Tag Archives: self care

Informed by trauma

By Laurie Meyers September 22, 2017

In 1995, the Centers for Disease Control and Prevention and Kaiser Permanente began what would become a landmark study on the health effects of adverse childhood experiences. Over the course of two years, researchers collected detailed medical information from 17,000 patients at Kaiser’s Health Appraisal Clinic in San Diego. In addition to personal and family medical history, participants were asked about childhood experiences of abuse, neglect and family dysfunction, such as emotional and physical neglect, sexual and physical abuse, exposure to violence in the household and household members who had substance abuse problems or had been in prison.

Researchers found that the presence of these negative experiences in childhood was predictive of lifelong problems with health and well-being. The more negative experiences a participant had, the more likely — and numerous — these problems became. Another disquieting finding was that adverse childhood experiences were incredibly common. Almost two-thirds of participants had endured at least one adverse childhood experience, and more than 1 in 5 respondents had endured three or more such experiences.

In the decades that followed, this discovery of the prevalence and devastating effects of trauma spurred the development of practices such as trauma-informed counseling, which stresses the importance of recognizing and treating trauma and, most importantly, preventing additional trauma.

Drawing on basic counseling skills

According to the U.S. Substance Abuse and Mental Health Services Administration, programs, organizations or systems that are trauma informed:

  • Realize the widespread impact of trauma and understand potential paths for recovery
  • Recognize the signs and symptoms of trauma in clients, families, staff members and others involved with the system
  • Respond by fully integrating knowledge about trauma into policies, procedures and practices
  • Seek to actively resist retraumatization

In many ways, trauma-informed care involves using skills that every counselor should already possess. “Remain empathic, open, nonjudgmental and steady. Steadiness is particularly important,” says American Counseling Association member Cynthia Miller, a licensed professional counselor (LPC) in Charlottesville, Virginia, whose practice specializes in trauma. “You don’t want to overreact to things a client tells you. But you don’t want to underreact either. Screen for trauma at intake. Don’t just ask a client if they’ve ever been abused or neglected. Many clients won’t define themselves as victims of abuse or neglect, and if you ask it that way, you’ll miss it. Ask behaviorally instead.”

Miller suggests using questions such as, “Has anyone ever hit, punched, slapped or kicked you? Has anyone ever put you down, called you names or made you feel worthless? Has anyone ever touched you without your permission? Have you ever witnessed a violent or upsetting event that really troubled you?”

“If a client responds with a ‘yes’ to any of those questions, ask them if they’d like to share more about it now,” Miller continues. “Help them feel in control of what they disclose and when and how much. Don’t make the mistake of thinking you need all the details and then push to get them. You can retraumatize someone that way. Instead, ask them how they think the experience impacted them and if they think it is related in any way to their current struggles.

“At the opposite end, if they respond to everything with ‘no,’ don’t assume a trauma never happened. It may very well be that they’re just not telling you about it right now because they don’t yet feel comfortable. Stay open to the possibility and rescreen as appropriate.”

When specific questions about trauma don’t elicit answers, ACA member Rebecca Pender Baum, a licensed professional clinical counselor in Kentucky who has worked with survivors of sexual assault and interpersonal violence, often asks clients if there is anything they haven’t already told her that they think she needs to know. She has found that this approach often helps clients express concerns that they have been holding back.

Jane Webber, an ACA member and LPC in New Jersey who has written extensively about trauma and disaster, often mixes less threatening questions in with questions related to trauma. For example, in the midst of gathering basic background on family history, she will ask clients about events such as accidents or a history of falling. She then works up to questions about physical and sexual abuse. Webber emphasizes the importance of counselors using the same calm, steady tone of voice for all questions to prevent distressing the client.

Webber also finds it useful to tell her clients, particularly those on the younger end of the spectrum, that they can answer her questions via text during the session. She says that sometimes clients are more open to texting about things that they might struggle to express verbally.

Webber urges counselors to be intuitive with clients and look for signs of unexpressed trauma such as sweaty palms, restless movement in sessions and failure to make eye contact.

Miller says that she stays alert “for what I think of as disordered self-soothing,” which may include “substance use, self-injury or aggression. Individually, any one of them can be a clinical indicator. As a triad, they’re almost certainly covering up an untreated trauma.”

A different focus

At first, it may seem strange to treat every client as if he or she is a trauma survivor. However, clinicians who use trauma-informed counseling say that the practice is also about changing the overall focus of counseling by moving away from the “problem” approach. That approach demands, “What’s wrong with you? What did you do wrong? What’s making you act that way?” says Webber, a lecturer in the counselor education department at Kean University’s East Campus in Hillside, New Jersey. “[Trauma-informed counseling] is a paradigm shift from what is wrong with the client to what happened to the client.”

Julaine Field, an ACA member and LPC from Colorado Springs who works with traumatized children, agrees with Webber. Field explains that rather than focusing on changing a client’s thoughts or behaviors, trauma-informed care seeks to understand how people react and adapt to experiences.

