Monthly Archives: August 2016

Counseling survivors of sexual assault

By Brooke Bagley and Joel Diambra August 26, 2016

My journey (Brooke Bagley) of developing a five-phase model of counseling began in 2013 as I was completing my master’s-level graduate program and transitioning into a therapy position at a local area sexual assault center where I had worked since 2010. For the past three-plus years, I have listened to horrific stories, learned to establish rapport, identified helpful strategies, Bagley_Diambraempowered my clients, observed healing, prompted restoration and marveled at my clients’ resilience. All the while, I was unintentionally and unknowingly developing an effective counseling model.

During the past two years, I’ve also been receiving supervision toward licensure from Joel Diambra, the secondary author of this article. I discovered (or uncovered) “my” model of counseling when he recognized that I had a sequential pattern to my counseling and asked me to begin identifying what I was doing and the reasons I was doing it. Thus, I began to reflect on my counseling practice and, over the course of several weekly licensure supervision meetings, we crafted a five-phase model — my way of counseling survivors of sexual assault toward healing and restoration.

Just the thought of counseling someone who has been sexually assaulted may be daunting for many counselors. I think it’s fairly natural for most counselors to feel professionally inadequate when they knowingly encounter their first client who has been sexually assaulted. Although my five-phase model is based in foundational counseling theories and skills, I offer it here as one guide for counseling clients who have experienced sexual assault. Perhaps it will provide a road map for other counselors serving similar clients.

 

Phase 1: Assessment and education 

Phase 1 primarily consists of effective assessment skills, identification of presenting problems and initiating the first steps toward building rapport and developing language (matching age-appropriate terms, paralleling word usage, avoiding trigger words, etc.) that is most effective for the client. The amount of time spent in this phase typically ranges from one to three sessions depending on the client’s trauma history, presentation and comfort with therapy, and assessment of the client’s basic needs.

During this phase, it is imperative for counselors to maintain a high level of empathy to create an environment of acceptance and comfort. Many survivors of sexual assault struggle with feelings of shame, guilt, embarrassment and defectiveness, and have a decreased level of trust in others who are outside their identified support systems. To facilitate an environment that feels supportive and safe, I use the client’s own language, focus on appropriate and accurate reflections, and allow the client to emote without much intervention on my part.

The psychosocial assessment covers basic client-related information familiar to most mental health providers. This assessment provides insights regarding a client’s familial, medical and work-related history, in addition to current issues and past functionality. I complete the assessment to focus more on trauma-related history, both specific to sexual trauma and complex trauma (any previous trauma-related incidences a client identifies as having experienced). This focus is helpful in gauging client resilience, gaining insight into a client’s threshold for stress and obtaining increased awareness of potential maladaptive cognitive patterns the client might possess related to any current situations or traumas. At this point, the initial narrative (the client’s first retelling of the traumatic experience) is established, and I am able to incorporate the client’s language into future interactions to help in developing rapport and trust.

Phase 1 also consists of a psychoeducational focus that is helpful in increasing the client’s confidence in pursuing and maintaining therapy services. After completing the psychosocial assessment, I file the assessment in the client’s chart to review later in the therapeutic process and provide the client with trauma-related materials on normative responses that may be experienced in all facets of the client’s functioning (cognitive, emotional, physical, mental, social, etc.) At this time, I walk the client through a trauma symptoms checklist that includes emotion-, behavior- and cognitive-related questions. These questions and the corresponding answers offer insights into the client’s level of affectedness, while simultaneously educating the client on how and why certain symptoms have manifested.

Phase 2: Rapport and strengths

Building rapport and identifying strengths are major components of allowing successful trauma processing and resolution to occur. In phase 2, I encourage clients to take a break from our immediate focus on the sexual trauma and to instead explore their perceived strengths. This action facilitates the instillation of hope. This phase deviates slightly from other trauma-focused therapies by offering clients allotted time to engage in intrapersonal exploration that is separate from their trauma. This approach is geared toward a focus on what they still have versus what they feel they have lost.

