Tag Archives: therapeutic alliance

Beyond words

By Nevine Sultan September 28, 2017

Attempting to work from a purely cognitive or emotional perspective with clients who have experienced sexual trauma is like trying to build a sturdy house without laying down a solid foundation. Facilitating recovery from sexual trauma demands the inclusion of the site of the original wounding — the body.

A clinical vignette

“Jerry” arrives seven minutes late for his intake appointment. He appears disoriented and confused.

“Please,” I say, inviting him to take a seat. When our eyes meet, he turns his gaze to the floor and explains, “I think I stopped at a gas station on my way here.”

Jerry’s face is flushed and his nostrils are fluttering. Although his head seems to be the most active part of him, I am drawn to Jerry’s feet, legs and hands. The rigidity in the lower half of his body is intense. Jerry’s left foot is twisted outward in a painfully supinated position. His hands are imprisoned beneath his thighs, and his shoulders are hunched forward. The word concave comes to mind. I feel a sense of hollowness in my core as I realize that Jerry is holding his breath like a dam straining to hold water that might cause irreversible damage if released all at once.

We talk briefly. Jerry tells me about his anxiety, the panic attacks that have besieged him up to twice daily over the past few months, his ceaseless hypervigilance, the memories that haunt him, the persistent need to wash his hands and the nights dotted with brief slumber from which he is jarred awake by horrific nightmares. “I’m also having problems with my girlfriend,” Jerry says. “I know I can trust her. It’s just … I can’t shake that feeling.”

As Jerry speaks, his voice is jittery and his lips tremble. His breathing shifts from closed to ragged. “I was out taking a walk in my neighborhood one night. A guy drove up to the sidewalk and asked for directions to the community pool.” Jerry’s pitch lowers, his articulation becomes less sharp, and he drifts inside himself. I shift in my chair to gently facilitate his return to the here and now. He looks up before continuing.

“As soon as I started talking, he got out of the car, opened the door to the backseat, and then … I don’t know. It happened quickly.” He pauses. “I woke up in a hospital. My wrists were really bruised.” Jerry scans the room with his eyes, which are filling with tears. “I couldn’t save myself.” He weeps, pulling his hands out from beneath him and rolling them up into fists.

My stomach clenches, and I feel a sting in my eyes. I am all too familiar with this narrative. Many of my clients who have suffered sexual trauma describe similar experiences of numbing and freezing and an overwhelming sense of self-betrayal. I take a deep breath and redirect my attention to Jerry, who is still sobbing. I give him a few minutes. As he recovers from his outburst, he returns to holding his breath.

“Jerry?” I say gently. He looks up. “Thank you for trusting me with that. See if it’s OK to exhale. Slowly.”

Understanding dysregulation

Every word that Jerry says matters. I note his narrative. It is significant. I also note the paranarrative — the cauldron of sensations, emotions and racing thoughts bubbling beneath the surface of his quivering demeanor. This agitated vessel is holding a fusion of fear, isolation, shame, avoidance, mistrust, physical and emotional numbing, negative beliefs, impulsivity, diminished agency and an outright inability to tolerate the present.

While Jerry’s thoughts and emotions are overly active, his body is entirely ignored. Consequently, he is caught in the unconscious frenzy of persistent fear and some terribly unforgiving stories: The world is dangerous. I will never be safe. I can’t protect myself.

The harm Jerry has endured did not compromise his thinking or his emotions alone, however. Jerry has suffered a severe wounding to his body; hence, his collapsed posture, his irregular breathing and his restricted movement, coupled with his overall sense of being overwhelmed and his inability to maintain a state of calm.

As French phenomenological philosopher Maurice Merleau-Ponty pointed out in his seminal text, Phenomenology of Perception, our bodies are the agents by which we exist in the world. They are also the receptacles of memories that, often vanished from our conscious awareness, are still deeply etched within our being. When those memories are triggered, we experience suffering at a highly existential level that transcends consciousness. Facilitating the recovery of clients who have experienced sexual trauma must include opportunities for repairing connections with all dimensions of their being.

John Hughlings Jackson, known as the “father of English neurology,” outlined a human nervous system composed of three parts: social, sympathetic and parasympathetic, which has since inspired Stephen Porges’ polyvagal theory. Jackson’s model is hierarchical: The higher elements inhibit the lower elements. When a higher element on the hierarchy fails, a lower component takes over.

The highest element of the nervous system is the social one, responsible for relational contact and communication. Lower on the hierarchy is the sympathetic nervous system, which kicks in when we experience a disturbance in our inner or outer environment, thus activating our fight/flight/freeze/dissociate response. Should we not fight or flee, we plunge into freezing, immobility and dissociation. Unless the parasympathetic nervous system is reactivated, we remain frozen, incapable of responding to our environment.

Paradoxically, nonthreatening surprise situations are likely to elicit a sympathetic nervous system response, whereas threatening situations are likely to elicit a parasympathetic response, which is why many of us freeze or dissociate when confronted with a seemingly hostile situation. A healthy nervous system is one that self-regulates through a balance of sympathetic and parasympathetic functioning — that is, an arousal-activation event is followed by a period of rest and digest. An unhealthy nervous system, on the other hand, remains in either hyper- or hypoarousal, giving rise to startle, panic, hypervigilance, restlessness and emotional flooding, or to emptiness, exhaustion, disorientation, dissociation and emotional numbing, respectively. Clients who have not resolved traumatic events are often stuck in hyper- or hypoarousal.

In the aftermath of a traumatic event, survivors are likely to develop generally maladaptive coping symptoms that offer temporary relief from dysregulation. These coping symptoms include various process and substance addictions, obsessions and compulsions, and self-harm. Regardless, clients suffer the following interruptions:

  • Physical/perceptual (inaccurate kinesthetic reactions to perceived threat, anxiety, dissociation, collapse)
  • Contextual (difficulty perceiving and making sense of surroundings)
  • Emotional (fixation on fear, rage or sadness)
  • Cognitive-behavioral (intrusive, racing thoughts; memory loss; self-destructive patterned behavior)
  • Spiritual/existential (loss of sense of self)

Jerry tends to cycle between hyper- and hypoarousal, as evidenced by his frequent experiences of hypervigilance and panic attacks, and his often collapsed and frozen posture. When agitated, he attempts to manage his dysregulation in a number of maladaptive ways, including engaging in impulsive (e.g., breaking up and making up with his girlfriend repeatedly) and compulsive behaviors (e.g., continually washing his hands).

Although traditional cognitively and emotionally oriented psychotherapy approaches may help Jerry ease some of these coping behaviors, they do not include methods for addressing his dysregulation. Working with Jerry’s physical process allows me to help him identify when he is in hyper- or hypoarousal and bring himself back to what leading neuropsychiatrist and interpersonal neurobiologist Daniel Siegel refers to as one’s “window of tolerance,” or the zone in which our arousal state is balanced.

Honoring the somatic narrative

The somatic approach to healing trauma was inspired by a phase-oriented model for treating trauma and dissociation that was established in the early 20th century by French psychotherapist Pierre Janet. The somatic approach requires an understanding of how nervous system dysregulation is activated as a consequence of trauma and which parts of the body and brain are involved. The counselor uses this information to help clients create a sense of safety, to facilitate clients’ use of internal resources to regulate arousal and enhance self-efficacy, and to help clients address traumatic memories and explore novel ways of being in the world. Interventions include focus on nonverbal experience, kinesthetic awareness and reshaping body movement.

In the aftermath of his traumatic assault, Jerry’s ability to organize his experience was compromised, resulting in dysregulation of arousal, challenges tracking his surroundings and increased cognitive and emotional processing. This sent his thoughts and feelings into overdrive, making it difficult to control his impulsivity. With his inability to self-regulate, Jerry is virtually incapable of remaining connected with his present moment, and specific trauma-related (and sometimes neutral) stimuli can trigger an immediate impulsive response.

According to Pat Ogden, the pioneer behind the popular attachment-based somatic approach to healing trauma known as sensorimotor psychotherapy, a primary task faced by counselors working from a somatic approach is to help clients create a balance among the various processes used to organize experience. This is done using a bottom-up model that views human experience as an initially sensory process that informs emotion, which then informs thought and behavior. Focusing on the here and now is especially important when using a body-centered approach because it allows the counselor to address how a past event is manifesting in the present.

Finally (or perhaps first and foremost), when working with the somatic dimension, high levels of therapist presence and attunement are needed to support a therapeutic alliance with appropriate boundaries that is built on safety and trust.

