Monthly Archives: January 2019

PTSD and climbing out of the valley of the shadow of death

By Shirley Porter January 31, 2019

Max came into my office and sat down. He was a big guy in his late 30s. When I asked how I could help, he responded that he believed he had posttraumatic stress disorder (PTSD). When I asked what led him to this conclusion, he said he had been a sniper in the military and had been abused as a child. (Author’s note: The name of this client has been changed, but the content is accurate in accordance with his written and informed consent to share his story.)

My approach to trauma work has evolved over the years based on what we have come to learn about trauma through research, as well as on my own clinical observations. My therapeutic approach is rooted in client-centeredness, transparency, reverence, compassion and a belief in client strength and resiliency. On the basis of these values, essential components of this approach include accessible language/education, collaboration and evidence-based practice.

When it comes to education and accessible language, the use of metaphors can provide our clients with a much-needed bridge to understanding and normalizing their experiences. Active collaboration with our clients allows them the opportunity to find their power and use it. Because the experience of trauma often involves a feeling of loss of control and having things happen against one’s will, safe and respectful practice requires that clients be informed and willing participants in all aspects of the therapeutic process. And, finally, using evidence-based interventions allows us to provide professional, competent care in helping clients to alleviate their distress, process their trauma and reclaim their lives.

Introduction to the valley of the shadow of death

I often use the metaphor of the “valley of the shadow of death” to explain to my clients the experience of PTSD and the stages of healing. Some clients recognize this metaphor from the Bible’s well-known 23rd Psalm, which begins, “The Lord is my shepherd …” However, its use does not require any spiritual or religious belief on the part of the client or the therapist. I chose this metaphor because of its power.

As I wrote in my book Surviving the Valley: Trauma and Beyond, trauma occurs in “a dark and desolate place that exists in the shadow of some kind of significant ending — a real or symbolic death. In this place, you are apt to feel a profound sense of loneliness, despair and hopelessness. … There are no obvious pathways out of the Valley. The terrain looks treacherous and foreboding. It is difficult to know where to begin.”

In the valley of the shadow of death, the sky is often starless. It can be difficult to recall better times or to hope for them in one’s future. Experiences that send one into this valley typically involve the experience of witnessed, threatened or metaphorical death (e.g., the “death” of trust, innocence, a sense of safety, the belief in fairness or justice). Hope can be elusive.

In my practice, this metaphor has proved to be a powerful means of helping clients find the words to explain what their experience has felt like. I typically introduce this concept somewhere between the first and second phases of trauma work, but I am explaining it to readers here so that the metaphor will make sense from the outset. What follows is the phases of trauma work, explained from the perspective of the metaphor of the valley of the shadow of death.

Phase 1: First things first

Max had never been assessed for PTSD previously. His symptomology was intense. At times, he could be completely dissociated from his body, such as when he walked on a broken leg for a week because he did not feel the pain.

Emotionally, Max was numb. He hadn’t felt emotions for years. He lived his life in survival mode — making him fantastic in a crisis — but Max’s body and mind were always on high alert for threats. He was exhausted, having flashbacks and starting to experience life-threatening medical issues.

We began our work together by assessing and identifying his injuries and normalizing his symptoms. I also started to reflect back his strength, resiliency and courage. At the same time, I was clear with him that he deserved, and would need, external supports along the way. We worked on connecting him with resources for veterans and with medical supports. Max found the metaphor of the valley of the shadow of death to be an apt representation of what he had been living.

 

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Once we have determined that our clients are in the valley, we need to identify, assess and begin to respond to their injuries. There also may be crises that require our immediate attention and response. 

Some clients will have landed hard in the valley. They may have physical injuries in addition to the psychological ones. Before we even think about moving forward or delving into details of the trauma, we need to identify and assess injuries by asking clients which ones are causing them the most distress currently. (I use the Traumatic Stress Symptom Screening Checklist, which I developed and included in my book Treating PTSD: A Compassion-Focused CBT Approach.) At this point, we can discuss whether mobilizing community, medical, family or peer supports might be helpful to the client. If the client needs help connecting with these supports, we may need to liaise or advocate on the client’s behalf.

Reassurance is a component of this phase. Some clients may be carrying the added burdens of guilt or shame that can come with the misunderstanding that if they were stronger, they would not have ended up in this dark place. Thus, we may need to let them know that traumatic stress reactions are not a result of weakness or character flaws; rather, these are normal reactions to what they have been through.

Given that despair and hopelessness can be part of the symptomology of individuals who find themselves in the valley, checking for suicidal ideation and intent is also essential at the start. If a client is suicidal, it is best we are aware of this at the outset so that we can conduct a risk assessment, create a safety plan with the client and mobilize appropriate resources.

Some clients will not have the strength at this point to hold on to hope. With these clients, I tell them that with all they are dealing with, I recognize that their strength might be lacking, but not to worry because I will hold on to hope for them. I further reassure them that I fully believe we will be able to get them to a point where they can effectively manage their distress and reclaim their lives. (Many of my clients in this situation have responded with relief and gratitude.)

Clients might also be living in unsafe environments that require safety planning or other interventions. This can be another piece of assessing and responding to crises in this phase.

Phase 2: Stabilization and gathering tools for the journey

Throughout the course of trauma work with Max, I provided him with information on how trauma, and specifically complex trauma, can affect the mind and body. He was familiar with the fight-or-flight trauma responses but had not realized that his capacity to respond so effectively in high-risk situations was a result of conditioning through his military training. His experiences and symptoms started to make sense to him, and thus his shame receded.

Max had learned to ignore his physical needs at an early age, which is common with children who suffer from chronic childhood abuse. The first homework assignment that I gave him had three parts to it: 1) to notice when he was hungry and to eat; 2) to notice when he had to go to the bathroom and to do so; and 3) to notice when he was tired and to go to sleep. He smiled when I gave him this assignment and asked how I knew.

Max related to the image of the “warrior spirit” (described further later in the article). Although it had meant something else in his military life, we redirected the energies of his warrior spirit to focus on protecting his healing and well-being.

 

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After assessing and attending to injuries and addressing any crises that clients might be facing, it is time to help them get their bearings in the valley and gather the tools they will need for their stabilization and containment — both for use now and on their trauma processing journey (should they choose to take this path).

Some clients will need time to rest and heal before moving on to the next phase of trauma work. We would not expect someone who has just been injured to begin what could quickly become a treacherous climb. Likewise, our clients will need to be stabilized before moving forward in trauma work. They need to be at a point at which they can successfully tolerate or reduce their distress without moving into crisis.

Education is an important component of this phase. Our clients need to know what is normal and what kinds of challenges they might encounter on their journey in the valley. Knowledge about how trauma affects the mind and body can provide our clients with footholds in the valley. We want to help them better understand trauma — specifically, what types of experiences can lead to traumatic stress responses, how people tend to react during traumatic events and the range of normal reactions following such events.

Our clients need to be aware that normal reactions following trauma might include difficulties in the physical, emotional, cognitive and spiritual aspects of their lives. During this part of the work, we are normalizing their reactions during and following their trauma experiences while empathizing with their current distress. It is important that we use easy-to-understand language and concepts in recognition that when our clients are in the throes of severe PTSD symptoms, they can handle only small, personally meaningful pieces of information. 

This part of the work also involves helping our clients identify and become comfortable using the tools and resources that will assist them in better tolerating or reducing the distress that they might encounter on their healing journeys. In my work, I have come to recognize 10 such resources or tools to support clients in their journeys.

Within the clients

1) Recognizing their “warrior spirit” within. This involves giving a name to the persona we want to encourage clients to connect with in terms of dual awareness — the strongest, wisest part of who they are that has allowed them to survive the trauma and brought them to this place.

2) Reducing commitments to reduce distress and give clients the time and space to heal.

3) Confronting or advocating with the people, systems, etc., that were involved in causing the trauma in an attempt to address these wrongs or to achieve a sense of justice (when it is safe to do so).

4) Using distraction strategies. These are actions that clients can take to remove themselves from spirals of nonproductive, stress-elevating thinking. Examples: going for a walk, texting a friend, cleaning, drawing.

