Monthly Archives: November 2016

A scar is not a wound: A metaphor for counseling

By Peter D. Ladd November 10, 2016

In the client-counselor relationship, describing traumas from past experiences can reveal unresolved suffering in which a client’s beliefs, emotions and behaviors are filled with deep negative images. Ideally, clients will share their trauma with therapists and how images from the past continue to affect them. By describing their trauma, many clients can normalize past experiences and are able to face future traumas with more positive attitudes.

However, as counselors, we realize how accessible these traumas become for clients who slowly drift back into old patterns when new trauma enters their lives. New trauma that is even remotely similar to past trauma can resurrect old beliefs, trigger negative emotions and generate compulsive patterns of behavior. The question becomes, how do counselors stop clients from drifting back into old traumatic patterns when new traumas enter their lives?

 

Using metaphors

One successful possibility is the use of metaphors. According to Judy Belmont, metaphors allow counselors to unlock a client’s way of thinking by creating flexibility and evoking emotion. They allow clients to visualize their thoughts and connect them to their feelings.

Neurologically speaking, metaphors allow the neuropathways of the brain to realign in a way where thinking and feeling bring into account a similar picture from a past incident. This leads to a more comprehensive understanding of experiences such as trauma, abuse, loneliness and loss.

Let’s look at one such example with elements that most people around the world would understand — namely, wounds and scars. It may be impossible to get through life without experiencing some form of physical or psychological wound that affect a person’s everyday experience. You trip and fall down the stairs, you are in an accident, someone close to you dies … these are examples of wounds that hopefully will heal. If they do heal, many times you are left with a scar that reminds you of the incident that took place.

But there can be confusion over the healing process and how the person perceives his or her wounds developing into scars, especially if they are psychological scars. My hope is that the metaphor “a scar is not a wound” will help clarify this healing process with an emphasis on psychological healing.

42 QmF1bUhlcnpJK0YrUysyTy5qcGc=When someone has a wound, the healing process can involve suffering that may feel worse than the initial acquiring of the wound. However, most people find this experience tolerable based on a belief that a certain level of suffering is required to allow the wound to heal. In turn, people with a healing wound assume that they are “on the mend.”

In many cases, a healed wound may leave a scar as a reminder that successful healing has taken place. Although the scar may be ugly, annoying, a topic of conversation or not as favorable as regular tissue, it is still an image of success signifying that a wound has healed. If the scar begins to throb or becomes painful at a future date, many people still tolerate it as a reminder of successful healing. They do not hold the scar to the same traumatic standard as they do the original wound.

At this point, it may be safe to say that, metaphorically speaking, a scar is not a wound.

 

An overview

When helping clients understand their past traumas, it may benefit therapists to describe these traumas as open wounds that need to heal. In mental health, when someone experiences a past mental wound, the healing process can be quite similar to that of a physical wound. For example, in therapy, when exposing past mental wounds, the associated suffering may feel worse than the suffering from the original traumatic experience.

Furthermore, mental health clients can confuse the difference between necessary and unnecessary suffering with these wounds. When experiencing a physical wound, it seems much easier to accept suffering as necessary. A mental wound may be harder to accept or tolerate, however. Even when clients work through the suffering associated with mental wounds, they may remain anxious about the possibility of the wound returning.

Many clients in mental health are at a disadvantage when it comes to the healing process, in part because they cannot look at their wounds and watch them heal. Instead, they must trust in the therapeutic alliance between client and counselor to form a belief about how the mental wound heals. Neither can these clients look at their wound and visualize growth and change.

For therapists who find meaning in the power of images, this may be an appropriate time to introduce the metaphor “a scar is not a wound” to help clients visualize their healing. When normalizing past traumas with clients, therapists can describe trauma as an open wound that needs to heal. Eventually, the client and therapist may want to discuss turning wounds into scars.

A scar can be used as a metaphor that reminds clients of past open wounds but in a positive manner. Helping clients transform wounds to scars is a metaphorical way of making past trauma meaningful and positive. Instead of clients looking at new trauma as a return to an open wound, they can use the metaphor of a scar as reassurance that they have gained resilience for future traumas in their lives.

