Tag Archives: Human Development Across the Lifespan

Human Development Across the Lifespan

Preparing for retirement goes beyond a good 401(k)

By Laurie Meyers November 29, 2017

Thou shalt contribute to thy 401(k) — or 403(b) or individual retirement account, etc. It is the first commandment of retirement planning. Contribute early and often, perch on that nest egg and make sure that it’s big enough for you to live on after you retire.

That’s sound advice. After all, you will need lots of money to support yourself once you’re unwilling or unable to work any longer.

But then what? After your financial future is secure, are there really any questions left to answer or obstacles to overcome? Well, yes. As it turns out, there’s a lot more to sound retirement planning than saving money. Consider: What are you going to do with the rest of your life? Where will you get your social interaction now that you’re not gathered around the coffee pot with your co-workers? What will you do with your time? What happens when you and your partner are together all day, every day? Who are you without your job?

Professional counselors may not be experts in financial planning, but they can certainly help clients explore what they want their lives to look like after retirement and take steps to make that vision a reality.

Exit ahead?

As a society, our definition of retiring is changing. Largely gone are the days of people walking out the door at age 65, gold watch and pension in hand. The majority of Americans today either need or want to work beyond what once was considered “full retirement age.” Working past retirement age could mean spending a few extra years at an existing job, cutting back to part time or even trying out a new career entirely. There’s no “right” or predetermined path. Clients need to consider what would work best for them.

“Start by thinking about if you like what you’re doing. Do you want to do it until you retire?” asks Christine Moll, a past president of the Association for Adult Development and Aging (AADA), a division of the American Counseling Association.

Deciding whether to stay in a job isn’t just a matter of willingness, adds Moll, a licensed professional counselor (LPC) who practices in the Buffalo, New York, area. People also need to consider whether they will be physically able to stay at their current job as they are approaching retirement age.

Wendy Killam, an ACA member and co-editor of the book Career Counseling Interventions: Practice With Diverse Clients, agrees. “Our physical decline really starts in our 40s, so it’s incumbent upon people to start thinking about what they are going to be able to handle physically,” she stresses. “Can I do this job forever, or do I need to think about doing something less strenuous?”

Killam, also a former president of AADA, adds that if clients are considering changing jobs in anticipation of retirement, the earlier they do it the better. She recommends that clients make this kind of move, if possible, in their 50s rather than in their 60s.

“As people get older, they face more ageism,” explains Killam, a professor in the Department of Human Services at Stephen F. Austin State University in Texas. “Someone may say, ‘Hmm, this person is 60. How long could they really be useful?’” She notes that although U.S. workers are protected against age discrimination, cases can be tough to prove.

Even entertaining the idea of changing jobs can be scary, and figuring out what that next job will be can be terrifying. That’s where career counseling comes in for people who are looking toward retirement but still need or want to work for several more years, says Killam. “Counselors can offer career guidance, testing and career exploration. They can give a wide number of [assessment and aptitude] tests that can help clients consider opportunities that they might not otherwise have thought of.”

Counselors can also help these clients research what jobs are available and in which markets. Clients may find that some positions aren’t very prevalent in their local job market. “I may decide I want to be a marine biologist, but I don’t want to move from Texas,” Killam says. In those cases, clients casting an eye toward retirement need to decide whether they are willing to relocate.

As a kind of trial run for retirement, Killam sometimes encourages her clients to take a minivacation at home for a minimum of one to two weeks. “Stay at home, stay totally disconnected, and see what that’s like,” she urges. “It gives you an idea: ‘Is this something I can really do?’”

Some clients may find that rather than abruptly retiring, they would prefer to transition to part-time employment. In fact, Killam adds, as society seemingly embraces an expectation of remaining in the workforce longer, that kind of arrangement may become more common.

Taking time to process

There is no magic age or plan for retirement, and regardless of when it happens, it marks a significant time of transition and loss, Killam emphasizes.

However, proper preparation can make going through the loss less painful, says Nancy Rhine, a licensed marriage and family therapist with a private practice in the San Francisco Bay area.

When people decide to retire, “there’s a lot of anticipatory anxiety,” she says. “We tend to focus on … the process of retirement: When do I tell my boss? Am I going to have enough money? How will I pay my bills?”

In the flurry of planning and questioning, the emotional element of retiring can get lost, says Rhine, who specializes in gerontological counseling. She advises clients to take a few months, at minimum, to go through the steps of exiting their jobs so that they have time to process all of the attendant emotions. For clients feeling anxious or uncertain, Rhine recommends that they ask about the experiences of friends or colleagues who have been through the retirement process already, talking their fears and questions over with others and keeping a journal. She finds that when clients write down their thoughts, it prevents them from “spinning their wheels” by obsessing, ruminating and overthinking.

When the final month of work arrives, the mood often becomes celebratory, Rhine says. Clients typically are looking forward to giving up the daily grind. Flash-forward to the final week, and there are often farewell lunches with co-workers and maybe even a party. And then the party is over. What then?

“Now you’re thinking, ‘I don’t have to get up early, I don’t have any set schedule.  … This is great! I’m going to call my friend and go to lunch with her, watch the news …’ That tends to last about a month,” Rhine says.

Moll agrees, explaining that although the newly retired do typically feel a sense of freedom, there is usually a point at which people sit up and ask themselves, “Is this all there is?”

“Then,” says Rhine, “you tend to start thinking, ‘A lot of my friends were at the office. That’s who I was talking to every day.’” Clients may then decide to reach out to retired friends for inspiration, only to find that some are busier than ever, serving on every committee and constantly on the move, while others are sitting on the couch, bored out of their minds. Neither option necessarily speaks to the way these newly retired clients want to live their own retirement years.

Clients frequently fall into the trap of comparing themselves with others who have retired and thinking, “I’m not doing this right. What’s wrong with me?’” Rhine says. “There’s a tendency [for clients] to want to rush through and figure out the answer really quickly. You don’t know who you are in retirement yet. Give yourself time. There is no one way to do it; no one-size-fits-all.”

Moll adds that part of the transition is letting the pendulum swing from doing nothing to beginning to find structure.

“I advise people to take their time,” Rhine says. “Don’t sign up for a lot of responsibilities, such as volunteering or joining committees, right away.” Overscheduling and trying to figure everything out all at once can lead to clients feeling overwhelmed and depressed, she says. Instead, she encourages recently retired clients to let the dust settle before sticking a toe in the “after” pool. “Then go try things,” Rhine says. “Go to a book club one time and check it out, volunteer for one shift someplace, join the gym.”

To further help these clients stave off anxiety and depression after retiring, Rhine also urges them to be committed about getting exercise any way they can, getting outside every day and eating well.

Rhine says it can take as long as three to six months for retirees to get their “sea legs.” She adds that people who have been working in high-stress jobs in particular are going to feel exhausted and will need to take time to rest and decompress.

In search of

Because many people do a substantial portion of their socializing through work, retirement may require a search for a new social circle, and that isn’t always easy, Moll says. Although clients have to do the work and open themselves up to these new relationships, counselors can help them identify potential social networks.

For instance, if clients have a place of worship, Moll urges them to think about how they might make connections there. If clients aren’t spiritual or religious, she asks about hobbies that might give them opportunities to meet others with similar interests.

Moll has even suggested that retired clients invite their neighbors from down the street for a backyard cookout. “Know your neighbors,” she advises. “You don’t have to adopt them. You don’t have to give them holiday gifts. Just talk.”

Moll notes that clients who are retired need to be open to meeting new people. She shares that her father was “adopted” by a bunch of younger golfing buddies whom he met while hanging out at the local bar.

Many people, but men in particular, equate their work with who they are. “Your identity may be your career or your job, but you are more than that,” Moll tells these clients. “You need to look at what the other components are that define you.”

For instance, she might ask, “Do you have areas of interest that you want to spend more time on or make money off of? Do you have extended family that you moved away from that you now want to move closer to?”

Moll says she knows many retirees who have full and busy lives that revolve around babysitting grandchildren, volunteering, working part time or traveling. “I think you need to find rhythm and passion,” she says. “You need to find a passion that you’ve dreamed of doing, being [and] having, and a rhythm that’s appropriate for you today, and just go with it.”