Rapport building starts with intentional focus on empathy versus sympathy and the utilization of unconditional positive regard. This is accomplished by allowing clients to clarify their self-perceptions, identify as “survivors” or “victims,” and so on. This is the perfect time to incorporate the language or narrative the therapist has picked up from clients in the initial sessions. This conveys to clients that they were heard and listened to and, thus, are being cared for. I often explain the difference between empathy and sympathy during this phase to help clients identify which felt most supportive and when. This is also helpful to clients outside the counseling office because they are better able to identify those in their lives who provide this level of support and others who are less able to support them.

During the second phase, survivors of sexual abuse often report a reduced perception of control, diminished trust in others, a negative view of self and decreased feelings of worth related to being loved, cared for and valued. In this phase, I encourage clients toward increased positive views of self and self-confidence and the ability to seek support from individuals who can provide it. This skillset and a more positive perception of self are helpful over the course of the therapeutic journey.

Additionally, I explore clients’ past coping successes — activities they have previously engaged in that have been helpful in decreasing general stress — and work with clients towards creating a coping skills “kit” for emergency access. This provides go-to coping strategies when future trauma-related escalation occurs. When packing their kits, clients have included such items as adult coloring books, chocolate, scented oils, music playlists, the contact information of support people and so on.

Phase 3: Cognitive intervention

In phase 3, I explore clients’ cognitive processing. We work to identify thought patterns that lead to self-deprecating perceptions and triggering responses. I often alternate between the cognitive distortions focus of cognitive behavior therapy (CBT) and the emotion-incorporated theory of rational emotive behavior therapy (REBT).

During this phase, I recall the initial assessment (initial narrative of recent trauma) and work with clients to identify how they retell their history and describe their current functioning. Using a predeveloped checklist of common cognitive distortions, I work with clients in session to identify which distortions they are experiencing. Once clients are aware of these patterns, I encourage ongoing mindfulness activities to increase recognition of these cognitive distortions outside of therapy.

For example, I often give homework in the form of thought logs to help clients record triggering events, thought responses and actions taken. For clients who are less engaged in homework, a simple rubber band on the wrist is used to help clients heighten and maintain awareness. They do this by snapping the rubber band every time they experience a trigger. The hope is that if they find themselves snapping recurrently, they will in turn pay more attention to their maladaptive thoughts and can then better self-identify and later verbalize these patterns in therapy. Some of the cognitive distortions that clients commonly report to me include: “I am damaged”; “I will never be the same”; “I should have done something different”; “Nothing good ever happens to me.”

Once we identify negative thought patterns and triggers, we begin working toward positive and realistic reframes while continuing to focus on coping skills from the previous phase. I encourage clients to share their perceptions of their situations and, together, we begin to break down these thought patterns to help them process their experiences differently. For instance, a client might state, “My family seems uncomfortable when I bring up my assault. They must think I am overreacting.” In this case, we would work to create a healthier, more adaptive reframe such as, “My family may appear uncomfortable when I bring up my assault, but maybe it is because they are not sure how best to support me.”

This provides a reevaluation of the client’s perception. The hope is that clients will then recognize the potential in their support systems and, incorporating increased self-confidence from the previous phase, will feel comfortable conveying and eliciting more effective and efficient support from friends and family members.

Phase 4: Emotion focused

Phase 4 is primarily focused on emotion-based responses and interventions, along with the incorporation of mindfulness. I purposefully separate this from and have it follow the cognitive phase because I have found there are residual and intense emotional responses that often outweigh clients’ abilities to rationalize or self-soothe. Clients with complex trauma or a lack of effective coping skills often report numbness, a sense of disconnect from their bodies, intense and seemingly uncontrollable anxiety responses, and self-harming or self-medicating behaviors in various forms. In this phase, I primarily use Gestalt-based interventions to help clients better understand mind-body communication as it relates to emotional response.

The Gestalt interventions I use with clients are primarily focused on bodily sensations and reexperiencing physiological reactions. For this focus, I teach and encourage clients to practice body scanning on a regular basis but especially when experiencing more intense emotional reactions. The purpose is to have clients become better acquainted with specific aspects of their emotional functioning and the associated feelings linked to their bodies. This interventionBranding-Images_survivors allows in-the-moment understanding of how certain emotions manifest physiologically and encourages an increased awareness of clients’ specific responses to emotions in triggering conditions.