Creating shared space

Essential to facilitating Jerry’s connection with his physical process is my personal embodiment — that is, my ability to be in contact with and present in my own body. By anchoring myself in my body and my present-moment experience, I am better able to create an empathic space for our encounter.

I use my sensory experiences to inform the therapeutic process and guide me toward a well-rounded understanding of how Jerry exists in the world based on how he exists in the therapy room. Understanding the experience of my body when I am in contact with Jerry helps me reach out within our intersubjective space with the deepest respect for his pace while acknowledging that I am affected by his experience. From this place of compassion and empathy, sharing and being, and phenomenological engagement, an integrative somatic process begins in which I serve as a bridge between Jerry and the rest of the world.

“When you are ready,” I say to him in gentle invitation.

Organizing the client’s experience in the here and now

I listen to Jerry’s verbal narrative. I also attune to the story his body is telling and how my own body is receiving that. What body postures does Jerry fall into as he recounts specific parts of his story? What gestures accompany certain words, phrases or recollections in the here and now?

Such physical manifestations are indicative of how Jerry’s body has encoded certain events implicitly. Jerry is physically manifesting content from his implicit (unconscious), somatic memory of the traumatic event that may or may not be congruent with his declarative (conscious) memory. Keeping in mind the fallibility of declarative memory, working from a somatic approach supports access to Jerry’s implicit memory, which offers us additional insight into his experience.

Attending to Jerry’s somatic narrative, I notice that his fists hold the highest energy. My own fists are wound so tightly that I can feel my nails digging into my palms. I also notice that I am holding my breath in anticipation. I release my breath, unfold my fingers and share some observations with Jerry in the form of brief contact statements designed to enhance his awareness.

I also pose exploratory questions. “I’m noticing that as you talk about feeling incapacitated in the moment you were grabbed, your hands are balled into fists. Would it be all right to bring your attention to your hands for a moment?” Helping Jerry consciously connect with the most reactive part of his body invites his capacity to self-witness and be self-aware. This activates the prefrontal cortex that, according to body-centered trauma expert Bessel van der Kolk, is responsible for emotion regulation, cognitive and social behavior, and decision-making.

As Jerry accesses his past experience in the here and now from a nonreactive place, he is better able to observe it, recognize that it happened in the past, notice how it is manifesting in the present and identify new ways of understanding it. Next, we work to identify the emotions that arise with the declarative and implicit memories of the experience and any thoughts that accompany the physical and emotional manifestations.

“What are you sensing in your fists right now?” I ask. “Examples of sensation are tingling, tightness, cold, heat.”

“They’re stuck,” Jerry says. “I can’t do anything with them.”

I ask Jerry to name the feelings that accompany that sense of stuckness. “Examples of feelings are anger, sadness, guilt, fear. ‘I feel …’ Can you fill in the blank?”

Jerry stares at the ground. “I feel … angry.” He begins to weep inconsolably. “I’m so, so angry.” He drops to the floor and curls into a fetal position. I give him a few minutes to be where he needs to be, to experience being balled up and angry.

“I’m so mad at myself. I didn’t save myself. Who does that?” I recognize that I didn’t have to invite Jerry to reflect on any thoughts accompanying the emotion and the sensation; the thoughts are emerging on their own.

Minutes later, Jerry is still holding his fists, but his tears are subsiding. I grab a box of tissues and sit on the ground near him, close enough to offer the nonphysical support he may need. I pull out a tissue and drape it gently over his left fist. He flinches and opens his eyes, looking straight ahead.

I wonder if it might be helpful to invite some awareness around how he is organizing this experience. “What are you holding inside your fists, Jerry? And what is that doing for you?” Jerry continues to look out into the ether. “Your fists,” I prod gently. “If your fists had a voice and could speak, what would they say? ‘I …’ Can you fill in the blank?”

Jerry is silent for a few seconds. “I … I am …”

“Yes, Jerry. Keep going,” I encourage him.

“I am … very angry,” he offers meekly.

“Is that what the anger inside of your fists sounds like?” I nudge gently. Jerry shifts slightly in his fetal position and then stops. “What does your body need to do right now?” I ask. “Expand? Contract? Walk away? Move closer? Is it OK to explore that need?”

“I think I need to move,” Jerry says. Without further invitation, he sits up. His upper body is still collapsed, and he seems undecided. I invite him to attend, once again, to what his body needs. Jerry inhales a little more deeply, expands moderately with his intake of breath, tightens his fists further and bellows, “I AM SO ANGRY!”

“Say that again,” I urge. “Give your fists the voice they need.”

“I AM SO ANGRY!” he screams, over and over. Twenty times. Thirty times. “I WILL NEVER LET ANYONE DO THIS TO ME AGAIN!” Jerry says even louder, holding his fists chest high and shaking them like he has someone by the collar.

Once Jerry has experienced a full release of energy, his tight fists unfold, although with some reservation. “Would it be OK to let go of the rest of that?” I invite.

Jerry’s eyes close, and I realize he may be unwilling to let go. I offer a compromise. “You don’t have to let go of your anger forever,” I say. “Maybe you can leave it in a safe place so that you can have it back whenever you want it.”

Jerry seems open to this idea. After some deliberation, he looks at a print hanging on the wall behind me and says, “I think I’ll leave it behind that picture.”

Jerry and I have just worked through a process of using an implicit memory (balled-up fists) connected with his traumatic incident to initiate a recalibration of his nervous system. This process involved:

a) Creating a shared space facilitated by my presence

b) Helping Jerry identify different facets of memory (implicit and declarative)

c) Using contact statements to help Jerry recognize the orienting patterns he is using to organize his experience (“I’m noticing …”)

d) Inviting Jerry to name his sensory, emotional and cognitive experience (“What are you experiencing …?”)

e) Allowing Jerry’s body to tell its narrative (“If your fists had a voice and could speak …”)

f) Exploring modification of Jerry’s orienting patterns (“What does your body need right now?”) and experimenting with new ways of being

g) Restoring empowering actions (“Give your fists the voice they need.”)

The next step involves making sense of our process. The hope is that Jerry will use his new understanding of his experience to make new choices informed by the here and now.

Creating meaning and energizing change

“What was that like for you?” I ask.

“I don’t know,” Jerry says. “I feel like a heavy load has been lifted.” I nod. “From these,” he continues, raising his hands.

I acknowledge and affirm Jerry’s reflection. “Those fists were holding on pretty tight. What did it mean to hold tight?”

“I think … I felt in control.”

“Can you say more about that?”

“Yeah. Like I wasn’t going to lose it, I guess.”

I feel that Jerry and I are in a safe enough place for my next question. “What would happen if you allowed yourself to completely lose it?” Jerry clenches. “OK to exhale?” I invite.

Jerry releases his breath slowly. “I don’t know.”

“Jerry?” I invite him to make brief eye contact with me. “I’m not sure I buy that.” I smile gently. “What would happen?”

Jerry thinks but maintains eye contact. “I mean, I just lost it, right?”

I offer a perspective: “Seems like you trusted yourself with that too.”

“I did,” he says solemnly.

“What is it like for you to trust yourself?” I ask. “‘I …’ Can you fill in the blank?”

“I feel pretty big right now.”

“Hmm. What does big look like?” I invite. “Can you show me?” Jerry lifts his body and expands his chest. Although he does this slowly and with seeming caution, I am aware that he has given himself permission to explore a place beyond his wound. I open the door for a final inquiry that will help Jerry take what he has learned about resourcing himself outside of the therapy room: “What might you do with that bigness, Jerry?”

Working through roadblocks

Accessing and working with certain memories in the here and now is not always a straightforward process. In Jerry’s case, he sometimes exhibits an aversion to being in the present. For example, although Jerry shows relative ease connecting with his anger, in a later session he experiences great difficulty accepting his shame.

Jerry’s resistance manifests, initially, as indirect eye contact and fixation on the ground. Once we begin exploring this and Jerry identifies the emotions and thoughts connected with it, he manifests an outburst of physical agitation that is marked by twitching in his chair until he falls to the ground.

I invite Jerry to remain seated on the floor and connect with the ground (using a process we call grounding), which helps him feel connected to and supported by something outside of himself. Next I ask him to explore his center of gravity by way of a process called centering, which brings his attention back to his physical experience. Finally, I suggest containment, a self-holding exercise designed to facilitate self-regulation and awareness of one’s boundaries and overall physical presence.