A trauma-informed counselor helps clients understand where their behavior is coming from by explaining trauma’s effects on the brain and emotional regulation, says Field, a counseling professor and coordinator of the clinical mental health track in the Department of Counseling and Human Services at the University of Colorado Colorado Springs. “[Counselors] can also help [clients] understand the real importance of basic self-care, deep breathing, good eating, exercise and that a focus on wellness on a daily basis is the best way to fight the trauma impact and arousal,” says Field, who has also counseled veterans and survivors of interpersonal violence.

A recurrent — and perhaps predominant — theme when talking about trauma-informed counseling is safety. Making the client feel safe and welcome is paramount, say trauma experts. That sense of safety starts with the environment. Counselors should make sure their offices appear warm and inviting, considering everything from comfortable seating to appropriate lighting (neither too harsh nor too dim), says Pender Baum, an assistant professor of counselor education and practicum internship coordinator at Murray State University in Kentucky.

Clients should also feel that they have some control over the counseling process. “Even if you don’t know if a client has been through trauma, you can do things as a clinician that communicate to clients that they are safe and in control of what happens in the consulting room,” says Miller, an assistant professor of counseling at South University in Richmond, Virginia, who has also worked with incarcerated women.

“Let them determine where they want to sit. Ask if they are comfortable. Give them permission to decline to answer any question they are uncomfortable with and to take breaks at any time during the intake if they start to feel uncomfortable,” she suggests. “Pay attention to body language, tone of voice and other cues of emotional distress, and respond to them. Be willing to pause during a session and encourage clients to take a breath, ground themselves or stretch.”

Establishing safety

Both Miller and Webber stress that uncovering trauma is not an automatic green light for counselors and clients to start dissecting the past.

“Establishing safety is the most important and, often, the longest stage of treatment,” Miller says. “Don’t jump immediately into reprocessing, and don’t assume that everyone needs to reprocess. And remember that if you take away someone’s primary coping skill — however maladaptive it may be — you’re leaving them with nothing to soothe themselves when their emotions run high unless you teach them more productive skills.”

Webber spends substantial time helping clients build coping skills. She says that deep breathing is the fastest, easiest and most effective way to regulate emotion, but she cautions that there is no one-size-fits-all approach to this technique. Some people like to use counting — breathing in for three or four beats, holding the breath for another three or four beats, and then slowly breathing out, perhaps for six to eight beats.

However, some clients find it stressful to focus on counting, Webber says. In those cases, the counselor and client should just focus on breathing in and breathing out. She directs clients to inhale slowly and to exhale twice as slowly, noting that the slow exhale is what calms the nervous system and helps decrease a person’s level of physical agitation.

Another factor in breathing “style” is environment. Some people need to look at something specific such as a wall to focus on their deep breathing, whereas others prefer to close their eyes, Webber says. Counselors and clients should experiment with what works best. It can also be difficult to visualize what breathing from the diaphragm means, so counselors should practice their breathing in front of a mirror so they can better demonstrate it to clients, Webber advises. Because it is hard for people to learn when they feel overwhelmed, she also emphasizes the importance of teaching deep breathing and other grounding techniques to clients when they are calm.

Another grounding technique that Webber uses is anchoring in a safe place. Before asking a client to visualize a safe place, however, she says it is important for the counselor to know whether the client has experienced sexual or physical trauma. In those cases, “safety” for the client might mean hiding behind a locked door, which doesn’t provide a healthy, calm image.

“They may not have a happy place,” Webber says. “We might have to create a brand-new place [to visualize], such as a place with no people.” Counselors can help clients visualize their safe places by asking what environments are most comfortable for them.

Webber also uses tapping as a grounding technique. Tapping is a form of bilateral stimulation that helps clients desensitize feelings of trauma and stress. Webber leads clients through deep breathing and asks them to imagine something that is agitating but not overwhelmingly traumatic. Then, she instructs them to use their hands to tap their shoulders repeatedly, alternating between left and right. After about 40 taps, she asks clients to stop and smile.

Clients can also use tapping in public if they are feeling agitated or overwhelmed. Simple and inconspicuous techniques include tapping a foot on the ground three times, lifting a heel in and out of a shoe, or simply looking left and then right repeatedly, Webber says.

Even in the midst of teaching clients coping skills and grounding techniques, their safety is never far from Webber’s mind. To avoid retraumatizing clients, she monitors their level of distress in each session, giving them a scale on which 1 represents complete calm and 10 represents overwhelming agitation. Webber begins and ends sessions with the scale. She also pauses and does a quick check within the session if the client shows signs of agitation or arousal. If the client’s distress level is too high, Webber stops and does some grounding and deep breathing with the client.

All of the professionals interviewed for this article stressed the importance of counselors receiving supervision or working in tandem with a trauma specialist if needed. “When you start to feel in over your head, you’re probably in over your head,” Miller says. “That’s a good time to get supervision or to consult with someone who has more training and experience than you.”

However, there are basic principles of trauma-informed counseling that all counselors should know, Field says. These include:

  • Psychological first aid
  • Mindfulness techniques
  • Breathing techniques
  • Grounding strategies
  • Relaxation methods

“Psychoeducation about the brain and the impact of trauma on the brain is something that all practitioners can do,” adds Field, noting that simply normalizing the effects of trauma can be enormously helpful for many clients.

