Monthly Archives: September 2009

Rewriting the ’rules’ of grief

Lynne Shallcross September 15, 2009

Six weeks into her pregnancy with triplets last spring, Kristin Douglas, a licensed professional counselor at Laramie County Community College Counseling Center, had a miscarriage.

Douglas, who’s earning her doctorate in counselor education at the University of Wyoming, was no stranger to the grief caused by miscarriage. At the time of her own miscarriage, she was counseling multiple clients who were going through the same thing.

With her counseling background, Douglas had a larger selection of tools for dealing with grief than most people, but her experience drove home the point of the truly individualized nature of loss and grief. “It taught me that it’s a really sacred and individual experience,” says Douglas, a member of the American Counseling Association. “No two grief experiences are alike.”

Because she was working with clients who were also dealing with the aftermath of a miscarriage, Douglas made a personal decision to share her experience with them. “That was part of my own ethics,” she says, adding that she told her clients, “I want to be fully present for your experience, and I recognize that your experience is very different.”

Grief over a miscarriage sometimes falls under the category of “disenfranchised grief,” counselors say, because it often goes unacknowledged. If a woman has yet to share the news of her pregnancy or wasn’t showing before her miscarriage, those around her are less likely to notice her loss or grasp the depth of the loss, leaving her feeling less legitimized in her sense of grief.

Talking to others about her miscarriage was helpful to Douglas in her grieving process. Also beneficial was art journaling, a combination of drawing with pastel chalk and writing that allowed her to think through her grief logically while expressing herself creatively and emotionally. As many counselors are already aware and Douglas discovered firsthand, the grief didn’t disappear – it only changed with time. At the beginning, her sense of grief was physically, emotionally and spiritually intense, Douglas says. And although she says she doesn’t “fixate” on the miscarriage now, there are times when she still feels greater pangs of grief, including milestones such as first birthdays or first Christmases that never materialized.

Beyond death

While the death of a family member or friend is commonly recognized as a substantial loss, counselors agree it’s far from the only event that produces feelings of grief. “When we think about grief, generally speaking, we think about death,” says Howard Winokuer, president of the Association for Death Education and Counseling and founder of the Winokuer Center for Counseling and Healing in Charlotte, N.C. “But I think that’s a very limited and tunnel vision view of grief. Grief is the end result of any loss, and loss is so broad.”

Keren Humphrey, a retired counseling professor and author of the book Counseling Strategies for Loss and Grief, published by ACA, agrees that losses can be wide and varied. And she says counselors need to recognize all losses as legitimate. She gives the example of a woman who has always dreamed of having children finding out that she is infertile. That discovery could bring shattered expectations, a lost sense of the future and a lost sense of self as a parent. “That could actually be more challenging and more disruptive than dealing with the death of someone,” says Humphrey, who is CEO of 4 Directions Consulting in Rockwall, Texas, and holds a doctorate in counseling. Losses can include a wide range of life events, from job loss and homelessness to acquired disability and incarceration, Humphrey points out.

Russell Friedman, executive director of the Grief Recovery Institute, defines grief as the “conflicting feeling caused by a change or an end in a familiar pattern or behavior.” He adds that grief isn’t limited to the death of a loved one or even traditionally recognized losses such as divorce. One of the most profound changes that can potentially lead to grief, he says, is moving. “Our lives are lived in our houses. Therefore, our emotions are connected to the house,” says Friedman, a member of ACA. “The human condition doesn’t like change; it rejects change. It wants stasis so it can go back to what it knows.”

Although non-death losses might not be equal to death, they can’t be compared, Friedman says. “All loss is experienced at 100 percent. There are no exceptions.” What changes from loss to loss is the strength of the feeling, he says, which can depend on the time and intensity of the relationship.

Counselors say it is completely appropriate to place non-death losses under the umbrella of grief. In fact, it’s important to recognize them. “We’re talking about loss as the real or perceived deprivation of something one considers meaningful,” Humphrey says. “If it’s meaningful for me and I lose it, then it’s loss, whether you think it is or not.” Kenneth J. Doka, a professor of counseling at the graduate school of the College of New Rochelle, has written two books on disenfranchised grief. “The concept of disenfranchised grief emphasizes that every society has ’grieving rules’ that determine a socially conferred ’right to grieve,’” Doka says. “Generally, for example, these rules give family members the right to grieve the deaths of other family members. But in many situations – including non-death-related losses – a person might experience a significant loss but be deprived of the opportunity to publicly acknowledge the loss, openly mourn and receive social support.”

Rules can’t dictate how a person feels, says Doka, a member of ACA. “Whenever somebody has a meaningful attachment and they lose their attachment, at least one of their reactions is going to be a reaction of grief. We need to be sensitive to how an individual defines attachment. We need to understand the meaning that people give to the loss and not compare losses.”