Rhine and Moll say that retirees’ hobbies and interests may even turn into business opportunities, part-time jobs or simply a way to earn a little money on the side. Moll had one client who had spent most of his career in retail. After retiring, he needed to supplement his income, but he didn’t want to remain in the retail field. Looking for other ideas, he and Moll talked about his interests.

“He and his wife enjoyed traveling but did not have the funds to [as he put it] ‘follow life beyond the AAA TripTik,’” Moll says. Moll and the client talked about how he might turn his interest in traveling into a job opportunity, and in a few weeks, the client arrived at his counseling appointment with big news. He had found a part-time job delivering small buses and ambulances around the United States and into Canada. The company would pay for him to fly home once the delivery was completed. The client not only turned his hobby into a money-making opportunity but was also able to share his journeys with his wife, who often went along for the ride.

“Together, they traveled throughout the Southwest, along the California coast and to Calgary, Canada,” Moll says. The client’s wife died before he did, and Moll says the memories from those trips were a source of comfort and joyous remembrance for the remainder of his life.

Crowded house

In 1991, a Japanese physician, Nobuo Kurokawa, coined the phrase “retired husband syndrome” in a presentation to the Japanese Society of Psychosomatic Medicine. For years, Kurokawa and other Japanese physicians had been seeing scores of older women with serious health problems such as ulcers, rashes, polyps, slurred speech and other ailments that were seemingly without cause. However, the women’s mysterious physical complaints appeared to have a common starting point: the retirement of their husbands. Accustomed to having the house to themselves, these Japanese wives were now confronted with spending the bulk of their time with their formerly high-powered and frequently demanding husbands — and Kurokawa theorized that it was making them sick.

Spousal tensions triggered by retirement aren’t exclusive to Japan, and they aren’t caused solely by husbands. Retirement of either or both partners can cause significant relationship strain. Even so, Rhine notes that the home is often still traditionally the woman’s bailiwick, and many of the problems she sees with clients do start when the husband retires.

“Here’s the wife — her husband is home all the time, and she’s thinking, ‘Get out!’” Rhine says. Meanwhile, the husband is trying to adjust to retirement and is unsure about what his wife needs.

“She may need to get out of the house more to be with her friends and commiserate,” Rhine says. But the same may hold true for the husband, she adds. After all, he is also dealing with the loss of his regular schedule and personal space. One possible solution is for the wife and husband to set up a schedule in which one of them goes out while the other stays home a couple of mornings each week.

Rhine also stresses communication skills — particularly the “I” statement — with her retired clients. “‘I feel this.’ ‘I need this.’ It requires you to think, ‘What is it that I feel? What is it that I need?’” she explains. These basic skills make it easier for each partner to say things such as “I feel like I need more space,” “I feel pressured” or “I feel criticized,” Rhine says.

In fact, couples need to sit down and have a conversation about retirement well before either person stops working, Moll says. Otherwise, they risk running into scenarios such as a husband working hard to map out all of his post-retirement activities, while the wife harbors plans of her own to return to school, Moll says.

“He’s retiring thinking they’re going to travel, and she’s picking up where she left off,” Moll says. “There has to be some conversation about each other’s dreams and goals and how to get those met, while also finding time to be with and enjoy each other’s company.”

Both Rhine and Moll say it is never too early to start planning for retirement.

Rhine tells clients to dream about what they want to do and to think about where they see themselves in five, 10, 15 or more years. “Allow yourself to have dreams. Hope is a big part of emotional health,” she says. “There’s going to be a lot of good chapters opening up. Will there be hard times? Yes, life has hard things, but odds are there are going to be a lot of good times [too]. Stay open to possibilities.”

Says Moll in conclusion: “We retire from work; we don’t retire from life.”

 

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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.

Examining our assumptions about emerging adulthood

By Peter Allen June 12, 2017

For many counselors and educators, the term failure to launch is a familiar part of the American lexicon. Some have referred to this phenomenon as an “epidemic,” and a few prominent clinicians have even described it as a “syndrome.”

This classification is problematic for a number of reasons, including that it fails to consider the longer arc of human history and development. Referring to our clients as having “failed to launch” begins the relationship with judgments and disconnection rather than a sincere desire to understand and help. When we commence our helping relationships by adopting a judgmental and comparative stance, we start off on the wrong foot with our clients and communicate to them that we have little to learn. This is, in effect, very poor modeling of the skills and traits that we hope to instill in them.

The problem

What do we mean by failure to launch? Usually this language is used to describe young adults, typically between the ages of 18 to 25 or so, who have not met the traditional benchmarks of adulthood in some fashion. The stereotype usually depicts young 20-somethings who are living in their parents’ basements, playing video games and generally not contributing to the household in a meaningful way.

In general, we observe a lack of motivation and a delay in the acquisition of skills and traits that we typically associate with adulthood: financial autonomy, independence, stable relationships, responsibility and some sense of obligation to society or the collective. We want our adolescents to grow into mature, productive adults. Because numerous examples of these adults are readily available for view, the contrast between them and the so-called failure-to-launch crowd becomes striking.

The English word adolescence comes from the Latin word adolescere, which means “to ripen” or “to grow up.” This is important because young adults, despite some thinking to the contrary, are very much still in adolescence. They are in the period between childhood and adulthood, with a foot in both worlds, so they exhibit characteristics of both stages. This presents unique challenges for those of us who encounter them in this in-between stage.

Although we basically understand what adolescence is, when it ends depends on the culture in which we were raised. For example, in Mexican culture, the quinceañera is held for young women at age 15. This coming-of-age celebration marks the beginning of adulthood in that culture. The Jewish faith marks this moment at age 13 with the tradition of the bar mitzvah and the bat mitzvah. In Japan, an event called Seijin no Hi (Coming of Age Day) occurs at age 20 and marks the passage into adulthood. The Chambri people of Papua New Guinea, sometimes called the “Crocodile People,” use ritual scarification to mark the passage of young males from childhood to adulthood. This ceremony can take place anytime between the ages of 11 and 30.

It is interesting to note the difference in timing for these cultures. I am particularly struck by the range of ages in the Chambri custom. They have perhaps come closest to identifying the actual biological range within which adolescence occurs.

Taking a cognitive behavior approach

Young adults are sometimes just beginning to evaluate the power of their own thinking to positively or negatively shape their world experience. There can be some confusion about the difference between thoughts and beliefs. In my own evaluation, a belief is simply a persistent thought that has become true or seems real to the person. For instance, if I have the thought that God exists, and if I think this way for long enough, it becomes a belief.

I like to use a story that I call “A Tale of Two Apple Trees” to teach this concept. In this story, I have an apple tree on my property. I have a lot of thoughts and beliefs about this apple tree. This apple tree is my property. I bought it, I watered it and I fertilized it. So when a stranger walks by and picks one of my apples, how do I feel? I feel angry. What am I likely to do with my anger? I am likely to have a confrontation with this person. My beliefs led to my emotion, and my emotion led to a behavior.

My neighbor also has an apple tree in her yard. Like me, she has a number of thoughts and beliefs about the apple tree, but they are quite different from mine. She believes that everyone deserves to have food. She also thinks that because she has many dozens of apples on her tree, she can certainly spare a few for someone who wants them. So when someone walks by her property and picks an apple to eat, how does she feel? Most likely she feels happy. What is she likely to do? It is likely she will approach this person and have a positive interaction. Her thoughts led her to certain feelings, and those feelings precipitated specific behaviors.

The point here is not about determining the true nature of apples and apple trees in the world. The point is that, objectively, the same thing happened to both of us: Someone picked an apple off of a tree in our yard. But our respective experiences of that event were drastically different. Based on my beliefs, I experienced anger and then behaved in a confrontational manner. My neighbor experienced happiness and then behaved in a friendly manner. We all must choose what to believe based on our life experiences and what makes the most sense to each of us.

As clinicians and educators, I think we have collectively failed to monitor our own thinking about this population. We know that thoughts lead to feelings, and feelings can lead to actions. Are we applying this knowledge to ourselves in our work with young adults? We should acknowledge that we have chosen certain beliefs about young adults and, as such, these cognitive structures are negatively influencing our experience of working with this population. One of my goals is to bring those structures into our awareness so that we can nobly wrestle with them and make more assertive decisions regarding how we are going to show up in relationships with our clients.

