Monthly Archives: January 2014

A game plan for life

By Clare Lochary January 24, 2014

Football-smallAthletes experience the thrill of victory, the agony of defeat and everything else that comes between the highs and lows of competition. Sometimes, though, they need help managing the accompanying feelings, which is one reason sports counseling has become a growing specialty. Unlike sports psychology, which focuses primarily on game-time performance, sports counselors take a more holistic approach by also paying attention to the mental well-being and pyschoemotional needs of athletes.

If an athlete “has major depression or severe OCD [obsessive-compulsive disorder], all the mental training in the world isn’t going to accomplish much,” says Jim Afremow, a licensed professional counselor (LPC) and sports psychology specialist who is also the author of the recently published book The Champion’s Mind: How Great Athletes Think, Train and Thrive. “I think it’s really exciting because in the last 20 years, both sports psychology and sports counseling have become more mainstream.”

A fair amount of overlap exists between sports psychology and sports counseling, in large part because performance is often the primary gateway to mental health treatment for athletes. “It’s really a good thing to have a person who works as a sports psychologist around performance to be licensed and versed in mental health counseling, because they do overlap and intersect in a lot of ways,” says Dwight Hollier, an LPC and nationally certified counselor who works as the director of transition and clinical services for the National Football League (NFL).

Athletes may seek out counselors with the goal of overcoming a specific obstacle, such as shutting out distractions when shooting free throws in basketball or playing without fear of reaggravating an old injury. But while the initial treatment goal may be to improve the athlete’s game-time performance, a sports counselor can provide coping techniques that are of use off the field as well.

Competencies for sports counseling, sometimes called athletic counseling, were first outlined in 1985 by the Association for Counselor Education and Supervision’s Counselors of Tomorrow project. The ACA Encyclopedia of Counseling includes the following definition for sports counseling: “A process which attempts to help individuals in maximizing their personal, academic and athletic potential. This is accomplished through a proactive, growth-oriented approach that incorporates the principles of counseling, career development, movement science, psychology and human development.”

Sports counseling has applications for clients from the professional ranks all the way down to amateur and youth athletes. That’s because sports can be an integral part of a person’s identity across the life span or at different points along the life span. Helping clients of all ages apply the lessons they have learned through athletics to life at large can be a hugely rewarding and productive type of treatment, according to professionals who work with this client population.

Clearing hurdles

Of course, asking for help for anything other than sports-related goals may initially be outside the comfort zone of many athletes, especially those performing at higher levels. “There’s a stigma about seeking counseling — ‘Oh, I’m a high-profile athlete; I don’t need counseling’ — especially for men,” says Tauyna Tinsley, a counselor educator at California University of Pennsylvania, an LPC in private practice and one of the founders of the American Counseling Association’s Sports Counseling Interest Network. “Sometimes the player is trying to see whose ‘side’ you are on — ‘Coach’s side or my side? Is it going to impact my playing? I don’t want Coach to find out and it impacts my playing time.’ It’s about developing a therapeutic relationship and understanding the counseling process.”

The question of confidentiality often comes up in sports counseling, especially in situations when the counselor directly or indirectly works for the organization that sponsors the athlete or his team. Emphasizing the privacy of the counseling experience to athletes is key.

“We have to adhere to ethical codes [regarding client confidentiality],” Tinsley says. “You [an athlete] talking to me doesn’t mean I’ll tell your coach, but that’s always a question.”

The philosophy of “playing through the pain” has also been ingrained in many athletes, so they may regard the idea of unburdening themselves to a counselor as frivolous or weak. Sports counselors must find ways to overcome such hurdles and help athletes to feel strong about their choice to seek counseling.

When Afremow is trying to connect with an athlete, he quotes basketball great Kareem Abdul-Jabbar. “Kareem put it right on the money when he said, ‘Your mind is what makes everything else work.’ In sports or in another career or as a student, let’s start with the mind,” Afremow says. “In our society, we want to start with the physical in terms of your muscles. Let’s work on your relationship with yourself and what you do.”

Adds Hollier, “The challenge in working with athletes is getting them to understand that everybody has emotional struggles and there are counselors who can help you to work through those challenges the same way a coach helps you learn plays.”

Building up an athlete’s healthy personal identity — one that isn’t measured by statistics or recognized by trophies — is an important part of sports counseling. Afremow takes an eclectic approach to treating athletes. He uses both Gestalt therapy and pyschodynamic approaches but mainly focuses on cognitive techniques because he says athletes are familiar with and tend to appreciate concrete goal setting.

Tinsley also favors cognitive behavior techniques and has found that approaching problems from an existential perspective works well with athletes.

On the plus side, many athletes are familiar with the process of working with health professionals such as trainers and physicians, so they may be more open than other client populations to the idea of creating and executing treatment plans. And once they buy into the concept of counseling, they tend to be very results-oriented.

“I like working with athletes and most counselors would [too],” Afremow says, “because they’re so driven and they’re really motivated to make positive changes.”

Fortunately, the tide slowly seems to be turning in favor of better mental health for athletes. This past September, the National Athletic Trainers’ Association outlined a broad set of guidelines calling for trainers and team physicians to increase their awareness of early signs of mental illness and to make referrals without compromising athletes’ confidentiality.

Have you got game?

Some sports counselors are former athletes themselves. Tinsley went to Augsburg College in Minnesota on a basketball scholarship. Hollier played linebacker in the NFL for nine years, primarily with the Miami Dolphins. As an undergraduate at the University of North Carolina, he initially majored in speech communication with an eye toward pursuing a broadcasting career, but he found himself feeling anxious on the microphone in front of crowds. After enjoying a psychology class, he decided to double major instead. He went on to earn his master’s degree in counseling the year before playing his final NFL season.

“Sometimes we athletes can take that mental toughness” — seen as an advantage on the playing field — “to mean we can’t have or show emotions. Suck it up, no matter what’s going on,” Hollier says. “That’s where we can get confused and miss opportunities to get assistance and recognize that there are different kinds of strength.”