Doka traveled to North Dakota after the Red River flooded in 1997. He remembers speaking with a woman who had emigrated from Germany, bringing with her Christmas ornaments that had been in her family for hundreds of years. The ornaments had been washed away in the flood, and she was devastated. Although the loss of Christmas ornaments might not have been significant to others, Doka says the event led to a profound sense of loss for the woman.

Doka adds that grief can accompany even happy occasions. For example, when a student graduates from college, he might be excited for the next chapter of life even as he grieves what he’s leaving behind. The birth of a child can be a joyous occasion, but it can also bring a loss of independence and freedom. “It doesn’t make you a bad mom if every once in awhile you grieve the loss of independence you had before,” Doka says.

Times of change

The field of grief counseling has changed during the past 15 to 20 years, Humphrey says, and one thing that’s fallen by the wayside is Elisabeth Kübler-Ross’ five stages of grief model. “We know better than that now,” says Humphrey, who is a member of ACA. “Everybody experiences loss and grief differently and uniquely. We need to start from people’s unique experience of loss and grief rather than applying universal templates.”

One of the major problems with the stages model is its adherence to a timeline, Winokuer says. The main factor in progressing from stage to stage is time – meaning if enough time passes, the wounds will heal. But it doesn’t work that way, says Winokuer, an ACA member who has worked in grief counseling for 30 years. “Time does not heal wounds. In time, wounds can heal. But in order for wounds to heal, a person needs to do their grief work,” he says.

As counseling has moved away from the stages model, Doka says, it’s moved toward one of individual pathways. “To think that we’re going to respond to a major crisis in our life in exactly the same way is, at best, naïve,” he says. An individualized model also opens the door to better counseling of multicultural clients, says Doka, who is a senior consultant to the Hospice Foundation of America and runs a small private practice in Poughkeepsie, N.Y. Counselors should try to interpret clients’ behavior through the lens of their culture, he says. In some cultures, visible emotion might be expected at a funeral, whereas in others, the atmosphere might be more restrained.

Viewing attachment through a cultural lens is also important, Doka says. In Hispanic culture, the Spanish expression for godparents translates to “coparents,” and the relationship is an important one. While the death of a godparent might not be viewed as particularly significant in some cultures, in the Hispanic culture, it is regarded as a very serious loss. “On a very basic level, we have to understand that each culture has its own levels of attachment,” Doka says. “Each culture experiences, expresses and adapts to grief in its own way.”

Another change Humphrey has witnessed in the field of grief counseling is greater understanding of the role that meaning reconstruction plays in loss and grief. “What a particular loss means is different for everybody,” she says. She gives the example of a person who is a busy, hard worker developing a chronic illness. That person may be unable to retain the same job or maintain the same level of performance. “Their assumptions about who they are have been shattered,” Humphrey says. She adds that grieving is the process of reconstructing the meaning that was disrupted and making new meaning. Counselors can help clients with that process by encouraging them to understand the assumptions they once held, reviewing which assumptions have changed and which have remained the same and then supporting them as they discover new meanings, Humphrey says.

Individualized treatment

When seeing clients who are dealing with grief, Doka says the most important thing for counselors is to understand that everyone grieves in a different way. “The first thing we need to do is very carefully assess what their reactions are and how our clients are responding and, again, not to assume they should respond in any particular way.” Doka helped develop the theory of a continuum of grieving styles, wherein some clients fall toward the intuitive or emotional end and others fall toward the instrumental or emotionally muted end. The job of the counselor, Doka says, is to help clients identify and use their traditional strengths. “What kind of losses have you experienced before, what’s helped you through them and what has not been so helpful?” Doka asks his clients. “It’s helping people become aware of their own style.”

One of Doka’s clients came for counseling after his brother died, leaving behind a pregnant wife and an unfinished house. The client spent almost every weekend working on his brother’s house and, through that process, dialogued with his brother. “It was very effective grief work for him,” Doka says. Counselors also say the days of telling clients to move on and forget about the loss are over. In Western psychiatry, emphasis used to be placed on the need for the bereaved to cut themselves off from memories of the person to get over their loss, Humphrey says. “That really was quite an error. Now the emphasis is on helping people establish a continuing bond.” That bond, she says, is a connection with the deceased – a way to honor the relationship while still moving forward with life.

One way of maintaining a continuing bond is through linking objects, Winokuer says. Although maintaining a person’s room or closet exactly the same way years after the person dies isn’t healthy, keeping a few items to remember the person by can be very helpful, he says.

One of Winokuer’s clients was a widow in her 70s. Before her husband died, the two of them took walks together regularly. As a linking object to her late husband, the woman kept the jacket he had worn during their walks and wore it herself to feel close to him. A linking object is not only a constant acknowledgment of the new reality, Winokuer says, but a catalyst to feel.