This begs a question: Can mental scars be more than reminders of past wounds? Can they be viewed as products of successful healing? The scar metaphor creates growth and change by using the natural process of healing as a model for mental health. Such a model can be used when future traumas that are even remotely similar to those from the past might suggest a traumatic relapse. Recognizing the difference between a scar and a wound can stop a continued drift into old beliefs, emotions and behaviors.

The scar/wound metaphor is a clear and simple way of reminding clients with posttraumatic stress disorder, secondary traumatic stress reaction, apathy, abuse, loneliness or loss that traumatic experiences can sometimes create resilience. Therapists can help clients learn from their scars. They can be symbols of successful healing. They can be viewed as a source of wisdom, similar to what is found in many survivors of physical wounds. Scars are not wounds, and when a new trauma is experienced, counselors can help clarify the difference.

This metaphor follows a growth and change model for treating clients. Ironically, it also follows a medical model by explaining the process of healing that takes place when doctors treat a physical wound. More important, it references the natural healing process, whether mental or physical.

This provides clients with a more holistic view of healing. It also allows clients to rely on a schemata or map of healing that they know and understand. Finally, it puts traumas in a different light in which necessary suffering is viewed as a natural process that can have positive results.

 

Multicultural implications

Metaphors are used in most cultures, making them especially useful in the field of therapy. Universal themes that transcend cultural differences give certain metaphors more reliability and validity. The “scar is not a wound” metaphor leaves little room for cultural misrepresentation.

Furthermore, the image of a scar is a universal concept that has deep meaning from a cultural perspective. For example, some African cultures create scars on their faces and bodies as a statement of rank, courage or pride in their communities. The scar may signify going through some difficultly and coming out the other side intact.

The “scar is not a wound” metaphor, therefore, becomes multicultural because scars and wounds are viewed as universal phenomena that can be interpreted in many different ways, with most of these interpretations symbolizing a sense of healing.

 

Group supervision

Because supervision and instruction are often provided in a group format, the “a scar is not a wound” metaphor can encourage more dynamic and inclusive results. Some examples of questions for groups are:

1) When is an effective time to bring up the “a scar is not a wound” metaphor when discussing the group members’ past traumas?

2) What were your experiences of having a wound turn into a scar, either physically or mentally?

3) What are your beliefs regarding your physical and mental scars?

4) Do you know of any culture that views scars as a sign of success when working through a difficult time?

5) Do you think it is ethical to use examples from physical healing to describe mental healing?

 

Potential problems

For those looking for a more scientific explanation of healing, the “a scar is not a wound” metaphor may be viewed as too conceptual, with little use of facts to back up one’s description. This may be especially true with new supervisees who are looking for factual definitions for such phenomena as trauma, DSM-5 disorders and other natural scientific concepts that make up the lexicon of mental health counseling.

There also might be those who question whether clients who have experienced trauma want to look at their scars in such a positive light. These clients may view their scars as grim reminders of past traumas that should be buried and not revisited. They may view these scars with failure and embarrassment and not appreciate the intrinsic value in seeing scars as a “success story.”

In addition, those who are looking for a more linear, step-by-step approach to healing may find such a metaphor too esoteric and not fitting for mental health counseling. These clients may want cause-and-effect answers that help control their anxiety about the possibility of future traumas.

Some counselors may find the use of the metaphor too nondirective, preferring more control over the information they share with their clients. In addition, it may not appeal to those therapists who hold little interest in the workings of the unconscious mind.

 

Additional applications

This metaphor can work well with groups whose members have suffered “wounds” that have produced negative results in their lives. For example, many individuals struggling with addiction have a history of trauma ranging from intrapersonal to interpersonal and leading them to their individual addictions. Some of these traumas remain open wounds that go even deeper than the addictions themselves. Blame, shame and low self-esteem may haunt these clients. Their open wounds have not turned to scars and may be the major cause of any relapse that takes place. Sometimes the open wounds become their own emotional addictions. In fact, healing the individual’s physical addiction may require healing his or her emotional addiction. This phenomenon can take place in both addictions counseling and mental health counseling.