Helping the helper

Another tenet of trauma-informed counseling is self-care. Immersing themselves in others’ problems and pain can take a toll on counselors, and counselors who regularly engage in trauma work face an increased risk of vicarious or secondary traumatization. According to the second edition of the APA Dictionary of Psychology, burnout can be “particularly acute in therapists or counselors doing trauma work, who feel overwhelmed by the cumulative secondary trauma of witnessing the effects.”

To continue to treat clients affected by trauma with compassion, counselors must extend some of that same consideration toward themselves. A practice of good self-care can help trauma-informed counselors to safeguard their own mental and physical health.

That is a lesson Jessica Smith, an LPC with a private practice in the Denver area, learned early in her career. “My work used to define me,” says Smith, an ACA member who specializes in addictions and trauma. “If I did a pie chart of where I found meaning in my life, three-quarters of it would have been my work as a counselor when I first started out on this professional journey, but through my burnout and recovery, I’ve learned that I am so much more than this work. I care about my clients deeply, but I also love and care about myself deeply too.

“I used to view self-care as a burden — just one more thing to do. But now I see it as an opportunity to show up more fully in my life and the lives of those around me, including my clients.”

Smith now makes self-care a regular part of her day. “I start my day with meditation, journaling and movement in the form of walking, yoga or another form of exercise. I infuse self-care throughout my day through meals, writing, music, mantras, and connections and conversations with other colleagues. I have a mantra that I say before each session, which is, ‘Help me to be a conduit or reed to transmit … messages to this person in a way that they are able to receive them. Help me to remember that I cannot fix, change or save this person and that I am only one small part of their healing journey on this earth. Give me love, give me hope and give me light.’”

The creative interventions that Smith does with clients — including movement, art, visualizations, writing and breathwork — also serve as a kind of pressure valve, she says. “I’m constantly checking in with my body during sessions, especially when I’m working with [clients who have experienced] trauma, to notice, breathe into and release any areas of tightness and tension.” Smith finds that her body reflects the tension in clients’ bodies. “[I] check in with them about their sensations, then disclose mine as well in order to help model healthy body awareness and connection.”

At the end of the day, Smith clears the office by burning sage and consciously making a decision to let go of any residual trauma or distress. When she gets home, she physically “shakes off” the day before going into the house.

“I end each day with a meditation and gratitude practice where I write down three things I am thankful for that day,” Smith says. “I stretch and do heart-opening yoga poses, then go to sleep.”

Counselors need to have self-care strategies that allow them to gain distance from their work and give them the ability to check out mentally and physically from the responsibilities of being a counselor, Pender Baum says. She has learned to literally put self-care on her calendar.

“I live by my calendar, so if it is on there, it becomes just like another required staff meeting or counseling session,” she says. “It’s not negotiable. Admittedly, I can still struggle with this one at times, [but] it’s important not to let work get in the way of your me time. Get that self-care in whenever you can. It might be closing the door for five minutes and doing some deep breathing or taking a walk around the building. Something to break up the day and get you away from your office.”

It’s also important to engage in activities that don’t have a timeline or deadline and, most importantly, that are fun, Pender Baum says. “I like to kayak, watch movies with my husband [and] read to my daughter. Others might like going for a run, reading their own book [or] soaking in a bubble bath.”

Another self-care strategy that Pender Baum emphasizes for counselors is to avoid isolation. “Developing connections sometimes can involve seeking out professional development opportunities. This helps to keep you connected to the profession, learn new skills and be around other professional counselors without hearing the traumatizing stories from clients.

“For example, just this summer, my mother — a fellow counselor educator and counselor — and I attended a training on finding meaning with mandalas. We not only learned a fantastic clinical skill, but it was very therapeutic [for us] at the same time.”

Pender Baum also stresses the importance of peer support and supervision. “It’s … important to debrief after particularly difficult cases,” she says. “Have that peer support group, supervisor [or] consultant on hand that you can engage with. Have a mentor or be a mentor to someone.”

Smith participates in two therapist support groups that meet once a month. “Since I’m in private practice, isolation can be a risk, so I do these groups as well as go to lunch or coffee with at least one friend or colleague in the field each week,” she says. “I take time off each month and no longer feel guilty about doing so as I did early on in my career. I try to do a training or workshop quarterly for self-care, connection and to nurture my inner student.”

Pender Baum says counselors need to know themselves. “Give yourself permission to experience the emotions, but also set clear boundaries,” she says. “Know your limits, avoid overtime, commit to a schedule, and recognize and change negative coping skills.”

All counselors should also be aware of the signs and symptoms of vicarious trauma, Pender Baum stresses.

“Vicarious trauma can change one’s spirituality, and this can impact the way we see the world and how we make sense out of it,” she says. “Some counselors experience difficulty talking about their feelings, anger or irritation, an increased startle response and difficulty sleeping. Others might experience over- or undereating, an ever-present worry that they are not doing enough for their clients [or] possibly even dreaming about clients’ traumatic experiences. Still others might feel trapped in their jobs, lose interest in things they typically enjoy and even [experience] a loss of satisfaction and accomplishment. Some experience intrusive thoughts related to client stories and feeling hopeless.” These are all signs that counselors need to step back and focus on self-care, she says.