Because of their focus on the physical, these exercises shift clients’ attention from the self-destructive emotional and cognitive narrative to their internal resources. With this, the counselor is tasked with pacing the session so that the client is not overwhelmed. Introducing these safety-enhancing exercises is often helpful as sexual trauma clients experience the need to recalibrate from the potentially overpowering experience of confronting their trauma.

Establishing a time frame for the therapeutic process

Clinicians working from a somatic approach are highly aware of the challenges of creating time parameters for their therapeutic work. On the other hand, it is not uncommon for clients to ask, “How long will I be in therapy?” My response is that it depends on a number of factors, including:

1) Whether the traumatic event was a single, first-time incident or is recurring

2) The client’s developmental history (i.e., milestones, attachment patterns)

3) The client’s current coping strategies

4) Systemic factors (i.e., family, community and broader social support)

5) Client openness to working with the body

6) Therapist consistency and the quality of the therapeutic alliance

That said, somatic therapy tends to be time intensive, unlike, say, brief solution-focused or cognitive-behavioral work. Jerry attended weekly 80-minute therapy sessions for approximately 10 months, followed by biweekly 50-minute sessions for three months. He is currently coming in for monthly 50-minute check-ins.

Although Jerry has not forgotten his traumatic incident, he has learned how not to be hijacked by memories, how to self-regulate when confronted with somatic, emotional or cognitive triggers and how to tap into internal resources (including his body) to address present-moment needs.

Closing reflections

Embracing a somatic approach in working with Jerry’s sexual trauma engages his verbal and nonverbal narratives, opening a door to reshaping his way of being in the world and catalyzing new intentions and experiences. It also helps us focus on what is versus what was or what might be.

Working in the present enhances Jerry’s awareness of who and how he is in the world, what he does and how he does it, and how remaining stuck in the past or allowing himself to be hijacked by the future are choices he can modify as he works to reconnect with his window of tolerance. Being aware brings present-moment possibilities and options center stage. The emphasis is no longer on irreversible past or anticipated future experiences but on what is happening in the here and now.

Thus, clients take responsibility for their needs, feelings, thoughts and actions. Taking responsibility and ownership of situations and experiences is, in itself, a holistic, anchoring and awareness-enhancing behavior. With it comes an increased ability for clients to push the boundaries that are stifling their self-expression, identify immediate needs and engage in self-mobilization, creative experimentation, somatic expression and self-regulation, all of which are at the heart of an existence that has made peace with its past and is grounded in the present. As clients’ awareness is ignited on a holistic level, they are empowered to decide whether their patterned behaviors still serve a purpose and how those behaviors can be modified to meet present needs.

How we inhabit our bodies reflects our way of being in the world. Through our bodies, we sense and experience, receive and perceive. Exploring the physical body and its manifestations of past sexual trauma helps clients integrate the physical, emotional and cognitive dimensions of their experience. Sensory-kinesthetic exploration brings history to life in the present and anchors it here, where it is more accessible.

Conscious engagement with the body’s innate knowledge permits clients to access their own strengths in the process of healing. How empowering and transforming for our clients who have suffered from sexual trauma to recognize that their well-being exists within their own bodies — the very site of their original wounding.

 

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

Nevine Sultan is an assistant professor of clinical mental health counseling at the University of St. Thomas in Houston and a licensed private practitioner specializing in trauma, dissociative disorders and grief. She embraces an embodied phenomenological approach to counseling and psychotherapy, research and teaching. Contact her at nevine.sultan@gmail.com.

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.

Helping students change with dignity

By John J. Murphy August 26, 2016

“We may need to solve problems not by removing the cause but by designing the way forward.”

— Edward de Bono

 

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In the book All I Really Need to Know I Learned in Kindergarten, author Robert Fulghum said he had learned life’s most important lessons as a young child in kindergarten. In that same spirit, this article could be titled, “Most of What I Know About Counseling Students, I Learned From Students.”

As much as I appreciate my formal training, the best lessons of all — the ones that really got my attention and took hold — have come from the young people I’ve been privileged to serve. MurphyThese lessons can be condensed into two practical principles of school-based counseling: 1) Involve students and 2) build solutions from strengths and resources.

As further testimony to the expertise of my youthful teachers, these two strategies are strongly supported by mountains of empirical research in counseling and psychotherapy. More specifically, research indicates that counseling outcomes depend largely on the quality of the client-counselor alliance, the client’s hope for a better future and the extent to which the client’s opinions, values, strengths, social supports, life experiences and other “client factors” are incorporated into counseling.

This article translates these findings and principles into the following steps and techniques of solution-focused counseling, a practical and culturally sensitive approach to helping young people change with dignity.

Step 1: Establish collaborative relationships

The client’s perception of a strong client-counselor alliance is the most reliable predictor of successful outcomes, and client involvement is the key to a strong alliance. The more involved students are in their own counseling, the better the outcomes. The following techniques help to strengthen alliances and improve outcomes in solution-focused counseling.

Adopt the ambassador perspective. Approach every session as a cross-cultural exchange and every student as a unique “culture of one,” with the humility, respect and curiosity that a foreign ambassador would show when entering an unfamiliar country or culture. Good ambassadors look, listen and learn from people before making any assumptions
or suggestions.

Compliment students. Anything we can do to boost students’ hope will improve outcomes, which is why compliments are an important part of solution-focused counseling. Compliments help to reframe students’ views of themselves and their circumstances, and they are often folded into questions in solution-focused counseling. For example, asking a student who complains of being stressed out and depressed, “How have you managed to juggle so many things for so long?” invites a more hopeful and empowering self-perception. Students can be complimented for attending counseling sessions (“It takes courage to meet like this”), cooperating in the conversation (“I appreciate your help and patience in answering my questions”) and trying to improve their lives (“With all you’ve been through, where do you find the strength to keep on trying instead of giving up?”).

Fit counseling to students versus students to counseling. Just as a tailor adjusts a suit to fit the owner, we need to customize counseling to each student rather than requiring students to conform to our favorite ideas and methods. This means incorporating students’ key words and phrases into the conversation, exploring their theories and opinions, and determining what they want from us and our services.

Incorporating students’ language into counseling conversations validates their perceptions and reinforces the client-driven emphasis of solution-focused counseling. For example, if Maria says, “My teacher gets on my back all the time about my behavior,” we could ask, “What have you found helpful in getting your teacher off your back?”

Another way to fit counseling to students is to explore their opinions about the problem and potential solutions. This can be done through asking questions such as, “What needs to happen to improve things at school?” and “If you were counseling people in a similar situation, what would you advise them to do?” A student’s ideas about the problem and its possible solution can be cobbled into interventions that are more likely to be accepted and implemented by the student than interventions that come from other sources.

Obtaining feedback from students is another way to ensure the provision of student-driven rather than counselor-driven services. The Outcome Rating Scale and Session Rating Scale — two four-item client feedback scales that take one minute to administer and score — provide ongoing snapshots of students’ perceptions of counseling progress and alliance. Collecting feedback from clients during every meeting, and adjusting services based on this feedback, has been shown to dramatically improve counseling outcomes regardless of one’s theoretical orientation.

Step 2: Develop practical goals

In addition to providing students with a sense of hope, purpose and direction for the future, goals help them persist in the face of setbacks and obstacles. Effective goals share several characteristics that can be summarized in the 5-S guideline: significant, specific, small, start based and self-manageable.

Significant: The most important feature of a counseling goal is its personal relevance to the client. Good goals are goals that matter to students, and we can develop these goals by asking questions such as “What are your best hopes for counseling?” and “What is the most important thing you want to change about school right now?”

Specific: Goals also need to be specific and concrete so that students, counselors and anyone else involved can tell when they are reached. The following sample questions help counselors partner with students to develop specific goals: “If we videotaped you being less anxious at school, what would we see you doing?”; “What will be happening next week to let us know that we’re on the right track?”

Small: Practical goals are small enough to be attained, yet challenging enough to inspire action. Questions that help in this regard include the following: “What will be the first small sign that things are moving in the right direction?”; “You rated school as a 2 on a 10-point scale. What would a 2.5 or 3 look like at school?”

Start based: When asked what they want from counseling, most students tell you what they don’t want: “I want to get in less trouble at school” or “I want to be less depressed.” When students state goals in negative terms, we can ask the following “instead of” questions to encourage goals that express the start or presence of something desirable rather than the end or absence of something undesirable: “What will you be doing in class instead of getting in trouble?”; “What would you rather be doing instead of being depressed?” In addition to being more noticeable and measurable than negatively worded goals, start-based goals are more motivating because they focus students’ attention on moving toward what they want (solutions)
rather than away from what they don’t want (problems).