In addition, counselors can build a repertoire of other metaphors grounded in the “scars are not wounds” metaphor. For example:

  • “You can’t see the picture while inside the frame.” — A metaphor for a therapeutic alliance
  • “A counselor should focus on trauma not drama.” — Staying with the counseling process
  • “It is the broken helping the broken.” — Getting away from counselors as experts
  • “No client is as sick as his or her file.” — Looking for possibilities, not facts
  • “It takes more courage than brains to be an effective counselor.” — Being a model for change

 

 

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Peter D. Ladd is a licensed mental health counselor and the coordinator of the graduate mental health counseling Program at St. Lawrence University. His interests include existential and phenomenological counseling and conflict resolution. He has written 10 books from this perspective. Contact him at pladd@stlaeu.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.

Technology Tutor: Mastering your domain (name)

By Rob Reinhardt November 8, 2016

It’s been some time since I have conveyed knowledge about a technical concept here in the Technology Tutor column. Now seems like a great time to discuss something that continues to be confusing not just to counselors but also for others who don’t possess inside knowledge of how the internet works.

We aren’t necessarily required to have this knowledge. However, possessing it can be incredibly helpful in making important decisions involving our businesses and the Health Insurance Portability and Accountability Act (HIPAA). To provide an illustration, I have only basic knowledge of how automobile engines work. I just want my car to run when I need it to. However, I have educated myself about what sort of maintenance my car needs so that it continues running well and to ensure that I have a good sense of what the mechanic is explaining to me when it doesn’t. This level of knowledge allows me to make educated decisions and to save time and money.

With that in mind, let’s look at a significant underpinning of the internet: the Domain Name Service (DNS). Despite the internet being commonplace for more than two decades now, the inner workings of DNS remain a mystery to many. Yet it is very important that business owners understand how it works because it plays a significant role in many of their business, technology and marketing decisions. For that matter, it is beneficial knowledge for all of us to have because it can be integral to privacy and security of data. For example, it’s important to know that your choice of domain name can significantly affect your search engine results. Because many potential clients will search for “counseling your city,” having those terms as part of your domain name can be beneficial. Furthermore, knowing that you can register more than one domain name and point them all to the same website can also be integral to marketing.

Two examples of domain names are counseling.org and tameyourpractice.com. You’re probably used to seeing domain names in your web browser address bar or as part of someone’s email address. Domain names are all owned by an individual entity, whether that is a person, a corporation or another organization. The process of purchasing a domain name is called registration.

The questions I hear most often about domain registration include:

  • Do I have to host my domain with my web host?
  • How are my domain, web host and email connected?

Let’s start with the technical details, and then I’ll draw an analogy to help pull it all together. When a domain is registered, three important things are established: the owner of the domain page22name (the registrant), the company responsible for maintaining the domain name records (the registrar) and the name server(s). In many cases, the registrar and name servers are connected/owned by the same company, but that’s not required. At this point, your domain isn’t actually doing anything but sitting there. It’s simply a placeholder and not associated with a website, email address or anything else. This is where DNS comes in.

Devices connected to the internet (such as web servers, email servers and even your computer) are assigned a numerical internet protocol (IP) address that looks something like 75.103.237.161 (the American Counseling Association’s web server). Imagine having to remember the numerical address of all the websites you’d like to visit. Fortunately, you don’t have to. DNS converts the domain name to those numerical addresses. Although bookmarks might help with that, you’ll likely agree that it’s more visually appealing to look at counseling.org than 75.103.237.161 in your browser address bar.

To give you a visual, here’s a simplified version of what a DNS record looks like:

Domain name – tameyourpractice.com

Name     Type*     Address

www     A     104.99.99.999

@     MX     109.99.99.999

*For the curious, A = Address and MX = Mail Exchange (because it involves email, thus the “@”)

When you type www.tameyourpractice.com into your web browser, DNS responds, directing you to the actual numerical address of the server hosting the Tame Your Practice website. It knows that you want to go to the website because of the “www” and because you’re using a web browser.