Other symptoms include:

  • Chronic lateness or absence from work
  • Low motivation and an increase in errors at work
  • Overworking
  • Avoidance of responsibilities
  • Conflict at work and in personal relationships
  • Low self-image

Pender Baum also urges practitioners to listen to their peers, family members, friends and loved ones if they say they are noticing a change in them. Counselors may be unaware that they are showing signs of burnout, and feedback from others can be helpful in preventing a crash from overwork and stress.

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

  • “Coming to grips with childhood adversity” by Oliver J. Morgan
  • “The toll of childhood trauma” by Laurie Meyers
  • “Traumatology: A widespread and growing need” by Bethany Bray
  • “The transformative power of trauma” by Jonathan Rollins
  • “A counselor’s journey back from burnout” by Jessica Smith
  • “Stumbling blocks to counselor self-care” by Laurie Meyers

Books (counseling.org/publications/bookstore)

  • Terrorism, Trauma and Tragedies: A Counselor’s Guide to Preparing and Responding, third edition, edited by Jane Webber & J. Barry Mascari (fourth edition being published in 2018)

Webinars (aca.digitellinc.com/aca)

  • “ABCs of trauma” with A. Stephen Lenz
  • “Children and trauma” with Kimberly N. Frazier
  • “Counseling students who have experienced trauma: Practical recommendations at the elementary, secondary and college levels” with Richard Joseph Behun
  • “Traumatic stress and marginalized groups” with Cirecie A. West-Olatunji

ACA interest networks

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org

 

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

Nonprofit News: Self-care for caregivers

By “Doc Warren” Corson III March 20, 2017

The field of counseling is one that offers great rewards. We get to see people go from their worst to their best. We get to be a part of the change that our clients are seeking.

Even so, the hours and hours we spend listening to the pain of others can take its toll. That raises an important question: While you invest so much in “saving” others, are you neglecting yourself? If so, you, like many of us in this profession, could be in danger of compassion fatigue or burnout.

 

Understanding compassion fatigue and burnout

Working as a counselor can weigh on you. You may find that you are having more difficulty being empathic in situations in which it once came naturally to you.

And although this compassion fatigue may start at your job, it can bleed over into your most intimate relationships. You may even find yourself feeling that you cannot possibly give anything else emotionally to others.

Among the signs of compassion fatigue are:

  • Excessive blaming
  • Bottled-up emotions
  • Isolating from others
  • Substance abuse
  • Compulsive behaviors
  • Poor self-care
  • Legal problems
  • Apathy
  • Feeling mentally and physically tired
  • Feeling preoccupied
  • Living in denial about problems
  • Difficulty concentrating

Burnout is closely related to compassion fatigue, but in extreme cases it can have more serious impacts on a person’s physical and mental health. Some of the signs of burnout include:

  • Chronic fatigue
  • A quick trigger to feel angry or suspicious
  • Susceptibility to illness
  • Forgetfulness
  • Insomnia
  • Loss of appetite
  • Anxiety
  • Depression

Burnout does not just happen overnight. Instead, there are stages and patterns that can help you to identify the issues and assist you in addressing them. Although having a great deal of enthusiasm for a project is considered positive and can often lead to a wealth of progress, look for signs of stagnation, frustration or apathy that may follow. Each is a sign of trouble.

Stages of burnout:

  • Enthusiasm
  • Stagnation
  • Frustration
  • Apathy

 

Prevention

Prevention is vital if one wants to keep working at optimum levels. Look at the list of practical ways to find balance, recharge and stay focused. Be prepared to think outside of “normal therapist behaviors” and identify those things that help you remain focused and energetic. Consider hobbies and activities that you once enjoyed but perhaps stepped away from because of graduate studies or other life-related obstacles. Embrace what you once enjoyed, especially those things that are far removed from the helping professions.

As for me, I re-embraced classic car restoration and time spent in nature, while adding classic farm tractor collecting (among other hobbies). So, go see that play or musical, get your hands dirty, listen to loud music or take part in other events. You cannot stay “on” all the time and still be effective as a counselor.

Here are some tips on prevention of compassion fatigue and burnout for helping professionals:

  • Get educated on signs and symptoms of compassion fatigue and burnout
  • Practice self-care
  • Set emotional boundaries
  • Engage in outside hobbies
  • Cultivate healthy friendships outside of work
  • Keep a journal
  • Boost your resiliency
  • Use positive coping strategies
  • Identify workplace strategies
  • Seek personal therapy

We are involved in one of the most emotionally draining professions that exist. You are here because you want to help people make a change and sustain that change. So give yourself the ongoing maintenance that your body and mind require. Find the answer that works best for you and follow through. We have too many people depending on us. We owe it to them, but, most importantly, we owe it to ourselves. Let’s do this.

 

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Dr. Warren Corson III

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

 

 

 

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

 

The Counseling Connoisseur: Break away: Five vacation hacks for the responsible counselor

By Cheryl Fisher September 5, 2016

The alarm was relentless, even with several taps on the snooze button. I finally surrendered to the morning and rolled out of bed, practically tumbling over my 65-pound goldendoodle, Max, who was snoring below my feet.