I ask clients to walk me through a recent trauma-related episode, having them focus on what they felt bodily versus emotionally or cognitively. Many clients report feeling like anxiety manifests in their digestive tract (stomach, bowels) in the form of cramps and intense aching or, alternatively, in the form of pressure in the temples of the head or behind the eyes.

Some clients will report a complete disconnect when they experience intense emotional reactions. They become physically numb and feel no sensation — much like physical denial. Clients who disconnect are more prone to self-harm. They tend to revisit this unhealthy form of coping even if it has not been in active state for them for some time.

A common practice I use for working with this trauma response is based in mindfulness. I encourage clients to engage all five of their physiological senses by directing them to pick different therapeutic items up in my office (essential oils, stones, stuffed animals, mints, wall art, etc.) to smell, touch, taste, listen to and focus on visually. Once this senses-based intervention has been practiced within the therapeutic office, I encourage clients to continue using this intervention at home. A more severe tactic of grasping ice has been found to be helpful for clients who have tendencies toward self-harm. The ice allows for a physiological stimuli or shock to the body that engages sensation centers in the brain similar to those engaged in cutting, burning, etc. The hope is that these clients will choose items that are pleasing to them over items that are unpleasant, thus creating more positive experiences that involve bodily sensations.

Phase 5: Trauma narrative

The final phase in this model is focused on the trauma narrative. It is at this point in the therapeutic process that clients are displaying and self-reporting more stable emotional and cognitive-related responses to stress and more effective use of healthy coping skills.

I encourage survivors of sexual assault to begin writing out their trauma narratives, which occurs in session. Retelling their stories has been empirically proved to decrease the severity of the trauma response. It also allows clients to apply new meaning to their experiences and incorporate new and positive self-views and language. I do not recommend writing trauma narratives outside of the therapy session, however, because clients with a recent trauma can still be easily triggered. This is especially true when the narrative directly engages their previous trauma.

Once an initial narrative is written, I have the client read it out loud two separate times within the same session, or sometimes over the course of two sessions depending on the client’s responses to the narrative work. The first time, clients read their accounts of their trauma verbatim. From there, we are able to explore and process their reactions to the narrative and gauge their level of trauma response. I then ask clients to reread their narratives in the third person, as though they are telling someone else’s story. This allows them to take a bird’s-eye view of their trauma experience and perceive it differently, which often results in clients permitting more empathy and understanding for themselves.

Implications and model tenets 

My experience with this model in treating survivors of sexual assault has been favorable. Using this five-phase model, I have maintained a high client retention rate of 70 percent and a low cancellation rate of approximately 25 percent (compared with a typical rate of 40 percent within our center) over the past 18 months. Most clients report an overall increase in functionality after three sessions. These same clients have engaged in trauma work sooner in the therapeutic process than have our clients treated without the five-phase model.

Tenets of this model include effective assessment skills, a focus on client history and complex trauma, empowerment and encouragement of clients, an empathic strength-based approach and the incorporation of CBT/REBT and Gestalt-based interventions.

 

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Brooke Bagley, a national certified counselor, is a therapy team leader/supervisor and clinical mental health therapist at the Sexual Assault Center of East Tennessee. Contact her at brookelynnbagley@gmail.com.

Joel Diambra is an associate professor of counselor education, associate department head and director of graduate studies in the Educational Psychology and Counseling Department in the College of Education, Health and Human Services at the University of Tennessee in Knoxville. He is a licensed professional counselor-mental health service provider. Contact him at jdiambra@utk.edu.