Here’s the kicker. Other services for Tame Your Practice, such as email, might be hosted on an entirely different server and thus have an entirely different IP address. Fortunately, because of the magic of domain names, you don’t need to know that. All you have to do is send an email to rob@tameyourpractice.com (our contact form makes this really easy), and DNS points it to the correct server.

Interestingly, there are potential benefits to hosting your DNS separately from your web hosting, and both separate from your email. Web designer Kat Love has written an excellent article on that topic (see bit.ly/DNSSeparate). The confusion often happens because so many companies provide everything — domain registration and hosting, web hosting, email and more — in one nice package. People sometimes assume that’s just how it’s done and may not even realize that things such as domain names and web hosting are entirely separate functions. Remember that you have important choices and can host each service with a different company.

Let’s bring this all together with an analogy. Consider your name. Even though people may know your name, they may not know where you live or how to reach you by phone. This is akin to how domain names work. Consider someone in your list of contacts. You may have that person’s street address, home phone number, cell phone number and email address. When you decide to contact that person, which path you follow will depend on how you want to communicate with that person. You don’t simply call out the person’s name and hope for the best. You navigate to his or her name in your contacts and choose the correct item. That contact listing is your own personal DNS for that person. With domain names, you don’t have to keep all the IP addresses in a contact list; DNS does the calling and navigating for you.

Understanding this core functionality of the internet will not only help you understand how applications, websites and other services interact online, but can also increase your confidence about making implementation decisions regarding technology.

Need help applying these concepts to your own situation? Send me an email with your questions.

 

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Rob Reinhardt, a licensed professional counselor supervisor, is a private practice and business consultant who helps counselors create and maintain efficient, successful private practices. Before becoming a professional counselor, he worked as a software developer and director of information technology. Contact him at rob@tameyourpractice.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.

From the President: Counselor resilience

By Catherine Roland November 7, 2016

Catherine Roland, ACA's 65th president

Catherine Roland, ACA’s 65th president

Dear Counseling Colleagues,
This month, Counseling Today includes a cover story on death, dying and grief counseling — topics that can be difficult to reflect on and discuss. However, counselors have learned to embrace what is, hope for what can be, and the deep and consistent resilience that can emerge from transitions.

Transitions can be caused by instances of violence, disaster (both natural and unnatural) and death. Developmental transitions that occur can also be sources of grief and loss. But some of these transitions can also reward us with a sense of accomplishment and joy.

That’s the topic of my column this month — the idea that as we age/stage, the process continues mixing into a wonderful confluence of … well, life experience. Counselors and counselor educators have a twofold responsibility. One is to our clients and students, and the other is to ourselves. Self-care, self-reflection and tending to our personal wellness are crucial activities that allow us to be the best practitioners, advisers, students and professors we can be — throughout any transition period.

What are these transitions that occur during certain aspects of our lives? One example is family transitions that take place because of remarriage, divorce, children leaving home or other events that throw off the balance of the family dynamic. It takes effort to recapture that family homeostasis. Another example is a career change or relocation that appears to be a positive step but causes upheaval in some way. Also consider the personal transitions that occur throughout your life, such as establishing independence as a young adult and moving away from home; making choices about your education or relationship status; reflecting on your sexual orientation or identity as an adult of any age/stage; or navigating the reality of someone you care deeply about becoming ill or dying.

Any of these transitions may involve grief, loss, anxiety or joy. If we recognize these transitions and reactions within ourselves, it will be infinitely easier to work with clients and students, and we will be more effective in the process. When counselors view the developmental transitions that naturally take place across the life span as just that — natural — it can seem simpler to work through them.

The act of reevaluating, accepting and activating your resilience as a human being will greatly assist the work you do as a counselor, while also boosting your own life satisfaction. I witness this resiliency every time I speak to a group of counselors at a division, branch or region conference. I urge counselors to embrace their strength and their passion for action and advocacy. We need the spirit!

Every day, consider taking two positive steps or reframing two events that don’t appear at first glance to be supportive, life giving or even safe. If you put such situations into a reframe of strength, they might just become different in your mind. This might entail the idea that the event is a natural progression or, if not, that an event or action can be influenced by your positive energy, resilience or pure dogged determination. Your influence would be a wonderful addition to reimagining any event. Are you willing to try that in your life?