Afremow, a member of ACA, grew up in an outdoorsy family that enjoyed playing sports. As a professional, he was drawn to learning what makes people tick. “Put those together and [sports psychology is] a perfect marriage to me. I’m helping people to be more vitally engaged in their lives and to overcome obstacles, personal and interpersonal, and the demands of their careers. I really enjoy everything about the field,” says Afremow, the founder of Good to Gold Medal PLLC, a sports and performance psychology coaching and consulting practice.

That said, counselors don’t need to be jocks (or ex-jocks) to treat one. It’s an axiom of the sports world that great players don’t always make great coaches. Similarly, great sports counselors are made in the classroom and through professional training, not on the field of play. Aspiring sports counselors should seek sports counseling classes within their programs and attend workshops or conferences on the subject. They should also read scientific literature on sports counseling and applied sports psychology.

California University of Pennsylvania, where Tinsley is an associate professor, offers a graduate certificate program in sports counseling. The program provides counselor training competencies in three core areas of study: foundations of sports counseling, contextual dimensions of sports counseling, and knowledge and skills for the practice of sports counseling.

Although it’s not necessary to know the difference between a shotgun formation and a shot put ring to be a good sports counselor, practitioners do need a profound understanding of the culture that surrounds a particular game or team. Each sport’s culture may have specific values, traditions and language, and a proficient counselor will be aware of them.

“You have to be genuine but nonjudgmental,” says Hollier of effective sports counseling. “Anybody, but especially young people, can smell the fake from a mile away. You’re not trying to fit in and be like them, just understand their challenges. If you don’t understand that culture, you may take it for granted. Sometimes you only get one shot at these men [NFL players] because of the stereotypes and things that have been preached to them as kids.”

Tinsley, who focuses on multicultural issues, looks at athletes as a distinct cultural group. Sports counselors will need to check any preconceived notions about “dumb jocks” or “pampered superstars” at the door, she says, and try to genuinely understand the problems their clients face.

“The athlete population can be discriminated against,” Tinsley explains. “Many people who’ve come through a sports counseling program never realize what athletes go through, aside from the glory of the media or getting into trouble. We’ve got to be knowledgeable about the history and meaning of sports or the culture of sports. [For instance], football is a very different culture from women’s field hockey.”

Tinsley got a crash course in athletic culture during a trip to Botswana. She had planned to model her experience working with high school academic support groups for student athletes to teach life skills to Botswanans dealing with HIV and AIDS. When she arrived, she discovered an entirely different view of sports than what she knew in the United States.

Botswanans used the word motshameko, loosely translated as “play,” to describe their games, which were engaged in only after all meaningful business was accomplished. Motshameko generally was not integrated into the country’s education system or its national development, so Tinsley had to adjust her expectations and approach to the project accordingly.

But even in the comparatively sports-mad culture of the United States, assumptions shouldn’t be made with clients. “If you sit down with five athletes and ask them what sports means to them, you’ll get five different answers,” Tinsley says.

Afremow’s learning curve involved arriving at a true understanding of the physical dedication of elite athletes and the demands they placed on their bodies. Early during his stint working with the Arizona State University football team, he asked a player who later played professionally if he had any major injuries. “At this level,” the player responded, “we’re all injured. It’s just usually how bad.”

Where to work

The sports community can be small and insular, so securing a start in the field or immediately expecting to make a living exclusively as a sports counselor can be difficult. Over time, though, athletes and programs tend to reward longevity and loyalty. For sports counselors working with a particular team, it’s worthwhile to show up at practices and games even when there is no specific counseling goal to be met. Face time is important for integrating yourself into the culture of a team, which is by nature exclusive. “It’s hard to get in, but once you get in, you’re really accepted,” Afremow says.

Sports counselors also have to exercise some flexibility in the way they treat their clients. Elite athletes, in particular, have multiple demands on their time and can’t always break away to visit a counselor’s office. Multitasking — such as having a counseling session while an athlete is on the training table or in an ice bath — is not uncommon in the field of sports counseling.

Working with a professional sports franchise or college team may be the most readily apparent type of employment for sports counselors, and certainly those opportunities can be exciting. Afremow has worked with Olympic teams, including the Greek national softball team and the Indian men’s field hockey team (field hockey is the national sport of India). He also worked with individual athletes at the 2004 Olympic Games in Athens, Greece.

Hollier, in his current position with the NFL, provides resources and educational training for players throughout their careers through the NFL Player Engagement Department. Under its Total Wellness initiative, all current and former players and their families are offered eight free confidential counseling sessions. In addition, using a peer-to-peer model, some former players have been trained in Mental Health First Aid, suicide intervention, relationships and transitions. These “transition coaches” assist current and former players facing any number of challenges, Hollier says.

“We also provide professional development and life skills sessions that include character, leadership, financial literacy, post-experience career and relationship management,” he says. “We also assist with degree completion and continuing education as well as job shadows, internships and career boot camps, among other things.”

Generally, an NFL player’s athletic life cycle is divided into three parts, called the Prep-Life-Next platform. “It’s about providing the right resources to help our men to be successful, not only on the field but beyond,” Hollier says. “It looks at pillars of strength — physical strength, personal strength derived from family and relationships, financial strength. We all know the physical strength — that’s stuff we can see in the locker room and weight room and on the field. The one that tends to get overlooked is emotional strength and spiritual strength.”

Outside the rarified realms of elite athletics, there are plentiful professional opportunities that make excellent use of sports counseling skills. School counselors can expect to work with athletes and can benefit from being knowledgeable about how sports might inform a student’s life in both positive and negative ways.

Tinsley is a champion of intervention and prevention programs, including a high school program called Academics in Motion that places a youth development counselor with athletes to help them improve their grade point averages and prepare for life after high school.