In keeping a continuing bond and not “letting go” of the loss, there will be times when grief resurfaces, Doka says. “We realize we maintain a continuing bond to our loss and that there are times in our life when it’s quite normal to expect that we may have, even years later, surges of grief,” he says. Doka experienced his own surge of grief when his first grandchild was born. While it was a very happy occasion, Doka regretted not being able to share the experience with his own father, who had already died. “At that point in time, I profoundly missed the opportunity to talk to my dad,” Doka says. “We live with the loss and we understand it and reinterpret it at different times.”

As Doka’s clients approach the end of their counseling work with him, he asks them what times in their lives they think the loss might become significant again, whether it’s a wedding, the birth of a child or any other milestone. By examining this question ahead of time, Doka says his clients aren’t caught by surprise when a resurgence of grief happens somewhere down the line.

Help in healing

Since the stages of grief model first appeared, many new treatments have surfaced. Here are some methods counselors recommend to help clients who are dealing with grief.

William Worden’s task-centered approach. Winokuer says Worden’s tasks imply that healing isn’t simply a matter of time passing; rather, there is work to be done. The first task is accepting the reality of the loss. With a death, that might mean making calls to family members or planning the funeral. In a divorce, that might mean someone moving out, taking off the ring and telling friends.
Worden’s second task is feeling and working through the pain of grief, third is adjusting to the new environment and fourth is “reinvesting yourself and learning to live again,” Winokuer says. The process isn’t linear, Winokuer stresses, so a client might be reinvesting herself and then feel the pain again.
Thematic genograms. Humphrey recommends asking clients to create a three-generation genogram and then trace the loss and grief experience of various family members through the generations. She says the process opens up opportunities to discuss how loss affected the family through the years and how family members dealt with it.
Written dialogue. One of Winokuer’s clients, a 70-something physician, suffered a loss when his wife died of breast cancer. The man wasn’t very emotive, but he was a very good writer, so Winokuer asked the man to write a letter to his wife about what had happened since she had died. After the client read it to Winokuer, Winokuer then asked him to write a return letter as though his late wife were responding to what he had written.
Objects of connection. Like Winokuer’s linking objects, Humphrey says people often have a keepsake they hold onto that reminds them of and connects them to their loss. Bringing that object into a counseling session can be a springboard for people to begin talking about the item and the meaning of the loss. The objects of connection give counselors a chance to validate the loss and to ensure that the person is healing in a healthy way. If either not having the object or not being able to check on the object is troublesome and impairs the person, it alerts the counselor that there might be a problem, Humphrey says.
Making a booklet. Douglas creates little booklets for her clients that help them detail their grief journeys. She encourages clients who have lost someone to write down information about the person, what their relationship was to the person, what their reaction was to the news of the death, details of the funeral, how they are coping with the loss, things they wish they had told the person, things they’ll miss about the person and so on. This provides clients with a chance to tell their grief story while working at their own pace, Douglas says.
Creating a resilient image. To withstand feelings of grief, Humphrey assists clients in developing an image of themselves as resilient people. She gives the example of a man struggling to stay focused at work because he’s troubled with thoughts of his mother’s death. Humphrey might help the client create an image of himself floating in water, not having to push or swim or make any effort. The client could then use the image to cope in the moment, she says.
Journaling. Winokuer recommends journaling to his clients because writing helps to organize and give structure to thoughts. “It makes it more concrete, more real,” he says, adding that writing also helps clients acknowledge the reality of the loss.
Empty chair. Counselors recommend the Gestalt empty chair technique with clients who are dealing with the loss of a person through death or other events such as divorce. The client can talk to the person as if he or she is there, sharing feelings, saying goodbye or working out an unresolved issue. Much like journaling, Winokuer says, this method helps make a person’s thoughts more concrete. (For more, read “Empty chair offers closure to grieving clients” on page 34.)
Art. Douglas recommends using art as a powerful tool for working through grief and the many painful feelings that accompany it. One of Douglas’ clients was an art student who lost a loved one to suicide. Over the course of several weeks, her client drew multiple images representing each of the feelings she had experienced at the time of the suicide and throughout her grief journey. Douglas and the client discussed the images during session, and over time, the artwork turned from bleak, dark, charcoal black-and-white drawings to bright, colorful images of peace and hope. “The drawings were a way to help her make sense of her feelings, express herself in a language she was very familiar with and visually see patterns and progress to her healing journey.”
Rituals. Doka is a believer in the healing power of rituals after people experience a loss. The ritual of continuity emphasizes the continuing bond with the deceased, Doka says. He and his family put up memorial ornaments on the Christmas tree every year for loved ones who have died. “It’s a way of saying this person’s still part of our holiday,” he says.
Doka says one of the most powerful rituals is a ritual of transition, which marks some movement or change in the grieving process. One of his clients, Marion, was a middle-aged woman whose husband had died seven years prior after having been ill for many years with Lou Gehrig’s disease. Every night before going to sleep, they had touched their rings together and recited their wedding vows, “in sickness and in health.” Years after her husband’s death, Marion was ready to begin dating again but felt unable to take off her wedding ring. Doka helped Marion, a committed Catholic who took her wedding vows very seriously, plan a ritual of transition at her church. After celebrating Mass, the priest called Marion to the altar. In front of her family and friends, the priest repeated the wedding vows in the past tense – “Were you faithful in good times and in bad, in sickness and in health?” Marion affirmed she had been, and the priest asked for the ring back. Marion’s ring was later linked with her husband’s ring and welded to the frame of their wedding photograph, “symbolizing that her vow was now fulfilled,” Doka says.

