia, among other indicators, she says. Counselors should talk with these clients about how to turn those things around and return to a healthier, happier lifestyle, she says.

In terms of counseling theories to help clients manage the intertwining of life and work, counselors say there are a variety of directions to go, depending on the individual’s unique circumstances. Adams draws from psychodynamic and family systems approaches, especially if he thinks it’s important to explore the underlying factors influencing a client’s career and life choices. “I may also draw from cognitive and behavioral approaches if clients need help with certain issues [such as] developing stress management skills,” he says.

Morrison uses cognitive behavior techniques as well as some existential techniques to help clients develop an idea of their life roles, life goals and perceived purpose in life. Sanderlin most commonly uses rational emotive behavior therapy techniques and relaxation techniques with her clients.

Regardless of the approach, Blustein cautions counselors to affirm their clients’ experiences at work. “There has been a tendency in years past to understand work problems as unresolved family issues or long-standing problems with authority or the like,” he says. “I think those perspectives invalidate clients’ lived experiences at work. So affirm and validate their experiences at work. Don’t interpret them as something else.”

Every counselor needs to understand how work and life intersect, Morrison says. “Employment is a huge part of a person’s identity,” he adds. “To neglect or avoid that would be missing a huge part of their life and missing a big piece of the puzzle when you’re talking about mental health rehabilitation and successful outcomes.”

Sanderlin agrees. “It goes back to feelings of self-worth,” she says. “People relate what they do or how well they do it to how good of a person they are.”

To contact the individuals interviewed in this article, email:

Christopher Adams at cadams15@fitchburgstate.edu

David Blustein at david.blustein@bc.edu

Charles P. Chen at cp.chen@utoronto.ca

Blaise Morrison at blsmorrison@gmail.com

Melissa Sanderlin at melissasanderlin@gmail.com

Lynne Shallcross is a senior writer for Counseling Today. Contact her at lshallcross@counseling.org.

Letters to the editor: ct@counseling.org