Community counselors also deal with current and former athletes, sometimes in unexpected ways. Tinsley had a former student who went to work in a drug and alcohol treatment facility. He was surprised to discover that many of his clients still identified as athletes years after their playing careers had ended.

“They were still wearing letterman jackets into middle adulthood,” Tinsley says. “Some research has shown that athletes who retire from sports, unless they developed a healthy identity, may engage in negative behavior.”

Hanging up the cleats

One of the most common issues sports counselors address is the end of an athlete’s career. Career development is mentioned as part of the definition of sports counseling specifically because retirement can be such a traumatic and confusing time for athletes. That’s true both for star athletes who must deal with a steep drop in income and attention, and for amateur athletes who are losing an activity that provided them with a significant measure of personal pleasure and identity.

“The postcareer blues is a very real phenomenon,” Afremow says. “It’s a death or a loss of a part of themselves and what they spent a lot of their time doing.”

Sometimes, the end of a playing career is visible from a long way off — for instance, the scholastic athlete who won’t play competitively after graduation or the pro athlete planning to retire at the conclusion of a specific season or event. Other times, the end arrives more suddenly, in the form of a career-ending injury or the athlete getting cut from a team. Either way, it is a major transition for the athlete to handle. Sports counselors can help these individuals envision the next phase of their lives and find new ways to use the skills they learned on the field or on the court.

“I had a great nine-year career in the NFL, but by about my sixth year, guys in the locker room started calling me the ‘old dude.’ I had to think about what to do next,” Hollier says. He went on to earn his master’s degree in counseling and then began working as a psychotherapist in an intensive outpatient program for adolescents three months after he retired from the NFL.

During their playing days, athletes make use of important traits such as creativity, the ability to react to change, perseverance, resilience and team-oriented thinking. Sports counselors can point out to athletes that these characteristics are also huge assets in postsports careers and interpersonal relationships. Channeling an athlete’s passion into a new pursuit can help that client transition to a new phase of life in a positive way.

“Just knowing that you’re going to have some feelings about [the end of a playing career] helps,” Hollier says. “I can provide assistance understanding how that skill set translates into that next passion or job.”




Clare Lochary, a writer and editor based in Baltimore, is a columnist for Lacrosse Magazine. Contact her at




The ACA Sports Counseling Interest Network

The ACA Sports Counseling Interest Network would be a good match for those counselors desiring to make a career out of this specialty, as well as for those who want to make sports counseling one aspect of their career. For example, advisers for athletes are those whose responsibilities include academic advising, life skills development, performance enhancement and psychosocial development at both the collegiate and high school levels. Professional counselors may hold positions as academic advisers for athletes, may be in private practice for clinical and mental health issues or may hold full-time positions within professional sporting organizations, colleges/universities, school settings or community agencies.

There is no cost to join the ACA Sports Counseling Interest Network, whose members share ideas via an online forum through the ACA Connect Community. For information on joining the interest network, go to

In addition, the Sports Counseling Interest Network will be holding an open meeting at the ACA Conference & Expo in Honolulu on Friday, March 28, from 7-8 a.m. at the Hilton Hawaiian Village Resort. All individuals interested in the network are invited to attend.


Quieting the inner critic

By Laurie Meyers January 23, 2014

ShhhhAlthough there are differing definitions of self-esteem, most counseling clients would probably use the common cultural definition: a feeling of having respect for yourself and your abilities.

Of course, defining self-esteem isn’t the same as understanding the important role it plays in emotional health. It’s a role that many clients may underestimate.

“Self-esteem is at the core of everything we do,” says Stacey Chadwick Brown, a practicing licensed mental health counselor and a member of the American Counseling Association. “Low levels of self-esteem create a negative dialogue — an ‘inner critic ’— that can really get in the way of achieving goals.”

Brown, like a growing number of counselors and researchers, believes that dispelling the clouds of low self-esteem requires the cultivation of self-compassion. But to find that compassion, counselors and clients must first recognize and address the problem of low self-esteem.

Self-esteem is, in a sense, the narrator of the stories people tell themselves every day — a kind of spoken-word “soundtrack.” It informs the mind’s internal dialogue and dictates how people view their relationships, abilities and achievements.

The problem, says Brown, who also teaches future counselors at Edison State College in Ft. Myers, Fla., is that most people are not aware of the effect this internal dialogue has. Individuals can become so self-critical that they begin to blame themselves for everything, she says — even things that are clearly out of their control. The effect is overwhelming and can lead to a downward spiral resulting in significant depression and anxiety, she adds.

Of course, most people don’t spin out of control, but that doesn’t mean low self-esteem isn’t intertwined with whatever presenting issue brings them into a counselor’s office. “Many of my clients come in with self-esteem issues,” says Tina Gilbertson, an ACA member who is a licensed professional counselor and author. “I believe that low self-esteem is a silent epidemic.”

If low self-esteem is as widespread as Gilbertson asserts, then children are client(s) zero. The lessons and behavioral patterns people learn in childhood have a significant — and sometimes damaging — effect.

Planting the seed

“Children, from the time they are infants, get feedback about their behavior and how they learn, so if they don’t have the proper environment or an environment that allows them to grow and learn things about themselves, they are at risk. They don’t know the rules or what the boundaries are, and that makes them really vulnerable,” says Sandra Meggert, who contributed a chapter titled “‘Who Cares What I Think?’: Problems of Low Self-Esteem” to the sixth edition of Youth at Risk: A Prevention Resource for Counselors, Teachers and Parents, published by ACA.

“But if you think about a plant … if you give it proper nourishment and put it in the sun, it grows to be a healthy plant. A child is kind of like that. If the child is in an environment where there is lots of positive feedback, he or she can thrive,” explains Meggert, an ACA member who is a faculty member at Antioch University in Seattle and a former school counselor. “Getting positive feedback about how well one is liked will have an incredible effect on self-esteem.”