Self-manageable: Students may initially focus on how other people should change instead of considering what they could do differently (“My teachers need to back off and chill a little”). This perspective, accurate as it may be, usually impedes solutions by holding others responsible for changing while placing oneself in a passive and powerless role. When this occurs, counselors can acknowledge students’ perceptions while inviting them to consider what they might do to improve

the school situation: “What have you found helpful in getting your teachers to back off and chill?”

Step 3: Build on what is ‘right’

Instead of emphasizing what is wrong, missing and not working (problems, deficits, limitations), solution-focused counseling invites students and others to notice and build on what is “right” with students and their lives (successes, strengths, resources).

Build on exceptions. Struggling students typically are aware of their failures and problems at school, which is one reason why building on exceptions is so effective in grabbing and keeping their attention. Exceptions refer to the “good times” at school — times when the problem could have happened but did not. These nonproblem occasions are minisolutions that are already happening, just not as often as people would like.

Building on exceptions is a core technique of solution-focused counseling that involves three steps: 1) eliciting exceptions (“When is the problem absent or less noticeable?”), 2) exploring the conditions under which exceptions occur (“How did you make that happen? What was different about your approach?”) and 3) expanding their presence and frequency at school (“What will it take to make that happen more often at school? Are you willing to try that approach in another class?”). This strategy is based on the practical idea that it is more efficient to increase what students are already doing than it is to teach them brand-new behaviors from scratch.

Many students are surprised to learn that they are doing “something” right, and they become more hopeful when they realize that they already have what it takes to turn things around at school. On a more personal level, building on exceptions encourages struggling students to change the question from “How can I be more like other students?” to “How can I be more like myself during my better moments?”

Build on other student resources. In solution-focused counseling, all students are viewed as resourceful and capable of changing. It is our job as counselors to help them identify and apply the “natural resources” in their lives toward school solutions. Natural resources include heroes and influential people (family, friends, actors, athletes); resilience and coping (students’ abilities to cope with life’s adversities); values (students’ deeply held beliefs); special interests (cooking, sports, movies); and community support systems (places of worship, neighborhood groups, clubs). These resources, individually or in combination, can be woven into respectful Branding-Images_Studentsinterventions that improve school behavior while respecting students’ cultural heritage and life experiences.

Let’s look at a quick example involving Ben, a 10-year-old student who loved baseball. After a few minutes of general baseball talk, we explored similarities between the challenges of school and the challenges of baseball. For instance, we talked about how long the baseball season is and how important it is to not let a few bad games ruin the entire season. Ben agreed to try a baseball experiment at school that involved “stepping up to the plate every day” and doing his best, knowing that he would sometimes “strike out” and have bad days. Ben improved his classroom behavior over the next two weeks, and his teacher commented on his impressive turnaround.

This example captures the general nature of building on student resources — identify an available, naturally occurring resource in the student’s life and link the resource to a school solution. Because every student offers a unique set of resources, resource-based interventions are constructed one student at a time with no preconceived notions about what they should look like. You are not likely to find them in treatment manuals or lists because a) they cannot be selected or developed before meeting the student, b) they evolve from the student-counselor relationship and are often formulated on the spot in collaboration with the student and c) they are based completely on material supplied by the student — which is precisely why they work so well. I describe these techniques and many others in greater detail while offering more than 50 real-world illustrations in the new third edition of my book Solution-Focused Counseling in Schools (2015), published by the American Counseling Association.

Solution-focused counseling rests on two main values. First, students should be given every opportunity to be actively involved in their own care because they are the very people for whom school-based counseling services are designed. In addition to honoring core principles of multiculturalism and social justice, giving clients a voice in shaping and evaluating counseling services results in better outcomes. Second, all students are doing “something” to help themselves — if only to keep the problem from getting worse — and these assets and resources can be applied toward school solutions. Without denying the reality and pain of school problems, we can improve outcomes by identifying students’ strengths and resources and incorporating them into the counseling process.

I hope this article was successful in showing that solution-focused counseling in schools is far more than a set of techniques. It is instead a new and different way to approach young people, problems and solutions.

 

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

John J. Murphy, a professor in the Department of Psychology and Counseling at the University of Central Arkansas, is the author of several well-regarded books, including the third edition of Solution-Focused Counseling in Schools, published by the American Counseling Association. Contact him at jmurphy@uca.edu and learn more about his work at drjohnmurphy.com.

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.

Counseling ‘unlikeable’ clients

By Laurie Meyers August 25, 2016

It’s not a politically correct statement, but, sometimes, clients are tough to like. Yes, counselors are supposed to remain professional at all times and practice unconditional positive regard. But they are also human, and fending off creeping feelings of “dislike” can be a challenge, especially when clients espouse racist, misogynistic or homophobic beliefs; have abrasive personalities; or simply remind counselors of someone in their own lives whom they find difficult to be around. So the question becomes, how do counselors handle that reality?

Tamara Suttle is a licensed professional counselor (LPC) in Castle Rock, Colorado, with more than 30 years of experience in mental health. She also runs a business in which she provides supervision, consultation, private practice coaching and counseling for other therapists. In her Branding-Images_Difficultopinion, most counselor education programs and the counseling profession itself don’t do enough to prepare future clinicians for those instances when they will experience negative feelings toward a client. In truth, she says, it’s a bit of a taboo topic.

“If your professors don’t talk about these things and our clinical supervisors don’t talk about these things and our colleagues and our friends and our bosses and our professional associations don’t talk about these things, then we learn pretty quickly that we aren’t supposed to talk about these things or even experience these things,” says Suttle, a member of the American Counseling Association.

But in reality, all counselors experience discomfort with and dislike of a client at some point in their careers, says Keith Myers, an LPC and ACA member in the Atlanta metro area. “If someone tells you that it does not [happen], they’re not being honest with themselves,” he says. “We are counselors who also happen to be human beings.”

Digging deeper

The key is being able to set aside and even learn from those negative feelings when they pop up, Suttle says. To do that, counselors need to discern what is truly at the root of those feelings.

Lauren Ostrowski, an LPC at a group private practice who also works at a community mental health agency in Pottstown, Pennsylvania, agrees. “To me, what is far more common [than fully disliking a client] is working with clients who do things or have traits that I don’t like,” says Ostrowski, a member of ACA. “Even if I feel like I have a client I don’t like at all, I make it a point to figure out what it is they are doing or saying that I don’t like. Then I figure out whether the problem is really me — [making] a value judgment perhaps — or whether they are doing something in session that also affects their everyday life that they are motivated to change.”

Suttle acknowledges that after reflecting on her negative feelings toward a client, she sometimes discovers that the problem actually resides with her. She is reacting with dislike because the client triggers personal issues she has struggled with herself, such as having been raised to be a people pleaser.

“I’m sure many therapists can relate to having a certain type of client that they simply prefer not to work with,” Suttle says. “For me, that has historically been a client who is so focused on people pleasing and [is so] passive or passive-aggressive that she is often unable or unwilling to own her truth and … tell the truth.”

“After years of struggling with this type of client and [having] lots of opportunities to reflect on my struggles, I now recognize my discomfort as being much more about me and my own people-pleasing tendencies than those of my clients,” she continues. “It’s one of those issues that I must continually be cognizant of and work on in order to work with clients.”

Likewise, Myers says that his feelings of dislike or discomfort with a client are often about him. “Most times … it’s [dislike] about an interpersonal issue or a client reminding me of someone I know or knew,” he says. “I think, for me, it comes down to countertransference and how a client may stir up my own unconscious — or, at times, conscious — parts of me.”

Myers and Suttle both stress the importance of counselors practicing self-reflection to identify personal issues that can creep into counseling.

When Suttle works with other counselors who are struggling to like one of their clients, she looks for what she calls “signature issues” in the counselors’ backgrounds. She does this by helping them to construct genograms. The purpose is to identify how a counselor’s family members interacted in relationships going back several generations, such as Suttle’s long line of people pleasers.

Together, Suttle and the counselor search for behavior patterns related to family relationships. For instance, passivity might be a pattern in the counselor’s family. Suttle also asks about how conflict was handled in the counselor’s home growing up. As an example, a counselor whose father punched walls when he was angry might not be comfortable with conflict. This could engender a negative reaction to clients who push back, are stubborn or struggle to control their anger, Suttle notes.