When we use the term “failure to launch,” we clearly display our belief that the young adult has failed in some capacity. I have also heard this called prolonged adolescence; in other words, this particular period of adolescence is taking longer than normal. Who determines what is normal? Struggling is a word often used with this population. They are certainly not thriving and not succeeding like their counterparts, who have not been labeled as “struggling.” Even the term late bloomer, which on the surface seems gentler, indicates that these individuals are not on time in their development.

Let’s assume that you came to see me, a counselor, to help you work through some issue. Perhaps you and your partner come in for couples counseling to work on better communication. How would you feel if I said to you, “Sure, I can help you with your failure to communicate”? My guess is that you would experience an immediate disconnection from me because you may not perceive yourself in that way. I am starting out from the position that you have failed. Or maybe you want to become more assertive with your parent, and I respond by saying, “I would be happy to help you while you struggle to assert yourself with your parent.” Wanting to work on something is not the same thing as struggling with it. This language betrays my internal dialogue about you.

We know that we cannot think ill of our clients, even unintentionally, and then hope to show up with compassion and warmth for them in session. There is a discipline involved in thinking well of clients, actively, so that their best interests are always at the forefront of our efforts. If we begin our work with young adults from a judgmental place, then our feelings and behaviors will follow accordingly.

That is why I advocate for a term I encountered while researching this subject: emerging adulthood. I believe this is a judgment-free term and one that is actually more accurate. Then our primary cognitive framework can begin from an understanding that these people are emerging as adults, in their own individual way, and there may be some issues or difficulty for them during this period.

Around the world

Many factors contribute to the belief that emerging adults have failed in some capacity, but one factor in particular has a very powerful influence on our perceptions of how young adults are developing — whether they leave their parents’ homes within the “proper” time frame. According to the Pew Research Center, in 2014, 32 percent of young adults ages 18-34 were living at home with their parents in the United States. This number is likely higher than most readers might have guessed.

As I thought more about this, I wondered how the rest of the world views this issue. Fortunately, the Pew Research Center has collected extensive data about young adults living at home in Europe. According to this research, Denmark is at the lowest end of the spectrum in Europe, with about 19 percent of young adults ages 18-34 living at home. At the high end of the spectrum is Macedonia, where about 73 percent of young adults in the same age range live at home with their parents. Most of Eastern Europe is in the 50 to 60 percent range. Most of the Scandinavian countries are in the 20 to 30 percent range. Why is there no failure to launch “epidemic” there?

In much of Latin America, including Central and South America, it is common for young people to live at home with their parents until they have completed school, partnered with someone in a long-term romantic relationship or begun their career. In an article from 2007, psychologist and researcher Alicia Facio and her team found that 71 percent of Argentinean emerging adults lived with their parents or other relatives.

Let’s turn to Asia for a final example. A 2014 Huffington Post article titled “Here’s Why It’s Not Weird for Indian Men to Live at Home With Mom and Dad” stated: “Typically, in the Indian culture, returning home after high school or college is not only encouraged, but expected. Even living in America, parents who have migrated here from India have instilled in their children the idea that living with their parents is how Indian ‘joint-families’ work. Most children will stay with their parents up until marriage and some even after marriage, and the Indian ‘society’ accepts this as the norm. There is no taboo, no judgment, and there is no shame — from the male or female perspective. Children are meant to stay with their parents to be taken care of, and as the parents grow older, the children are expected to take care of their parents in their home.”

The key part of this passage for me is the part that states there is no taboo, no judgment and no shame. Unfortunately, the American approach has plenty of all three.

There are actually numerous benefits to young adults staying at home beyond the age of 18 or 19. These benefits are not discussed much in the United States but are well-known to many other cultures around the world.

One thing young adults can do with greater success when they stay at home longer is save money. And nothing helps someone “launch” like having some money saved. In addition, with some healthy boundaries in place, the increased contact between young adults and their parents can actually lead to better long-term familial relationships. As the example about Indian families shows us, young adults who live at home longer are more likely to take care of their parents down the road when the parents may need support. The stability of this living arrangement also reduces anxiety for the young adult, and that readily lends itself to healthier development.

My assertion is that the American cultural emphasis on independence and autonomy is the driving force behind the current so-called failure-to-launch phenomenon. We want our young folks to be independent, but when they are actually capable of this varies widely from a developmental perspective. It is clear that Indian culture places a greater value on family connectivity than on independence. Therefore, there is much less pressure to get young adults out of the home, and thus they have more time to develop in a more stable environment — and with less shame. If American cultural beliefs are in conflict with the biological reality of human development, then perhaps it is our culture that should change.

If a young man is 25 and living at home in Argentina, his family is most likely accepting of this. It is normal for them. They do not see it as a problem provided that this young man is contributing to the household in some way. But a 25-year-old young man living at home in the United States is very likely to be viewed as being delayed somehow or, worse yet, considered lazy. This may be true even if he is contributing to the household, like his Argentinean counterpart. The same exact thing is happening in both situations (just like in my story of the apple trees), but our opinions of these young men depend on our beliefs about what is normal and healthy.

Integration of knowledge

This phenomenon is partly because of a failure to integrate knowledge from a variety of sources and disciplines. Practitioners in our field often draw on knowledge from psychology, but by also integrating information from anthropology, biology and sociology, we can develop a more accurate picture of what healthy human development looks like.

By now I hope I have demonstrated that the accepted timing of the path to adulthood depends entirely upon the culture in which one is raised. Biology tells us that the adolescent brain finishes developing in a person’s mid-20s. This piece of information alone should cause us to rethink our expectations of the average American 18-year-old. This neuroscience is widely known but seldom applied in day-to-day interactions with young adults.

Anthropology demonstrates to us that it is normal human behavior to live at home with one’s parents into one’s 20s. This is happening at very high rates all over the world. This discredits the idea that these other countries are all raising their young adults incorrectly and have been for millennia. This is not an “epidemic”; it is well within the range of normal human behavior. Sociology tells us that societies organized around principles such as family connectivity are sustainable over long periods of time.

When we put the knowledge from all of these disciplines together, it is fairly easy to see where we are going astray in the United States. When I presented this information to a group of clinicians, it was suggested to me that perhaps American culture is itself in adolescence. If that is true, then we should view ourselves as developing rather than as having arrived.

The counterarguments 

The principal argument I have heard repeated in many circles is that by letting our young adults live at home for a longer period of time, we will be raising a generation of infantilized people who will then be ill-equipped to manage their own lives. This is a valid concern, but I would respond by saying that the countries I have mentioned don’t seem to be creating generation after generation of incapable young people.

These cultures have been operating for centuries, continuously, and despite some current economic challenges, they seem to be making it work. If they were raising such incapable young adults, we probably would have seen their societies collapse decades or even centuries ago.

Having pointed that out, I am not suggesting that all young adults should get a free pass until age 25. On the contrary, we run the risk of enabling them by assuming, without testing them, that they are incapable of certain things. At the same time, we should rethink our basic position that a “healthy” person leaves the home at age 18 or 19 and should sail into adulthood with minimal disruptions from that point. What is healthy in the vast majority of the world appears to be leaving the parents’ home closer to a person’s early to mid-20s.

Both maturity and ability fall on a spectrum, so what I advocate for is the middle path. Some 18-year-olds are going to be very responsible and autonomous, while some 30-year-olds are going to need extra supports. We do not serve our clients well as counselors by comparing them all to the high-performing 18-year-olds. I acknowledge that in many cases young adults are experiencing significant gaps in their skills, engagement or motivation and need intervention to create healthy lives for themselves. In those instances, clinical and educational interventions are indicated.

Part of what we need to do better as counselors is ascertain exactly what the problem is before we intervene. Learning disabilities can play a large role in difficulties related to healthy development. If learning differences are a main cause of a young adult client’s stresses and problems, then it is we who have failed to adequately assess those challenges and make reasonable accommodations.

It has been mentioned to me several times that the difference between the other countries I have named and the United States is that young adults who live at home in those other countries are expected to contribute to the household. All of the clinicians I have asked about this have told me that they have worked with so-called failure-to-launch cases in which they discovered that the primary intervention was actually to coach the parents to communicate their expectations more clearly and to establish better boundaries.

My experience of young adults is that they will take a good deal — every time. So if parents offer full financial support and a free place to live with few or no obligations attached, young adults will gladly accept. This does not indicate pathology in them, however. Instead it indicates intelligence and shrewd negotiating skills, both of which transfer quite well to the real world.