Becoming an expert

All these counselors agree that to be an effective grief counselor, professionals must be properly educated. Winokuer says the Association for Death Education and Counseling offers certifications in thanatology, or the study of death. Although earning a grief counseling certification might be helpful for some professionals, Humphrey doesn’t believe it’s the only way to become educated on the topic. “The most important thing is to be intentional about expanding knowledge and remaining current with the research,” she says. Doka also emphasizes the importance of staying up to date in the field by paying attention to grief counseling research and literature and attending conferences. “Get current, keep current,” says Doka, who edits Omega: The Journal of Death and Dying.

Validating a person’s loss is another important component of grief counseling, Doka says. Douglas agrees, adding that for many disenfranchised losses, such as miscarriage, clients need counselors to acknowledge the loss and be nonjudgmental. Clients will be uncomfortable talking about their grief if they think someone is going to judge them, Douglas says, so counselors must honor and validate their experiences.

Before counselors take on the job of helping clients deal with loss and grief, Humphrey says, they need to look in the mirror. “Get your own house in order,” she says. “If you’re going to help people with grief and loss, you need to have examined your own loss and grief issues.”

Based on her experience helping grieving clients, as well as grieving her own losses, Douglas offers a reminder to her fellow counselors. “Educate yourself on the grief process and ways to work well with those who are grieving, but also remember that you are your best instrument. Your compassion, warmth, presence, attention to detail and intuitiveness will be your most powerful healing tools.”

ACA offers a Grief and Bereavement Interest Network for counselors looking to network with colleagues. For more information, contact Bernadette Joy Graham at bernadette_joy@yahoo.com.

Grief in the workplace

Dealing with a loss is hard enough, but when those who are grieving are expected to get on with life and go back to work, the challenge to heal looms even larger. Joanna Parker, coordinator of bereavement services at Duke University Hospital, developed a workshop for managers and supervisors at Duke on helping employees cope with loss and grief in the workplace. She’s adapted the workshop for other audiences, so Counseling Today asked her what counselors should know about grief in the workplace.

“The topics of death and grief are not very comfortable topics for people to engage in,” says Parker, a member of the American Counseling Association. “Especially with workplace norms, this might be where you put on your professional demeanor and you leave all your personal stuff at home.” But the challenge of leaving the grief at home, Parker says, is that people spend so much of their lives in work settings, and for many individuals, work serves as their de facto social network as well.

A traditional three-day leave of absence for bereavement often means people return to work in the thick of grief. “For a significant loss – loss of a spouse, loss of a child – that’s so insignificant as far as what somebody is going to need, as far as not just dealing with logistics, but just being able to come through that acute grief,” Parker says. “I think there’s a lot of pressure on employees – What’s the expectation? How am I going to be viewed? – to buck up and get back to work.”

Even if clients have to resume their jobs while still dealing with intense grief, there are a few ways counselors can help them make a smoother return, Parker says. First, help normalize the experience for clients and help them see that a wide variety of reactions to grief can be very normal. Then brainstorm with the client about what might be helpful to them when they go back to work. Help them determine their limits and learn to speak up if they need to be taken off a project or work from home. Finally, encourage clients to open an avenue of communication with their supervisors. Parker says it’s often helpful for employees to request setting up a regular check-in time with a supervisor. The supervisor can see on a regular basis how the employee is coping, while the employee is given a low-stress opportunity to express concerns or problems.

– Lynne Shallcross

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

Getting adolescent boys to buy in to yoga, meditation and relaxation

Carol Marks-Stopforth September 14, 2009

“Yoga? I’m not doing no yoga! Not enough testosterone! Yoga’s for girls! It’s just not me!”

These were the kind of comments thrown at me when I first introduced a yoga/meditation/relaxation (YMR) group to 15 adolescent boys. Now, three years later, when a new boy joins the program, I still hear the same lines of protest. But before I can open my mouth, one of the older residents will say, “No, you have to do it. It’s not so bad. I didn’t want to do it when I first came, but it’s straight. You’ll see – you’ll like it. And the best part is the relaxation. She hypnotizes you.” Thwarting any questioning of my powers, he quickly adds, “She levitates, too.”