5) Using mindfulness strategies. This involves moving clients’ awareness from their distressing reliving of past negative events, or their distressing fears of what might happen in the future, to the present moment via the five senses. Examples: noticing a favorite color in the room; feeling the chair one is sitting on; picking up a stone and noticing its texture, color and shape.

6) Using self-soothing strategies. This involves using the senses to calm, soothe or reenergize. Examples: sipping a hot drink, listening to music, inhaling the scents of nature, wearing soft and comfortable clothes, looking at a picture of a loved one.

Through connection with others

7) Seeking counseling support with a mental health professional who specializes in trauma work.

8) Seeking medical support to address physical or psychological pain resulting from injuries or symptoms that are causing distress.

9) Seeking spiritual support from a religious/spiritual leader or peer.

10) Accepting offers of support from caring friends, family members or peers to do household tasks, help with children or take on other responsibilities.

Phase 3: Beginning the climb

Since Max’s life seemed to go from one crisis to the next, it took some time for him to get to a place in which he wanted to start the climb out of the valley. We started with eye movement desensitization and reprocessing (EMDR), but he didn’t want to continue with it because he found the distress that ensued in the days that followed too disruptive to his academics (he was in a college program). Neither did he feel that he had time to do the homework that came with traditional cognitive behavior therapy (CBT). So, I adapted my interventions and created a compassion-focused CBT intervention that we could use in session.

Using a varied approach that met Max’s needs during any given session, we went down many paths together — grief and loss, guilt, shame, anger, dealing with relationship boundaries and so on. Over time, Max began to experience emotions again and had to learn how to manage them. He also started learning to respect his body and its needs. He became very proficient at self-care.

 

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Some of our clients will not want to proceed with the journey to climb out of the valley. For them, stabilization and containment will be enough. Given that the climb out of the valley can be life-threatening if people go into it unprepared or unwilling, we should never push our clients to take this step. Trauma is often about loss of control or boundary violations. Healing cannot be. We need to respect our clients’ decisions and inner knowing.

For those clients who wish to proceed with the climb and who appear to be strong enough and well-resourced enough to manage it, we have a number of evidence-based options to offer them. As trauma therapists, I believe we need to be skilled in more than one evidence-based trauma-processing intervention (e.g., EMDR, trauma-focused CBT, CBT). Too often I hear of clients being blamed when they don’t fit with the therapist’s approach. Being client-centered as a therapist means that we need to select or modify interventions to best fit the needs of individual clients.

Often, our clients will need to travel many pathways related to their trauma. These pathways might explore issues of grief and loss, the question of forgiveness of others and self, anger, ongoing depression and anxiety, the adjustment of relationship boundaries and so on. Each individual client’s pathway will be unique. Each individual client will lead. We will accompany, providing a safe, professional alliance and skilled interventions to assist the client in moving through, and eventually out of, the valley.

Phase 4: Living with the scars and reclaiming one’s life

Max became aware of how the trauma experiences he had survived had changed him. He learned to appreciate his resilience, adaptability and survival skills. He also came to acknowledge and embrace the truth of his strength and courage. Through accepting who he was, and is, along with his entire story, Max came to a place of peace.

During our last few sessions together, Max spoke about the newfound sense of peace he possessed. For our final session, I wrote him a letter reminding him of where he had started and highlighting his subsequent successes. I also recalled the qualities in him that I had come to admire. Finally, I reinforced in the letter the message that he possessed all that he needed inside of himself to deal with whatever challenges he encountered, but I reminded him that if he ever needed support again, he knew how to ask for it.

 

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Some of our clients will have lived in the valley for several months or years. For these clients, the thought of leaving the valley can invoke both excitement and fear because they will be learning to live in a new way. Thus, the last phase of our trauma work involves assisting clients as they learn to live with the scars (visible or invisible) of their trauma experience; reclaim their lives; acknowledge and celebrate their successes; and move forward on life’s path without us.

PTSD does leave scars, but those scars need to become part of one’s story, not all of it. In this final phase, we work with our clients on how to move forward in reclaiming their power and their lives. Sometimes we will need to assist them in identifying community resources that can continue to support them (such as peer support groups) or causes in which they can become involved that will be meaningful to their healing. Clients living with a disability or chronic pain resulting from their trauma experiences might need a team of medical professionals to provide ongoing support.

This is a time for clients to make conscious and informed decisions concerning how they will move forward in creating their lives outside of the valley. What kind of person do they wish to be? What are their hopes and dreams? Who do they want to have walk beside them on their journey? Do they have certain relationships that need to end or change? These are some of the questions that our clients might explore as they exit the valley. 

This final phase is also a time of celebration, kind of like a graduation, as we prepare and plan for the end of the therapeutic relationship. With that being said, some clients will worry about addressing future challenges without our support. In such cases, we can do some role-playing and problem-solving in advance to help alleviate their concerns regarding potential future challenges. For some clients, this might be an opportunity to rewrite their expectations regarding relationship endings. In collaboration with our clients, we can plan how our last sessions will play out.

Somewhere in this phase, we can also take the time to remind clients of where they began in the valley and where they are now, of how they have changed and what they have accomplished. Although this is something we should be doing in each session whenever there is a success, in this final phase we have a chance to summarize all of these successes at one time so that we can both appreciate the extent of their progress. This is often overwhelming for clients — in a positive, celebratory way — as they come to realize how incredible their healing journey out of the valley has been and as they start appreciating the depths of their own strength and resiliency.

 

 

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

Shirley Porter is a registered psychotherapist and a registered social worker who has been providing trauma counseling for more than 25 years. She currently works in the counseling department at Fanshawe College and is an adjunct clinical professor at Western University, both in London, Ontario, Canada. She is the author of two books on trauma: Surviving the Valley: Trauma and Beyond, which was written for survivors of trauma and their support people, and Treating PTSD: A Compassion-Focused CBT Approach, which was written for therapists.

Contact her at traumaandbeyond@gmail.com or via her website, traumaandbeyond.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.

Counselor self-disclosure: Encouragement or impediment to client growth?

Written and compiled by Bethany Bray January 29, 2019

W. Bryce Hagedorn once counseled a client who was wrestling with intense feelings of shame regarding things he had done during the Vietnam War. The client, a veteran of the U.S. Marine Corps, felt responsible for the soldiers he had lost during combat. He never expressed any details connected to these painful and complicated memories, however, until Hagedorn used a pivotal therapeutic tool: self-disclosure.

Hagedorn is also a Marine Corps veteran who has served in combat. The disclosure of his military service “opened the door to share things that the client had never shared before, even with going to the Department of Veterans Affairs [for treatment] for years. Before he was able to share, he wanted to know if I would be judging him,” says Hagedorn, a licensed mental health counselor and director of the counselor education program at the University of Central Florida.

When used sparingly, professionally and appropriately, counselor self-disclosure can build trust, foster empathy and strengthen the therapeutic alliance between counselor and client. However, counselor self-disclosure also holds the potential to derail progress and take focus off of the client. It is a tool that should be used with care — and in small doses, according to the ethics professionals working at the American Counseling Association (see sidebar, below). Learning how, when or whether to use self-disclosure with clients is best achieved through training, experience and supervision.

Hagedorn notes that once a clinician self-discloses, the client may naturally be inclined to ask questions seeking additional personal information about the counselor. “If you’re going to self-disclose, know ahead of time where your bailout point is,” says Hagedorn, a member of ACA. “Once you open the self-disclosure door, where are you going to stop? When I worked with couples, they could see that I was wearing a wedding ring. I was often asked how long I had been married, if I had kids or if I ever struggled like [the clients were] struggling. Know where you’re going to stop answering questions.”

Hagedorn doesn’t believe that self-disclosure should be an automatic, out-of-the-gate technique for counselor practitioners. Rather, he advises, counselors should consider it a tool to keep in reserve, using it only when appropriate — and with clear intention.

“I’m in favor of less is more with self-disclosure,” Hagedorn says. “If you’re going to self-disclose, you have to do it with dignity and understand the reasons why a client is asking [for personal information from a counselor]. Explain to the client, ‘Even if I have walked down a similar path, it doesn’t mean I have walked down your path.”