The parents of young adults are often used to parenting children. After all, they have done this for most of their parenting lives when we encounter them as counselors. It requires a deliberate and skillful shift for them to begin parenting their new young adults effectively. Our job as counselors is to help them facilitate a smooth and supportive transition, not to judge them for perceived mistakes that we likely would make were we in their shoes.

In addition, when we encounter young adults and their families in our work, we should take very thorough histories so that we can understand the family’s unique culture and context and what is normal for them. From there, we can more effectively intervene for everyone’s benefit. For example, if the parents need to establish better boundaries, why would we offer intensive therapy to the young adult? If the parents have wonderful communication and boundaries, why would we presume to “teach” them something when we could be offering the young adult coaching and therapy services? The intervention must always flow from a careful and proper assessment of the situation and presenting problems.

The one-size-fits-all approach dictates that if someone uses the term “failure to launch,” then we assume the young adult is to blame for whatever is going on. This is an incredibly simplistic model for an astonishingly complicated developmental process. In short, our task as counselors is to separate legitimate clinical issues from normal, developmental ones.

Conclusion

As clinicians and educators, we need to actively monitor our thinking about young adults and choose a set of cognitions aligned with biology and normal human development. Our schools, clinics and programs need to be free of judgment-laden language that disconnects us from our clients and students.

We need to also recognize the wisdom that comes from a variety of cultures, countries and research-based science. We should acknowledge that we might have some cultural beliefs that, although deeply held, are incongruent with healthy human development. When we encounter these beliefs, we need to work publicly and privately to change them. The result will be better education and treatment for our emerging adults — and a better society as a whole.

 

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Peter Allen is a licensed professional counselor and the program director at College Excel (collegeexcel.com) in Bend, Oregon. The company helps college-bound young adults who have attention-deficit/hyperactivity disorder, depression, anxiety and executive functioning deficits to succeed academically. Contact him at petercallen@gmail.com.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

 

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Related reading on emerging adulthood from the Counseling Today archives: Validating the quarter-life crisis

 

 

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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.

LGBTQ issues across the life span

By Laurie Meyers March 24, 2017

The specific biological mechanisms that underpin how people develop as lesbian, gay, bisexual, transgender, questioning or queer (LGBTQ) are still undiscovered, but what many researchers have determined is that neither sexual/affectional orientation nor gender identity is a choice. Rather, they are innate, unchangeable parts of who a person is, much like skin color.

And like people of color, LGBTQ individuals regularly encounter significant prejudice throughout their lives. This stigma can make life’s typical slings and arrows all the more painful. Although tremendous progress has been made in LGBTQ rights in the past few decades, counselors must still work to understand the barriers that these clients face across all stages of the life span.

“Growing up in any marginalized group can cause issues surrounding identity,” says Misty Ginicola, the lead editor of the new book Affirmative Counseling With LGBTQI+ People, published by the American Counseling Association. “For LGBTQI+ persons” — referring to individuals who identify as lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual, ally, pansexual/polysexual or two-spirited — “the unique identity surrounds not only who they bond with and are attracted to, but very often also their own gender identity and expression. Rather than having their differences be celebrated, unfortunately, LGBTQI+ people commonly grow up in an environment where they internalize very early on that their differences are taboo or undesirable, particularly if they grow up in a disaffirming religious context. Being marginalized also puts a person at greater risk of experiences of trauma and bias incidents, which impacts how safe a person is in any given context.”

Growing up LGBTQ

In general, experts are finding that children and adolescents are growing more comfortable with coming out at an early age, according to Ginicola, a professor of counseling and school psychology and coordinator of the clinical mental health counselor program at Southern Connecticut State University. If this coming-out process transpires in a supportive and affirmative environment, it can help LGBTQ students to form a strong sense of self and establish healthy relationships, she notes. However, in many cases, these individuals face significant stigma from an early age.

“Being LGBTQ in school requires continuous negotiations between authenticity, connection, safety and health,” explains Colton Brown, a member of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (ALGBTIC), a division of ACA. “Students may find themselves in unsupportive or even hostile environments.”

ALGBTIC President Tonya Hammer notes that physical, emotional and verbal bullying of LGBTQ students begins as early as elementary school or even prekindergarten. “While physical bullying, particularly that which results in injury and at times death, is prevalent and probably the most talked about since it makes the news sometimes, the cyberbullying and the emotional and mental bullying that take place can often be just as harmful … if at times not more so,” she says.

LGBTQ individuals may be subject to bullying across the life span, but the experience of being bullied can be particularly devastating when it occurs early in a person’s life, says Hammer, an assistant professor of counseling and coordinator of the counseling program at Oklahoma State University. “The power of language and words to inflict damage — especially on children — is often dismissed,” she says.

Insults and taunts — long a staple of playgrounds and classrooms — have found an additional and often particularly vicious arena in cyberspace, warns Hammer, whose research focus includes both bullying and the intersection of gender and sexual/affectional orientation. “Cyberbullying — from Instagram to Snapchat — is only growing and, unfortunately, much harder to address and remedy,” she says. “If physical bullying takes place on school grounds, counselors, teachers and administrators have the capability to take action. However, much of cyberbullying takes place outside of their purview, as well as that of parents, and often goes unnoticed by adults.”

Transgender students are particularly at risk for bullying, stigma and rejection, says Brown, a counselor in the college clinic at the University of Central Oklahoma and a doctoral student in counseling psychology at Oklahoma State University. “Transgender students often face difficulty with coming out because their authentic selves are typically much more visible than [that of] LGBQ students,” he notes. “These students face bathroom and locker room barriers that may come from peers, teachers, administrators and even state policies.” Transgender students also may be excluded from participating in many extracurricular activities such as sports teams because of their gendered nature, he says.

Brown points out that these painful exclusions are happening during a crucial developmental period when adolescents are typically learning how to form various emotional bonds. Transgender and other LGBQ adolescents “may be looking for friendship or romance but can be met with rejection [instead],” he says.

Further complicating matters for many transgender adolescents is that they may not be able to fully establish their personal identities. Those who wish to transition medically need parental support until they are 18, Brown explains.

But transgender students are not the only members of the LGBTQ community who face unique barriers in coming out and finding community, Brown says. Bisexual youth also often find themselves struggling for acceptance and a sense of belonging, not just among heterosexual, cisgender students, but also within the greater LGBTQ community, he says.

“Bisexual people are generally defined by who they are dating at a given time,” Brown explains. “For example, if a male student is dating a female student, then [he is] assumed to be heterosexual. If that same male student is dating a male student, the script flips, and he is now considered gay. Students do not often consider that this student may actually be bisexual. These perceptions can result in these students not feeling ‘straight enough’ for the heterosexual kids or ‘gay enough’ for the gay kids.”

“Bisexual students are in this middle ground in which they may be left without a close-knit group unless they find other bisexual students,” Brown continues. “These students may also struggle more with coming out due to the continued pressure to define themselves outside of who they are or are not dating. Other students also internalize monosexist messages from adults, media and culture and may harass or discriminate against bisexual students. These factors can result in bisexual students feeling shame and may result in internalized biphobia.”

The potential rejection and lack of support may lead LGBTQ children and youth as a whole to be wary of being their authentic selves with friends, teachers, parents and counselors, Ginicola says. “They may also attempt to hide this identity from romantic partners before they have accepted their affectional orientation or come out to others,” she continues. “In this context, identity development in adolescence is disturbed, particularly if they experience rejection.”

A safe space

The good news is that counselors can help bridge the acceptance gap for LGBTQ youth.

“Counselors can create a safe space by a variety of means,” Hammer says. “It can be as simple as displaying an HRC [Human Rights Campaign] ‘equal’ sign in their office or a small rainbow flag somewhere. I know that sounds minor, but small symbols can signify something to students.”

“It is also a matter of having resources available,” she says. “GLSEN [formerly the Gay, Lesbian and Straight Education Network] has a resource called Safe Space Kit that provides curriculum, activities and also stickers that can be displayed which indicate that your office is a safe space. Additionally, counselors can provide programming that is LGBT inclusive or sponsor organizations like a Gay-Straight Alliance. There are activities or weeks that counselors can help organize, such as No Name-Calling Week, Ally Week and Day of Silence.”