With one eye open, I made my way to the shower and blasted the scalding droplets over my sleepy body, allowing the water to wash away the slumber. Eventually, I resurrected to a new day.

Walking to my bedroom, I threw on the work attire I had set out the evening prior and towel dried my hair, desperately trying to hide the impending gray that was peeking through faded highlights. I painted on my face, twisted up my hair and headed to the kitchen, where I grabbed my oatmeal packet and a glass of juice.

Perusing my day planner (yes, I still use the old-school paper kind), I reflected on the day ahead. It would include seeing eight clients, submitting end-of-the-month claims, contacting an insurance company regarding a denial, returning phone calls from prospective clients and scheduling my own dental appointment. Glancing over the client list, I noted that my last two appointments were with couples that were still refining their communication from competitive yelling matches to accusatory squabbling.

Sigh. By this point, I felt horribly exhausted — and it was only 6:30 a.m.!

I texted my husband, “I am working till 8 tonight. Love you.”

“I love you too!” I heard from the other room. He was still home?

I walked into the other room, kissed the dogs and rubbed my husband behind the ears. Perhaps coincidentally, I suddenly realized it was time for a vacation.

 

Take a break

As counselors, we spend hours listening with great attentiveness to the pain and suffering of others. I see approximately 25 clients per week. That is 25 hours of meetings with individuals who are hurting and hoping to discover an elixir to their pain in our therapeutic work together. It is, by far, the most rewarding (and exhausting) vocation I have had the privilege of engaging in.

With that privilege comes great responsibility, which includes accessibility. Technology allows clients to seek immediate connection to their counselors via text, instant messaging and email. Counselors are now (theoretically) accessible 24/7.

I remember receiving a text message from a client at 11:30 p.m. I am normally snoring at that time, but this particular night, I was up reading a book when the message buzzed through. The client was texting me her suicide note.

Of course I acted on it by calling the police on my landline and hanging on the business phone with the client until she was found and taken to the hospital. But the magnitude of responsibility around receiving that message haunted me for days. What if I had been asleep when it came through?

The point is that we do “people work” that often involves crisis intervention related to life-and-death issues. Our jobs, while incredibly rewarding, are stressful, so we need to take breaks to retain some form of homeostasis in our lives.

 

Strike a balance

Unlike many other career paths, counselors must navigate the needs of their clients when planning vacations. There are ethical and legal issues to consider when taking a hiatus from a clinical practice. Standard A.12. of the ACA Code of Ethics mandates that counselors do not abandon or neglect clients and instead make “appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacations, illness, and following termination.”

Furthermore, counselors may be held legally liable should something happen to a client in the counselor’s absence if no backup care was provided. Therefore, there must be a balance between self-care and client care.

 

Tips for a smooth (and responsible) getaway

Here are five quick tips for planning that much-deserved vacation while still attending to your practice.

1) Alert your clients of your pending absence in advance and discuss backup plans with them. My daughter (who lives out of state) requested that I spend a month with her following the birth of my grandson. Although I longed to spend as much time as possible with them, I also was concerned about the needs of my clients. I discussed this with my daughter (and son-in-law), and we decided on a three-week visit instead (to be evaluated and changed as needed). I then began informing my clients about my pending absence several months prior to the delivery. Together we discussed strategies for coping and created scenarios for possible relapse that allowed for preventative measures. Finally, we discussed using a backup counselor for added support.

2) Arrange for a backup counselor. I have made arrangements with several of my colleagues to trade off services when vacations arise. Although my clients have never activated this backup system, I have found that it is a great comfort to them to have it in place.

3) Set a clear away message on your phone and email settings that provide the telephone numbers for the Warm Line, Hot Line and emergency backup counselor. Not all clients will require a session with a backup counselor, but a brief interlude with a Warm Line professional can alleviate their nervous jitters in your absence.

4) Unplug. This is probably one of the most challenging aspects of going on vacation as a counselor today. In the olden days — you know, in the age of landlines — clients left messages that were addressed when the counselor returned to the office. But technology provides the impression of total accessibility, even when you are on vacation. For example, while I was in Scotland, I had a client continually attempt to email and call me. Despite my months of preparation with her and my detailed away message that provided phone numbers for additional support, she was relentless in her pursuit. Finally, I returned her call, directed her to a support in my absence and turned off my phone.

5) Contact the ACA Risk Management Helpline for additional guidance. Invariably, there are going to be times when you must leave unexpectedly and are not able to provide your clients with weeks of preparation. The Risk Management Helpline, sponsored by the American Counseling Association, can provide guidance to ACA members concerning standards of practice that will best support the safety and well-being of your clients … and the enjoyment of your much-needed and deserved downtime. See counseling.org/knowledge-center/ethics for more information.

 

Conclusion

As counselors, it is imperative that we take time for vacation, unplug from our clients and reconnect with ourselves, our family members and friends, and that which is sacred in our lives. In doing so, we not only replenish our own reserves (which allows us to remain available to our clients over the long term), but also provide our clients and colleagues with a model of good self-care.

On that note, I think I will pack up my Jeep and head to the beach for a few days of sun, sand and solitude!