Letters to the editor: ct@counseling.org

 

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

Helping students change with dignity

By John J. Murphy

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

— Edward de Bono

 

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

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

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

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

Step 1: Establish collaborative relationships

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

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

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

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

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

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

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

Step 2: Develop practical goals

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

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

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

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

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

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

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

Step 3: Build on what is ‘right’

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

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

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

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

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

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

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

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

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

 

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

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

Letters to the editor: ct@counseling.org

 

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

Counseling ‘unlikeable’ clients

By Laurie Meyers August 25, 2016

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

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

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

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

Digging deeper

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Setting aside personal beliefs

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

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

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

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

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

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

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

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

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

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

‘Liking’ versus ‘accepting’

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

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

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

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

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

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

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

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

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

 

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To contact the counselors interviewed for this article, email:

 

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

Letters to the editor: ct@counseling.org

 

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

 

 

Radical alignment: A psychospiritual approach to conflicting values

By Carol ZA McGinnis

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

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

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

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

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

 

Authenticity and trust

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

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

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

 

Awareness, knowledge and skills

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

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

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

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

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

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

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

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

In short, this process occurs through three steps:

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

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

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

 

 

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

 

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

 

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The counselor’s role in ensuring school safety

By Bethany Bray August 24, 2016

Samantha Haviland was a junior and a peer counselor at Columbine High School in April 1999 when two of her fellow students brought weapons to school, killing 12 students and one teacher before dying by suicide.

The massacre at the Littleton, Colorado, high school is often cited as the event that launched an era in which U.S. schools practice lockdown drills as often as fire drills. In less than two decades since, phrases such as active shooter, rampage violence and post-Columbine have become part of the American vernacular.

Haviland, a past president of the Colorado School Counselor Association and director of counseling support services for the Denver Public Schools, doesn’t usually disclose her connection to Columbine to the students with whom she works. But it is undeniably an experience that she still carries with her.

“What it does do is remind me, every day, of the vulnerabilities of our school communities and our students and the need for mental health,” Haviland says. “It is very sad to see that 17 years later, we struggle with the exact same thing — and worse. … What I do see is a lot of heightened awareness from school staff and a lot of fear, both from students and staff. It can be scary to go to work every day with the knowledge that this is now an [issue].”

Today’s reality is that school counselors and school administrators need to have well-crafted crisis plans ready to go. But equally as important, Haviland says, is the attention that school personnel should pay to the smaller, day-to-day issues that affect a school’s safety, from racial microaggressions and bullying to dating and relationship violence.

School counselors need both preventive and reactive tools in their toolboxes, and “there’s no magic wand for any of it,” Haviland asserts.

A visible presence

Violence can be defined as anything that is done with the intent to harm someone else, says Zachary Pietrantoni, a licensed school counselor who just finished his doctorate in counselor education and supervision at Southern Illinois University. In school settings, conversations about safety should take into consideration that violence can be physical, such as fighting, or nonphysical, including aggressive behavior that is verbal, psychological or carried out over social media, Pietrantoni says.

The antidote to school violence — in all its forms — is an inclusive and resilient school environment in which counselors play pivotal roles, say many of the professionals interviewed Branding-Images_lockersfor this article. One key way school counselors can foster a culture of safety is by making themselves a familiar face and ready resource for students, parents and school staff.

“Make yourself the person they turn to,” says Kevin Curtin, an associate professor of counseling at Alfred University in New York state. “Be present, be visible. You want everyone to know that you’re the go-to person.” That might mean helping a parent or colleague to better understand a student’s mental health diagnosis, or talking through a challenging situation regarding a particular student with a teacher, he says.

Although school counselors are part of the leadership in their school buildings, Curtin thinks the word facilitator is a better fit than leader. “Establish a relationship with everyone,” he advises. “You have to work with all the teachers, specialists, parents, the principal and the assistant principal. You need to collaborate effectively with everyone. Make sure you’re a contact point. It’s a unique role. … While you’re not the ultimate boss [in a school], you need to be a leader for everybody.”

School counselors can foster this mindset among students by being highly visible throughout the school, says Curtin, who spent 17 years as a counselor and clinical director at an alternative school in Rockville, Maryland, for students who were identified as being at risk. “You want to go from classroom to classroom during the first week of school every year and introduce yourself,” says Curtin, an American Counseling Association member who is a certified school counselor and licensed mental health counselor. “I used to joke that I should have rollerblades because I was constantly roaming. I was visible. I made sure I knew every student and their families. I wanted to be trusted. … I wanted them to know they could come to me, and I wanted my colleagues to feel the same.”