When meeting with students, school counselors can create supportive environments by using language that does not assume a student is attracted to any particular sex, Brown says. “This can let students know that you are open to them sharing that information when they are ready,” he says. “School counselors can also be sure to have pamphlets and information sources that include LGBTQ issues and use these examples if they present to classes. Counselors can also include LGBTQ sensitivity training in any presentation they may give to faculty and staff so that the supportive environment may be spread.”

GLSEN has been tracking the school experience of LGBTQ students since 1999 through its National School Climate Survey. Although the survey has shown an improvement in awareness and acceptance of LGBTQ students in schools, significant harassment and discrimination still exist, particularly in relation to transgender students. The 2015 survey found that 85.7 percent of LGBTQ students heard negative remarks from their peers specifically about transgender people, whereas 65.3 percent heard negative remarks from teachers and other school staff members. The survey also found that 22.2 percent of transgender students had been prevented from wearing clothing considered inappropriate based on their legal sex, while 60 percent of transgender students had been required to use a bathroom or locker room of their legal sex.

In late February, President Trump rescinded a 2016 directive issued by President Obama that ordered schools to allow transgender students the use of bathrooms that match their gender identity. The battle reached the Supreme Court with G.G. v. Gloucester County School Board, in which Gavin Grimm, a transgender boy, filed suit against the Virginia school board alleging that it violated Title IX of the Education Amendments of 1972 by denying him the use of the boys’ restroom. On March 2, in a development indicative of growing support for transgender individuals, 53 major businesses signed on to a “friend of the court” brief in support of Grimm. However, the case ultimately was sent back to a lower court.

School counselors can play a critical role in supporting the rights of transgender students, Brown says. “School counselors can help advocate for and with transgender students through engaging in school policy discussions and promoting fair bathroom, locker room and athletic policies,” he urges. “They can also be outspoken against bullying of transgender students and assist other school professionals with stopping bullying. Importantly, school counselors can also support transgender students simply by using [these students’] identified names and gender pronouns. Although this seems small, many students are not supported in this way, and acknowledging [their] true selves can help foster their development.”

Brown also encourages school counselors to educate themselves about the multiple identities that fall under the transgender umbrella, such as gender-queer (individuals who do not identify with conventional gender distinctions, such as solely male or female, but instead identify with both or neither) and gender-fluid (individuals whose gender identification fluctuates over time).

Hammer adds that the Southern Poverty Law Center and its Teaching Tolerance program provides materials for schools that focus not only on LGBTQ identity issues but also ethnicity and racism. “It is important to remember that our cultural identity, no matter what our affectional/sexual orientation, is made up of so much more,” she says. “The intersection of our ethnicity, age, religious and/or spiritual orientation, gender, affectional/sexual orientation, where we live, etc., are all important factors to consider when working with a client. As a counselor, you should not ignore any aspect of a client’s culture. For example, the intersection of affectional/sexual orientation with a person’s religious and/or spiritual identity can either be a source of support and comfort for someone, or possibly a source of rejection and trauma.”

As always, Hammer says, the most important thing to focus on when working with LGBTQ students is the counselor-client relationship. “Listen to them with respect and treat them with dignity and not as if they are abnormal,” she says. “Let them know that they matter — to you, to their families and to the world.”

Working for a living

One of the hallmarks of adulthood is the ability to support oneself, which typically means going to work, notes ACA member Larry Burlew, whose research specialties include issues around adult development, gay men and career development. However, work can be an uncertain and sometimes hostile place for LGBTQ individuals, Burlew says.

For instance, those who are LGBTQ often have no legal protections against discrimination in the workplace, says Burlew, a counselor educator who is retired from full-time teaching and is currently an affiliate professor at the Chicago School of Professional Psychology in Washington, D.C. There is no federal anti-discrimination protection for LGBTQ individuals, and only 20 states and the District of Columbia prohibit discrimination on the basis of sexual orientation or gender identity.

“It’s easy for them to be dismissed from work without necessarily a good reason,” says Burlew, who was also a licensed professional counselor with a small private practice for almost 30 years.

Even if a workplace is not actively hostile, there may be what Burlew calls a “lavender ceiling” — an environment of subtle but pervasive anti-LGBTQ discrimination. So when LGBTQ individuals first enter the workplace or start a new job elsewhere, they are often dealing with a lot of unknowns, he says. As a result, some LGBTQ individuals decide not to come out or be out at work, choosing instead to keep that part of their identities very private, Burlew says. For LGBTQ individuals, this can require a delicate balancing act between developing and keeping social workplace connections and not fully revealing who they are, he continues.

Even those individuals who are fully out at work often still find themselves managing perceptions, Burlew says. “I think that LGBTQ workers get very creative about how to be successful. When you get to an organization, you get creative about how to present who you are in a way that is acceptable to fellow workers,” he says. “[The question becomes], how do you introduce it in conversation?”

LGBTQ workers also have to determine how they will handle microaggressions, Burlew says. He adds that he has been in situations in which he had to decide whether it was safe to address certain comments and jokes that disparaged the LGBTQ community.

Concerns about how they might be perceived can even influence professional choice for LGBTQ individuals. “I’ve had [clients] throughout the years such as gay men who wanted to go into, say, construction and had fears about that,” Burlew says. He would have these clients visualize going to work in the environment that they feared and imagine how they would be received. Then he would talk with these clients about their fears and explore possible scenarios to help them build skills for dealing with problematic situations.

Burlew uses the example of a gay man working in project management at a construction site who hears that some of the workers have been making fun of him when he isn’t around. What are this man’s options? He has to decide whether he feels safe trying to change the environment (a process called an active adjustment) or if he will choose to change himself instead (a reactive adjustment).

In the case of an active adjustment, Burlew and the client would discuss the potential consequences of trying to change the workplace. They would then work on how to use assertive communication to address the problem. This might include having a conversation with the men making the jokes and saying something such as, “I’ve heard that you don’t want to work with me, and I was just wondering if it has anything to do with me being gay?” Burlew would help the client develop assertive communication skills through role-play and practicing what he wanted to say. Burlew and the client would repeat these techniques until the client felt comfortable addressing the problem on his own.

In the case of a reactive adjustment, Burlew would help the client reduce his stress level through systematic desensitization. He would do this by having the client talk about the incident in which he experienced the most stress. They would continue to “practice” the incident until the client could imagine the situation without feeling an undue level of stress.

Burlew and the client would also talk about avoiding work scenarios, if possible, that caused the client the most stress. If avoiding these situations was not possible, Burlew would help the client evaluate how to move forward by asking questions. Did the client need to stay in the position for his career? If so, for how long? Were other alternatives possible, such as pursuing additional education or staying with the company but taking another position?

Relationships and family

Life isn’t just about work, of course, but also about personal connections and family.

Young adults can sometimes struggle to establish intimacy, and Burlew says this can be even more of a challenge for LGBTQ individuals because they are often still trying to sort out who they are. They may not be fully out, even to themselves, he explains, which can delay establishing relationships. Then, as these young adults begin making connections in the LGBTQ community and start dating as LGBTQ individuals, additional challenges can arise.

“In addition to the bountiful issues that face heterosexual, cisgender couples, LGBTQI+ couples face [other] stressors from being marginalized,” Ginicola says. “Experiencing bias incidents, trauma and rejection from loved ones can add incredible stress to a relationship. It can be particularly traumatic to have people who are supposed to unconditionally love you — parents, family and your closest friends — disapprove of or reject your partnership while celebrating heterosexual relationships with showers, weddings and family pride.”

Problems can also arise if partners have different degrees of “outness.” As Ginicola explains, “If one person in the relationship is fully out to others, and one partner is not, this can cause additional struggles within the relationship, where one person may feel invalidated.”

In such cases, it is important for counselors to explore the reasons that one partner prefers to remain in the closet or less out, she says, paying particular attention to how each partner’s coming-out experience may have differed. The partner who fears being fully out may have come from a culture in which being LGBTQ was not just taboo but also put the individual at high risk for violence. Or the person may have grown up in a religious background that stridently disapproved of LGBTQ individuals, Ginicola explains. Counselors should also encourage the out partner to talk about how it feels for the relationship to be “hidden,” Ginicola says. By improving communication, counselors can often help these couples resolve their conflict in a way that works for each partner, she says.