Till next month …

 

Surf fishing before sunrise in the Outer Banks, North Carolina

Outer Banks, North Carolina/Photo via unspash.com

 

 

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Cheryl Fisher

Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland, and a visiting full-time faculty member in the Pastoral Counseling Department at Loyola University Maryland. Her current research examines sexuality and spirituality in young women with advanced breast cancer. She is currently working on a book titled Homegrown Psychotherapy: Scientifically-Based Organic Practices, of which this article is an excerpt. Contact her at cy.fisher@verizon.net.

 

 

 

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.
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Counselor addresses self-care, guilt in the wake of Orlando shooting

By Samuel Sanabria July 5, 2016

“When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’” — Fred Rogers

 

It was 9:53 a.m. on Sunday, June 12, when I received a text from my husband regarding the mass shooting at Pulse, an Orlando, Florida, nightclub catering mainly to lesbian, gay, bisexual and transgender (LGBT) individuals.

I was wrapping up the week at a sex education and counseling conference in San Juan, Puerto Rico, where I was sitting in our closing plenary session. It had been a week of personal empowerment. I had been absorbed by the many workshops on sexual inclusivity, especially regarding the LGBT community. I was surrounded by like-minded professionals who were advocating for change in our society’s attitudes toward sexual minorities. My evenings were spent enjoying time with my husband and 7-year-old daughter, who had come with me to Puerto Rico to enjoy the beach and pool at the conference hotel. It was a nice way to kick off the summer with my family.

As I sat in the final session, I looked down at the text and read the headline of the link my husband had sent me, “Orlando Shooting: 50 People Killed.” Reading further, I learned the shooting had taken place at Pulse, which is just a few miles from our home. I had enjoyed visiting the nightclub with my husband and friends on numerous occasions.

After reading the article again, my thoughts quickly turned to my immediate friends who might have been at Pulse when the shooting occurred. I began to worry. I could no longer focus on the session and stepped outside to begin texting friends to see if they were OK. Thankfully, my friends were safe, but they were as distraught as I was and were anxiously going through their own lists of friends. Social media was filled with news of the shooting. Some posts provided reassurances of loved ones’ safety. But, heart-wrenchingly, other posts were from people seeking information about family and friends who were still missing.

As we traveled back home the next day and as the names and faces of the victims were gradually released in the media, I was struck by how many young people of color were killed on what was “Latin Night” at the nightclub. As a gay Latino man who had visited Pulse, I felt a strong connection to the victims and their families. I didn’t talk much during our flight back to Orlando. I spent the time turned inward, trying to make sense of what had happened and thinking about what my city was going through. I was distressed by my roiling emotions and felt trapped by the logistics of travel. I couldn’t wait to do something to help the victims and their families.

After arriving home, I visited The Center, Orlando’s LGBT community center, to volunteer crisis counseling and Spanish translation services. The common area of The Center was a beehive of activity as volunteers welcomed visitors, organized donations, worked crisis phone lines and did their best to help people affected by the shooting. Local individuals, organizations and

Lucia Lassiter-Sanabria, the author's 7 year-old daughter, at a memorial site set up recently at the Dr. Phillips Center for the Performing Arts in downtown Orlando. "I had been talking to Lucia about the [Pulse] shooting and wanted to show the enormous amount of love and support that was given.  It was a tender moment watching her walk around and look at the pictures of the victims and reading some of the signs of love," says Sanabria.

Lucia Lassiter-Sanabria, the author’s 7 year-old daughter, at a memorial site set up recently at the Dr. Phillips Center for the Performing Arts in downtown Orlando. “I had been talking to Lucia about the [Pulse] shooting and wanted to show the enormous amount of love and support that was given. It was a tender moment watching her walk around, look at the pictures of the victims and read some of the signs of love,” says Sanabria.

businesses had donated food, water, services and gifts, while others were providing safe spaces for anyone who needed support. People from all over the country and the world were donating money to support the survivors and victims’ families. And, of course, professional counselors from around the state had stepped up to provide grief and crisis counseling.

Witnessing all of this activity and the many people who were traumatized or retraumatized by the news and stories of the shooting, I felt the magnitude of what this tragedy had done, not only to the victims at Pulse but to our entire community. It was at this point, standing there witnessing the outpouring of grief and anger, that I felt anxious, insignificant and powerless. I immediately felt an internal pressure to do as much as I could to help.

Throughout the week, I met with and provided support for survivors of the shooting; debriefed with my students in each of my summer classes; took my daughter and a couple of her friends to the LGBT center with sympathy cards I had helped them create; attended vigils; donated money; and locked arms with other LGBT activists and allies to block the well-known hate group, Westboro Baptist Church, from disrupting the funeral of one of the victims.

Despite this involvement, I still felt anxious, insignificant and powerless. These feelings stubbornly remained in the face of so much need. As my anxiety grew, I began losing sleep, had difficulty concentrating and was irritable. The worst part was my need to reenact, in my imagination, some of the stories I had heard on the news and from the survivors I had spoken with. These feelings were exacerbated by the litany of anti-gay and pro-gun political messages being expressed by the talking heads on various media outlets.

I realized I was experiencing burnout as a result of vicarious trauma and needed to make some immediate changes, starting with recognizing the importance of self-care.