 

The many aspects of self-disclosure

Counseling Today recently collected insights about counselor self-disclosure from American Counseling Association members of varied backgrounds and practice settings. Read their thoughts below.

We encourage readers to add their own thoughts to this discussion by posting comments at the bottom of this article.

 

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Kimberly Parrow is a doctoral student at the University of Montana. She is a licensed clinical professional counselor who specializes in working with clients to address grief and posttraumatic growth.

Client comments often spark the urge for self-disclosure. The feelings of connection in a professional counseling relationship tempt counselors to self-disclose, sometimes without warning. I think the consideration of providing personal details to clients occurs regularly [but] believe situations when such disclosures are appropriate are few. Appropriate self-disclosure is client-focused, validates the client’s experience and spurs further exploration. A constructive disclosure is brief, focused on meaning and light on story.

Professional counseling relationships require a harmony of the necessary theoretical and relational components. When the pull to disclose occurs, I take a moment and ask myself three things:

a) Is the disclosure grounded in theory?

b) Is there any other way to keep the locus of the experience within the client’s world?

c) How will the disclosure affect the therapeutic relationship?

For these reasons, I think it is important to keep in mind that the decision to disclose should not be made in the moment. An appropriate disclosure is the product of thoughtful planning.

I once had a young adult client recovering from a tragedy that killed several people and left him clinging to life. Our work began after several months of hospitalization and physical therapy. A number of sessions became focused on his feelings of dissociation regarding his own near-death experience. He would make statements such as, “I almost died, and it feels like I don’t care.” He explained the feeling was getting in the way of connecting with his family and friends. His support people couldn’t understand why he wasn’t more thankful to be alive, and neither could he. Feelings of isolation and confusion were becoming a sticking point in his recovery. He felt alone in a rare experience. However, he wasn’t and isn’t alone; I have had a near-death experience too.

My decision to disclose took several days. The disclosure would be tied to our treatment goals, but keeping the locus on the client was a challenge. A discussion of my experience might be too alluring and could pose a threat to our therapeutic relationship and focus. Eventually I decided on a very brief statement, [saying], “I almost died once too,” and waited for the subject to surface again. When it did, I shared my brief statement. It was simple and powerful. In that moment, he was able to trust that my validation of and explanation for his dissociation was real, because I had also lived it. As a result, our therapeutic bond deepened, and our trauma recovery work gained traction.

 

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Benjamin Hearn is a school-based counselor in Columbia, South Carolina.

Self-disclosure is something that we all do with our clients from the moment we begin interacting with them. Our clothes, offices and other nonverbal communications all disclose things about [us], either intentionally or unintentionally.

Our more common notion of self-disclosure, however, centers on information we share about ourselves verbally with our clients. One piece of information that I have found myself often considering whether to disclose is my identity as a gay male. I most often disclose this information when I have sufficient client rapport and a client voices an incorrect assumption about me, such as asking about my wife. At other times, I may use disclosure to model a healthy gay identity or to promote a sense of similarity between myself and a client.

This latter approach was particularly helpful with a teenage client who had recently come out as gay but did not know other gay people and conceptualized them using common stereotypes. In order to keep the focus on him while disclosing, I framed my disclosure with a question afterward, saying, “I’m not sure if you know this, but I’m also gay and wonder if you see me as fitting within these stereotypes?” This allowed my client to explore differences in gay identities, as well as modeling a secure identity. He noted that he was surprised at how casual I had been in my statement, after which I was able to assist him in exploring reasons that he was anxious about his own disclosure to others.

Regardless of the content being self-disclosed, counselors should consider the possible risks and benefits of disclosure prior to disclosure and how they will keep focus on the client afterward. This can be done by questioning how a client responds to the information or by ending the disclosure using an empathy statement such as, “I remember when my own child left for college. You feel like the house and your life is just emptier.” Though this statement contains a self-disclosure, it is framed in a way that acts as an empathy statement, which the client is then able to evaluate according to their own experience.

Overall, mindful and intentional self-disclosure can act as a powerful technique in the therapeutic relationship [that] can normalize client issues, model healthy behaviors and increase clients’ own self-exploration.

 

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John J. Murphy is a licensed psychologist and professor of psychology and counseling at the University of Central Arkansas. He is the author of the book Solution-Focused Counseling in Schools, published by ACA.

The decision to self-disclose, like any counseling decision, is based on my judgment of its potential to enhance clients’ goals. For me, self-disclosure is never planned but occurs spontaneously, just as it does in other relationships and conversations. Self-disclosure can help convey our humility, humanity and understanding. Research indicates that the most effective counselors are seen by clients as genuine, compassionate and accessible, and self-disclosure can help foster such perceptions.

The following examples of self-disclosure occurred in a psychoeducational group that I led for parents and guardians of children with behavioral difficulties:

  • We started the first meeting by stating that some parents describe parenting as one of the most joyful, gratifying and challenging experiences of their lives. I commented that parenting was much more draining and humbling than I ever expected, adding that “if I made as many mistakes on a job as I do as a parent, I’m pretty sure I’d be fired within a week.” They liked that metaphor and brought it up a few times in subsequent meetings.
  • I made the following comments in a meeting during which a parent stated how hard it was to change her parenting style: “Some of my parenting habits have been really hard to break. One that comes to mind is the use of those short ‘precision requests’ we discussed last week. Even though I teach it to parents, it’s hard for me to do it with my own kids. So, I have these times when I can almost see the words traveling from my mouth toward one of my kids, and I just want to reach out and pull them back before they get there. I’m not sure why I expect these words to work now when they haven’t worked the last 100 times. It’s frustrating and embarrassing.”

Both examples framed the experience of making and accepting mistakes — a valuable skill for any parent — as a shared, inevitable part of any major life journey, parenting or otherwise. While neither example was deeply personal or self-revealing, I hope that acknowledging my own parenting blunders and frustrations helped level the relationship and enhance my approachability.

Self-disclosure, like anything else we do as counselors, is only as useful as clients’ response to it. Obtaining regular client feedback on their experience of the alliance can also help detect a client’s response to self-disclosure and other aspects of our overall counseling style and approach.

 

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Catherine Beckett is an adjunct faculty member in the doctoral counseling program at Oregon State University. She also has a private practice in Portland, Oregon, specializing in grief counseling.

Like many other aspects of counseling, clients are going to have different experiences with different approaches. One question I always ask during the intake process is, “If you have had counseling in the past and it worked well, what was it about the therapist’s approach or style that was positive for you? Or, if it did not work well, were there aspects of the approach or style that contributed?”

Some clients say, “That therapist shared too much; I didn’t like it.” Whereas others may say, “That therapist wouldn’t even answer basic questions about him[self] or herself, and I found it hard to have a relationship with somebody I didn’t know at all.” So, within the bounds of what I believe is ethical and what I feel comfortable with, I will try to be respectful of a client’s preferences in the service of building a positive alliance.

The second principle I have found useful is the practice of requiring myself to have clarity about the purpose of a disclosure prior to making it. I suggest to clinicians whom I supervise that they be able to follow any disclosure with, “The reason I am sharing this is …” This serves two purposes. First, it holds counselors responsible for clarity around intention. Second, it makes the purpose or intention clear to the client, as opposed to — and guards against the possibility of — a disclosure coming across as chitchatty, or as the counselor making the session about him/her.

I also believe that counselors need to be very cautious about using disclosures to convince a client that we understand how she or he feels. Even if we have had an experience similar to what that client is going through, the reality is that we don’t know how she or he feels. We had our own experience, and the experience of our client may be quite different.

 

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John Sommers-Flanagan is a professor of counselor education at the University of Montana and the author of eight books, including Tough Kids, Cool Counseling, published by ACA.

My first thought about self-disclosure is that it’s a multidimensional, multipurpose and creative counselor response (or technique) that includes a fascinating dialectic. On one hand, self-disclosure should be intentional. If counselors aren’t aware that they’re using self-disclosure and why they’re using it, then they’re probably just chatting. On the other hand, self-disclosure should be a spontaneous interpersonal act.