Identifying the personal issues and biases that contribute to a counselor’s dislike of a client is an important step, but that alone will not solve the problem, say Myers and Suttle. Both stress the importance of counselors receiving supervision and even engaging in individual therapy when their personal issues trigger feelings of dislike toward a client.

“Supervision and consultation play a huge role in processing the material and my own internal responses that occur within my counseling relationship with clients,” Myers says. “Having someone who comes alongside me in my process of helping others and is willing to see me through a different lens … who is often challenging me and exploring my conscious and my unconscious feelings. … [That] is so important to me keeping those ‘dislikes’ [about a client] in check.”

“Another thing I do is participate in individual therapy,” Myers says. “Sometimes if a client is rubbing me the wrong way or I feel irritated or agitated with a client, my therapist provides me with a safe space to be able to process those things.”

In addition, Ostrowski urges counselors to seek more informal supervision when struggling with negative feelings toward a client. “This doesn’t have to be the official [type of] supervision with a contract and consultation agreement, etc.,” she says. “While I think that kind of supervision is important, here I’m talking more about a trusted co-worker or another clinician where you can just have a discussion about exactly what you are reacting to, how you reacted in session and what you are going to do moving forward.”

Suttle has a consulting group that she meets with regularly, and she urges other practitioners to participate in similar groups to help them deal with problematic feelings toward clients.

Setting aside personal beliefs

In accordance with the ACA Code of Ethics, counselors know that they must not force their own beliefs on clients, but what happens when a client espouses beliefs that are hateful, personally hurtful or just uncomfortable to the counselor?

“Sometimes working with clients who have different values can be challenging,” Ostrowski says. “In that case, I really try to learn more about the client’s worldview and, in some cases, ask about how looking at a situation in a certain way may affect them or their family. Often, they are already aware of these things and will say that they understand that it causes certain trouble with extended family dynamics or may be part of why they don’t have a relationship with someone important to them. There can be some very fruitful discussions about how important their beliefs are to them compared to what it is that they want in life and whether there is some sort of balance that they see.”

When Myers, a past co-chair of the ACA Ethics Committee, is working with a client who has strong prejudices or biases against certain groups and is making judgmental or harsh comments in session, he tries to tie it back into the therapeutic process.

“I normally use this time to explore these comments so that I can gain further insight into the client’s background, values, beliefs [and] family-of-origin issues,” he explains. “This is usually an opportunity to hold the tension while exploring deeper with the client. And if we believe it’s important to be fully accepting and nonjudgmental with all clients, then it’s important for us to accept those who are different from us and who hold very different values and opinions, even when they are being judgmental.”

Although Ostrowski often manages to make therapeutic use of a client’s biases or prejudices, she acknowledges that it isn’t always easy, recounting the story of one of her recent cases as an example. “A few days after the tragic shootings in the Orlando nightclub [at Pulse in Florida on June 12], I had a client discussing his beliefs on the whole idea with me. Let’s just say that [the client’s beliefs and Ostrowski’s beliefs] were about as far opposite as one can get, and on top of that, he had a lot of the facts incorrect. I did mention that I had heard different facts on the news, but he disagreed,” she says. “I stopped trying to point out things that were different from what I had heard, and I allowed him to discuss how all of this had affected him, restating what he was saying and asking for more information.”

Ostrowski says the situation served as a good reminder for her to closely monitor her reactions when faced with a client’s prejudicial statements and biases. “I will say that for the rest of the session after the topic was brought up, I was checking every statement or question I used before I said it to see whether it was to benefit me or my client,” she notes.

It is important for counselors to know themselves well so they can better guard against their personal beliefs and biases slipping into the counseling session, Ostrowski says. However, that doesn’t mean that counselors have to give up their personal beliefs.

“We can keep our worldview [as counselors] and simultaneously learn more about the world as our clients see it,” she explains. “For that matter, it’s not even about hiding our beliefs, but more about disclosing only those that would further the conversation we are having with our clients about what they believe and leading them in the direction of their therapeutic goals.”

Regardless, hearing a client spout hateful or misinformed comments in session can still take a toll on counselors, Myers and Ostrowski say, and that is one reason why they think counselor self-care is crucial in these situations. Myers take breaks to walk in nature after client sessions that may have been upsetting because the activity helps him clear his head. Ostrowski, meanwhile, has found that staying grounded helps her and can be particularly useful while in session.

“[Staying grounded] may decrease the feeling of being emotionally flooded or overwhelmed,” she explains. “[It] can be as simple as taking the time to notice your feet on the floor or your hips in the chair. The possibilities are endless. Each and every one of us can find some way that we can move or notice the location of our body in the room or the chair in a way that is not distracting to a client. It takes only a matter of seconds and can change the trajectory of the session because of having an increased ability to stay present with the client in that moment.”

‘Liking’ versus ‘accepting’

Other clients can be difficult to like not so much because of their beliefs but because they possess abrasive personalities.

Christine Moll, an LPC who practices in the Buffalo, New York, area, points out that no one ever said that counselors have to like every client they come in contact with. She cites the writings of Carl Rogers — one of the founders of the client-centered approach — to support her statement.

“He called for empathy,” Moll explains. “Nowhere did he say like, but [rather] embracing the person with concern or care, wanting the best for that person.”

Moll, an ACA member who is also a past president of the Association for Adult Development and Aging, says she has definitely encountered clients whom she didn’t like, but she always tries to put her personal feelings in perspective. “I have worked with clients that I have found difficult, arrogant, elitist or biased,” she says. “But I am not in their lives. I don’t need to share a fence with them. I think to myself that if I [have to put my reactions] aside, it’s just for 50 minutes, and I tell myself, ‘It’s not about you.’”

Regardless of how a counselor feels about a client, the goal should always be to help that client find and attain a good quality of life, says Moll, who is also a counselor educator at Canisius College. “I try to use what I’ve not liked about a person and figure out how to reframe it,” she notes.

For instance, clients might come to counseling complaining that no one likes them and they don’t know why. Moll explains, “I might point out a [client’s] passion for life that other people might see as a chip on the shoulder and say, ‘I see your energy and your passion for life, and if you feel threatened and put up against a wall, you are going to fight back. That’s great. That’s a gift. But can you see how that can lead people to see you negatively?’”

Ostrowski suggests exploring whether a client’s difficult personality is connected to the reason that person is seeking counseling. “For example,” she says, “if clients come across very gruff and unpleasant, it could be that they have emotions that they don’t understand or they struggle to have effective conversations, thereby leading them to react in ways that are perceived as unpleasant because of self-protection strategies.”

Moll also tries to identify positive aspects in even the most unpleasant client. “I was raised with the idea that everyone’s got something [good] about them,” she says. “If I find a glimmer or find a good quality, I praise it.”

Myers comes back to the importance of always putting the client first in the counseling relationship. “I will say, yes, it is harder to work with a client that I don’t like, at least at first. But then I remind myself that I must accept each client where they are in their lives and that I don’t have to like them necessarily to fully accept them, support them and offer them respect.”

 

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To contact the counselors interviewed for this article, email:

 

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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

 

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.

 

 

Radical alignment: A psychospiritual approach to conflicting values

By Carol ZA McGinnis

Standard A.4.b. of the 2014 ACA Code of Ethics notes that “counselors are aware of — and avoid imposing — their own values, attitudes, beliefs and behaviors” in an ethical practice. Counselor educators and students often need a practical approach for accomplishing this goal when it comes to conflicting religious or spiritual perspectives in the counselor-client relationship. Through a process of radical alignment, this ethical mandate can be accomplished.

Despite recent legislative trends, most notably in Tennessee, the prohibition of referral due to counselor-client value conflict may present a problem for practitioners who need additional help in adopting a genuine empathetic orientation.

One way to approach this potential dilemma is to adopt a psychospiritual approach that is oriented toward the identification of “common ground” or universal themes that are likely to exist in any counselor-client relationship. This kind of self-awareness and exploration is found in pastoral counseling programs that have a vested interest in integrating a religious or spiritual view in counselor training versus secular versions that tend to view this aspect of the client simply as a component of client diversity. The problem with the latter view is that it discounts intellectual and emotional aspects of religious or spiritual beliefs that inform the counselor photo-1462663608395-404cb6246eaffrom a holistic level. When we are not able to bring our full capacity into the session — if we merely bracket, ignore or set aside this part of our humanity — it would seem implausible to fully attend to a client’s needs.