Another area in which LGBTQ individuals and couples face significant barriers is family planning. “In some states and in most international adoptions, same-sex couples cannot adopt,” Ginicola points out. “Therefore, they may have to utilize expensive alternatives, such as artificial insemination or IVF [in vitro fertilization] or surrogacy.”

“Again, counselors should employ affirmative counseling techniques to support these individuals and partnerships,” she says. “Acknowledging the realities and struggles of being an LGBTQI+ couple or relationship is important, as is providing nonjudgmental support and connecting clients to resources that can help them with family planning that is specific to LGBTQI+ couples.”

Taking a toll

As individuals face the various struggles that are unique to being LGBTQ throughout childhood and into adulthood, it can take a significant toll on the body.

“The LGBTQI+ person is under much greater stress than is typical for a heterosexual, cisgender person,” Ginicola says. “If the person has intersectional identities that are also marginalized — ethnic minority, immigrant, differently abled — this stress will be exponentially increased. Although anxiety, depression and suicidal ideation are common as a result of this increased stress across the LGBTQI+ spectrum, the research indicates that each subpopulation experiences different physical and mental health problems.”

“For example,” she continues, “lesbian and bisexual women are more likely to be obese and are more likely to smoke. Gay men are more likely to experience eating disorders, including anorexia, drink excessively and use substances to cope, which impact their physical health.”

In addition to all of this, medical doctors aren’t always cognizant of how LGBTQ health needs might be different from the needs of their other patients, says ACA member Jane Rheineck, a past president of ALGBTIC. For example, she notes, gynecologists often offer lesbians — even out lesbians — birth control.

In addition, LGBTQ individuals often feel uncomfortable or unsafe disclosing in doctors’ offices, Rheineck says, which means that they may delay or even altogether avoid seeking health care. Counselors can help by educating LGBTQ clients about some of the unique risks that they face, but also by providing them with validation, support and empathy for these difficulties, she says.

“Psychoeducation surrounding minority stress, understanding why these negative coping factors are there, [and] recognizing and validating the stress that they experience is crucially important,” Ginicola says. “Cognitive behavior therapy can be helpful in this regard. [It involves looking] at how their inner self-talk and coping skills are moving them more toward their goals or further away.”

Ginicola says counselors can also help clients find LGBTQ-friendly health care through resources such as the Gay and Lesbian Medical Association’s website (glma.org), which has a provider finder.

Being older in a youth-obsessed society is not always easy, but being older and LGBTQ can be even more difficult, Ginicola asserts. Older LGBTQ adults are not only discriminated against in general society but can often find themselves marginalized within the LGBTQ community, she explains. “Therefore, they may experience bias incidents both inside and outside of their community,” she says.

Older LGBTQ adults were more likely to have come out in a hostile societal environment, says Christian Chan, a former family counselor and current doctoral candidate in counseling at George Washington University in Washington, D.C. This history of intense stigma and marginalization puts older LGBTQ adults at even greater risk for mental health issues such as depression and substance abuse, he notes. In addition, at a stage in life when health care issues may necessitate the need for long-term care, older LGBTQ adults are more likely to have a difficult time securing it because retirement communities and nursing homes often discriminate against those who are LGBTQ, Chan and Ginicola say.

Counselors can help this client population, but only if they are aware of the issues, says Chan, who serves as the student trustee for ALGBTIC and the member at large for outreach and advocacy for the Association for Adult Development and Aging, a division of ACA. He emphasizes the need for further training in counselor educator programs and beyond.

“[We should] focus on extending training on how to discuss sexuality, affectional [orientation] and gender identity in conversations and meaning-making around self-disclosure and coming out,” says Chan, who is also president of the Maryland Counseling Association. “It appears to me that many counselors are unsure about how to navigate these questions at large in counseling, which makes the counseling less culturally responsive to older LGBTQ adults.”

Chan urges individual counselors to help their LGBTQ clients build social support networks. “This is especially important in the sphere of redefining family for older LGBTQ adults,” notes Chan, who adds that the concept of family may need to be extended beyond the traditional definition for these clients.

Chan also points counselors toward organizations such as Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders (sageusa.org) and the National Resource Center on LGBT Aging (lgbtagingcenter.org) that specialize in helping older LGBTQ adults. AARP’s website (aarp.org) also contains a significant amount of information on LGBTQ issues.

Transgender individuals walk a particularly difficult and dangerous road throughout the life span, confronting widespread misunderstanding and discrimination and an extremely high likelihood of becoming victims of violence, Ginicola says.

“Trans persons, particularly trans women of color, face incredible bias both inside and outside of the LGBTQI+ community,” she says. “When a person transitions, their family and partner must transition with them, which may not always be possible. For example, a trans male, designated as female at birth, may have been in a relationship with a lesbian. When he transitions to male, his partner may experience identity issues and  difficulty in accepting a male as her partner. Transitioning can bring a transgender person such relief in terms of finally being able to be their authentic self, but at the same time, they are likely to experience rejection, bias incidents and discrimination within their personal and professional lives. This is why trans persons are also at the highest risk for suicide.”

Ginicola says that affirmative counseling is crucial to transgender — and, indeed, all LGBTQ — clients. “Affirmative counseling is truly about validating an identity,” she says, “while understanding the realities of being marginalized, building coping skills, connecting clients to affirming communities and making cultural accommodations.”

 

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ACA Illuminate

The American Counseling Association will be holding Illuminate, an innovative counseling symposium focused on serving the needs of the LGBTQ community and those who work with members of this community, from June 8 to 10 in Washington, D.C.

Illuminate is a passion project for ACA President Catherine B. Roland, who has made LGBTQ issues one of her presidential initiatives. “The inspiration [for Illuminate] occurred many years ago and became real right after I was elected ACA president,” Roland says. “I knew that the marginalized population of the LGBTQ community, and the diversity and multiple identities within it, should be a focus of mental health treatment.”

Roland’s goal for Illuminate is to help more counselors and counselor educators gain a greater awareness of the needs of the LGBTQ community and learn how to offer the best care. She also hopes that the symposium will generate additional specific strategies for working with the population, families and career aspirations of LGBTQ adults across the life span.

For more information, visit counseling.org/illuminate. The deadline for early bird registration is April 7.

 

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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.

Journal articles (counseling.org/publications/counseling-journals)

  • “Long-Term Outcomes of Lesbian, Gay, Bisexual and Transgender Recalled School Victimization” by Darrell C. Green, Paula J. Britton and Brian Fitts, Journal of Counseling & Development, December 2014
  • “I Am My Own Gender: Resilience Strategies of Trans Youth” by Anneliese A. Singh, Sarah E. Meng and Anthony W. Hansen, Journal of Counseling & Development, April 2014

Counseling Today (ct.counseling.org)

Practice briefs (counseling.org/knowledge-center/practice-briefs)

  • “Counseling People Living with HIV/AIDS” by Brandon Hunt
  • “LGBTQQ-Affirmative Counseling” by Anneliese Singh and Maru Gonzalez

Books & DVDs (counseling.org/publications/bookstore)

  • Affirmative Counseling With LGBTQI+ People edited by Misty M. Ginicola, Cheri Smith and Joel M. Filmore
  • Group Counseling With LGBTQI Persons by Kristopher M. Goodrich and Melissa Luke

Podcasts (counseling.org/knowledge-center/podcasts)

  • “Queer People of Color” with Adrienne N. Erby and Christian D. Chan
  • “Group Counseling With LGBTQI Persons” with Kristopher M. Goodrich and Melissa Luke
  • “Living Straight: Coming Out After 40” with Loren Olsen
  • “Counseling Queer* (LGBT) Youth” with Anneliese Singh

ACA divisions 

  • Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (algbtic.org)

 

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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.

Walking with clients through their final days

By Laurie Meyers October 31, 2016

During the time that Kerin Groves spent by her dying client’s hospital bed, she could tell that he felt conflicted. “I sensed he kept hanging on because his adult children were unable to cope with him dying,” she recalls. “The son kept urging him to fight and get better, even though the patient was in his 90s and ready to go.”

When the man’s children left his room for the day, he visibly relaxed. Groves, a licensed professional counselor (LPC), gently pointed out the difference in his tension level.