But other environments, such as those where children are expected to be perfect or where there are no boundaries or consistency, can result in a failure to thrive.

“We all need to feel like we belong somewhere,” Meggert says. “Kids want some kind of structure, some kind of security and reassurance that things will always be this way. So when there is a lot of inconsistency or mixed messages, it’s very confusing. They won’t know which way to go, and since they are learning about their own self-value from other people and other interactions, it will affect their self-esteem.”

“For instance, failure to listen and give positive feedback [to children and adolescents] is really damaging,” Meggert says. “So is being rejected or neglected. These things create an environment in which it is really hard for a child to learn about getting along with other people. Parents need to be able to admit mistakes and, if necessary, apologize to a child. Those are all role-modeling things that can teach a child how to get along.”

“Children are also learning from role models, and if their role models are maladjusted or have self-esteem issues, that will influence their interactions,”
she adds.

As author and researcher Brené Brown puts it in her book I Thought It Was Just Me (But It Isn’t), “Family messages die hard. And many times they are very insidious. The messages become part of the fabric of our families. Until we can recognize and understand why and how they influence our lives, we just keep living by them and passing them off to the next generation.”

The larger problem

Self-esteem isn’t just about “feeling good.” Research indicates that low self-esteem can cause significant health and emotional problems. In an article published in 2009 in the Journal of Abnormal Psychology, two large longitudinal studies found that low self-esteem is a risk factor for depressive symptoms throughout the adult life span. The authors noted that while their findings were based on nonclinical samples, participants in both groups who demonstrated symptoms of major clinical depression had significantly lower self-esteem than others, leading the authors to believe that low self-esteem is a risk factor for major depression as well.

Some have suggested that rather than low self-esteem causing depression, it is a case of depression eroding self-esteem. However, a recent article in the journal Psychological Bulletin detailing conclusions drawn from multiple research studies reported that although depression can influence self-esteem levels, low self-esteem is much more likely to precede depression than vice versa.

This connection between self-esteem and depression demonstrates the extreme consequences low self-esteem can have. According to the World Health Organization (WHO), more than 350 million people of all ages suffer from depression worldwide. In a fact sheet published in October 2012, the WHO also stated that depression is the leading cause of disability worldwide and a “significant burden to global health.”

Even in the absence of clinical problems, low self-esteem can significantly impede everyday functioning. “I think that a lot of people in general struggle with self-esteem,” says Carolyn Russo, a Seattle-based licensed mental health counselor in private group practice. “It’s something we always have to work on. If we don’t have good coping skills or don’t feel confident in our abilities or ourselves, that can manifest itself in multiple areas, such as in our family lives and intimate relationships, and in our interactions and functioning at work and school.” Someone with low self-esteem is also more likely to accept and internalize outside criticism, Russo adds.

Research from a 2010 issue of the Journal of Personality and Social Psychology supports Russo’s claim. It found that people with lower levels of self-esteem not only reacted to rejection with increased negative self-appraisals and self-blame, but also exhibited higher levels of the stress hormone cortisol.

Ultimately, low self-esteem may resemble something akin to what Brené Brown defines as shame in I Thought It Was Just Me (But It Isn’t): “The intensely painful feeling or experience of believing we are flawed and therefore unworthy of acceptance and belonging.”

As Stacey Chadwick Brown explains, “In some cases, I’m seeing situational [low] self-esteem, which is easier to work with because it is connected to a person’s situation or circumstances, such as someone who is going through divorce, has failed a very important exam or is financially stressed because the economy is bad. Many times, those issues can be addressed fairly quickly.”

“However,” she continues, “if I’m dealing with low self-esteem that is rooted in internal dialogue, clients usually feel that they are a bad person and they are not deserving of love. They may even have been a victim of sexual abuse or parental abuse, which raises questions such as ‘If my mom didn’t want to hang out with me, what good am I?’”

Although these feelings can be incredibly painful, clients must learn to face them and accept them before they can work through them. “I think there is a strong relationship between self-esteem and accepting your feelings,” Gilbertson says. “If you believe that you are unworthy of acceptance, how can you learn to accept and make sense of your emotions?”

Self-acceptance is not easy, particularly when someone is stuck in a cycle of self-blame and harsh criticism. People need help breaking the cycle, preferably sooner rather than later. Observes Russo, “I see clients at their lowest — or one of their lowest — points. By then, issues of self-esteem and self-worth have become a much bigger problem than if they had come in sooner.”

Clients need to know that they are not alone, that the struggle for self-acceptance is part of the human condition. “One of our biggest challenges as human beings is to tolerate what we feel,” says ACA member Deb Del Vecchio-Scully, a licensed professional counselor and trauma specialist based in Connecticut. “Avoidance increases suffering. If we can just learn to tolerate and accept what we feel, it increases our sense of self-compassion and can open the door to some kind of peace.”

Low self-esteem meets self-compassion

Just as low self-esteem can have negative consequences, the opposite is also true: Higher levels of self-esteem are often linked to increased life satisfaction and better mental and physical health. For instance, a 2012 article in the Journal of Personality and Social Psychology details a large longitudinal study of individuals ranging in age from adolescence to old age. Researchers found that higher levels of self-esteem were linked to higher levels of relationship satisfaction, job satisfaction, occupational status, salary and physical health.

Another study, published in a 2010 issue of the journal Cognition & Emotion, concluded that people with higher levels of self-esteem are less likely to feel distressed by rejection or negative feedback.

So, how can people raise their levels of self-esteem? “True self-esteem entails self-compassion,” says Gilbertson.

In a chapter in the book Wisdom and Compassion in Psychotherapy, psychologist and self-compassion researcher Kristin D. Neff explains self-compassion this way: “Compassion … presupposes the recognition and clear seeing of suffering. It entails feelings of kindness, care and understanding for people who are in pain, so that the desire to ameliorate suffering naturally emerges. Finally, compassion involves recognizing the shared human condition, fragile and imperfect as it is. Self-compassion has exactly the same qualities — it is just compassion turned inward.”