No empirical research has been conducted on the term “radical alignment.” The idea is supported, however, by the collective works of Kenneth Pargament, Henri Nouwen and Pierre Teilhard de Chardin, each of whom contributed to a wider understanding of how religious and spiritual views intersect with human interaction. They determined that religious and spiritual beliefs are an invaluable part of daily living oriented toward meaning, spiritual growth and our identity as a member of a larger community.

Recognition of universal themes that connect all people regardless of faith tradition, spiritual orientation or creed can provide the counselor with valuable insight into the inner workings of the client without compromising the counselor’s core beliefs.

 

Authenticity and trust

The idea of radical alignment begins with the premise that the humanistic principles of authenticity and trust must reside at the core of the counseling relationship. We find these same fundamental principles in the ACA Code of Ethics as veracity and fidelity, which seem difficult, if not impossible, to promote when personal values have been completely removed from the interaction.

Although counselors are health professionals much like physicians and nurses, we rely on the establishment of rapport in the counseling relationship, which is more akin to religious confession than a physical checkup. In this complex aspect of the counseling relationship, only the affirmation of commonly held beliefs and values can provide a tangible path to an ethical practice.

The crux of the problem then becomes more about the “how” of finding solid ground when a counselor’s and client’s beliefs and values clash. How does the counselor begin to determine these elements to connect, or align, with the client? The answer is to return to the fundamentals of what it takes to provide a comprehensive counselor education: the development of appropriate awareness, knowledge and skills (http://www.cacrep.org/wp-content/uploads/2012/10/2016-CACREP-Standards.pdf).

 

Awareness, knowledge and skills

To accomplish this, counselors-in-training need practice in exploration and self-awareness activities that will help them to identify and validate their own beliefs and values. These activities will increase their knowledge of religious or spiritual language and behaviors that may alienate clients who hold very different views, while also helping them develop skills for determining universal themes through which radical alignment can occur.

Awareness in this capacity might involve exploration of previous beliefs and values that have stayed consistent or changed over the counselor-in-training’s lifetime. Core values may be highlighted through activities such as journaling, digital storytelling and discussion board exchanges in an online environment. Through these activities, counselors-in-training can learn how to communicate specific meanings, values and beliefs that they have attributed to specific life events and that might guide their day-to-day decisions.

Face-to-face exploration might involve dyad or group activities that include the creative expression of core beliefs. This could involve sharing symbols, rituals, sacred texts or even types of food that help to bring about deeper awareness of how beliefs and values are affirmed and communicated.

Gaining knowledge of what others believe, with attention given to ritual, family tradition and sacred texts, can help counselor-in-training learn about language and actions that clients could interpret as hostile or distancing. When structured responsibly, respectful exposure to various religious and spiritual views can help affirm the belief systems of counselors-in-training and provide a deeper understanding of how these values may fit within the larger context of other worldviews.

This process should not be part of a master plan to bend or subordinate individual beliefs. Rather, it should highlight similarities and differences that can be important in counseling. For example, the concept of prayer may seem universal to one student until further exploration highlights how this term can mean very different things to different clients, or even potentially have no connection to clients who hold Eastern religious/spiritual views.

To determine universal themes, the counselor-in-training must learn to identify client beliefs and values that may be related to the client’s presenting problem without feeling threatened. Although it is still possible for unexpected countertransference to occur, previous exploration and awareness of counselor beliefs will mitigate this response and allow the counselor to focus on determining underlying universal themes. Even if these themes are not completely consistent with the client’s views, recognition of these elements can help the counselor to align with the client in a radical way.

Let’s say, for example, that the counselor-in-training is a Pentecostal Christian with devout beliefs that relate to the sanctity of marriage. The client, meanwhile, professes no particular faith and engages in casual sex with many partners. Further exploration of the client’s values may result in the prioritization of truth as a core belief. This value would be understood as a universal theme that cuts through religious and spiritual orientation and can provide the counselor with a platform to align with the client. The counselor-in-training may not be able to genuinely empathize with the ramifications of the client’s sexual promiscuity, but her desire for truth in all relationships would be a place where radical alignment could occur.

So too might a Muslim counselor-in-training who possesses a strong religious belief to honor his father and mother connect with a client who regularly lies to his parents through a shared universal theme of a desire for justice. This focus would permit the counselor-in-training to be genuine in his empathy for the client who feels bullied and ignored by those people who are closest to him in his life. Through radical alignment, the counselor-in-training could build trust with this client. That sense of trust would be needed by this client to help him move away from self-destructive behaviors and toward healthier goals that have been identified in an authentic counseling relationship.

In short, this process occurs through three steps:

1) Collect and identify client beliefs and values associated with the presenting problem.

2) Determine a core belief that can be understood as a universal theme that is shared by the counselor-in-training.

3) Engage in radical alignment with the client to promote fidelity and trust in the counseling relationship.

 

 

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Carol ZA McGinnis, a licensed clinical professional counselor and national certified counselor, is a pastoral counselor and counselor educator who specializes in anger processing. Her passion involves teaching with attention paid to religion and spirituality as positive factors in both counseling and counselor development. Contact her at cmcginnis@messiah.edu.

 

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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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Embracing intuition

By Lynne Shallcross July 24, 2016

One meaning of intuition is “something that is known or understood without proof or evidence.” Given that definition, it’s not surprising that objectively studying and measuring a counselor’s intuition can be challenging. But that hasn’t stopped Jesse Fox from trying.

In 2013, as part of research Fox was doing for his dissertation, he set out to observe and track counselor intuition, a concept that he defines as rapid, nonconscious insight into what is going on in a client’s mind or behavior. Fox, an assistant professor in the Department of Pastoral Counseling at Loyola University Maryland, says counselor intuition is a little like breathing — more automatic than it is controlled.

Fox believes counselor intuition can be quantified and observed, and in his research, he aimed to accomplish that by looking at how 44 counseling experts responded to a variety of two-Branding-Images_intuitionminute client video segments. Four of those counselor experts viewed nearly 40 client video segments, identifying six to 10 directions a counselor could take with each individual client based on what had happened in the corresponding brief video. Then the remaining 40 counselor experts viewed those video segments and rated the possible next steps on a 5-point scale ranging from “strongly agree” to “strongly disagree.”

The result? Fox says intuition was apparent in the way that the counselors leaned collectively toward certain directions to take with each client. “The best way that I could say [it] is that there was substantial common perspective that [the counselors] brought to those sessions,” says Fox, a member of the American Counseling Association who presented a poster session on his research at the 2015 ACA Conference & Expo in Orlando, Florida.

‘Substantial commonality’

Fox, who is in the process of submitting his research for publication, believes his study is the first of its kind to go beyond counselor self-reports in an attempt to look at intuition in a more scientific manner. By looking at the study results and the like-minded way that the counselors responded to the clients in the videos, Fox believes it is possible to “see” counselor intuition taking place. Additionally, he wanted to contribute to the study of intuition a standardized set of scenarios that could be given to any counselor to study his or her intuitive reaction.

In the setting Fox created, the expert counselors had nothing more than the individualized two-minute video segments to go on when making their decisions about what direction a counselor should take with each client. Fox says that setup required the counselors to draw from information they had accumulated across the course of their careers. “They don’t have all the information [about each client],” Fox says. “They just have a two-minute segment, so they have to rely on information they’ve stored long term that they have to access very quickly.”

Ideally, counselors want to have a full session, at minimum, with each client before making any decisions, Fox says. “But in this case, it was a challenging task, and what elicits an expert’s ability is that you give [him or her] something with high challenge and see what happens.”

Despite the standardized nature of the client video segments and the resulting similarity in the counselors’ reactions in Fox’s study, he is careful to point out that he isn’t claiming that no variation exists between counselors after they reach a certain level of experience. “What I am saying is that there certainly does seem to be some substantial commonality that people develop over time that helps to guide them toward good and bad directions to take,” Fox says.

Recognizing patterns

Some of the original research on intuition was done with chess players half a century ago, Fox says. What researchers found was that chess masters “see the board differently,” he says. Whereas novice players might need to think through a decision tree of outcomes, master players instinctively know the right move based on the information they have stored up over past years.

“It takes you time to develop expertise, and what you’re doing during that time is you’re beginning to recognize certain patterns that come up,” Fox says. “So if you took those findings and you applied them to counseling, what’s happening probably is that as people practice therapy, they begin to recognize certain patterns of clients that come to them.” Master counselors, just like master chess players, can identify those similar patterns and make decisions based on what they instinctively see, Fox says.