“[I] let him know it was OK to go whenever he was ready, and I assured him that I would be there to help his son get through it,” Groves says. “He looked right at me, held my gaze for a time and then closed his eyes for the last time. Given permission and support, he was able to go in peace.”

Groves, an American Counseling Association member who has worked with older adults in retirement communities, assisted living, nursing homes and home care settings, is among a select number of counselors who routinely help individuals and their families cope with the process of dying.

Acceptance and denial

Receiving a terminal diagnosis, or having a loved one receive it, is almost too much to comprehend initially, says Mary Jones, an LPC who spent 20 years counseling patients and their families in an oncology center. “People go into shock, and there is an inability to wrap their minds around what they are hearing,” she says.

Loved ones who are in the room when the terminal diagnosis is given often go through a secondary trauma — shock at what they are hearing and concern for their loved one’s feelings, Jones says. In fact, she adds, these loved ones may initially experience more anxiety than the person receiving the diagnosis.

branding-images_final-daysJones counseled patients with varying prognoses, including those who would go on to live long lives after treatment, but in her role, she often saw people at the very end, when they had been told they had only months or weeks to live. “Once they know that treatment isn’t working and there are no more options, it seems like people hit a fork in the road emotionally,” she says.

One path certain patients chose was accepting their impending deaths but also determining to answer a weighty question: What do I do next? In her role as a counselor, Jones would talk to these clients about their legacies — what they wanted to say to or leave behind for their loved ones.

One of her clients was a father with a young son. He made a video that talked about the things he wanted his son to know but wouldn’t be there in person to tell him. The video included subjects such as what the son should know about middle school, about girls and about sex.

The other fork in the path that Jones commonly witnessed was complete denial of the terminal diagnosis. She heard patients make statements such as “This isn’t happening” or “I’m not going to die.”

As a counselor, her role was to try to guide these patients toward acceptance. She acknowledges that the task was difficult. “It so goes against our belief and training and experience [as counselors] to have to say to someone, ‘But your end is near,’” she says.

Jones would sit with these patients and encourage them to talk about their feelings regardless of what they were: fear, anger, sadness, disbelief, etc. After validating what they were feeling, she would circle back around to acceptance and the importance of deciding what they wanted to do or say before they died.

Groves, currently a private practitioner in Denton, Texas, often used existential and person-centered therapy when working with individuals in denial about their impending death. “Person-centered therapy gives the patient the lead in directing the conversation in the way they feel it needs to go, at their own pace,” she says. “We talk about denial openly and how it helps or serves a purpose, as well as how it might work against them. Helping a client make a cost-benefit analysis regarding denial is empowering and respectful of [his or her] needs.”

Of course, it isn’t uncommon for family members to be dealing with denial too. Jones, who would also provide family therapy in her role, says this can create tension between family members and the person who is dying, just when that person needs more support than ever.

Seeking support

Emotional support from family members is important, but the principal source of support for many clients is their husband, wife or partner. If discord is already present in the couple’s relationship, these problems will only be exacerbated by the stress of serious or terminal illness, says ACA member Nicole Stargell, who has used emotionally focused therapy (EFT) with couples facing breast cancer diagnoses. EFT operates on the premise that to feel “attached” (safe and secure) in a relationship, couples must be able to manage and share their emotions, she explains.

When certain people experience conflict or distress, they withdraw — sometimes physically — and don’t want to talk about the problem or issue, Stargell says. Other people are “pursuers,” she continues, and their desire is to talk about what is wrong. Pursuers will actively seek responses from their partners.

Anytime that either partner displays withdrawing or pursuing behaviors, implicit assumptions are being made, says Stargell, an assistant professor of counseling and the field placement and testing coordinator at the University of North Carolina at Pembroke. For instance, partners who withdraw often do so because they perceive themselves not to be strong enough to cope or view themselves as being deficient in some other way. When pursuers try to talk to withdrawers about what is wrong, this just reinforces the withdrawers’ feelings of deficiency, Stargell explains. Meanwhile, pursuers are thinking that withdrawers don’t regard them as being important enough to try to talk things through with them. As a result, both partners end up feeling alone and unsupported, which isn’t good for either individual’s mental or physical health, she says.

Using EFT, Stargell would identify the cycle of misunderstanding that plays out repeatedly between the couple but make it clear that neither partner is to blame. Next she would help the couple start to reframe their interactions by asking them to talk about a conflict and actually say out loud what they were thinking in response to their partner’s behavior.

Stargell would then help the couple see that their reactions had more to do with self-blame than with the other person’s actions. In other words, there was no implicit message attached. She would also have the couple role-play, taking turns presenting a problem and practicing reacting differently to what the other person said or did.

Stargell also works with couples to identify triggers or recurring situations that tend to set off the negative cycles. For instance, in the week following chemotherapy, the partner who is a withdrawer and is undergoing treatment might retreat emotionally, in part because he or she is sick and feels like a failure for not being able to perform his or her normal role, such as being the one who washes the dishes. Because the withdrawing partner is sick, the pursuer doesn’t want to push for interaction. However, Stargell says, it’s not uncommon for the pursuer to feel some anger or resentment about the things the partner with cancer — or the couple together — can no longer do. The withdrawer can typically sense the underlying tension, which makes him or her withdraw even more. Together, Stargell and the couple would talk about what the couple could do differently the next time the withdrawing partner has chemotherapy.

Approaching the end 

There are many ways that counselors can support and assist clients who know that they are dying. “I have helped clients find meaning in their personal [histories] and accept suffering during the dying process by engaging in life review and reminiscence, with both laughter and tears, allowing them to say what they haven’t been allowed to, reconciling unfinished business from the past [and] helping them connect with and share their true feelings with their loved ones,” Groves says. But sometimes, the most significant role is “just sitting with them in silence as a companion,” she adds.

Groves has also helped clients facing death to work through their fears and concerns. These have included issues such as feeling guilt about being ready to die when family members beg them to keep fighting; fear of more pain or agony; weariness from long medical treatments; spiritual doubts or fears; and anger over family conflicts erupting or being exacerbated during the medical crisis.

Jones would sometimes take on a sort of facilitator role with these patients, making sure they received what they wanted or needed in their final weeks or days of life. But counselors can also advocate for patients in other ways, Jones says. Especially toward the end, patients with terminal illnesses can experience a significant amount of pain but may not want to take yet another medication. She recommends that counselors working with this population educate themselves about alternative methods of pain relief and relaxation techniques.

As the end approaches, some individuals find it easier to accept that they are going to die, whereas loved ones often have the opposite reaction, Groves notes. “Curiously, people who are near death may be more calm … because they have accepted their prognosis, while their loved ones struggle with denial and avoidance because they are not ready to let them go,” she says. “When a person dies, the opportunity to make peace with them is over, so at least when the person is still hanging on, the belief or hope that it can be reconciled is still there. They may fear letting that person die with unfinished business still between them but struggle to vocalize those unsaid things because they don’t feel it’s appropriate or acceptable.”

Groves says counselors can also play an important role in preparing family members for what to expect in the dying process. “If hospice is involved, their nursing staff may make an extra effort to help counselors explain to the family what is happening biologically, the signs of impending death and other medical information,” she says. “A counselor can also be of help with active listening, reflecting feelings, normalizing emotional responses, addressing spiritual and existential concerns, and [exuding] warmth. Many people do not know what to do or say, so they do or say nothing at all, leaving the family members stranded in their grief. Counselors are equipped to sit with people in pain and be present with them.”

Groves also believes that being present when a loved one dies can be very healing for family members. “It’s very hard to witness a death and, frankly, most people fear and avoid that experience,” she says. “They are typically afraid they will be overwhelmed with their feelings and be unable to cope. But if one is willing and able to tolerate the discomfort, with the support of the counselor, being with a dying person in their final moments allows one to genuinely embrace the natural process of death and confront its reality, which is important for healthy grieving.”

 

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Related reading: See Counseling Today‘s November cover story, “Grief: Going beyond death and stages

 

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

Letters to the editorct@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.

 

 

Growing up: An allegory

By Shawn Patrick September 15, 2016

When I turned 39, I had a midlife crisis. I wasn’t home on my 39th birthday. I was on another continent, sitting in a hotel lobby at stupid early o’clock, jet-lagged and writing because I couldn’t sleep. I looked up, saw the date and realized my birthday had occurred while I had been traveling, the day lost somewhere in the time vortex that opens up when flying overseas. Technically, then, it was the day after my 39th birthday when The Voice screamed at me, “What have you been doing with your life???!”