Ultimately, self-compassion is about acceptance. “When you accept emotions, you are accepting the parts of you that they are connected to,” Gilbertson says. “Embracing those feelings is an act of self-esteem. It is a way to say ‘I matter.’”

Acceptance increases self-knowledge, Gilbertson says. “You can’t esteem a person you don’t know, so how well do you really know yourself?” she asks.

When clients finally face themselves, they may be surprised by what — or who — is behind their inner critic, Russo says. “Most of the time I’ve found with my clients that the voice in their head isn’t necessarily their own,” she says. “Maybe there was a traumatic incident that just stays in their head. It could be their mom or a teacher who really reprimanded them and that stuck and they are allowing that to replay over and over again.”

“Many times,” Russo continues, “what I see is that [the voice] is a caregiver or parent. Home might be a shame-based place, and for years they may have parents telling them they are wrong. It’s about finding out who that voice is and differentiating it from the client. It’s a turning point for clients once they realize that it’s not their voice.”

Cultivating self-compassion

How can counselors help clients discover and start tapping into their self-compassion? It starts with recognizing when low self-esteem is linked to the problem a client is presenting with.

“Well-intended counselors are really wanting to help people, but sometimes we miss the forest for the trees,” Brown says. “We go and learn about how to help people with major issues such as experiencing depression or recovering from an accident, and these [take] very targeted interventions. Also, things are very time sensitive since we are often dealing with limitations such as insurance benefits, so we try to get in there and solve problems.”

The key, Brown says, is for counselors to step back, take a look at the big picture and ask why these issues keep coming up. In many instances, she asserts, the answer to that question leads back to a client’s low self-esteem.

Not identifying self-esteem issues early on in counseling can slow down the healing process, Russo says. “When clients come in, they really want relief. If they don’t start to get relief, they’re not going to want to work on the deeper issues.”

Most of the time, clients know that there is a behavioral and emotional pattern contributing to their problems, but they don’t know what it is or how to deal with it, Russo says. So, part of her process involves collaborating with clients to figure out what those patterns are.

“We’re so quick to identify a solution to the ‘problem,’” Gilbertson says. “[But] sometimes exploring and making sense of something untangles the problem and makes it less of a problem.” Helping people to understand their feelings — and convincing them that their feelings are normal and valid, not wrong or dangerous — is a very powerful counseling tool, she says.

“It’s hard to accept something you don’t understand,” Gilbertson continues. “That’s why [counseling] is uniquely suited to help people with self-awareness and acceptance.”

Gilbertson’s realization that she really needed to focus on self-compassion with her clients eventually led her to write a book, Constructive Wallowing: How to Beat Bad Feelings by Letting Yourself Have Them, which will be published by Viva Editions this spring.

“I kept having the same conversation with my clients over and over again about, as they called it, wallowing: ‘I will never feel better if I allow myself to feel what I am feeling. I can’t let myself slide down this hill to the bottom,’” Gilbertson says. “My book focuses on self-compassion, which I define as the absence of baseless shame. Shame gets started through even [functional] parenting and appropriate discipline because kids can’t make the distinction between themselves and their actions.” In Gilbertson’s view, nobody escapes childhood without a load of baseless shame.

Thankfully, just as clients did not build their shame alone, neither do they have to dismantle it alone. Gilbertson says that by providing her clients with acceptance and compassion, she is teaching them to apply these tools themselves. The process involves giving clients the freedom to express their feelings and letting them know it’s acceptable to have those feelings. By asking questions and pointing out patterns, Gilbertson guides her clients in examining their feelings, discovering what’s behind them and figuring out why they are always mad, sad, etc. “That gives them skills they can use when I’m not around,” she says, adding that it’s important to let clients know that their emotions are the result of many factors.

Different counselors use different tools to help their clients examine their inner lives. Brown likes to use journaling with her clients. “Journaling helps to give a realistic assessment of a client’s self-view,” she says. “The process is not so much about digging into the vaults of their minds but introducing the concept of the inner critic. Sometimes [in counseling], we ‘name’ the inner critic. It’s something that helps them think of the critic as separate from the self. We use humor, draw pictures of the inner critic and try to realize where the critic comes from. Is it your mother? Is it Martha Stewart?”

Brown is a firm believer that every client can benefit from journaling if they give it a legitimate chance. “If you can just convince people how important and helpful journaling is so that they will actually do it a few times, then they will understand the beauty [of it] is two-fold: You can just dump all the negative thoughts and feelings out on paper, and you can also look back on it and track those feelings, see what you were doing, where you were.”

“Of course, the counseling environment is a big part of the process,” Brown says. “It needs to be as relaxed and comforting and nurturing as possible. I’m there to support them — it’s almost a re-parenting. You need to show appreciation, point out strengths, have compassion.”

Russo also uses writing exercises to help clients struggling with self-esteem issues. “I have them write down ‘thought records’ to identify those most negative thoughts. Then we ask: ‘How we can reframe them? Make a list. What would a friend say about you? How would they explain you to another person?’ Sometimes that helps them to see outside themselves. Asking friends and family members how they would describe them [the client] can help build relationships and also let them see how other people see them, which may be different than they thought. This can help build esteem. It also helps me to get an idea of where they are and what the next step is — what do you want to be, what do you want to accomplish?”

Russo also suggests activities such as yoga, relaxation exercises and meditation for clients as a way to show compassion toward mind and body by mediating stress. She also believes these practices encourage clients to focus on the here and now and cut out the extraneous, even if only momentarily, allowing them to focus on what they are feeling. Russo sometimes conducts relaxation sessions in the counseling environment.

Del Vecchio-Scully incorporates mindfulness and yoga into her practice and also uses art therapy. She sometimes has clients paint and decorate paper, putting down any words or pictures that make them feel hopeful and compassionate.