“Counselor intuition is that little itch at the back of your head, that small voice prompting you to take a risk and to speak [to] a client’s situation that may seem like it’s coming out of left field,” says ACA member W. Bryce Hagedorn, the director of the counselor education program at the University of Central Florida who served as the chair of Fox’s dissertation study on counselor intuition. “Clinically, intuition is born out of experience in the profession, experience with the client and experience with the client’s presenting concerns. It is a way of subconsciously tapping into these realms and making conclusions that may not be directly observed but rather ‘felt.’”

Some counselors report relying on intuition extensively, Hagedorn says, “oftentimes forgoing specific theoretical orientation for the sake of a clinically sound intuitive moment.”

Still, Fox and Hagedorn acknowledge that the use of intuition in counseling is not without controversy. Some critics question intuition’s very existence on the basis of its subjective, self-reported nature. Others maintain that counselors should not rely on intuition because human judgment is flawed and people make mistakes, Fox says.

On the other side, proponents of intuition might argue that in therapy, there is no way of fully removing the human element, Fox says. “In other words, we’re kind of stuck with humans, with human judgment,” he says. “If you can find a way of identifying what makes people experts or intuitive, why not go find out what makes them that way and then try to teach other people how to do it?”

Regarding the use of theory versus intuition in therapy sessions, Fox thinks counselors should strive for a combination of both. Theory gives practitioners a guiding framework from which to work, but counselors should simultaneously seek information that comes from assessments and the counselor’s experience or intuition, he says.

Counselors interested in developing their intuition can work toward greater awareness of their “gut moments,” Fox says. When counselors feel their intuition kick in, they should become conscious, skilled observers and take the time to “unpack” those situations, he suggests. “When you experience intuition, investigate it,” Fox says.

Unfortunately, no shortcut to honing intuition is available, Hagedorn says. “Outside of gaining more experience, interacting with seasoned clinicians, journaling, recording their sessions and seeking supervision, it can be quite challenging to create intuition in the short game,” he says.

Fox offers two book suggestions for counselors looking to develop their intuition: Educating Intuition by Robin M. Hogarth and Intuition: Its Powers and Perils by David G. Myers.

Counselors should avoid going to either extreme on the intuition spectrum, instead shooting for somewhere in the middle, Fox says. If the intuitive, human element is removed entirely, then it’s no longer therapy, he emphasizes. But on the other hand, it wouldn’t be wise for counselors to rely solely on their intuition in every situation, he says. Counselors should always strive to pull from more than one source of information, Fox says, whether that second source is supervision, consultation, assessment or something else.

Hagedorn agrees. “Therein lies the main crux of the problem: knowing when to apply intuition,” he says. “I don’t believe it is an either/or but rather a both/and in the sense [that] intuition and clinically proven assessments and interventions both belong in the therapeutic setting.”

 

 

From the trenches

To further explore how and why counselors integrate intuition into their work with clients, Counseling Today asked a handful of leaders in the field to weigh in with their views. Responses have been edited for length and clarity.

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Richard S. Balkin is a professor and assistant chair in the Department of Counseling and Human Development at the University of Louisville and the editor of the Journal of Counseling & Development.

How do you define counselor intuition?

The definition that makes the most sense to me is “knowing without knowing,” and it came from a writer for The New Yorker, Malcolm Gladwell. In other words, you have an understanding about an event, phenomenon or experience without having gone into the reasoning and formal process of learning about the phenomenon, event or experience.

In what ways can intuition help the counseling process?

Intuition is most often aligned with the counseling relationship. When the counselor knows the client, being intuitive may become second nature. With a strong working alliance, the client may feel more comfortable with feedback, even if it is confrontational, due to the trust and the feeling that the counselor understands.

Can counselors hone their intuition?

I view intuition as a function of the relationship. When the client-counselor relationship is strong, the client is apt to take more risks, but so is the counselor. Risk-taking, from the counselor’s perspective, is rarely about trying some new empirically supported treatment, though it can be. Rather, risk-taking from the counselor often involves, “What happens if I say this to the client? Are we at a point where I can be this honest, genuine and even direct?”

How is this developed? I often go back to my nearly 40 years of martial arts training — time on the mat. When you know without knowing, it is often because of the experience in working with clients and trusting yourself as a counselor. [Rhonda] Neswald-Potter, [Shawne] Blackburn and [Jamie] Noel talked about this as professional self-concept [in a 2013 Journal of Humanistic Counseling article], and I think it aptly applies.

Why is the topic of intuition sometimes controversial in counseling?

“Knowing without knowing” flies in the face of the accountability movement and the focus on empirically supported treatments. We know the relationship and intuition are the most important elements in counseling. But these components are difficult to investigate empirically, whereas treatment approaches lend themselves to empirical investigation much more readily. Ultimately, we end up spending more time on elements that affect very little variance in terms of counseling outcomes, as opposed to concepts like intuition, which are tied more closely to the counseling relationship.

How should counselors balance the use of intuition with the use of more objective interventions such as assessments? 

Both are needed. We live in an era of accountability and where our ethical code mandates the use of interventions based on rigorous research methodologies. Intuition alone does not suffice, but of course it is a naturally occurring phenomenon within the counseling relationship. There are times when objective assessments provide important and valuable information that the counselor might otherwise miss. However, such assessments are not error-free, and counselors should utilize their subjective insights to complement or confirm what is identified objectively. Objective assessments are a nice check and balance to counselor intuition, but counselor intuition is also a nice check and balance to objective assessment.

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Jeff L. Cochran is a professor of counseling at the University of Tennessee and president of the Association for Humanistic Counseling, a division of ACA. He is also co-author, with Nancy H. Cochran, of the book The Heart of Counseling: Counseling Skills Through Therapeutic Relationships.

How do you define counselor intuition?

I think of counselor intuition as the counselor’s ability to make informed responses in the moment in therapeutic relationships. This can mean hearing a client’s emerging communication and responding to that, even when the counselor is not sure of [the] correct understanding. A counselor does not often have time [to] evaluate what her client is communicating; rather, she has to respond with her hunches.

With that said, there is also a necessary balance. I encourage students and beginning counselors to learn to wait. A first-hunch intuition might not be right. It’s best to have the hunch, realize it and set it aside. Then see if it persists [and] continues to feel right.

Does intuition take time to develop?

Beginning counselors often understandably hold back, at times too much, in [the] therapeutic relationship, which can make one hard to connect with. I work with beginning students to listen to recordings of sessions. I ask them to state their first impressions of how they might have responded, then evaluate how that in-the-moment response might have worked.

Can counselors hone their intuition?

Counselor intuition comes from within and from without. I think each counselor works from her own “n of 1” example for understanding the world. I’m OK with that as long as the counselor’s view of self and the world is continuing to develop through open self-reflection, through listening well to her or his thought patterns, and attending to and finding meaning in feelings. Self-reflection can inform a counselor’s intuition well if the counselor’s experience is considered through working toward unconditional positive self-regard, allowing her to see her experience most closely to what it really is, and [self-reflection] can tell her about self, others, the world and persons in relationships.

And, importantly, counselor intuition is developed through study. Through initial graduate study and ongoing life as a scholar, counselors study a range of counseling theories, with each carrying its own view of human nature, how we develop, what drives our problems and how we make significant life changes. Each counselor becomes [an] expert in one to a few theories and knowledgeable of others. And each counselor becomes [an] expert in the populations of persons that they serve and the problems commonly faced by those persons. So, when the counselor has to make decisions of how to respond in sessions, based on her hunches of what is going on with the person of her client, her intuition is informed by the meaning she has made of her own life experiences and by what she is continually learning as a scholar [and through] human nature and change.

Why is the topic of intuition sometimes controversial in counseling?

Counseling is research based, but it is not a science. We can know the factors of [the] therapeutic relationship that predict positive counseling outcomes. But we also want to think of counseling as a definitive science, where the only answers needed are to the question, “What techniques lead to what outcomes for what populations with what problems?” But the work is actually much more subtle than that. It’s all about the relationship, and there are many unknowns that we have to feel our way through with intuition.

Is intuition important for clients too?

Often, what clients get out of counseling is self-awareness, regaining trust in the value [of] listening to one’s own experience, which can be thought of as intuition. Many of the clients I served had given up their view of self in favor of how others see them or how they imagine that others see them. Many of the clients I served had come to doubt their own experience.