 

Counselor self-care

Most counselors are familiar with the importance of self-care. Many of us spend hours each day listening to difficult stories, and for those who work in crisis care, these stories can be exceedingly tragic. Providing empathy for our clients is the hallmark of our profession, but it is also a main contributor to compassion fatigue. Counselors often become so involved in their work that they do not take adequate time to check in with how that work is affecting them physically and emotionally.

It is important that counselors remain alert to the warning signs of compassion fatigue. Physiological symptoms may include physical exhaustion, headaches, insomnia and increased susceptibility to illness. Emotional symptoms include anger, irritability, gradual disassociation, depression and difficulty concentrating. Ignoring these warning signs can lead to counselor impairment, which puts clients at risk for harm.

Red sky with rainbowIt is a counselor’s ethical and professional responsibility to work toward reducing compassion fatigue. This does not mean fighting against these feelings, but rather working through them, both before and after meeting with clients. Giving oneself permission to break for self-care can also help reduce compassion fatigue. This can be as simple as pausing for a deep breath and identifying one’s physical and emotional responses throughout the day. It can also be vital to create some mental space between oneself and the work, perhaps by spending quality time with family and close friends.

Taking these steps may be challenging for some, especially when working with a community impacted by a tragic event. Luckily, my close friend and colleague has a background in crisis work and, knowing the importance of self-care, reached out to me daily with reminders to take breaks and meditate on my physiological and emotional responses.

Once I recognized the symptoms of compassion fatigue within myself, I made sure to spend quality time with my family and to show appreciation for them. These were meaningful experiences that helped me re-center myself.

Also, at my friend’s suggestion, and for the first time in my professional life, I attended a support group for counselors. I appreciated being able to share how this tragedy had affected me in a room of supportive individuals who were going through the same experience. This group outlet was important and I noticed a reduction in my level of anxiety. However, there was still something that kept me from moving forward. It wasn’t until I heard another counselor share her experience with guilt for not doing enough that something clicked inside me.

 

Recognizing and addressing guilt

Another common experience among crisis counselors is the feeling of empathy guilt and survivor’s guilt.

Empathy guilt is a reaction to someone’s pain or distress that leads to the belief that one should try to work toward relieving those feelings. This can also lead to the feeling that one is not doing enough to help others relieve their pain. Survivor’s guilt can occur with someone who has survived a traumatic event or, in the case of counselors, works directly with victims impacted by a traumatic event. The symptoms of empathy guilt and survivor’s guilt include feeling regret, isolation, helplessness and, in serious cases, suicidal ideation.

One of the best ways to work through guilt is to share the experience with others and to recognize that this is a common emotion that, if properly managed, can be used to further empathize with the experiences of our clients. During the counselor support group, I was able to share my feelings of guilt and begin the acceptance process. I realized that it was not necessary to fully rid myself of these feelings of guilt; instead, I could use them to gain better insight into my internal emotional processes.

I came to understand that there was no amount of hours I could volunteer, marches I could walk, sympathy cards I could help my daughter create or money I could donate that would change what had happened to the victims of the shooting. I realized that “never enough” was good enough. This realization became a central part of my self-forgiveness and healing.

 

Conclusion: Never enough is good enough

This tragedy has shattered lives. It will take years to understand why this happened, if we ever can. The greater Orlando community has been galvanized, and I can feel a sense of unity and compassion that is heartening.

Personally, I have come to grasp one of the most important lessons of being a counselor, advocate, ally and humanitarian: Despite our best efforts and whatever time we put in, we will never achieve “enough.” Once I understood this, I felt a profound sense of peace and self-forgiveness. As I write this, the need for caring and supportive counselors in Orlando continues. Fortunately, I am able to volunteer service in a way that doesn’t deplete me or put those seeking my help at risk of harm.

It still breaks my heart to think about the bright lives taken from our community. As I sat with the other crisis workers in our support group, I realized that we had all been affected by this senseless tragedy and that we needed support just like everybody else. We laughed, cried and hugged each other; we respected our own emotional struggles; and we sat in silence to honor the lost lives. Most important, we helped strengthen one another so that we can go back out there and do work that will never be enough.

 

 

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Samuel Sanabria is a licensed mental health counselor in the state of Florida with more than 15 years of clinical experience. He is an associate professor in the graduate counseling program at Rollins College in Winter Park, Florida. Contact him at ssanabria@rollins.edu.

After Orlando: Helping others, helping ourselves

By Laura R. Shannonhouse June 22, 2016

In the wake of the recent shooting disaster in Orlando, we find ourselves faced with the difficult task of moving forward with purpose and hope, both as individuals and as a people.  While we may not have been directly touched by this event, or we may have been personally immune to such tragedies in our own past, disasters like this one may feel omnipresent and inescapable in today’s media rich culture. This is especially true now, since the nature of this photo-1463797987952-208b34e8e887particular event was incited by hate towards a specific group, the lesbian, gay, bisexual and transgender (LGBT) community, which has been under a perennial struggle for acceptance.

 

There are many ways to directly help the victims and their families, but from my perspective as a counselor educator who researches crisis, disasters and cultural issues, I would like to share three thoughts as to how all of us can intentionally focus on the future: helping others, helping ourselves and ensuring that them and me are instead us.