Meggert believes that cultivating our ability to laugh at ourselves is essential to developing self-compassion. “Being able to laugh at yourself allows you to have perspective,” says Meggert, who conducts humor seminars and is the author of Creative Humor at Work: Living the Humor Perspective. “When you have a situation that is causing you stress, looking for humor distances you and gives you perspective, which helps make things look less devastating.”

Meggert thinks everyone should have what she calls a “humor kit,” a mental collection of favorite jokes or sayings, silly songs, puns, wordplay — whatever makes you laugh — to draw from when needed. It’s harder to self-criticize when you’re busy laughing, she asserts.

“Laughter is important. When you’re just doing ordinary things, look for the humor around you. It only has to be funny to you; you don’t have to share it,” she says.

Not just for clients

Before tackling self-esteem issues with clients, counselors may first need to look in the mirror and conduct a self-evaluation.

“We have to do some work on ourselves before we are ready to help others,” says Brown, who will be presenting an education session on “Understanding and Improving Self-Esteem for Yourself and Your Clients” at the ACA Conference in Honolulu in March.

In doing that dirty work, counselors may discover that they engage in self-judgment and negative self-thought more than they previously realized, Brown explains. If that is the case, it signals an important area that needs to be addressed.

“Experience and intuition can be very valuable tools. The more we allow ourselves to feel comfortable with who we are and become aware of baggage, the better we will understand and treat our clients,” Brown says. “We want to focus on clients, but we need to take care of ourselves, because that is a very important part of the counseling process.” To do that, she suggests counselors make use of the same strategies they suggest to clients.

Counselors need to practice self-compassion too, maintains Gilbertson. “Counselors cannot be more accepting of their clients’ feelings than they are of their own,” she says. “If they don’t tend to their own feelings and feel and accept them, they will not be able to tolerate clients’ [feelings] as well as they would like.”

Russo provides the same advice to her colleagues in the counseling profession that she gives to her clients. “We are our own worst critics,” she says. “If we were our own best friends, how would we react? We need to focus on finding our strengths. What are the things we are really good at? How do we feel when we do them? We need to try to do more of what we are really good at.”

“It’s also important to establish a sense of community,” she adds. “When we have a better sense of community, we feel good about ourselves. It’s all about promoting those feelings of connectedness.”

Using the tools of self-care to encourage self-compassion is just as important for counselors as it is for their clients. “I think we all need our [self-care] practices — whatever they might be,” says Del Vecchio-Scully, who is also the executive director of the Connecticut Counseling Association, a branch of the American Counseling Association. “You have to take care of yourself to take care of other people. I set the tone for myself to be as mindful and present as I can be with clients and myself.”

Her tools for self-care include exercising and meditating each day, meditating with clients and engaging in various creative projects. Yoga is also an essential part of her life. “It’s different for everyone,” Del Vecchio-Scully says. “Do something that you enjoy, something that you know you will do regularly.”

“Laughing is one of the best things we can do for ourselves,” she says. “It releases endorphins and helps relaxation, so laughing is an act of self-nourishment. Some people need to release stress physically, some mentally, some emotionally. Self-compassion and nourishment are about matching the individual and who they are with the activity that will promote the most well-being for them.”

“We are looking for a transformative state,” concludes Del Vecchio-Scully.



For further reading:

Gifted Children: Not immune to low self-esteem:

ACA member Michelle Muratori, a senior counselor and researcher at the Center for Talented Youth at Johns Hopkins University, explains why children identified as “gifted” are not immune to low self-esteem.




To contact the individuals interviewed for this article, email:

Stacey Chadwick Brown:

Tina Gilbertson:

Sandra Meggert:

Carolyn Russo:

Deborah Del Vecchio-Scully:




Laurie Meyers is the senior writer for Counseling Today. Contact her at

Act your age

By Kathleen Smith January 22, 2014

lifedirectionI sit up straight in my chair in the small office, nudging my glasses up the bridge of my nose and hoping my new client doesn’t realize we’re the same age. Yet her comfort level with these new surroundings appears seamless as she tucks her legs underneath her and explains why she is dressed for gym. Yoga is the only thing that lightens her depression.

“I’m not interested in being medicated,” she asserts, even if that means lying awake all night. She admits that the nights are the worst, when her fear of the future waits by her bedside like a dog wanting to be taken out, tail thumping anxiously.

A string of false starts — in life, school and work — has left this 20-something young woman confused about her own identity. It has also perplexed her parents, who feel anxious about how to nudge their daughter out of the nest without abandoning her. Not surprisingly, empathy can become a shallow well when credit card bills arrive faster than paychecks, so a neutral party — namely me, a counselor — feels less scary to everyone involved. Still, when my client first called to make an appointment, I could sense her mother over the speaker holding her breath, silently weighing my counseling credentials against the age in my voice — or the lack thereof.

I remember how strange it felt a few years back when my father was in the hospital after surgery to see him wheeled around by medical professionals who had been my high school classmates. To me, they were still teenagers daydreaming in second period biology; only now, they were in charge of people’s lives.

I imagine the parents of this young woman might have felt the same way upon entrusting their daughter into my hands as her counselor. Sounding and acting like a professional only goes so far when, on first impression, you can still pass for an undergraduate down the street at Georgetown University.

As a young professional, I am keenly aware that counseling is one of those professions where job experience is often measured by life experience. An oncologist doesn’t need a cancer diagnosis to know the ins and outs of the disease, but try doing marital counseling as a single person and you’ll get more than a few eyebrow raises. In the past year, my work with these 20-somethings (and even a few 30-somethings) who are struggling to shake off the strings of prolonged adolescence has given me insight into how I can help them with their dilemmas, both as a peer and as a resource.