Self-disclosure is an act that involves revealing oneself. As Carl Rogers would likely say, if your words aren’t honest and authentic, then your words aren’t therapeutic. From my perspective — which is mostly person-centered — the purest (but not only) purpose of self-disclosure is to deepen interpersonal connection. As multicultural experts have noted, self-disclosure can facilitate trust more effectively than a blank slate, because transparency helps clients know who you are and where you stand. What’s less often discussed is that it’s impossible to not self-disclose; we’re constantly disclosing who we are through our clothing, mannerisms, informed consent form, office accoutrements and questions.

I remember working with a 19-year-old white, cisgender, heterosexual male. He told me he was diagnosed as having reactive attachment disorder. After listening for 15 minutes, I was convinced that there was no possible way he could meet the diagnostic criteria for reactive attachment disorder. First, I used an Adlerian-inspired question/disclosure: “What if it turned out you didn’t really have reactive attachment disorder?”

You might not consider a question as self-disclosure, but every question you ask doesn’t simply inquire, it simultaneously reveals your interests.

Later, I disclosed directly, using immediacy: “As I sit and listen to all your positive relationships, it makes me think you don’t have reactive attachment disorder.” Despite my interpersonally clever use of an educational intervention embedded in a self-disclosure, my client didn’t budge, countering with, “That doesn’t make any sense, because I’m diagnosed with reactive attachment disorder.”

At that point, I wanted to use self-disclosure to share with him all the ways in which I was a smarter and better health care professional than whoever had originally misdiagnosed him. Fortunately, I experienced a flash of self-awareness. Instead of using disclosure to enhance my credibility, I spontaneously disclosed, “I’ve been talking way too much. I’m just going to put my hand over my mouth and listen to you for a while.”

As I put my hand over my mouth, my client smiled. The rest of the session was — in both our opinions — a rousing success.

 

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Zachary R. Taylor is a licensed professional counselor (LPC) and behavioral health director at a health center in Lexington, Virginia.

I specialize in working with patients who have chronic anxiety and panic, and I regularly disclose that I suffered from these disorders myself for more than 10 years.

The key is being specific about my experiences because many anxious patients feel no one understands what they are going through. Simply saying, “I too was anxious” often doesn’t connect. Instead, I choose specific stories about my many trips to the emergency room, my phobia of checking the mail, the clutching on to my Xanax and my sophisticated driving routes through town to avoid anxiety triggers.

When I share these things, it’s usually out of an effort to normalize their experience and get leverage because, if they know I’ve been there, they’re more likely to accept my help not only as a licensed counselor but also as a former anxiety sufferer who has used these same counseling principles to recover.

Second, I use self-disclosure to reinforce principles we are working on in counseling. For example, to this day, I still experience scary and sometimes tragic images that flash through my mind out of the blue. These used to send me into full-on anxiety spirals, during which I would go through all kinds of safety behaviors to reassure myself that I, and everyone I loved, was OK.

The only real difference between these images then and now is not that the images don’t come back anymore but that I learned how to do things many counselors know as cognitive defusion and psychological flexibility. This is the ability to recognize the imaginary quality of these images and learning how to have the courage to treat them as things I can safely ignore.

This example, in particular, is useful when patients believe every anxious thought, image or sensation and take them as something they need to either respond to or repress. It gives them a new vision that recovery doesn’t mean never having another anxious thought but learning to cope with them when they show up.

However, we must remember there’s a difference between showing patients our psychological scars versus our psychological wounds. There is a significantly greater risk in revealing hurts not yet healed. We must be judicious in self-disclosure, make it brief, always have a clear therapeutic purpose and have a reasonable expectation that the patient can manage the disclosure and that they never feel the need to care for us in the process.

 

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Richard S. Balkin is an LPC and the editor of the Journal of Counseling & Development. He is also a professor and doctoral program coordinator in the Department of Leadership and Counselor Education at the University of Mississippi.

In the second semester of my master’s program, my skills class was taught by a professor who followed a psychoanalytic orientation. She was clear that she would give feedback based on this orientation and that it was OK to reject her feedback as long as we supported any alternative with our understanding of theory. I do not recall any student rejecting her feedback. That being said, I do recall my first session with a client. When the client entered the room, I reached out to shake hands. When reviewing my initial session with the professor and class, I was asked [by the professor] why did I reach out to shake hands? When I indicated I thought that was the polite thing to do, I was told, “That’s about you, not the client.”

I remember being taken aback by this feedback, which seemed to me rather extreme. Not only did I listen to it at the time, but I was influenced by it for many years. Naturally, not shaking hands with the client easily extended to what I could possibly share with a client. If the initiation of a handshake was viewed as countertransference, I could only imagine what my professor would say if I were to self-disclose.

Of course, all of this was challenged in my first year working as a professional counselor, when I worked on a dual diagnosis unit with adolescents. Many members of the multidisciplinary treatment team were active in 12-step support programs, so self-disclosure as a means for teaching about addiction and working together was very natural. More importantly, the adolescents seemed to appreciate the candor and learn something from it.

No doubt, self-disclosure can be helpful, but it can also be self-serving for the counselor, contributing to an unhealthy dynamic in the counseling relationship. If the curative components of counseling truly are based on the counseling relationship, then counselors might do well to consider how self-disclosure will deepen the counseling relationship. In [the ACA-published book] Relationships in Counseling and the Counselor’s Life, my co-author, Jeffrey Kottler, and I mention ways that self-disclosure can be therapeutic, [including] communicating understanding and acceptance and promoting deeper reflection.

 

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Sidney Shaw is an LPC in Anchorage, Alaska, and a core faculty member in the School of Counseling at Walden University.

Researchers often describe two types of self-disclosure: immediate and nonimmediate self-disclosure. Immediate refers to process self-disclosures from the counselor about their own feelings or ways of experiencing the relationship with the client. Nonimmediate self-disclosure or counselor disclosure about their life, personal experiences or biographical information is often what counselors are referring to when they discuss self-disclosure. Immediate and nonimmediate self-disclosure both have potential to deepen the alliance and promote client wellness. That said, there can also be negative effects of indiscriminate self-disclosure. The litmus test of whether or not to engage in self-disclosure is to do so only when it will be therapeutic for the client.

In the spirit of self-disclosure, I’ll share an anecdote about nonimmediate self-disclosure from my own practice. Early in my counseling career, I worked with indigenous communities, and one of my first experiences was to co-facilitate groups on the topic of healthy families and communities. In preparing for the upcoming groups, my supervisor asked me, “Have you thought about what story you are going to share about yourself?” I replied that I had not considered it, and I could feel my anxiety rise as he mentioned it. As a recent counseling graduate, I was highly concerned about negative effects of self-disclosure — e.g., too much emphasis on me, communicating that how I dealt with a situation is how the client should deal with it, etc.

As my supervisor pointed out, and as supported by my subsequent experience and broader research findings on the topic, self-disclosure is frequently an important element of developing trust in working with indigenous clients. One of the groups that I co-facilitated was on the topic of male family relationships. With this in mind, I shared a brief story about my father, how we had been through a long period in which our relationship was conflictual and how we eventually worked to move toward a more harmonious relationship. Cultural context is an important factor to consider in terms of how and to what degree to engage in self-disclosure. Thoughtful and intentional self-disclosure can help counselors build alliances with individual clients and with communities outside of their own.

As counselors, we may initially intend to self-disclose in order to promote client well-being, but self-disclosure can subtly and unwittingly begin to creep toward serving our own needs. The question of whether or not our self-disclosure is therapeutic for the client is not one that counselors should answer in isolation. Ongoing consultation with skilled, wise and competent supervisors and peers is an essential element of helping counselors answer this question.

 

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Caitlyn M. Bennett is a licensed mental health counselor and an assistant professor at the University of North Texas.