 

I am so heartened by the outpouring of love for those who were affected and the political resolve for doing what we can to ensure that such tragedies become far more rare. In terms of the literature on disaster response, I would say that we are in the “honeymoon” phase of disaster, characterized by community cohesion and shared resolve. Unfortunately, research shows that this period is only temporary, usually lasting a few weeks, and is followed by disillusionment. Eventually, survivors will realize that there are limits to the assistance available. Those that were injured or lost loved ones will have to go on with rebuilding their lives. The universal calls to action and justice may be met with the reality that institutions often change slowly, if at all. A painful reminder of this can be seen in the heartfelt essay from the mother of one of the Sandy Hook victims, “Orlando, I Am Sorry Our Tragedy Wasn’t Enough to Save Your Loved Ones” (written by Nelba Márquez-Greene, a licensed marriage and family therapist and mother of a child who died in the 2012 shooting at Sandy Hook Elementary school in Newtown, Connecticut). So, for my first thought, I challenge you to maintain your resolve and support through the impending disillusionment.

 

In the months and years to come, those affected will face anniversaries of the tragedy and trigger events such as missed birthdays. The strongest protection against disillusionment is resilience. If you are in the position to help a survivor or someone affected, challenge yourself to be a point of resilience for that person for as long as you can. That being said, resist the urge to parachute in, and if you feel compelled to respond to someone that you don’t personally know, be sure to do it as part of an organized response effort. Also remember to act within your own scope of care as a friend, counselor or human. For a good article on how to respond, I would suggest Jamie Aten’s recent piece in the Washington Post, “Tips for helping a loved one after a tragedy, from a Christian disaster expert.” And, if you are now calling for political change, don’t stop until that change is realized.

 

As a helping professional that has worked with trauma survivors and responders, I have seen many times how those not personally affected by crisis may yet still be touched. The literature is full of terms such as vicarious traumatization, secondary traumatic stress (STS), compassion fatigue and burnout. All of these constructs describe how bystanders and responders to disaster can themselves have real physical and emotional reactions. STS can result from witnessing (directly or indirectly) a traumatic event, whereas burnout results from repeated and prolonged exposure to stress. The media will be full of vivid descriptions of the event, and it’s likely [that] continuous coverage will keep us on alert. Daniel Antonius condensed much of the recent literature on this phenomenon after the 2015 San Bernardino shooting in his article, “How the media-related ‘contagion effect’ after terror attacks impacts our mental health.” Consequently, my second thought is to protect yourself from the vicarious traumatization that you may experience from our 24 hour news cycle and practice self-care.

 

If you are more closely connected to the Orlando event, either because of some prior life experience with trauma or because you closely identify with the targeted group, then I would urge you to be on guard for common stress reactions. The list of possible symptoms is long and includes changes in emotional, cognitive, behavioral, physical and spiritual domains. If several of those listed symptoms look like they apply to you, then do the following:

  • Unplug – turn off the TV and social media
  • Do what normally helps you feel better (e.g. exercise, listen to music, be creative or routine, spend time with friends, etc.). For a longer list, check out the Department of Health and Human Services’ self-help guide, “Dealing with the Effects of Trauma.”
  • Consider pursuing mental health care. As a licensed counselor and trainer of new counselors, I definitely believe in my profession’s power to help those that are struggling.  There is no shame in asking for help, and there are often low-cost resources available in your community.

 

Since this shooting was, effectively, a hate crime, my final thought is one regarding empathy: live the African concept of ubuntu, or “I am because we are.” The construct of empathy is core to professional counseling (for a three minute visual summary, consider watching Brené Brown on Empathy). In my counseling skills classes, we often talk about “getting in the well” and genuinely connecting with others. Those are good clinical skills, but for those of us that aren’t in Orlando and aren’t directly interacting with someone personally affected by the shooting, it isn’t possible to truly show our empathy. Instead, we can ensure that we hold empathy close as a personal virtue in how we relate to others, especially those different from ourselves in beliefs or worldview. In my travels to Southern Africa on research projects and clinical outreaches, I’ve found that the Bantu word ubuntu truly captures this internalized empathy. In the words of Archbishop Desmond Tutu, “My humanity is caught up, and inextricably bound up, in yours … A person is a person through other persons …  A person with ubuntu is open and available to others, affirming of others [and] does not feel threatened that others are able and good, for he or she has a proper self-assurance that comes from knowing that he or she belongs in a greater whole and is diminished when others are humiliated or diminished, when others are tortured or oppressed, or treated as if they were less than who they are.”

 

In the wake of the recent horrific events in Orlando, I pray that we may all show love for each other, take care of ourselves and remember that I am because we are.

 

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If you are in need of immediate crisis counseling, contact the Substance Abuse and Mental Health Services Administration (SAMHSA)’s Disaster Distress Helpline: Call 1-800-985-5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor.

 

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Laura R. Shannonhouse

Laura R. Shannonhouse

Laura R. Shannonhouse is a licensed professional counselor (LPC), American Counseling Association member and assistant professor in the Department of Counseling and Psychological Services at Georgia State University in Atlanta. Contact her at lshannonhouse@gsu.edu