This past summer, a Pew Research Center poll reported that more young adults were living with their parents than at any other time in the past 40 years. My client was one of the 21.6 million millennials living at home in 2012, up 3.1 million since 2007 and the subsequent economic recession. Of this group, 45 percent are unemployed, and they’re more likely to be women, under the age of 25 and without a college degree. Desperate for their adult children to move out of the house, pick a career and pay the bills, baby boomer parents are nudging their offspring into psychotherapy offices with the hopes that professionals can offer a firm, fresh push in the right direction.

Every week, my client, struggling to launch out into the world, would lug in the weight of her family’s expectations and values. Before every session, we’d sketch a diagram of her family on the office chalkboard to remind us both that change doesn’t occur in isolation. Pushback from family members is inevitable when someone starts carving out his or her own identity, and fear and anxiety get passed around like the plague. She was drowning in emotions that accompanied constant comparison with relatives and peers, but together we began to wrap some crime scene tape around her reactions and play detective before she could sentence herself to failure.

After a fair amount of time and Kleenex, I felt comfortable challenging her to consider what it would look like to take responsibility for herself and her emotions rather than absorbing her parents’ anxiety. “What would make you want to support yourself because you value independence,” I asked her, “and not because you fear your father’s reaction?”

Defining a self outside of others’ expectations and emotions is a muscle that we both learned to exercise together. As her counselor, I checked the urge to assess my work according to her family’s perception of my value. Similarly, my client began to follow through with decisions that were intrinsically rather than relationally motivated. As is the case with any family, there were countless stops and starts along the way, times when a tense holiday gathering or a costly car repair let the fear of disappointment take control. As my client’s peer, I believe I drew patience and empathy for her in part from my own relationships with friends and classmates over the years — young adults who felt overwhelmed by student loans or couldn’t quite seem to escape the intense focus of their parents.

“You swim in the same water that your family does,“ I reminded my client on numerous occasions. “But you’re here to learn what it feels like to poke your head above the water and gain a little perspective.” By making the effort to initiate conversations with her parents that didn’t revolve around just grades or bills, she was able to inch toward an adult relationship with them. She slowly began to separate personal goals from the ever-fluctuating opinions and perceptions of others, which I truly believe is a lifelong endeavor.

I abandoned my glasses awhile ago in sessions with this client. They are no longer my secret shield, creating the illusion of experience and adding a few years to my age. I ceased fretting over my professional persona because I learned that my responsibility is to walk beside her rather than lead her — a task I hope her parents have learned as well. Appearances can be deceiving, but that’s what counseling is all about.



Kathleen Smith is a family systems counselor and postgraduate trainee at the Bowen Center for the Study of the Family. She is also a doctoral counseling student at George Washington University. Contact her at

Game on: Technology as counseling tool?

By Bethany Bray January 17, 2014

ipadWhen it comes to video games, the word “empathy” probably isn’t the first thing that comes to mind. Yet some video game designers have begun to stray from the pack, creating games with storylines that attempt to teach compassion or help the players manage their emotions.


Designers of the game “High School Story” recently wove in a new story arc about cyberbullying. Another game, “If,” an iPad app for ages 6 to 12, was created to teach empathy, self-awareness and listening skills.


“You have to meet people where they’re at,” Trip Hawkins, the creator of “If,” told USA Today in a recent interview. “Where are our kids right now? They’ve got their fingers on a device.”


Could these new games be used as counseling tools? Might they serve as a way to reach a digital generation that has grown up using screens – from iPads to smartphones – as part of their everyday lives?


“It’s a tool – another tool for teaching some of these basic concepts [such as empathy],” says Marty Jencius, an associate professor at Kent State University and co-founding editor of The Journal of Technology in Counseling. However, he cautions, counselors should be comfortable with the game and its medium (iPad, smartphone, etc.) themselves before attempting to use it with clients.


Most important, Jencius says games should not be viewed as a substitute for counseling but rather as one of many tools used by counselors. “Bad counseling skills don’t get fixed by technology,” he says. “[They’re] not a substitute for good practice and good technique.”


Janis Booth, an associate professor in the Mississippi College Department of Psychology and Counseling, contends it is natural and appropriate for counselors to make use of the same mediums – tablet computers and other technology – younger clients use all the time at school and home.


“To employ [technology], it is imperative that we become more technologically savvy and be extremely mindful of ethical issues related to both the hardware/equipment we are using – or suggesting our students/clients use – and the particular software or applications we are using,” she says.


Sarah Spiegelhoff, a counselor at Le Moyne College’s Wellness Center in Syracuse, N.Y., says technology – from social media and apps to blogging – can be a useful way to connect with clients. “I find technology resources to be great tools to supplement traditional counseling services, as well as a way for counselors to reach larger populations than we typically serve on an individual basis,” says Spiegelhoff, who is also an adjunct counseling faculty member at the State University of New York at Oswego.


“I find that college students are quicker to check Facebook and Twitter statuses than their email, so using social media has been one way for us to promote and distribute information on healthy living and outreach events,” she says. “I also share information related to new apps that promote wellness both through our social media accounts and directly in counseling sessions. For example, during alcohol awareness programming, we encouraged students to download free blood alcohol calculator apps. We also offer free mindfulness meditation MP3s through iTunesU. I find the MP3s to be a great resource because I am able to present them to clients in session, talk about their experiences listening to and practicing the meditations, and then develop a treatment plan that includes their use of the meditations outside of the counseling sessions. Since the MP3s are free and can be played on their computers, smartphones and MP3 players, clients are open to the idea and are able to introduce this practice into everyday living.”


Booth, who gave a presentation on smartphone apps that can be useful for counselors and their clients at the 2013 ACA Conference in Cincinnati, is excited about this new wave of video games and other technologies, but reservedly so.


“There are wonderful tools available for all forms of technology which, when used ethically and knowledgeably, can enhance both our ability to provide support to clients in and out of our offices and likely improve or simplify how we run our offices,” Booth says. “But to be used effectively, I think these mediums should be used to enhance the work of counselors, not replace it. What faculty supervisors, site supervisors and other counselor educators are attempting to teach students about what being a counselor actually means is what really matters.”