One of my areas of clinical expertise is anxiety, especially in adolescents and young adults. Anxiety has a way of making people feel out of control, and oftentimes, clients have told me that they “feel crazy.” Because of this, I have found when processing and making sense of the physiological aspects of anxiety — i.e., racing heart, tightness of chest, etc. — with clients, it can be empowering and validating to self-disclose my personal physical expressions of anxiety.

Prior to this self-disclosure, I find that general psychoeducation about anxiety [and its effects on] the brain and body serves as a catalyst to making sense of anxiety as well as serving as a bit of a normalizing factor. This helps me to gauge whether clients feel connected and understand the physiological impacts of anxiety. For example, their experience of anxiety may not involve as much of the physical experiences. Thus, me expressing my personal physical experiences of anxiety would not be helpful for the client.

After exploring psychoeducation, I begin to encourage clients to share about their personal physical experience of anxiety. If clients have a hard time identifying where in their body they experience anxiety, this is where I introduce self-disclosure by sharing, “When I feel anxious, I may feel my anxiety in my chest or my shoulders tense up. What about for you?”

I have found that this softens and makes exploring anxiety safer and more relatable without taking away from the counseling space being for the client. It also creates an added layer of connectivity for the therapeutic relationship. I have found that some of the most powerful sessions have been when clients feel understood by me as their counselor and also realize that I am only human too.

In all aspects of self-disclosure, I reflect on rapport and encourage my students to do the same. For example, I don’t make it a point to self-disclose prior to establishing a working therapeutic relationship. Self-disclosing prior to creating this relationship may create misunderstanding of what counseling will or will not look like for the client.

It is also important for counselors to remember that self-disclosure can be such a powerful tool. In my personal process of integrating self-disclosure with a particular client, I reflect on the pros and cons of self-disclosure, the difference of impact in emotional (personal feelings) versus content (facts) self-disclosure, the development of the client and multicultural factors. When I have explored this with counselors-in-training, we often focus on using self-disclosure “for good and not for evil.” That is, will the self-disclosure I choose to use be helpful for my client and their process or only benefit myself?

 

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Carol ZA McGinnis is a licensed clinical mental health counselor and approved supervisor. She is a pastoral counselor and clinical director for the AWI Counseling Center at the Fairview United Methodist Church in Phoenix, Maryland, and an associate professor and clinical mental health track coordinator in the graduate counseling program at Messiah College.

As a person-centered [counselor], I rarely self-disclose and only after professional consultation and deep reflection on how that content may be of significant help to the client.

One client who had decided to drop out of high school and pursue her GED received a brief self-disclosure from me at our termination session. I considered the fact that I had dropped out of high school and earned my GED many years prior to completion of my Ph.D. sufficient to disclose. [In doing so, I] meant to encourage and challenge the client to stay the course.

Another client I can recall self-disclosing to was a Muslim adolescent whose parents had asked with concern about my religious orientation. After consultation with my site supervisor and fervent prayer, I decided to disclose my faith tradition along with reiteration of my work that would focus on the client’s beliefs and not my own. It was rewarding to receive a copy of the Koran at our termination session in appreciation from the client and his family.

I do, however, use emotional self-disclosure fairly frequently to validate and normalize client anger. Oftentimes, people who come to me for help with their anger feel shame, guilt or fear, and it has been helpful for them to hear that I am in alignment with them when they report an unfair or unjust event as the source of that emotional response. This disclosure does not include circumstances or stories from my life but instead remains strictly within the realm of emotion in the moment.

One client example of this type of disclosure involved a [client’s] vague memory of an unidentifiable doctor who had engaged in questionable behavior during a medical physical when she was a teenager. The client could not recall what had happened beyond [the doctor’s] request to have her strip naked and do jumping jacks, yet the anger she held toward him was fresh. When this client cursed through tears at this person in the counseling session, I disclosed my own feeling of anger toward this person because he had violated her trust and his professional mandate to act in an ethical manner. Efforts to report this professional were largely unsuccessful due to the client’s blocked memory, yet the client reported feeling affirmed and validated by our work that focused on mitigating that traumatic event.

 

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The ethics of self-disclosure

Practitioners who choose to self-disclose information about their personal lives in counseling sessions often walk a fine line between using it as a tool to connect with clients and diverting attention away from clients and on to themselves.

When used incorrectly, self-disclosure can take focus away from the therapeutic work and the needs of the client. When used appropriately, however, practitioner self-disclosure can build trust, strengthen the therapeutic relationship and help a counselor to express empathy.

So, how much self-disclosure is too much? Practitioners must always put the client first when using any intervention, including self-disclosure, says Joy Natwick, ethics specialist for the American Counseling Association. Counselors should carefully consider their client’s needs and presenting issues and whether the self-disclosure could trigger an issue with which the client struggles, such as excess worry or caretaking behavior, she says.

In addition, self-disclosure should never be used as a response to the counselor’s emotional needs or in situations in which self-disclosure would jeopardize the quality of care to the client, Natwick emphasizes.

Self-disclosure should be regarded as a tool to engage clients and help move them toward their treatment goals. If it would have any other outcome, it is unlikely to be the correct intervention to use, Natwick says.

For additional guidance, consult the following standards in the 2014 ACA Code of Ethics:

  • A.1.a. Primary responsibility
  • A.4.a. Avoiding harm
  • A.4.b. Personal values
  • A.6.b. Extending counseling boundaries
  • B.7. Case consultation
  • C.2.g. Impairment
  • C.6. Public responsibility
  • H.6. Social media
  • I.1.b. Ethical decision making

 

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Related resources from ACA

Books (counseling.org/publications/bookstore)

Counseling Today (ct.counseling.org)

 

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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 editorct@counseling.org

 

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

Workforce projections show a coming surplus of school counselors, shortage of addictions counselors

By Bethany Bray January 28, 2019

According to the U.S. Health Resources and Services Administration (HRSA), there will be a shortage of addiction and mental health counselors and a surplus of school counselors and marriage and family therapists in the decade to come.

These predictions come from HRSA’s workforce projections, released recently for a variety of behavioral health professions, including professional counselors, through the year 2030.

Across the country, demand for addiction counselors is expected to increase by 21 percent through 2030, while the supply of these practitioners is expected to rise just six percent. For mental health counselors (defined as a practitioner “who work[s] with individuals and groups to deal with anxiety, depression, grief, stress, suicidal impulses and other mental and emotional health issues”), HRSA predicts that demand will grow by 18 percent while the supply of practitioners will grow by 13 percent.

In both cases, this would leave a deficit of many thousands of counselors across the United States.

“As indicated by the latest HRSA data, professional counselors who specialize in mental health and addictions are in high demand due to an ongoing, pervasive mental health workforce shortage and increased need, such as with the opioid epidemic,” says American Counseling Association President Simone Lambert. “As a profession, we must continue to advocate for access to mental health care in our schools and communities for clients of all ages and diverse backgrounds. In addition, we need to focus on creative solutions, such as telehealth, to service those in rural areas with limited mental health and addiction counselors. ACA continues to seek solutions toward licensure portability in the hopes that in the not-so-distant future professional counselors will be able to provide services across state lines or seamlessly relocate to assist struggling communities.”

On the flip side of the coin, HRSA reports that America is “producing a relatively large number of school counselors,” with a supply expected to increase by 101 percent through the next 11 years, far exceeding a demand growth of just three percent. Even if public schools across the country were to conform to the American School Counselor Association’s recommendation of one school counselor per 250 students, there would still be a surplus of school counselors in 2030, HRSA reports.

HRSA’s projected surplus of marriage and family therapists is not quite as extreme, with demand growing by 14 percent and workforce supply increasing by 41 percent through 2030.

HRSA released these behavioral health workforce predictions in December 2018.

This fall, the agency also released a state-by-state breakdown of supply and demand estimates for behavioral health jobs, including professional counselors, psychiatrists, social workers and other occupations through 2030.

Lambert, a licensed professional counselor and core counseling faculty member at Capella University, notes that the projected need for substance abuse and mental health counselors is reflected in the U.S. Department of Labor’s Occupational Outlook Handbook. The agency projects that employment of substance abuse, behavioral disorder and mental health counselors will grow 23 percent from 2016 to 2026, “much faster than the average for all occupations.”