The new boy generally looks puzzled. The guys informing him that he’ll like yoga are pretty tough looking; they don’t appear to be lacking in testosterone. So despite his skepticism, he bows to peer pressure and gives it a try.

The boys in my now twice-weekly YMR group have been placed at a 90-day residential facility for adolescents with substance abuse and other co-occurring disorders. I started the group because I wanted to find a means for the boys to calm themselves. Most of these adolescents’ relationships are filled with conflict. They are fighting with their families, are doing poorly at school, have serious legal charges and are on probation. They carry a lot of stress, which shows up in their distractibility, their impulsivity and the hair-trigger nature of their anger – if these boys were thermometers, their temperature would rise from 1 to 100 in a couple of seconds.

I began thinking about a group that would teach these adolescents techniques for self-regulating and managing their stress more effectively. I needed something that would work with both body and mind while also being fun. I knew firsthand about yoga and meditation’s ability to counteract stress as a practitioner myself for more than 30 years. But how could I present it effectively to a group of adolescent boys?

Initially, the boys were extremely resistant, almost to the point of mutiny. To name a select few of their diversionary tactics: The guys wouldn’t leave their shoes outside the room; they would tell me it was against their religion to do yoga; many of them suddenly developed “scoliosis”; everyone dropped onto their mats as soon as they had them and refused to get up; they wouldn’t even try the yoga postures, and if someone ventured an attempt, the others would laugh and insult him until he stopped; they threw things at each other; they pushed each other; someone would mimic my voice during the relaxation, and someone else would shout, “Shut the (expletive) up!”; two guys would be playing cards, while another would be listening to his iPod and handing one of the earphones to his neighbor so he could also listen as they tapped in time to the music.

There were many times when I said to myself, “This just isn’t working. I can’t do another one of these sessions.” But I always did, and over the years, I learned from the adolescents what worked for them and what didn’t. Along the way, the hour-long group developed a life of its own.

The process

Before the group begins, the boys help me get the mats. They leave their shoes outside the group room and assume a standing position on their mats. The adolescents complete the residential program at different times, so I describe the YMR group again whenever a new resident arrives, explaining that the group is divided into three parts: yoga to relax the body, meditation to relax the mind and a guided body scan to relax both body and mind.

I begin the group by asking the boys to rank on a Likert scale how they are currently feeling, with 1 being the least relaxed and 10 the most. I note the responses and then lead group members through a series of yoga postures. The postures begin very vigorously with Sun Salutes. By the time this exercise is completed, the boys have released some of their tension, are feeling more relaxed, are more accepting of the subsequent poses and are forming some group cohesion. We then do a series of balancing exercises. Because we have to concentrate to stay balanced, these exercises make us more focused. The remaining poses are designed to be calming. By the time we come to the shoulder stand, which heralds the end of the yoga session, the guys have released enough tension to move on to the next and most demanding section of the group – seated meditation.

I tell the boys that starting now, they must focus only on themselves. There is to be no side talking. After they have settled into a seated posture, I explain the technique, which is to focus on the breath. I talk a little about how the mind tends to wander, finding it extremely difficult to concentrate on the breath. I liken the mind to a wild horse that must be tamed, instructing the group members to simply return to the breath when they realize they are thinking about other things. Finally, I tell them I am going to stop talking and we are going to practice the technique for five minutes. I used to guide the group throughout the entire meditation until one of the boys said, “I can’t concentrate if you talk all the time. I think you should stop talking and let us do it on our own.” He was right, and I am moved each time by how good they have become at doing this very difficult thing. After the meditation, we have a 10-minute discussion about what it was like for them to engage in this practice.

Some extraordinary therapeutic moments have emerged from these discussions. I recall one young man from the inner city who exhibited a very tough exterior. His friend had been killed less than a year before. The other group members considered this boy a leader and tried to emulate his walk and style of dress. He talked softly and sparingly to his peers and refused to speak in group. “It’s just not me,” was his stock answer.

But when I invited responses after a YMR group, he said, “It was weird. I was listening to your voice, and when you said ’Breathe in darkness,’ I could see me and my boys fighting the other boys. I was fighting in the corridor, then everyone was running away. I went back to where the fight started. They were all gone, and my boy was lying on the floor bleeding. I took off my shirt and sat down with him and tried to stop the bleeding, but I couldn’t, and he died. Then I breathed out light, and I knew he was OK. He’s in heaven, and I don’t have to worry about him.”

For the first time since meeting him, this young man was looking me directly in the eye. Then he asked, “Can we do meditation again tomorrow?”

The boys like the last part – the guided relaxation – best. They sit or lie on their mats, eyes open or closed according to what is most comfortable for them. I then guide them through a detailed body scan using the breath to induce deep relaxation. After this final section of the group, I commonly hear comments such as, “I wasn’t asleep – I could hear your voice – but I wasn’t awake either. It’s like dreaming but being awake.”