Haviland says the role of the school counselor is to be a unifying staff member who builds relationships throughout the school building so that everyone feels safe and included. The goal should be to create an environment in which each student has “at least one positive relationship with a staff member. It doesn’t have to be the school counselor. It could be the janitor,” says Haviland, a member of the American School Counselor Association and the Association for Counselor Education and Supervision, both divisions of ACA.

Carleton Brown, a certified school counselor and counselor educator who researched school rampage violence for his doctoral dissertation, notes that perpetrators of school violence often lash out because they feel it is their only avenue to “be heard,” either by their peers or by society at large. That is one of the reasons, he says, that school counselors should strive to create opportunities for all students to feel heard, including helping them to establish relationships with trusted adults in the building.

“Create a sense of belonging [for students], a sense of ‘I belong here at this school’ — a personal stake in the school and the school environment,” says Brown, an assistant professor at the University of Texas at El Paso and past president of the Arkansas Counseling Association, a state branch of ACA.

The importance of staff-student relationships also comes into play in a phenomenon that law enforcement officials term leakage, Brown says. This is when a student clues a friend or classmate in to his or her plans for violence, such as telling the peer to stay home or avoid a specific area of the school on a certain day. If that peer is comfortable with a school staff member, he or she is more likely to come forward and report any potential threat, says Brown, a member of ACA.

The simple truth is that students always know of goings-on in the school that staff members don’t, notes Mark Lepore, a professor at Clarion University in Pennsylvania who was a school counselor for a decade. “When you ask teachers if bullying is [happening] in their classrooms, you’ll most likely get a ‘no.’ But if you ask students, they can tell you where it occurs, who is involved, how often it happens,” says Lepore, an ACA member. “It’s just this world that students are privy to, but we, as adults, miss it.”

To that end, school counselors can play a key role in making connections and building rapport with — and between — students, Lepore says. For example, counselors can help teachers facilitate weekly check-ins, in which a small amount of class time (for example, 15 minutes every Friday) is spent on a safety topic. This might include a lesson about social-emotional skills or an open-ended discussion about how safe students are feeling, he says.

“When [teachers and classrooms] check in every week, it seems so simple, but it makes a difference,” says Lepore, a licensed professional counselor and licensed clinical social worker. “Having this meeting every week sends a message to students that [staff] do care and issues can be talked about. There’s a lot of opportunity for counselors to be a part of that process.”

Pietrantoni, a national certified counselor and ACA member, worked as an elementary school counselor at a Title I school in Topeka, Kansas, where a program called Cool Tools was used. Students were introduced to a different “tool” each week involving a positive social behavior or characteristic, such as how to make friends, how to ask another child to play or how to be respectful or friendly. For example, one week the tool was trustworthiness, so the entire school focused on behaviors that demonstrated and fostered that characteristic. Each classroom would discuss that week’s tool and engage in role-playing. School counselors put up posters about the tools throughout the school and visited classrooms to review the week’s lesson with students.

Reaching those who are ‘at risk’

School counselors can also play an important role in ensuring school safety by working with teachers and other school staff to identify and reach out to students who are struggling. This includes students who are often truant or absent, have behavioral issues or are socially isolated.

For example, Lepore says, a school counselor or other staff member can be “assigned” a struggling student to interact with on a daily basis. The counselor or staff member would check in with the student at some point each school day, such as during lunch or as students enter the school in the morning.

During his time as a school counselor, Curtin regularly performed these check-ins with certain students. In some cases, the meetings were scheduled, such as when he ate lunch with a student or asked a student to stop by his office each day before lunch. Other times, he simply made a point of being in the hallway at a certain time of day when he knew the student needed to pass through. Regardless, he made sure to interact with the student daily.

“I used to have a big jar of candy [in my office],” Curtin remembers. “It’s just something little, but one piece of candy, right after lunch, if a student was meeting a goal. Something as little as that [can provide] positive reinforcement.”

As an elementary and middle school counselor in suburban Pittsburgh, Lepore facilitated peer mediation programs and an initiative called Circle of Friends, which grouped students who possessed healthy social skills with students who needed to work on those skills. First, parental permission was obtained. Then these “circles of friends” were grouped together for lunch or school events such as field trips. The interactions helped curb negative behaviors and made struggling students feel included, Lepore says.