 

 

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Find out more:

 

HRSA Behavioral Health Workforce Projections landing page

 

HRSA report: State-level Projections of Supply and Demand Behavioral Health Occupations: 2016-2030

 

U.S. Department of Labor Occupational Outlook Handbook for substance abuse, behavioral disorder and mental health counselors

 

 

 

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Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

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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.

Relationship management

By Laurie Meyers January 24, 2019

Consider the words of a certain New Jersey troubadour:

Everybody needs a place to rest

Everybody wants to have a home

Don’t make no difference what nobody says

Ain’t nobody like to be alone.

This declaration is from Bruce Springsteen’s 1980 single “Hungry Heart,” which tells the story of a restless man who believed contentment could be found in ceaseless wandering, in never putting down roots or making connections. Over the years, however, the man realizes that he is alone, tired and lonely. Without close relationships, he has nowhere to turn when he is weary and in need of succor. He comes to understand that “home” can be found in the people we are close to.

“Hungry Heart” was Springsteen’s first top 10 hit as a performer. The song’s memorable and upbeat melody may partially explain its popularity. But perhaps its appeal also comes from listeners’ recognition of an essential truth revealed in its lyrics: People are not meant to go through life alone.

“We are social creatures,” says David Kaplan, who is retiring this month as the American Counseling Association’s chief professional officer. “We are meant to be with other people. We thrive with other people. Communication [with others] promotes community and a sense of connectedness. Lack of communication promotes isolation and dysphoria. It also predicts an earlier death.”

Indeed, research has shown that social relationships serve as a buffer against stress and are a protective factor against the risk of disease. According to a research review published in the May 2015 issue of the journal Current Opinion in Psychology, in the face of chronic adversity, adults who are socially integrated — meaning that they possess a network of close relationships — have a 50 percent higher survival rate than those who are socially isolated. In fact, social support has a more significant effect on mortality than do behavioral risk factors such as obesity and alcohol consumption.

The effect of social relationships on health is both direct (e.g., promoting well-being) and indirect (e.g., reducing or blocking exposure to stressful events or minimizing the physical effects of stress). Recent research has focused on how social relationships minimize the impact of stressful events. The body responds to acute stress by mobilizing the neuroendocrine, autonomic, immune and metabolic systems. Over time, this mobilization can cause wear and tear on the body (called the allostatic load). Social support seems to lower the body’s allostatic load — with support being a key word. Research indicates that it isn’t enough to simply have social “ties.” Not surprisingly, negative, stressful relationships can actually have an adverse effect on a person’s physical and emotional health.

Of course, professional counselors, who build their work around the therapeutic bond, are already well aware of the vital role that supportive relationships play in people’s lives. Using this crucial relationship, counselors can help teach clients how to cultivate and maintain healthy relationships in all areas of their lives.

Why can’t we be friends?

The bonds formed between friends can be just as important as those within families. But in our fast-paced, global and mobile society, maintaining friendships can be challenging, especially as adults. People move away, develop new interests or start families and find it difficult to consistently make time for those outside of their family units. Suddenly, adults can find their friendship pool depleted, and they’re left struggling to remember how to make new friends.

As children, we are placed in environments that make it easier to form bonds. We go to school with others our age and participate in shared interests such as club activities and team sports. But as adults, these kinds of opportunities aren’t as readily available, notes Kailee Place, a licensed professional counselor (LPC) in Charleston, South Carolina, whose specialties include helping women with relationship difficulties. As a result, adults generally have to actively seek out ways to meet people and build bonds.

One way counselors can assist in this effort is by brainstorming with clients about their interests and values, thus making it clearer what types of things they are looking for in their adult friendship, Place says. “Counselors also model healthy relationship dynamics in the therapeutic environment, providing room for vulnerability without judgment, actively listening to [clients], providing feedback and generally fostering respect and compassion. This helps lay the groundwork for healthy relationships in the future or can challenge any current toxic relationships [that clients] may have,” Place says.

“Sometimes, clients need a refresher course on social skills and social cues,” Place continues. “This includes how to use small talk to build into more substantial conversation, how to maintain eye contact [and] how to recognize different facial expressions or the meaning behind different tones of voice. During counseling sessions, we can practice these skills [with clients], perhaps using role-play activities, going through exercises to recognize and identify facial expressions, working toward greater comfort with eye contact and gaining comfort in sharing details about themselves.”

Active listening is another essential skill for developing and maintaining adult friendships, says Kaplan, a past president of both ACA and the International Association of Marriage and Family Counselors, a division of ACA. As he explains, when people listen to someone else and then reflect back in their own words what that person just said, it conveys a message that the speaker matters to the listener. And how do clients learn the skill of active listening? By practicing, Kaplan says.

Melody Li, a licensed marriage and family therapist in Austin, Texas, agrees. She often has clients sit facing a partner, a family member or Li herself to practice reflecting back not just what the other person said but also the corresponding emotions embedded in the communication.

Part of being present and attuned is meeting a partner at a similar emotional level, Li explains. For instance, if a person is recounting something that angered them, such as an incident at work, and the listener conveys nonchalance, then the speaker will feel not only unheard but unsupported, she says.

Sherry Lewis is an LPC in Boulder, Colorado, who specializes in helping individuals, parents and families develop stronger emotional and relationship skills. She also holds workshops for children and adolescents on friendship skills and says that much of what she teaches in those workshops can benefit adults as well. In fact, Lewis regularly encourages parents to “listen in.”

“With the kids, we brainstorm things they think make people like or dislike others. Then we go back through the list and rethink the things listed,” she says. “Almost everyone, consciously or unconsciously, tries superficial ways to be liked or accepted by looking a certain way, performing or doing things to be liked, etc., but those are not the things that really make a difference. As the kids in the classes cross off more of the things they originally thought made friends, such as being smart, having things, being good at sports, art, etc., I ask them if they see a pattern. The kids figure out that it’s the way we treat others and how we make them feel that underlies others wanting to be around us more or less. This realization makes friendship less of a mystery and something anyone can improve by acting in ways that make others feel comfortable or positive.”

Lewis adds that maintaining social skills is an ongoing process that everyone needs to practice across the life span as they interact with the people in their lives. From Lewis’ perspective, we have become technologically overconnected as a society, while simultaneously allowing ourselves to grow personally disconnected.

Similarly, Li thinks the rise of social media has had an overall negative effect on people forming and growing interpersonal connections. She argues that social media “can give people the impression that they’re making a connection. A bite-sized piece of connection feels gratifying in the moment, but it is not satiating or meaningful in the long run.” She also believes that the frantic nature of continuously updating social media and news feeds has shortened people’s attention spans and harmed their ability to listen patiently.

Kaplan, on the other hand, doesn’t think that social media interferes with people starting and maintaining relationships. In his view, it is just another way to communicate, and frequent communication is essential to relationships.

“There needs to be quantity,” he says. “It might be online, verbal or face-to-face, [but] in one form or another, there’s no substitute for a quantity of communication with people that you care about.”

Kaplan and Li do agree about the adverse effects of another area of technology, however — the practice some people have of repeatedly scanning their smartphones while interacting with others. Although quantity of communication is important, so is quality, and being able to give full attention to what others are saying is a critical component of forging relationships. When spending time with someone they care about, people should put their phones away, Kaplan says. That advice might seem elementary, but in this day and age, counselors likely need to share it with clients who are working on their relationship skills:   

Feeling awkward

Making and maintaining new connections can be especially difficult if a client is shy or has social anxiety. All hope is not lost, however.

“Counselors can help immensely with debilitating shyness or social anxiety,” Place says. “Most people have some amount of anxiety or nerves when approaching new people, especially if the motivation is building a friendship.”

Place suggests that clients who struggle with social anxiety use grounding techniques such as slow, intentional breathing; carry a small object to fiddle with to channel nervous energy; or use a lotion with a calming scent such as lavender.

“I also encourage clients to challenge any irrational thinking they may be experiencing, such as dwelling on the assumption that people don’t like them, and to come to more accurate conclusions with the proof they have in front of them,” she says. “Keeping the mantra ‘this is temporary’ in mind is also helpful [because] emotions come and go, so those anxious feelings will come and go as well.”