But helping them rediscover and respect the intuition of their own experience didn’t usually come from the obvious route of pointing out that need. In hindsight, it was the counseling process — me following what I hear in my client’s self-expression and responding as a person in the moment, informed by years [of] scholarship and careful self-reflection — that led us both to my client’s newfound intuition and trust in self.

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Lori A. Russell-Chapin is a professor of counseling at Bradley University and co-director of the Center for Collaborative Brain Research. She also facilitates ACA’s Neurocounseling
Interest Network.

How do you define counselor intuition?

I believe there are four major factors that allow counselors to have intuition: early personal attachment, counseling experience, the vagus nerve and the default mode network (DMN) in
the brain.

Secure, early attachment will allow the counselor to be safe enough to trust the counseling relationship, and thus easily build therapeutic rapport. Once that is accomplished, psychological resonance will occur more often, and the client and the counselor will together solve problems easier with both “heads” offering solutions.

If a counselor does trust his or her judgment and intuition, the longer counseling is practiced, the stronger this intuition becomes.

The vagus nerve is the 10th cranial nerve and the longest nerve in the body. This nerve begins at the base of the medulla oblongata and ends at the abdomen. The vagus nerve takes in so much information from so many sources and senses, it was named from the word “vagabond,” as it wanders throughout the body. This [nerve] offers the counselor, and the client for that matter, invaluable and rich communication about many possible thoughts, senses and emotions.

The DMN in the brain consists of the posterior cingulate, precuneus, cerebellar tonsils, bilateral temporoparietal junction, medial prefrontal, bilateral superior frontal, inferior temporal and parahippocampus. This network has many functions, but one of the main functions is to allow us to introspect and retrospect. If we are relatively healthy and regulated, the DMN helps us understand the world of self and others. This network helps us to mind-wander and create better understandings about our clients from this wandering and being “offline” for a while.

Can counselors hone their intuition?

Counselors can hone their intuition by understanding there is top-down and bottom-up communication in the body. The brain informs the body — top-down — and the body informs the brain — bottom-up. These electrical and chemical impulses send messages about the world around us. Understanding that our physiology gives us those hunches or intuitive feelings may allow counselors to be more in tune with those emotions and sensations. Counselors have to listen to their brains and bodies.

Can you share an anecdote about intuition in your work as a counselor?

Recently, a student supervisee did not show up for a very important meeting pertaining to his future. The student supervisee was typically very punctual. I waited patiently for over 20 minutes. After I returned back to the university, something just didn’t feel right. I listened to my intuition, my body and years of counseling. I began calling around and could not get in touch with this person. I finally called the campus police and asked them to begin a search. Finally, the person was located and had overdosed. Because of my intuition and working with other available resources, a life was saved.

Why is the topic of intuition sometimes controversial in counseling?

Many helping professionals believe intuition is just a soft science, much like the old days of counseling. Today we know that counseling is not a soft science, as counseling does change the function and structure of the brain. The advances in EEGs (electroencephalograms) and brain scans have demonstrated those changes. Now that we also understand the function of the vagus nerve and the DMN, the implications to social connectedness and our social brain, it may not need to be as controversial.

How should counselors balance the use of intuition with the use of more objective interventions such as assessments? 

Assessment and intuition need not be in competition with one another. Both are necessary to a complete evaluation of the client’s needs. Quantitative and qualitative measures, whether that be in the form of self-reports, standardized tests or physiological impulses, are all essential to successful outcomes and efficacious counseling treatment.

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Jeffrey Kottler is a professor of counseling at California State University, Fullerton, and the author of several books that explore the counselor’s experiences with intuition, including On Being a Therapist, On Being a Master Therapist and The Therapist in the Real World.

How do you define counselor intuition?

One way to think about intuition is that it represents internalized experience. It’s a shortcut to solving problems, selecting courses of action or interpreting the world or one’s own experience based [on] cognitive templates that are developed over time. It is an ethereal or mysterious phenomenon precisely because words can’t really touch what it feels like.

How is intuition important in the counseling process?

Intuition is a felt sense, an inkling, sometimes felt in the body, sometimes in the heart or mind, that represents one possible interpretation of events or experience. As such, it is a hypothesis that is usually subject to testing and confirmation. I sense that a client is uncomfortable with what is transpiring in the moment, but if I stop and try to explain how and why I know this, I feel at a loss. Observable behavior is not yet apparent, except on a preconscious level. Such initial thoughts and feelings, if not supported with some other evidence, can indeed be problematic, or even dangerous. Calibrating one’s intuitive powers comes with systematic experimentation, making the sense more attuned and accurate after processing honest feedback.

In what ways can intuition help the counseling process?

Intuition sometimes leads to breakthroughs in ways nothing else can touch. Our field has traditionally been dominated by older, white, male theorists who worship logic, rationality, empirical verification and objective data. Of course, this is critical for scientific advancement. But in actual practice, we also rely on hunches, inklings, images and internal feelings that sometimes offer clues that would be inaccessible any other way. Likewise, if these feelings are based on personal biases, distortions, exaggerations or one’s own needs, then counseling can become self-indulgent and not in the client’s best interests.

Can counselors hone their intuition?

Intuitive powers are developed over time, with reflective experience, systematic assessment of accuracy and explorations into alternative domains that bypass mere language. The difference between beginners and veterans is that those new to the profession haven’t yet accumulated sufficient experience to know whether their feelings or hunches are targeted or appropriate yet. But with practice and commitment, all of us learn to be more responsive to others without needing to explain or interpret how the process actually happened.

Can you share an anecdote about intuition in your work as a counselor?

I was doing trauma work in Nepal after the series of devastating earthquakes that occurred last year. A man in his 80s wanted to talk to me about something that was bothering him. It was explained to me by a relative that although he wasn’t physically injured as so many others were, he was still very anxious. The challenge was that he was escorted into my “office” — a schoolroom that was one of the rare buildings still standing — and didn’t speak a word of English.

My Nepali language skills are feeble, and my translator left to help treat another patient. So we just sat there and stared at one another for a few minutes until I felt this really strong energy between us. I couldn’t get the idea out of my head that he wanted to hold my hands. Now it’s entirely possible that this was my feeling rather than his, but I nevertheless reached out to hold his gnarled hands in my hands. We just sat like that staring into one another’s eyes and holding hands. He kept talking to me, telling his story, and I kept nodding even though I could only understand a few words he was saying.

When the session was over, we stood up and hugged one another. He wouldn’t let go. I have no idea what actually happened between us, but it felt miraculous. When I have intuitive experiences like this, I deliberately try not to explain what happened. I learned from shamans long ago that sometimes when you make sense of experiences, you destroy their magic.

Why is the topic of intuition sometimes controversial in counseling?

I don’t agree that it is controversial. I just think it is misunderstood. Intuition is simply a thought, feeling, image, sensation or hypothesis that isn’t — yet — supported by more tangible evidence. It is just a starting point that must be checked out. It is ill-advised when people trust their intuition without assessing the accuracy or combining it with standards of care.

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Catharina Chang is a professor at Georgia State University and the president of the Association for Multicultural Counseling and Development, a division of ACA.

How do you define counselor intuition?

Counselor intuition is the counselor’s ability to connect with her client and to understand her client at a level deeper than the spoken words. Counselor intuition guides the counselor to act in a certain direction with her client. Counselor intuition can assist counselors in case conceptualization as well as helping the counselor decide how to move forward with the counseling process.

Can counselors hone their intuition?

I believe you either have intuition or not, but if you do have intuition, you can further develop your intuition. Some have asked whether counseling is a science or an art, and it’s both. Effective counselors understand the science behind good clinical skills, while respecting that the art of counseling is also important. Intuition is a part of the art of counseling. One’s intuition, I believe, comes out of your past experiences and knowledge, so it can be developed and fine-tuned. Counselor intuition allows the counselor to bring herself into the counseling process.

Why is the topic of intuition sometimes controversial in counseling?

From a legal and ethical standpoint, we want to be able to quantify everything, and intuition is something that can’t be quantified — which is why it’s important to follow your hunches/gut/intuition but be able to also back up that hunch with specific details.

How should counselors balance the use of intuition with the use of more objective interventions such as assessments? 

Both are important to be an effective counselor. Intuition helps us know when and where to probe deeper, thus assisting us to gain more concrete information.

 

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To contact the individuals interviewed for this article, email:

 

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Lynne Shallcross, a former associate editor and senior writer at Counseling Today, works for Kaiser Health News as a web producer. Contact her at lshallcross@gmail.com.

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