As an example, Booth references the iconic “Gloria” film series, in which Carl Rogers (person-centered therapy), Fritz Perls (Gestalt therapy) and Albert Ellis (rational emotive behavior therapy) are shown applying their respective therapy approaches with the same client. Booth watched the film as a counseling student and still screens it with her students today.


She says her students “still report learning a great deal about how to be an effective counselor from the master counselors in the film. … Do they experience Carl Rogers being empathic? Oh yes. Does it teach them to be empathic? No.”


“What we cannot teach by the use of technology or any other method,” she continues, “is how and what to feel in response to a client and how a client will comprehend that a counselor truly understands those feelings.”




Counselors, could iPad games and other technologies serve as useful counseling tools? If so, how are you using these tools with your clients? Leave your thoughts in the comment section.




For more reading:

More about Sarah Spiegelhoff’s work and use of technology


USA Today article on the iPad game “If”


NPR story: “In gaming, a shift from enemies to emotions”


Washington Post article on game with story arc involving cyberbullying


NPR story: “Video game creators are using apps to teach empathy”


NY Times article on crisis counseling via text message:



Bethany Bray is a staff writer for Counseling Today. Contact her at

Follow Counseling Today on twitter @ACA_CTonline

Gifted children: Not immune to low self-esteem

By Laurie Meyers January 14, 2014

smartchildrenAt first glance, gifted children would seem to be “immune” to issues of low self-esteem. After all, these children are generally thought of as successful high achievers. However, people who study and counsel gifted students say this is a potentially harmful misperception. These experts caution that while gifted children are not necessarily more at risk for low self-esteem than other children, their self-esteem issues are more likely to be overlooked.

Explains Michelle Muratori, a senior counselor and researcher at the Center for Talented Youth at Johns Hopkins University in Baltimore, “Competence and achievement are generally thought to be vital elements of self-esteem and are intertwined with a child’s evaluation and awareness of his or her own worth, so people may mistakenly conclude that gifted children are exempt from low self-esteem because they appear to be very competent and high achieving.”

However, some challenges specific to gifted students can cause significant problems. For instance, when gifted students are not adequately challenged in school or don’t have access to intellectual peers, problems such as underachievement, boredom and unhealthy perfectionism can emerge. This is a particular problem in schools that don’t provide a supportive environment for academic achievement, asserts Muratori, who is also a member of the American Counseling Association.

“While some school cultures embrace athletic or artistic achievements, they fail to embrace intellectual curiosity [due to fear about elitism], which gives academically talented students the clear message that they need to hide their intellectual gifts so as to avoid negative reactions from other students, teachers and other school personnel,” she says.

“These students may unfortunately internalize the message that it is not OK for them to be who they truly are, which may damage their global self-esteem,” Muratori concludes.

In fact, according to a 2008 study in the Creativity and Research Journal, a significant number of gifted students — possibly close to half — are not achieving their full potential. In addition, as many as 25 to 30 percent of high school dropouts may be gifted individuals. The authors believe that creativity may be connected to this “underachievement.” They suggest that highly creative students have a hard time conforming to a more rigid traditional environment. The study also cites previous research indicating that teachers generally prefer conventional achievers and “teacher pleasers” to more unconventional students.

Other factors may also contribute to a gifted child’s low self-esteem. Gifted children have varied personalities, of course, but certain characteristics are often associated with giftedness, Muratori explains. Many experience the world with great intensity, which can be overwhelming both to them and the people in their lives. As peer acceptance becomes more important, being acutely aware of being “different” may magnify feelings of loneliness.

A 2006 article in the journal Professional School Counseling said studies have shown that gifted children experience higher levels of anxiety, perfectionism, sensitivity and depression. In addition, according to an article in The Journal of Secondary Education, research has indicated that gifted children are very adept at hiding signs of depression, even in severe cases.

School counselors are often in prime position to identify self-esteem issues among gifted students. Muratori says a counseling strategy should include not only a comprehensive assessment of academic ability, including above-grade-level testing, but also other assessments that seem relevant, such as personality assessments, vocational assessments and self-esteem assessments. If necessary, these measures should be used to modify educational strategies to encompass greater academic challenges. The assessments should also be used to help students with social and emotional development as needed.

“If a student performs extremely well on an above-grade-level test in mathematical reasoning, for example, a school counselor can advocate for curricular flexibility and help the student gain access to more advanced course work in math,” Muratori says. “If this student is interested, the counselor might also encourage them to get involved in math-related activities outside of school such as a math circle, a math competition or an academic summer program with an intensive focus on math. Not only will these activities help the student develop their interest in math, they will also give them access to peers with shared interests and the opportunity to develop important social skills.”

“In addition to academic concerns,” she continues, “counselors should also look for indicators that a student may be in distress and in need of an intervention, such as depressed affect, eating disorders, sleep disorders, low motivation, underachievement, boredom, social isolation or disruptive behaviors. Individual or family counseling can help gifted children deal with any number of problems if these issues start to interfere with functioning at home or at school and cause distress.”

Once counselors are aware of the unique challenges that gifted children face, they can more easily implement strategies that help these children develop a healthy and realistic sense of self, Muratori concludes.




Laurie Meyers is the senior writer for Counseling Today. Contact her at



For further reading

Quieting the inner critic: Counseling Today‘s February cover story on helping clients with self-esteem issues:




Research cited in this article:

• “Underachievement and Creativity: Are Gifted Underachievers Highly Creative?” Kyung Hee Kim, Creativity Research Journal, April 2008


“Addressing Counseling Needs of Gifted Students,” Jean Sunde Peterson, Professional School Counseling, October 2006


“Depressive disorder in highly gifted adolescents,” P. Susan Jackson and Jean Peterson, The Journal of Secondary Education, Spring 2003