Eventually, Place says, clients have to test their coping skills in the real world so they can build confidence and experience. “Starting out small and safe is key to building a base of confidence and motivation,” she explains. “This can include striking up a conversation with a co-worker that a client feels relatively comfortable around or getting involved in a class of some sort where most people have a common interest. That common interest or common environment can take away the pressure of coming up with subjects to discuss. As these interactions go positively, clients see their ability and, ideally, build their energy and motivation toward more difficult social interactions.”

Li says it can be helpful for clients to be upfront about telling people that they’re shy and often don’t speak up right away but still welcome interaction.

Sometimes anxiety arises because the client feels socially awkward. “We’re all awkward. Some of us just fake it better than others,” says Li, who encourages clients to own their awkwardness and be open about it. She also works with clients to determine if there is something specific that is driving their perceived awkwardness, such as a particular incident or trauma.

Playing (and working) well with others

People might not automatically associate relationship skills with the workplace. Yet most people spend a significant amount of time at the office, which typically requires lots of interacting with co-workers. Negative office relationships not only contribute to unpleasant or downright dysfunctional environments; they can also affect how — or whether — clients fulfill their professional responsibilities.

Jessi Eden Brown is an LPC and a licensed mental health counselor in the Seattle area who specializes in workplace-related stress, work trauma and workplace bullying. She tells her clients that they don’t have to be friends with their co-workers; instead, they should strive for mutual respect and professionalism. Friendship — if it happens — is a bonus.

In addition to honing basic relationship skills such as having empathy and compassion, developing self-insight and being more accommodating, Brown teaches clients how to set a tone for working with others, how to give and receive feedback in the workplace, and how to resolve conflict.

Brown, a member of ACA, most frequently brings up tone setting when clients are preparing to start a new job or project, accept a transfer or change careers. “The process involves helping clients reflect on any changes they might want to make as they start over,” she says. “I often frame it as a way to redefine who you want to be at work.”

“Setting the tone includes thinking about relationships in the workplace. We’ll explore questions such as how much about yourself do you want to share with your new co-workers? Are there any reasons to be cautious at first — as is generally the case with bullied targets who are starting over? What strengths would you like to showcase? In what ways do you want to grow professionally? Are there any habits or behaviors you want to leave behind?”

Defining the desired tone allows clients to identify their goals and then work with Brown to brainstorm steps for achieving them. Brown believes this helps create a road map for clients to correct previous problems and approach situations in a new way. Once Brown and the client have developed that road map, she uses psychoeducation, modeling and role-play to work with the client on any specific skills that might be required, such as assertive communication skills, impulse control and anger management.

Giving and receiving feedback is an essential, yet frequently unpleasant, part of workplace relationships. Brown encourages clients to use “I” statements and to engage in reflective listening. When giving feedback, she is a fan of the feedback “sandwich,” in which the person providing the feedback opens with a positive statement about the recipient’s performance, follows up with an explanation of what the recipient needs to work on and closes with a general positive comment such as, “Overall, you’re doing really well.”

On the other side of the coin, Brown encourages clients to approach receiving feedback with an open mind, reminding themselves that they will probably hear information that they won’t like. Another piece of advice she gives: “You don’t have to respond in the moment — ever. If you hear feedback and feel defensive, tell them [the person giving feedback] that you need time to respond.” Clients can then take that time to ask themselves why they reacted defensively and to consider how they want to respond to the feedback, Brown says. Taking the needed time to gather their thoughts allows clients to re-engage and enter into a more productive discussion concerning the feedback, she explains.

All relationships have conflict, but conflict in the workplace can be particularly uncomfortable, especially if it involves a power differential, such as an employee who has a run-in with a supervisor who signs the paychecks. Brown starts by trying to normalize conflict for her clients, telling them that it’s everywhere. She also advises clients to observe their co-workers.

“Is there someone at work who seems to handle conflict particularly well? How are they doing it?” she asks. “You may even be able to tap them for information.”

Brown recommends that clients take a direct, solution-focused approach to dealing with conflict, including coming to the table with ideas for resolving the problem. If that approach doesn’t work, she advises clients to go through official avenues such as the human resources department.

But what happens when the conflict is with a supervisor or co-worker who doesn’t respond to attempts to resolve the issue? Under such circumstances, Brown works with clients on ways to not internalize the conflict. When clients look around at the larger picture, she says, they often find that they aren’t the only target of conflict — the problematic manager or co-worker behaves that way with most people. Brown also encourages clients to try to apply the lens of humor to the situation or to find other ways to keep the conflict in perspective, such as reminding themselves that this represents only one area of their lives. It doesn’t stop them from continuing to engage in positive interactions with friends and family or from seeking their support.

Of course, conflict isn’t the only kind of drama people encounter when it comes to relationship dynamics in the workplace. Power struggles, gossip and general office politics can create an uncomfortable and precarious atmosphere, notes Maggie Graham, an LPC in the Fort Collins, Colorado, area who specializes in career counseling and coaching.

“If people are … mired in a situation where office politics are swirling around them, and they want to avoid getting pulled into the vortex, simple cues and redirections can be very effective at communicating a clear boundary around gossip while steering clear of judging and alienating co-workers,” she says.

Graham recommends techniques such as changing the topic when conversations veer into murky waters and using body language and clear statements to set boundaries. For example, she suggests clients can gently hold up a hand like a stop sign and say, “Oh, that’s not a topic I want to chime in on. It’s outside my scope of expertise.”

Taking a chance on romance

Much has been written on nurturing established romantic relationships, but what skills do clients need when still looking for love?

“Clients with attachment issues or relationship anxiety may deeply want a relationship but also fear it working out,” notes Rachel Dack, a licensed clinical professional counselor with a private practice in Bethesda, Maryland, who specializes in helping clients with dating, relationship and intimacy issues. “Fear may lead individuals to play games in dating or sabotage developing relationships due to not feeling worthy or confident that someone could actually like them. The fears can be so deeply ingrained that they approach dating with walls for protection or mental blocks that don’t allow them to connect despite really wanting a partner.”

Understanding behaviors that are driven by attachment issues, relationship anxiety and other internal belief systems is often a crucial part of resolving dating difficulties, says Dack, a member of ACA. For example, Dack had a single client in her 40s who repeatedly spent money on prospective partners and insisted on paying for everything while dating.

“She would plan elaborate dates and vacations for the men she was interested in and used her financial assets as a means to connect,” Dack says. “She often felt insecure and anxious that men didn’t want to date her. When we explored her belief system, she had deeply rooted beliefs that she was not good enough and was unworthy of being picked by a great guy.”

The client’s reliance on using money to attract men was ultimately self-defeating, Dack says, because even when someone continued to date her, she couldn’t help but question whether he would have asked her out if she hadn’t paid for everything. This created a constant sense of rejection in the client despite her success in getting dates.

“She [also] had a tendency to dominate the relationship when it came to logistics — planning dates, picking activities, paying all of the time — while holding back her feelings and acting standoffish with men despite her interest,” Dack explains. “She didn’t know how to relate to the men who wanted a more equal relationship in which they could also be generous and giving because she was scared they wouldn’t like her if she stopped paying. We worked to explore her underlying belief system and her thoughts on gender roles, healthy relationships, money, herself and men.”

Dack helped the client look at how these beliefs shaped her behavior and encouraged her to ask herself whether her approach was serving its intended purpose. “She realized that her negative mindset was interfering with her goal of a healthy partnership and that she wasn’t giving men the opportunity to get to know her in a deep way,” Dack says.

Together, they discussed how the client might behave differently if she believed she was worthy of love. Dack encouraged the client to allow herself to be more vulnerable by letting a man pursue her. She also urged the client to become more emotionally invested in her relationships.

“It was hard for her to accept a man who wanted to make her feel special, but she learned to become more comfortable with this through time and practice tolerating the discomfort,” Dack says. Dack also helped the client learn how to love and care for herself, which allowed her to accept love and care from others.