I also want to share some news about our ACA 2017 Conference & Expo in San Francisco. To embrace the many areas of the profession in which our members specialize, we continue honing our education offerings. Each month leading up to the conference, I’ll highlight a few special aspects of the program in this column. So what’s being offered? Here are just a few examples to whet your appetite: 53 sessions on clinical mental health counseling, 29 sessions on LGBTQ issues, 29 sessions on diversity/multicultural counseling and 26 sessions on school counseling. To view the individual education session titles, organized by topic tracks, go to counseling.org/conference/sanfrancisco2017/session-events-2017/education-session-tracks. San Francisco, here we come!

Enjoy the Thanksgiving holiday. We have much to be thankful for!

Very best,

Catherine Roland

croland@thechicagoschool.edu

 

CEO’s Message: Anger takes center stage

By Richard Yep

Richard Yep, ACA CEO

Richard Yep, ACA CEO

Anger is sometimes an important emotion because it results in taking action to protect yourself and your family, friends, students or clients. For example, anger over some policy or act of evil can bring people together to make changes in society or local communities that result in a safe and caring environment. At other times, anger can create even more trouble, danger or harm. Clearly, anger has many faces.

In the United States, we are finally nearing the conclusion of a long, nasty national election cycle. This column is not about the candidates running for office. It is not an endorsement of any person, political party or campaign. Being involved in campaigns, supporting the party with which you best align and exercising the right to vote are all privileges provided to U.S. citizens. In fact, if you have earned the right to vote, I really hope you will utilize that important privilege.

But this column is about anger. During my lifetime, 15 U.S. presidential elections have taken place. I have been eligible to vote in 10 of those elections, but I probably began to really understand what candidates, issues and campaigns were about in 1968. Looking back, it is hard to remember an election cycle with as much vitriol and negativity as the current one. Contributing to this environment are the “always on” news channels, the ability to reach voters through social media at all hours and the ways that pundits “one-up” each other for ratings (not to mention what the candidates and their surrogates have said … and tweeted). I believe this election will go down as one of the most mean-spirited in our nation’s history.

Regardless of which individuals or groups are responsible for reaching this all-time low, is this really the best that we can do? What messages are we sending to those who will be adult voters for the next 15 national elections? What permission are we giving to children and adolescents to say things like the boy seen on television yelling, “Take that b—- down!” at a candidate rally he was brought to by his mother? The parent then tried to explain this away by saying, “Children are children.” Huh?

I’m all for allowing children to understand and value the rights they have as U.S. citizens. However, I also feel strongly about the importance of parents, counselors, mentors and other adults helping to shape these young people who will one day govern, lead and participate in the type of world society that we envision.

Next month, ACA members begin voting for those who will lead the association and its divisions and regions. Just imagine if the election for ACA president-elect sunk to the depths of what we have witnessed in this country for the past 18 months. We have three ACA president-elect candidates who have earned the right to run. Thankfully, they are respectful of one another and have engaged in professional discussions as they articulated their visions for the counseling profession. Wouldn’t it be nice if this type of behavior, civility and respect were hallmarks of our U.S. presidential campaigns?

Let’s all think about the message we want to share with our young people. I encourage you to use your considerable skills as professional counselors and counselor educators to help clients and students understand the meaning and uselessness of the anger generated during the presidential campaigns. The work you do is so incredibly important for our nation and (without exaggeration) our world that I hope you will recommit yourselves to creating a positive, caring, respectful and compassionate society.

As always, I look forward to your comments, questions and thoughts. Feel free to contact me at 800.347.6647 ext. 231 or via email at ryep@counseling.org. You can also follow me on Twitter: @Richyep.

Be well.