After the body scan, I again ask them to rank on a Likert scale how relaxed they feel at that moment. Generally, there is a significant difference between the first and second Likert scale. The first time, about 80 percent of the boys will rate their relaxation level as a 4 or a 5; the second time, their relaxation level will jump 4 or 5 points. It is not unusual for the boys to report 10s. The other 20 percent of the boys will begin at 0, 1 or 2 and jump to a 4 or a 5 on the second scale. Regardless of where they began, they experience a significant decrease in tension.

Evidence of positive results

The boys’ reports of being more relaxed are reflected in their behavior. This has been noted anecdotally by direct-care staff, who report that after the YMR group, the boys are “easier to deal with, not as demanding and nicer to each other.” Significantly, no incidents are reported that day following the YMR group. Parents or guardians do not directly acknowledge the benefits of YMR, but they sometimes comment they are amazed that their son is doing yoga and seems to enjoy it. When graduating from the residential program, the boys often talk about how much they grew to like the YMR group.

According to a study published by George Parks and Alan Marlatt in 2006, a meditation program involving severely addicted drug and alcohol users serving sentences at a prison in Washington state showed decreases in alcohol-related problems and psychiatric symptoms as well as increases in positive psychosocial outcomes. According to studies conducted in 2007 by Farris Tuma, the practice of yoga produced notable reductions in stress and post-traumatic responses in veterans suffering from post-traumatic stress disorder. Bessel van der Kolk, medical director of the Trauma Center outside of Boston, has recently received a National Institutes of Health grant to study the effect of yoga on traumatized women considered to be treatment resistant. Evidence is increasing that yoga and meditation are viable tools for relieving stress. That has certainly proved to be the case with the adolescents in my program.

As clinical director of the residential treatment facility, my emphasis is on providing a multidisciplinary approach to addiction and other co-occurring disorders. Ninety days is not a long period of time to work with disorders that have been a long time in the making, so our aim is to provide these young men with as many different approaches to care as we can.

In group therapy, we tend to lean toward the expressive therapies. For example, every youth in our program makes a body map while he is with us (the maps line the walls and are both aesthetically pleasing and instructive). Literature and poetry readings form the basis of other groups, while yet another describes the steps to recovery through an art project.

More traditional counseling is provided in individual and family sessions, which take place once a week. Here, too, YMR proves to be very helpful. I often begin both individual and family sessions with a brief guided meditation, having found that it defuses stress and allows clients to talk more easily about their problems. If clients are extremely tense, I do a few simple yoga postures with them. This tends to decrease their tension level and makes them more willing to engage. I even assign some clients “homework” – a five-minute meditation every morning when they wake up. They write a few sentences about what this was like for them, and during our next individual session, we go through their notebook together. Other clinicians in our program report that their clients have talked about how they use YMR to calm themselves. In particular, some of these clients have shared that if they do the relaxation part of the process, it helps them to fall asleep at night.

Carol Marks-Stopforth is an ACA member and a licensed mental health counselor. She is the clinical director of a residential treatment facility for adolescent males and is involved in a research project to study the effects of YMR on adolescents. She also runs a private practice in Boston. Contact her at cmarks1111@comcast.net. Letters to the editor: ct@counseling.org.

Corey, Digh to keynote ACA Conference in Pittsburgh

Lynne Shallcross

When Gerald “Jerry” Corey steps to the podium at the American Counseling Association Conference & Exposition in Pittsburgh this coming March, he’ll have two things on his mind: the counselor as a person and the counselor as a professional. “I want to address the importance of self-care for counselors and emphasize that who we are as a person profoundly impacts our effectiveness as a professional,” says Corey, professor emeritus of human services and counseling at California State University at Fullerton and an ACA fellow.

“As counselors, we ask clients to look honestly at themselves and to choose how they want to change,” he says. “It is essential that we are open to the same kind of reflection on our part.” Who counselors are and how they take care of themselves are paramount, Corey says. He points to research indicating that who the counselor is as a person can be the most important factor in determining therapeutic outcomes. “The human dimension is what most counts when it comes to counseling that produces results,” he asserts.

Despite retiring from the California State University system as a full-time professor in 2000, Corey’s schedule remains packed. In addition to still teaching a few classes each year at CSU-Fullerton, he leads workshops, teaches an intensive weeklong group counseling class at a different university almost every year, speaks at conferences and works on revising many of the 16 books he has written or cowritten. Corey, who earned his doctorate in counseling from the University of Southern California, often presents workshops with his wife, Marianne Schneider Corey. In the past 30 years, they’ve brought their lessons to universities across the United States, as well as to countries including Canada, Mexico, China, Hong Kong, Korea, Germany and Ireland.

“I am thrilled that Jerry Corey will be one of our keynote speakers,” says ACA President Lynn Linde. “He is a prolific author and has greatly influenced the training of professional counselors through his textbooks and workshops. In addition, he is an engaging and informative presenter. I learn something new every time I hear him or read his work. I am pleased that we will be honoring one of our illustrious members.”