Granted, I had earned a doctorate, had achieved tenure, had published manuscripts. I had two lovely children, and I had managed to stay married to the same person longer than any other person in his or my family history. These are not small accomplishments. But this is not what occurred to me in that panic-inducing moment. Rather, The Voice pummeled:

“Why aren’t you on The New York Times’ best-seller list yet? What happened to the blockbuster movie? Where is the Fields Medal? Why haven’t you played Carnegie Hall yet? You haven’t even photo-1458175049065-aefb15b1b58bbothered to figure out the grand unification theory bringing together quantum mechanics and the theory of relativity — you’ve been sitting back letting Stephen Hawking do all the work. What the &$@# is wrong with you?”

Part of the problem for those like me is that we still cling to our childhood fantasies of success. We grew up imagining ourselves getting discovered simply because Hollywood Movie Mogul in a red convertible Mercedes screeches to a halt while we’re walking down the street and shouts, “There, there is the person I’ve been waiting for!” And the other part is because we were given some remarkably confusing aspirational advice.

In grade school, I was in the first group of identified “gifted” children. I didn’t know what it meant, and no one else understood it either. But to the dozen of us who were selected, it meant that we could leave class a few hours each week and play games. This was a good deal in our opinion, so we didn’t question anything. Yet without our knowing, we were already receiving those sneaky messages about where our lives were supposed to end up.

The social strata are well-established by high school, telling us who is and is not supposed to be a productive member of society. We instinctively knew there were no real differences between these arbitrary groups; the “achieving” group could simply get away with more because no one expected us to do anything illicit. The “remedial” group included plenty of individuals who were extremely smart and capable, but for reasons well outside themselves, no one paid attention to them anymore. This stratification persisted due to factors outside our control and taught us about the many forms of privilege and its consequences.

Many of us slowly go insane from pressure to climb to the top of the mountain, to win, to be the best at whatever is deemed successful. If we don’t accomplish it, then we have let the whole of civilized society down, our ancestors are forever shamed, and our future offspring will only hope to dream about peeking through the window of a good school. Include the discourses bombarding teenagers about being “Someone” — e.g., a doctor is better than a nurse, a scientist is better than an artist, a rich person is better than a poor person. So often our legacies make no sense to us. We are pushed by unexplained, invisible forces, but if we make a mistake, we will ultimately carry all the blame for what goes wrong. Everyone loves to claim the credit when someone succeeds, but if that person fails, it’s all on you, baby.

I never knew what I wanted to do. When I graduated high school, I had one very well-meaning teacher give me the kiss of death. I experienced heart-palpitating conflict over choosing a college major. Enter this literature teacher who took great interest in my writing. At the end of the term, I asked him to sign my yearbook. He wrote:

“Good luck to you in all you do. I know you’ll go far. Keep writing because it’s clearly what you were meant to do. Of course the last person I said that to now only writes grocery lists. Best wishes, B.”

He had a genuine interest in my future, and I suspect he thought he was being funny. But he had no idea how this gong resonated throughout my core, highlighting the double bind I lived with: You can do anything you want, but what you want might not amount to anything.

When I turned 39 in a hotel lobby, all I’d really figured out was that in one year I’d be 40. What did I have to show for myself? Had I even come close to approaching some of the lofty aspirations I held for myself, or did I too end up writing grocery lists?

Part of maturity is realizing that the frenetic pace of youth cannot be maintained. Eventually, we have to abandon the immature need for immediate gratification. Recognizing our mortality means catching on to the idea that one is not interested in dying due to blowing out your own candle; death will come in its own time, so why not learn to live? These are the chronic existential conversations that infiltrated my head as an adult who had to concern herself with things like paying bills. And the appearance of children completely redesigns the landscape — a total home renovation that leaves you forever wondering where you left your keys. So pacing becomes a necessity. Priorities must occur because we are forced to write our own instruction manuals for adulthood.

But the adult dilemma becomes, did I pace myself too much? Did I slow down to the point of stopping? Specialization is an ironic creature. It is comforting to think you actually know something. However, the danger in such comfort is that it can easily lull you into complacency. Did I avoid the new thing because I didn’t have the time, or because it would mean stepping outside of what was familiar? In the guise of developing “expertise,” did I actually limit myself from gaining knowledge?

“How have you made your mark on the world?” Regardless of how far-fetched, lofty, idealistic or fantastic my earlier aspirations were, they were there to tell me to make more of myself. Not in the sense of being the best, biggest, brightest or richest, but in the way of being more than just what was prescribed for me. Have I challenged myself? Have I at least tried to take a risk, or do I still play it safe? Did I keep listening to what everyone else demanded for my life, or did I speak up and say, “Here I am, like it or lump it.”

Disturbingly, my answer at age 39 was, “Well, sort of.” In examining how I had established myself, I found that even though I wasn’t writing grocery lists, I hadn’t exactly written sonnets either. Perhaps I felt like something was missing because something was, indeed, missing. Perhaps I was being told it was time to take the next step. I had allowed myself to live with a list of “what if” questions — What if I’d done this? What if I had gone there? What if I were like that? — and I’d fallen into the trap of constant speculation. Everyone wants to be Yoda, but I was at risk of turning into nothing more than Super Grover stuck in a tree.

I didn’t know what my mark would look like, but I decided I could live as though I had made one and see what happens. I stopped saying “no” and started saying “yes.” That’s not to say that I suddenly started agreeing indiscriminately with some “you can do anything” illusion. Instead, I decided that fear or social disapproval would no longer be enough of a reason to prevent me from trying the new thing. “It’s the way it has always been done” was no longer a good enough reason to stay the same. Not knowing became the reason for acting.

Experiments in living can have curious effects. All kinds of wild ideas entered my mind. Not all were viable, but the energy that comes from rediscovering one’s creative power is intoxicating. It flows into every part of work and life.

If this were a fairy tale, I would stop at this “happy ending.” But I’m not trying to wrap my experience up in a neat bow, nor am I trying to say that this is just my story. I’m not 39 anymore. I’ve had a few years to live with my experiment, and I prefer living this way. But it has not made life easier. In fact, living as though the “what if” has already been answered makes life more challenging. But it’s a challenge I put to others — and especially to a counseling profession that also seem to have gotten stalled in its own internal-gazing.

Twenty years ago during my master’s program, my professors said that counseling was in its adolescence. Today, we are still struggling with questions of identity. Who are we? What are we about? What do we believe in and stand for?

We have gone through several fast-paced movements, some which have enhanced us and some of which have diminished us. Like so many tumultuous progressions, we regularly take three steps forward and two steps back. Yet we also seem to have lulled ourselves into a strange quietude, the kind where we exude certainty until we are asked to define what it means to carry this mantle. In our quest for legitimacy, we could very well have sold ourselves out, making us into a caricature of the professions we seem to think we should be. Are there lessons we can borrow from fields such as psychology, social work or psychiatry? Certainly. But at what point do we stop saying, “This is who we are not” and instead assert, “This is who we are?”

The “what ifs” have caught us for far too long. How many debates, circular arguments really, do we get into about which theory is the “best,” which specialty is the most important, who is the most moral or just? At what point will we admit to ourselves and the rest of the public how many of our choices have been profit driven — claims staked to promote our own brand of job security? What do our politics really say about us — not an individual’s personal views, but the fact that we as a profession still argue amongst ourselves about who is granted personhood.

What if instead of fighting over limited crumbs, we acted like a profession with a unified vision, not of what each counselor should do but of who our profession is meant to serve? What if we stopped proving our legitimacy through purely Cartesian lenses and instead recognized that the totality of our work cannot be reduced to widgets and Facebook memes but must also encompass a marvelous, mysterious human interaction? What if instead of resting on our certainties, we asked ourselves in what ways our insecurities have seduced us into believing that the illusions we cling to are the realities that everyone must follow? What if instead of being afraid of our differences, we took a chance to allow ourselves to be influenced by each other in the ways in which we arrogantly expect our clients to be influenced by us?

Prepare to grow up, Counseling. What have you been doing with your life?

 

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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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Shawn Patrick is an associate professor in the counseling and guidance program at California State University, San Bernardino. Contact her at shawn.patrick@csusb.edu.