 

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RELATED READING: See Counseling Today‘s article “Vote against anxiety: Managing 2016 election stress

 

Widening the scope of counselor self-education

By Kevin Glenn

Counseling is not a profession that has a knowledge ceiling. We are always working diligently to grow our knowledge so that we can be more efficacious for our clients. All too often, however, counselors may find themselves studying the same general areas: their chosen theoretical branding-images_self-educationorientations, research studies on their favorite evidence-based practices, literature handed out by supervisors and so on. As a result, a vast array of topics that could greatly enhance counseling in profoundly meaningful ways often gets overlooked.

No doubt most counselors are aware of this, but many may be unsure of where to start. The purpose of this article is to identify three areas of study that counselors can explore to widen the scope of their self-education: eclecticism, theoretical counseling and neuroscience.

An alternative form of eclecticism

Many counselors use eclectic practices. This can be advantageous to therapy because it enables counselors to implement a variety of evidence-based practices under the umbrella of science.

Regardless of how beneficial this approach is to counseling, however, it still comes with limitations of which many counselors, and even supervisors, are unaware. Does this mean that eclecticism is bad or ought to be avoided altogether? Absolutely not, but counselors can be engaged in efforts to improve their eclectic practices in much the same way that clients work to improve their lives.

In their chapter on eclecticism in the book Critical Issues in Psychotherapy: Translating New Ideas Into Practice (2001) Brent D. Slife and Jeffrey S. Reber point out some key limitations to eclecticism. For starters, eclecticism actually does not fully accomplish what it originally set out to achieve: escaping single theories. All too often, what occurs is a mashing of evidence-based practices into a single therapeutic brief case. This brief case creates a single theory, much like psychodynamics, cognitive behavior therapy (CBT) or existentialism. This is important for counselors to understand so that they do not become too comfortable with their carefully crafted eclectic brief case. Otherwise, they run the risk of not branching out and, instead, unintentionally maintaining a narrow practice.

The most common eclectic practice is a collection of evidence-based practices administered under the umbrella of CBT. Many counselors refer to this as “eclectic CBT.” Arnold Lazarus is most responsible for the advent of this approach with his BASIC ID model (behavior, affect, sensation, imagery, cognition, interpersonal factors and drug/biological considerations), which he referred to as technical eclecticism underpinned by a basic social cognitive theory.

This epitomizes the single theory of eclecticism referred to by Slife and Reber. That in and of itself is not a problem. What is important is that counselors continually remain mindful of not closing themselves off to other potential avenues for helping clients achieve healing transformations. After all, that kind of narrowness, or tunnel vision, is precisely what led counselors to escape from operating under only one chosen therapy.

Counselors who become aware of this do not need to feel that their eclectic practice is wrong or inadequate. Simply being mindful of the need to look for ways to continually improve their practice is all that counselors need to do. For example, counselors looking to grow their eclectic practice might encounter the solutions put forth by John Norcross and Larry Beutler in their chapter on eclecticism and integration in the book Current Psychotherapies (2013).

One alternative they explored was a form of eclectic-like practice known as assimilative integration, which could be thought of as technical eclecticism version 2.0 because it operates very similarly. The key difference is that counselors using this form of eclecticism first identify a comprehensive theory of therapy rather than a basic minimalistic one (as advocated for by Lazarus). From there, evidence-based techniques can be incorporated for use with a stronger philosophy of care. Assimilative integration gives counselors a more detailed instruction manual for evidence-based practice than does technical eclecticism.

The theoretical side of counseling

Many counselors may be hesitant to explore assimilative integration because it requires a grasp of theory and theoretical concepts of psychotherapy. I can sympathize with that hesitation because I have felt it myself. There is no doubt that our clients experience similar hesitations when we expose them to unfamiliar interventions and encourage them to explore uncomfortable aspects of who they are when working on goals and objectives. As counselors, we can set the example for them by exploring theoretical aspects that will improve our knowledge of psychotherapy, our use of interventions and how we meaningfully relate to our clients.