“Teachers are already so overworked,” he adds. “They often tune stuff out when asked to do more, but if they can see results, [programming] will be embraced. It’s finding the right program and the right fit, and [also] involving parents the whole way.”

Service learning and volunteer projects are also effective tools for helping students experience a sense of belonging and community, Lepore says, and this can curtail potential problems down the road. For example, students in Lepore’s school wrote cards and letters to the New York City Police Department after the 9/11 terrorist attacks. The police department responded and sent officers to visit Lepore’s school. What started out as a gesture of thanks became an unforgettable experience for many students, he says.

“Service learning is a really great vehicle for changing behavior and promoting [student] engagement. … Sense of belonging is a key factor in how students will achieve. Does a student feel they belong? If not, what can we do to fix that?” Lepore says.

Fostering a safe environment

The approaches school counselors take to cultivate a safe environment must be tailored to their schools’ unique needs, Haviland says, and the first step in that direction is assessment. She suggests that counselors create and administer student surveys with questions related to bullying and other safety indicators, such as whether students feel they have a teacher or other school staff member they can talk to when needed.

After reviewing the responses, counselors can help their schools create programs to meet the needs that students identified in the survey. This might range from concerns about dating violence among the student body to a need for additional extracurricular activities for students to get involved in, Haviland says.

Haviland recommends that school counselors administer safety surveys at their respective schools a minimum of once each year because the makeup of the student body and the perceived needs are constantly changing. “Have a pulse on the needs of your students at all times,” she emphasizes.

Pietrantoni says that forging partnerships with community groups such as nonprofit or advocacy organizations, churches and counseling agencies can be conducive to addressing specific needs in a school. For example, if bullying of students who identify as lesbian, gay, bisexual or transgender (LGBT) is an issue within the school, the counselor might facilitate a partnership with a community LGBT advocacy group to organize a schoolwide assembly focused on equality or to establish a gay-straight alliance, Pietrantoni suggests.

Another avenue for counselors to monitor the pulse of their schools is to create advisory councils that include students, parents and school staff, Pietrantoni says. This approach allows school counselors to gain multiple perspectives on issues going on in the school and the community at large.

“Not relying on one perspective will help broaden [a school counselor’s] program and perspective. This will give you eyes and ears in different areas,” says Pietrantoni, who begins a position as an assistant professor of counselor education at New Jersey City University this fall.

Crisis intervention and threat assessment

Creating and maintaining a safe, inclusive school culture requires that school counselors take a multilevel approach. At the staff and administrative level, this might include organizing teacher trainings, collaborating with a school resource officer and spearheading parent outreach. In working directly with students, it could range from organizing schoolwide programs on social-emotional behavior to providing group counseling with students who are at risk. As a whole, “school counselors are the leaders in creating a healthy environment,” Haviland says.

One key piece of the puzzle for Curtin was ensuring that his therapeutic team and school staff were trained in crisis intervention. The training helped staff de-escalate potentially volatile situations, such as when students became frustrated over something and were “about to lose it,” he says. Curtin worked at an alternative school where many of the students had emotional or behavioral disorders, so those situations were relatively common, he says.

The crisis training not only helped school staff learn how and when to intervene but also taught them empathic listening skills, says Curtin, who facilitated the trainings.

Another important skill to foster among school staff is the ability to identify warning signs that might indicate a student needs extra attention, Curtin says. These signs may include behavioral problems such as physical fighting or destruction of property, bullying or being bullied, suicidal tendencies, drug use, social withdrawal or isolation, impulsiveness, expressions of violence in writings or drawings, and outbursts of uncontrolled anger.

“Counselors are the front line in being able to identify potential risks and train others,” says Brian Van Brunt, executive director of the National Behavioral Intervention Team Association. He says all school staff, including teaching and nonteaching positions such as sports coaches, cafeteria workers, bus drivers and janitorial staff, should be given training in crisis intervention and mental health first aid.

“Nonclinicians are key. The same people you’d want to know CPR are the people you’d want to be trained [in mental health first aid],” Van Brunt says. Why? Because it’s equally likely that a student will become violent or suicidal on a school bus or on the playground as in a classroom, he says. When trained properly, these “first responders” can intervene effectively to stop potentially violent situations from escalating. They can also refer students who need counseling.