The process of forming an intimate connection — from early conversations to going on actual dates — can be a very scary or overwhelming undertaking for many people, Dack observes. She reminds clients that many of the negative scenarios they fear do not end up happening. Dack also helps clients reframe bad dates and past relationships — not only did the clients survive them, but they learned something that they can use going forward. “Clients often feel better when they take emotional risks aligned with their romantic goals [but] can feel hopeless when they avoid taking risks or give up on dating entirely,” she observes.

To prepare for dates, Dack has clients practice their active listening, communication and validation skills. “The balance of how much to speak and share versus how much to listen can be tricky to maneuver,” she says. “Often, clients fall on one extreme — either they are so eager to share about themselves that they do too much talking and oversharing, or they are very introverted, shy or scared to be vulnerable, so they prefer to sit back and do all of the listening.”

Many clients struggle with how to create a natural conversation flow, Dack adds. One of her clients, a man in his early 30s, had trouble getting more than one date with the women he pursued. He told Dack that women often said they didn’t feel a connection with him. As Dack and the client discussed how he typically interacted on dates, she helped him realize that because of his anxiety about potential rejection, he would ask numerous questions but not truly take in or indicate interest in his date’s responses.

Dack used role-play to train the client to slow down his questions, listen attentively and stay on topic for more extended periods of time. The client also practiced sharing his own experiences and emotions. “We explored what it means to connect and practiced validation skills so that his dates would feel heard, valued and understood,” Dack says.

Over time, the client’s enhanced ability to engage allowed him to achieve much better connections — and led to relationships that have extended well beyond one date.

 

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The power of forgiveness

“Forgiveness is important to relationships for many reasons, but primarily because it is a mechanism of healing ruptures that occur in all relationships,” says Veronica Johnson, an American Counseling Association member whose research focuses on forgiveness, conflict resolution and infidelity.

People who refuse to practice forgiveness in their relationships experience resentment, bitterness and anger, which can cause both physical and psychological problems, points out Johnson, an associate professor and chair of the Department of Counselor Education at the University of Montana.

Another reason forgiveness is essential to relationships is because it restores a sense of dignity and trust to both parties, Johnson says. “The offender is released from guilt and shame … [for] what they did, and the victim lets go of a desire to seek revenge and continue to punish their partner,” she explains. “In the presence of a good apology — which is also quite important in relationships — the victim’s dignity is also restored [because] they are validated in their experiences.”

Forgiveness, however, first requires a willingness to forgive, Johnson emphasizes. “Allowing clients the space to express the anger, resentment, grief, sadness and other host of emotions that accompany a relationship rupture is absolutely essential,” she says. “Only after the client feels validated and heard in expressing their experience can a counselor begin the process of helping the client see the effects that active unforgiveness has on their life.”

Johnson recommends Robert D. Enright’s book Forgiveness Is a Choice: A Step-by-Step Process for Resolving Anger and Restoring Hope as a resource. Enright emphasizes that therapists should never imply that clients must or even should forgive.

“Implying such can be experienced as blaming or retraumatizing for a client,” Johnson says. “We can help clients to see how their active unforgiveness impacts their life, and when they are ready to free themselves from the hurt, anger, bitterness, etc., then forgiveness becomes an option. The process of forgiveness that Enright proposes involves allowing oneself to fully experience the range of emotions that accompany the offense, actively choosing to forgive, working toward forgiveness by developing understanding and compassion for the offense and the offender, and discovering meaning, purpose and release from negative emotions associated with the offense.”

Johnson adds that forgiveness need not be accompanied by reconciliation. “We need to empower our clients to make decisions that are healthy for themselves and their relationships, and sometimes that might mean leaving an unhealthy relationship,” she says.

If the client is leaving an unhealthy relationship, the forgiveness work often shifts to self-forgiveness. These clients often need to learn how to forgive themselves for staying or for tolerating bad behavior in their partners, Johnson concludes.

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

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

  • Relationships in Counseling and the Counselor’s Life by Jeffrey A. Kottler and Richard S. Balkin
  • Mediating Conflict in Intimate Relationships, DVD, presented by Gerald Monk and John Winslade

Podcasts (aca.digitellinc.com/aca/store/5#cat14)

  • “Imago Relationship Therapy” with Susan Hammonds-White (ACA284)
  • “Love and Sex and Relationships” with Erica Goodstone (ACA231)

 

 

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

Letters to the editor: ct@counseling.org

 

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

Voice of Experience: Facing the wind

By Gregory K. Moffatt January 22, 2019

Sofia’s clothes were stylish and neatly pressed, and her jet-black hair was immaculate. Cropped short, not a strand was out of place. Subtle makeup highlighted her athletic features and youthful appearance, making her look much younger than she actually was.

Only by looking closely could I see a hint of red in her eyes. She had cried on the way to our appointment. Not surprising. Her life as she had known it was over.

Just two months before, Sofia (not her real name) had been a typical wife of a dozen or so years and the mother of two grade-school children. Aside from her stunning beauty, she could have been any one of a hundred other mothers in a car-rider pickup line or wandering the aisles of the grocery store. The life she shared with her husband consisted of packing school lunches, shuttling children and their playmates to soccer practice, managing their suburban home and running a small real estate business.

But all of that changed in a heartbeat. One careless decision led to a fleeting affair, which Sofia confessed to her husband, and their marriage was over. He couldn’t bring himself to forgive her, so she agreed to move out. Sofia was living in a small garage apartment belonging to a friend and saw her children for only a few hours on Saturdays.

Sofia was consumed with grief and, although you couldn’t tell by looking at her, every day she could scarcely get out of bed. The burden of her sadness was so heavy that, as I got better acquainted with Sofia, I could almost see her regrets weighing on her shoulders.

This isn’t a novel tale. Any of you reading this could undoubtedly identify many faces from your own client files, male or female, that would easily slip into the general details I’ve just laid out. After all, one of the main reasons people come to see us is because they’re facing the pains of life.

But one thing set Sofia apart from all of my other clients over the years. She taught me a lesson that has not only made me a better therapist, but has also helped me to manage my own depression as it has waxed and waned through the decades.

As much pain as she carried, Sofia forced herself daily to get out of bed and face the day, regardless of the tempest that was her life in the moment. Please don’t mistake my details of her appearance as misogynistic. My intent is simply to be descriptive of how much energy she spent preparing for the business of the day.

Anyone who has worked with grieving clients, clients experiencing major depressive disorder or similar diagnoses knows that failure to attend to personal hygiene is common. I have had clients come to sessions without showering, with their hair not having seen a comb or a brush in days, and still wearing a food-stained sweatshirt-and-sweatpants combo that doubled as their pajamas.

Not Sofia. Yet her appearance wasn’t an expression of vanity. It was one of professionalism and determination. She took full responsibility for her role in the dissolution of her marriage, but she refused to wallow in regret. In the most healthy way, she said to me more than once, “It is my fault, I am devastated, and I’m so sorry, but I will rebuild my life.” And she did.

Sofia’s appearance was an apt metaphor for a philosophy that said, “I will not be defeated.” And it worked for her.

In those early days of her new life, Sofia awoke each morning to face a strong headwind, but she plodded forward. Over the course of her recovery, the gale weakened into occasional gusts and, eventually, manageable breezes. All the while, the hole in her heart also began to heal.

As I’ve helped other clients work through life’s difficulties, I’ve recounted Sofia’s story numerous times. Even when she didn’t feel like it — even when it seemed her life was over — she got up, faced the day and conducted the business of life. What a powerful example.

Our final appointment was very brief. The cost of therapy was part of Sofia’s decision to terminate, but not the biggest reason. She explained that her days were getting easier and, just 15 minutes into the session, she thanked me and said, “I think I will be OK.” I couldn’t argue with her. As the door closed behind her, I knew she possessed the skills she needed to continue her recovery.

I was a very new therapist in those days, and I sometimes wonder which of us got the better deal. I doubt Sofia remembers me, but because of the lesson of courage she demonstrated, I’ll never forget her.

 

 

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Gregory K. Moffatt is a veteran counselor of more than 30 years. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.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.