So, start simple. A significant amount of literature is available that critically examines what we do in psychotherapy. Identify one or two subareas of this critical thinking and explore it at your own pace. Critical thinking about eclecticism is an ideal place to start. Critical Issues in Psychotherapy by Slife, Richard N. Williams and Sally H. Barlow is one of the most comprehensive yet reader-friendly resources I have found. Counselors looking for more of a challenge could explore Re-Envisioning Psychology: Moral Dimensions of Theory and Practice (1999) by Frank C. Richardson, Blaine J. Fowers and Charles B. Guignon. Articles in the Journal of Theoretical and Philosophical Psychology would likewise provide some excellent starting points.

Counselors who explore the theoretical aspects of counseling will gain knowledge about how to overcome the disadvantages of psychotherapy’s extant nooks and crannies. In turn, this will aid counselors, especially new ones, in dealing with those all-too-familiar crossroads in therapy. Additionally, counselors will gain the tools they need to develop a more comprehensive theory of care, greatly enhancing their use of the interventions they have selected for their brief case. Of course, this is also advantageous to clients because it promotes new avenues for growth.

There is much to learn from the theoretical side of counseling that can help counselors enrich their therapeutic relationships while maintaining professionalism. Recall that evidence-based practices are not the primary curative factor in counseling. That honor belongs to the therapeutic relationship that the client has with the counselor. Interestingly, evidence-based practices, as valuable as they are, do not inform counselors on how to relate meaningfully to clients. Theoretical and philosophical concepts of relationships do (which is why I find it extremely peculiar that the American Counseling Association does not yet have a theoretical division).

Regardless, as counselors discover and learn about theoretical modalities of relating to clients, they will instinctively formulate their own comprehensive theories of healing that can be incorporated into an assimilative integration approach. Counselors will quickly appreciate the meaningful value that a philosophy of care based on relationships can bring to their eclectic practices. They will also enjoy the flexibility to incorporate other knowledge and techniques not afforded by other modalities.

Neuroscience

Many counseling theories reject the psychodynamics concept of the unconscious, whereas affective neuroscience has been gathering evidence of the existence of an unconscious. Counselors who staunchly adhere to one of these other models may not find out about this evidence if they remain focused solely on cognitive-based avenues of practice. However, a theory based on how to relate to clients would be more open to all evidence of causes and amelioration of human suffering. Whether the cause revolves around faulty cognitions, wayward processing in the unconscious resulting from maladaptive past parent-child relationships, or emotionally minded impulses (see dialectical behavior therapy), it can be integrated into a comprehensive relationship-based approach to therapy because each of those elements can be explored within the therapeutic relationship.

The affective neurosciences have much to offer counselors about how to help clients process their emotions. In his book What Is Emotion? History, Measures and Meanings (2009), Jerome Kagan draws on neuroscience (affective and cognitive) to demonstrate that emotions promote a form of awareness in humans that comes before cognitive awareness. Kagan cites Antonio Damasio, most famous for his books The Feeling of What Happens: Body and Emotion in the Making of Consciousness (2000) and Self Comes to Mind: Constructing the Conscious Brain (2010), who uses patients with injuries to key areas of their brains, including cognitive regions, to demonstrate how emotion leads to consciousness and then thoughts.

Instead of cogito ergo sum (I think, therefore I am), Damasio is suggesting the truth is closer to I feel, therefore I am. It is our thoughts that actually make sense of the emotions we feel. Without cognition, our emotions would still exist but would be unintelligible to us. This is the case with children who suffer from hydranencephaly. These children are born without a neocortex for cognition but still feel emotions because their limbic systems remain intact.

Whether a counselor actually agrees with any of this is not the point here. The point is that the affective neurosciences offer key information that can aid clinical practice, provided that counselors are a) willing to widen their scope of self-education and b) use a philosophy of care that is amenable to synthesizing other scientific truths and knowledge that might be equally vital to therapy, even if they challenge our own worldviews.

When clients bring up unfamiliar material 

Another reason it is vitally important for counselors to widen their scope of self-education is so they will be prepared for clients who bring new and challenging information to the therapeutic setting. This applies equally, if not more so, to counselor supervisors so that they can aid budding clinicians in these experiences. Consider the following vignette.