Van Brunt, who holds a doctorate in counseling education and supervision, started his career as a private practitioner. He eventually became the director of a college counseling center before moving into the specialty of threat assessment. As he explains, threat assessment is different from the typical mental health evaluations that counselors do, which usually result in a diagnosis and treatment plan. With threat assessment, a practitioner determines how likely a person is to repeat a violent incident or follow through on a threat that he or she has made. In school settings, this often comes into play when administrators are deciding whether to allow a student to return to school after being suspended for a violent or behavioral incident.

“You need to get to the underlying question of whether that person is a danger to someone else. … You need to determine whether or not the person is a risk,” says Van Brunt, the author of Harm to Others: The Assessment and Treatment of Dangerousness, which is published by ACA. “[Threat assessment] is asking very different questions than a mental health assessment.”

Van Brunt presented a threat assessment case study at ACA’s 2016 Conference & Expo in Montréal. The case involved a female student whose bra strap was snapped by a male classmate in the hallway. In response, the female stabbed the perpetrator in the arm with a pencil.

Both individual and systemic issues need to be considered when conducting a threat assessment, Van Brunt emphasizes. In this case, the female student was surrounded by a group of male students in a dark hallway when the incident occurred.

“Often we need to look at both the individual and the community and ask questions about how we reduce this behavior going forward,” says Van Brunt, a past president of the American College Counseling Association, a division of ACA. “Consider the circumstance. Was this a reasonable reaction or not? … Why was the hallway dark? Why were these students left unsupervised?”

In this situation, a counselor should also consider — and possibly introduce school programming focused on — the bigger, systemic issue of how the student body understands (or doesn’t understand) personal and sexual boundaries, Van Brunt adds.

“This is where I think counselors have such a wonderful, diverse [skill set], building rapport and understanding the issue of cognitive distortion, how we understand things, how we put things together,” he says. “A lot of these [threat assessment] cases center on how people are thinking about things, which is really what counselors do best — helping people think differently when they choose a path [and] getting them to the solutions they want to go to.”

Brown agrees, noting the difference between making a threat and posing a threat. He suggests a team approach can be helpful when conducting threat assessments in schools. In addition to school administrators and school counselors, it can be beneficial to include school resource officers, law enforcement professionals and mental health counselors from the community on these teams. Having multiple viewpoints is vital, he says.

Determining whether a student poses a threat “is difficult for one person to answer,” asserts Brown. “My suggestion, when it comes to threat assessment, is to look at it from a holistic, integrative and multiteam way.”

Although it is important for school staff to look for warning signs of potential violence, Brown emphasizes that there is no “all-in-one checklist” of behavioral cues to monitor. He points to a 1999 FBI report by Mary Ellen O’Toole that analyzed 18 different U.S. school shootings.

“One response to the pressure for action [after a violent incident] may be an effort to identify the next shooter by developing a ‘profile’ of the typical school shooter,” wrote O’Toole, a former senior profiler for the FBI. “This may sound like a reasonable preventive measure, but in practice, trying to draw up a catalogue or ‘checklist’ of warning signs to detect a potential school shooter can be shortsighted, even dangerous. Such lists, publicized by the media, can end up unfairly labeling many nonviolent students as potentially dangerous or even lethal. In fact, a great many adolescents who will never commit violent acts will show some of the behaviors or personality traits included on the list.”

Instead, Brown suggests that school counselors take a holistic approach and consider the wider circumstance of a student’s full personality, home life, family dynamics, social situation and past interactions with peers and staff when assessing the potential for future violence.

“What research says is [that warning signs] are all a factor, but they are not the sole factor,” Brown says. “Some of the students who committed these acts [school shootings] were bullied or they were the bully. … That doesn’t mean that every student who is bullied will commit these acts.”

Curtin agrees. “It is important to understand that warning signs should be viewed in context. They do not necessarily mean that the young person is predisposed to commit violence,” he says. “Instead, I try to convey the notion [to graduate school counseling students] that warning signs are an opportunity for school counselors to check out and address any concerns or issues the child might have in order to determine an appropriate intervention.”