Corey received the Outstanding Professor of the Year Award from CSU-Fullerton in 1991, but he’s the first to admit that school wasn’t always his favorite place. “My entire elementary school experience was one long, painful road of frustration and rebellion,” Corey recalls. “To be blunt, I hated school.” Despite setbacks and low self-confidence through his adolescent years, Corey persevered all the way to graduate school.

After earning a bachelor’s degree in psychology and a master’s degree in counseling from Loyola University, Los Angeles (now Loyola Marymount University), Corey decided to pursue a doctorate in counseling while he taught at a high school and, later, a community college. The semester that he enrolled in a statistics course proved to be particularly challenging. “Although I enjoyed my counseling courses, I detested statistics and feared that I would not be able to pass,” he says. But Corey ultimately succeeded, thanks in large part to a supportive adviser and help from the high school custodian, who was studying to be a math teacher. “That experience taught me that by challenging my fears, they become manageable and that self-discipline pays off,” he says. “It is easy to feel engulfed by fear and to stop too soon, yet fears can be put into perspective by viewing obstacles as challenges that can be overcome.”

“Having people who believed in me gave me a sense of hope when discouragement set in,” says Corey, who went on to teach at California State Polytechnic University, Pomona and then CSU-Fullerton. “An important lesson for me at this time was recognizing the power a mentor can have on inspiring others to strive for their dreams. One of the most professionally meaningful aspects of my 48-year career has been to serve as a mentor for many students and to encourage them to pursue their vision.”

Much of Corey’s keynote address will reflect content from his forthcoming book, Creating Your Professional Path, being published by ACA in March 2010. On his list of talking points for the ACA Conference will be the personal issues that many counselors face, managing personal and professional boundaries, effectively managing stress, the challenge of balancing life roles and the importance of self-care.

Another topic on Corey’s list – a topic he believes is central to effective practice in counseling – is awareness of ethics. “Being an ethical practitioner is not merely a way to avoid a malpractice suit,” he says. “It is a route to counseling that makes a life-changing difference. Ethics is not a matter of simple solutions to the dilemmas we will face, for many of the dilemmas are very complex and could have several ethical solutions. There is no one correct ethical path. This implies that practitioners need to create their own perspective on working ethically.”

Corey will also touch on the topic of values, about which he says counselors are not and cannot be completely neutral. “No approach to therapy is value-free,” he says. “You have an ethical responsibility to be aware of how your beliefs and core values affect your work, and you need to take care to avoid unduly influencing your clients. Clinicians may not agree with the values of their clients, but it is essential that they respect the rights of their clients to hold a different set of values.”

Personal therapy is another important ingredient in a counselor’s personal and professional life, Corey says. “Practitioners must be aware of their own needs, areas of unfinished business, personal conflicts, defenses and vulnerabilities and how these can interfere in their professional work. Personal therapy during training and throughout therapists’ professional careers can enhance counselors’ abilities to focus on the needs and welfare of their clients. Therapists cannot take clients any further than they have taken themselves. Therefore, ongoing self-exploration is important.”

In that spirit of self-exploration, Corey plans to ask conference attendees to think about a strategy for keeping themselves alive personally and professionally. “Imagine you will be here one year from today,” Corey proposes. “What would you most want to say that you have changed in your life?”

In the fall of 2003, Patti Digh’s stepfather was diagnosed with lung cancer. He died a short 37 days later. Digh credits that event with waking her up to life. “The time frame of 37 days really hit me,” says Digh, an author, speaker and cofounder of The Circle Project, a consulting firm that designs diversity and leadership training for clients around the world. “By the time he got to those 37 days, it was really too late for him to live the life he’d always wanted – he had to ’make do’ with what he had because he was so sick, so quickly. It scared me. I literally started asking myself this question every morning as I woke up: ’What would I be doing today if I only had 37 days to live?’”

Digh’s answer to that question was to leave behind her life stories to her two daughters. She began detailing those stories in a blog, 37days.com, which gained 15,000 followers in the first six months. “I started writing, framing each story to end with a challenge, to teach them something, to open up a line of questioning for them,” Digh says. “I wanted them to know me as a human being and not just as their mother. I wanted them to know that I had screwed up – and that they would, too. I wanted them to gain insight into the bigger things in life beyond how to cook pasta al dente.” As Digh wrote, she noticed that six themes kept resurfacing – how to say yes, be generous, speak up, love more, trust yourself and slow down. Those themes are threaded throughout the 37 stories Digh shares in her book, Life Is a Verb: 37 Days to Wake Up, Be Mindful and Live Intentionally.