An eye movement desensitization and reprocessing (EMDR) therapist attempted bilateral stimulation with a minor client (I’ll call her “Rose”) in a treatment placement. Rose, who had been asking the treatment facility’s group clinician questions about how emotions and memories work in the brain, told the therapist she no longer wanted to do EMDR or CBT. The eclectic therapist — who used Adlerian therapy, CBT, dialectical behavior therapy, trauma-focused CBT and EMDR — inquired about the refusal. Rose revealed information she had learned in the group clinician’s group therapy sessions. This information, which came from the affective neurosciences, challenged Rose’s prior understanding of how the brain worked. In light of this new information, Rose had become disillusioned with EMDR. When Rose’s mother learned of this, she became equally concerned and approached the treatment facility’s clinical manager.

Previously unaware of the information from the affective neurosciences, the EMDR therapist determined that Rose was being resistant to therapy and also accused the group clinician of undermining the EMDR therapist to Rose and her mother. Although the ACA Code of Ethics say counselors of differing theoretical views are to collaborate, the EMDR therapist was confused by the affective neurosciences information and sought the help of the treatment facility’s clinical manager and clinical director instead of approaching the group clinician.

The group clinician was called into the clinical manager’s office to discuss the situation. The clinical manager, a licensed therapist, asked if affective neuroscience was a therapy and, if so, did it conflict with other therapies. The group clinician attempted to explain that affective neuroscience is not a therapy but rather a scientific discipline that sheds light on how emotions work in the brain via brain scans.

Because neither the clinical manager nor the clinical director was aware of the knowledge from the affective neurosciences, they immediately issued a supervisory directive that neuroscience was not permitted as a therapy or topic of conversation at the treatment facility. Both deemed the discipline too advanced for the facility’s clientele. This bewildered the group clinician because Rose had demonstrated an accurate understanding of what she had been taught from the affective neurosciences in the group therapy sessions.

Meanwhile, the EMDR therapist worked ardently and drudgingly to rebuild Rose’s buy-in to EMDR, never collaborating with the group clinician or working from where Rose was at now. The therapist’s session notes reflected an ardent stance that the group clinician had been unethical and Rose’s treatment had been sabotaged. The therapist also noted that she was employing various interventions from her eclectic approach to break through this new “resistance.” Ultimately, the therapist was never successful in restoring Rose’s buy-in.

Turning challenges into opportunities

The foregoing vignette is an example of what can happen when counselors remain unaware of knowledge and science outside of their chosen worldview and philosophy of care, and also refuse to educate themselves. The same could be said of the clinical manager and clinical director who, in their ignorance of the discipline, chose to shoo the topic away instead of embracing it for the benefit of the client. As informed consent experts teach us, this can create a slippery slope with federal law, which mandates that it is illegal for medical or behavioral health professionals to knowingly withhold scientific information that can have a bearing on a client’s choice to start or continue with therapeutic services.

Instead, we can embrace opportunities such as the one presented above by widening the scope of our own self-education. Deepening the practice of eclecticism with a comprehensive philosophy of care that does not close the door to other scientific knowledge is an excellent place to start. Yes, this might include stepping a little outside of our comfort zones into theoretical aspects of counseling, but this wider scope of knowledge and the understanding that comes with it will better enable counselors to dialogue with clients who bring challenging knowledge and questions to therapy.

These opportunities for dialogue hold the potential to strengthen the relationship between counselor and client, set an example for the client of humility and willingness to change, and deepen the overall therapeutic experience for both client and counselor. Supervisors who remain unaware of many other aspects of scientific knowledge and theoretical understanding risk stunting their supervisees’ professional growth when they are unable to help these supervisees navigate challenging situations with clients.

If all else fails, counselors ought to have the humility to say to clients, “I was not aware of this information. Can you tell me more about it? I will look into it moving forward.” What a brilliant example of humility we can offer to our clients by validating them in this way while simultaneously opening up new pathways for therapeutic conversations and rapport building. Any counselor looking to widen the scope of his or her own self-education should wholeheartedly embrace these opportunities to learn new information from clients while enriching their therapeutic experiences.

 

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Kevin Glenn is a licensed clinical mental health counselor and theoretical counselor. Contact him at klg65@gmx.com.

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

 

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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.