This is especially important to keep in mind in situations in which students have trauma in their backgrounds, Lepore says. “It’s changing the focus from looking at a student [and asking], ‘What’s wrong with you?’ to ‘What have you been through?’” he says.

School counselors “have a unique opportunity to know the students, their families and their unique situations,” Lepore continues. “We have more information [about a student’s background] than the teachers or administration have, and that can be of use for the betterment of the students and the school.”

Resiliency and response

Counselors are also key players in a school’s response to trauma or violence. This could involve any number of scenarios that affect the school community, from the death of one of its students to an act of violence (such as a shooting) in the local community or an act of mass violence that happened elsewhere but is widely reported in the news. Depending on the situation, it can be beneficial for school counselors to go classroom to classroom to discuss the incident and answer students’ questions about grief, self-care and other mental health issues, Brown says.

School counselors can also orchestrate “stations” throughout the school — safe places, such as the library, where students can take a break and talk to a staff person — following a traumatic or violent incident that affects the student body, Brown says. In such circumstances, counselors may need to meet with teachers and administrators to discuss the importance of temporarily relaxing school rules, postponing tests and altering academic schedules to enable students to freely seek the help they need, he adds.

If a traumatic event affects a large swath of the study body, the school’s counselor may want to arrange for additional counselors from the community or other schools to come on-site to provide services to the students. Likewise, if a particular class or student group is affected, it can be helpful to have a counselor or other mental health professional sit in with that group all day to offer support, Brown says.

As with threat assessment, school crisis response is most effective when it involves a team, Brown says. He suggests these teams include the school’s counselors, principals and administrators, teachers, other staff relevant to the situation and, in some cases, parents.

“The team will assess ‘how do we handle this situation?’ You want to prepare and respond in a way that makes the students feel safe, feel heard [and feel] that we’re not just going on with everyday life. You need to give students an opportunity to talk about it and mourn,” Brown says.

“The team [dynamic] is very powerful [in crisis response],” he adds. “It’s not fair for a school counselor to feel that all of this is on his or her shoulders. … The school counselor shouldn’t be the sole person responsible for the emotional welfare of a school.”

Parents as part of the safety equation

A significant amount of research shows a connection between student achievement and parents who are involved and engaged. According to the counselors interviewed for this article, a similar connection exists between parental engagement and safe school environments.

“Parents are key players in your schoolwide approach [for safety],” Curtin says. “Bring them in for meetings. Include them in planning. Empower them to help.”

Curtin suggests that school counselors include parents on any team that creates or revises a violence prevention or school improvement plan. Counselors should also keep in touch and work with their schools’ parent-teacher organizations and other parent groups, he says.

The driving philosophy is that a safe school is born out of community, Curtin says. His advice to school counselors: “Build relationships, be present, have good prevention programs and know the warning signs [for violence]. Help the at-risk and be there for them.”

 

 

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School safety and violence statistics

  • In 2014, there were more than 850,000 nonfatal victimizations (including assaults, thefts and other incidents) among students ages 12 to 18 at schools across the United States.
  • About 7 percent of U.S. high school students reported being threatened or injured with a weapon such as a gun or knife on school property in 2013.
  • In 2013, approximately 22 percent of U.S. students ages 12 to 18 reported being bullied at school during the school year. Females reported higher percentages of being made fun of, being called names or insulted, being the subject of rumors or being excluded from activities on purpose. A higher percentage of males reported being pushed, shoved or tripped at school.
  • In 2013, about 8 percent of U.S. high school students reported being involved in a physical fight on school property during the past year.
  • In 2013, approximately 7 percent of U.S. students ages 12 to 18 reported being cyberbullied during the school year. A higher overall percentage of female students reported being victims of cyberbullying.
  • In the 2013-2014 school year, about 88 percent of U.S public schools had a written plan for response procedures in the event of a shooting; 70 percent of those schools with a plan had drilled students on the use of the plan.

— Source: The National Center for Education Statistics, nces.ed.gov/programs/crimeindicators/

 

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To contact the counselors interviewed for this article, email:

 

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Bethany Bray is a staff writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

Letters to the editor: ct@counseling.org

 

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