Digh, the former vice president of international and diversity programs for the Society for Human Resource Management and author of two business books on global leadership and diversity, says she hopes to help counselors recognize those six themes – and find a way to imbed them into their own lives and work – during her keynote presentation at the ACA Conference. Digh believes the reason she has such a devoted following is because all of humankind can relate to those life themes and stories. “We all have some internal desire for our lives to have more meaning, to leave something behind,” she says.

Another part of Digh’s message will be dedicated to encouraging counselors to take care of themselves. People who work in helping professions often get trapped spending all their time on others, she says. “It’s OK to turn that kind of attention to your own self,” says Digh, who adds that making sure you’re a healthy and full person enables you to give back to the world at a higher level.

Linde believes that message will resonate with ACA members. “As we try to be all things to all people – our significant others, our families and our clients – we need to stop and reflect,” Linde says. “Patti brings her unique perspective and creativity to help us all remember what’s really important in life.”

Digh plans to remind counselors that incredible things happen all around them every day, but they – like most humans – often fail to slow down enough to recognize them. “I think in order to reclaim awe, we have to give up caring too awfully much about what other people think of us,” she says. “Sometimes, we hide our exuberance because we fear we might look naïve or foolish. I would scream with joy at seeing the ice cream truck, but you’d make a note in my personnel file. I think we can get back to seeing things as a miracle if we give up wondering or caring how others will perceive us.”

If all people, including counselors, were to take her six themes to heart and recognize the stories in their own lives, Digh believes it would make for a more full existence and less regret when our “37 days” are up. “Begin living the life that you want to live so that at day one (of your final 37 days), you don’t want to change dramatically,” she says.

To learn more about the 2010 ACA Conference & Exposition in Pittsburgh (March 18-22), or to register to attend, visit http://www.counseling.org/conference or call 800.347.6647 ext. 222. Register early to ensure the best rates.

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

Good things coming

Richard Yep September 1, 2009

Richard Yep

This past summer, the American Counseling Association hosted its first-ever Institute for Leadership Training, sponsored by the four regions of ACA. Rather than these four entities holding their traditional fall meetings, everyone gathered in Alexandria, Va., the city that is home to ACA’s national headquarters and just across the river from Washington, D.C.

More than 130 counseling professionals, representing approximately 40 states and U.S. territories, came for three days of intensive training, networking and advocacy on Capitol Hill. Quite frankly, this group was a force to be reckoned with. With keynote speeches on leadership, social media and what it takes to succeed, along with 12 very interesting content sessions, Institute attendees were exposed to many ideas and issues that will help them as leaders in the counseling profession.

Our attendees came from many different areas of counseling and spanned various demographic groups. What I observed is that leadership is a subject that goes hand-in-hand with diversity. When we open leadership opportunities to a diverse cross section of our members, we improve the collective thinking and advocacy that can be accomplished on behalf of the profession. And when we create a climate in which people of diverse backgrounds and interests genuinely feel they are part of the community, all sorts of creative thinking and dialogue can take place.

Our Institute for Leadership Training was successful in many ways and on many levels. Because it was held concurrently with our meeting of the Council of Presidents and Region Chairs, we had the added benefit of including the thoughts, interests and opinions of those who serve as division presidents and regional chairpersons of ACA. This is yet another example of the inclusive nature of the Institute and how it fostered greater communication among the diverse interests within ACA.

When three buses full of counseling leaders from the state, region, division and national levels of our association descended on Capitol Hill, the interests of the profession and those whom counselors serve were effectively shared with public policymakers in both the House and Senate. We visited Democrats, Republicans and independents; we talked with liberals and conservatives; we talked with people who have been on the Hill for decades and those just starting out after college. No one was immune from hearing about the good work of professional counselors. The visits were not about politicking so much as they were about advocating for the needs of those who, for one reason or another, do not have a voice. It represented the essence of why many of you have responded to the call to serve as a professional counselor. You would have been proud of your colleagues who made the trip to Washington. I certainly was.

So as we look ahead, I encourage all of you to stay abreast of the many public policy developments we will witness in the coming year. As our government deals with how to address an overhaul of the U.S. health care system, we must continue to ensure that behavioral health is included. In regard to education issues, we have never had a U.S. secretary of education with as much authority and discretionary funding as the one who currently holds office. (Speaking of which, read ACA’s interview with Secretary Arne Duncan on page 38.) Funding that flows to school districts across the country must include support for professional school counselors.

While Congress and the Obama administration tackle many important domestic issues, our job is to ensure that the needs of your clients and students, as well as the needs of the counseling profession, are included. This is your right, so I encourage you to tune in to the issues being featured on the public policy section of ACA’s website (http://www.counseling.org/publicpolicy) and to let your elected and appointed officials know of your interests and concerns. If you don’t, who will?

As always, I hope you will contact me with any comments, questions or suggestions that you might have. Please contact me via e-mail at ryep@counseling.org or by phone at 800.347.6647 ext. 231. Thanks and be well.