Monthly Archives: April 2019

@TechCounselor: Retaking ownership of your time

By Adria S. Dunbar April 15, 2019

For those of us who are counselors or counselor educators, it may feel like we are constantly juggling and, dare I say, multitasking during our days. As wellness experts, we know this is not healthy or productive. Even so, with so many possible distractions and so many things competing for our time and attention, sometimes we find ourselves being pulled (reluctantly) toward these counterproductive habits.

I’ve invested a significant amount of time over the past few months investigating my own use of time. In fact, for the first time in my life, I committed to pursuing a New Year’s resolution for 2019. I want to be more intentional with how I choose to spend the time I have each week. I don’t know about you, but I want to have greater ownership over my calendar rather than allowing my calendar to have ownership over me. I suspect that other counselors might also be struggling to find an ideal balance. So, here it is — a brief summary of some of the tools that are helping me increase my awareness around time.

 

1) I highly recommend a podcast called Hurry Slowly hosted by Jocelyn K. Glei. Listening regularly has been a great way for me to explore my own productivity habits related to time management, creativity, efficiency and balance. Glei describes the podcast in the following way: “Hurry Slowly explores how we make smarter decisions, feel more comfortable taking risks, and manage our attention more intelligently when we learn to take our time.” Counselor practitioners may particularly enjoy episodes by Jason Fried (“Whose schedule are you on?”), Cal Newport (“Using technology with intention”), Alex Pang (“Prioritizing rest and reflection”) and Fanny Auger (“Conversation isn’t about talking”). One of my personal favorites is Glei’s “Creativity vs. efficiency”.

2) I’ve also been using an online tool called Toggl. I have the app on my phone and downloaded on my MacBook. Toggl allows me (and reminds me) to track my time when I am working. For example, I had no idea how much time I was spending responding to email. Seeing the patterns allows me to make more intentional decisions about how to prioritize and block my time so that the time I am spending on tasks aligns with my work mission.

3) Laura Vanderkam is one of the leading experts on time tracking. She is the author of several books, including 168 Hours: You Have More Time Than You Think and Off the Clock: Feel Less Busy While Getting More Done. She also has a Free Time Makeover Guide (a pdf is available on her website), which is an eight-step framework to help you reconsider how you spend your time.

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In addition to these resources, or perhaps as a result of using them, I have also set some new norms for how I want to conduct the business of living my life. This has required quite a bit of self-reflection on my part, and technology has certainly impacted these results. Here is a list of a few of my new norms:

1) Plan for the next week on Fridays using (wait for it …) ANALOG tools. Typically, I was trying to make weekly plans on Sundays. There were several reasons this was not working for me, but two stand out. First, planning on Sunday meant that my work week was creeping into my weekend time. Second, it is much easier for me to plan for the following week when I’m still in work mode rather than weekend mode. I’ve been using a Clever Fox Planner to reach this goal. I still use Google Calendar for appointments, but my planner helps me prioritize and budget my time, while helping me stick to my focus for the week.

2) Once my schedule is set for the week, I try very hard not to make changes. I realized I was adapting too much to other people’s requests for meetings, phone calls, appointments, etc. I was rescheduling based on other people’s requests A LOT. Now that my schedule is set, I can better prioritize my time and feel an increased sense of control over my calendar, which allows me to spend my time in ways that align with my goals.

3) I’m still working on an earlier bedtime and wake-up time. This actually may be a lifelong growth edge for me. However, I have implemented a Screen Time curfew of 9 p.m. My iPhone settings have helped me stay committed to this practice.

I’d love to hear some of the strategies counselors are using to manage their own time, or feedback on any of the tools that you are trying to practice in your own life.

 

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Adria S. Dunbar is an assistant professor in the Department of Educational Leadership, Policy and Human Development at North Carolina State University in Raleigh. She has more than 15 years of experience with both efficient and inefficient technology in school settings, private practice and counselor education. Contact her at adria.dunbar@ncsu.edu.

@TechCounselor’s Instagram is @techcounselor.

 

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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.

Five points of discussion for conversations about racial injustice

By Amanda L. Giordano April 10, 2019

When teaching multicultural counseling courses, I often get questions from White students about how they can leverage their White privilege to help change America’s broken social system that privileges some while oppressing others. In addition to continuing to explore their own White racial identities, I encourage these students to initiate conversations with other White people in their lives about racial injustice. As more White individuals become aware of their White privilege and the racial injustice that exists in our country, greater degrees of systemic change are possible.

Counselors and counselors-in-training are uniquely equipped to facilitate these discussions, given their strong interpersonal skills and passion for advocacy. The goal of the conversation is to invite White individuals to engage in a dialogue about systemic privilege and oppression rather than become defensive. In an effort to assist White individuals who desire to initiate conversations with other White people about racial injustice, this article provides five possible points of discussion.

 

1) What characteristics do we attribute to race? Since the start of this country, we have fallen prey to an insidious scheme based on faulty logic: attributing characteristics and behaviors to race that have no rational correlation. We do it so frequently and so automatically that it often goes unrecognized. For example, if a Latino contractor does not complete his work satisfactorily, we are tempted to conclude, “Latino contractors cannot be trusted.” We erroneously attribute personal work ethic to race. Or, if we are cut off in traffic by a Black woman, we somehow link her behavior to the fact that she is Black rather than to an isolated driving decision.

When we pause and reflect on what characteristics and behaviors we attribute to race, we may be surprised by what we find. Logically, we know that skin color, eye shape and hair texture have no correlation with an individual’s morality, intelligence or trustworthiness — yet we have been socialized to make these associations. This is something that we need to unlearn.

Consider what would happen if someone watched a documentary about Charles Manson and concluded that he was a cult leader because he was White. We likely would explain that Manson’s role as a cult leader was the result of myriad factors (psychological state, early childhood experiences, environment, etc.) and that his behavior cannot be attributed to his race. In the same way, we need to examine the correlations we make between a person’s race and her or his personal characteristics or behaviors. How logical are these attributions? 

2) Do we desire people of color to “act White”? Many White people are genuinely trying to learn how to be culturally competent, but sometimes they can get stuck in a particular mentality: “I enjoy diversity … just as long as people of color act/talk/think in ways that I am familiar with.” Whether intentionally or unintentionally, we may encourage people of color to deemphasize their unique cultural identities to fit into the mold of White cultural norms. As a result, many people of color expend a lot of energy working to make White people feel comfortable around them (such as expressing only certain aspects of themselves while in the company of White individuals).

What is the cause of our desire for people of color to “act White”? It’s likely that we feel more at ease with what is familiar to us. There is a certain way of being that we deem “normal,” and it makes us comfortable when people behave accordingly. Therefore, the desire for people of color to “act White” is for our comfort.

Sadly, we rarely consider the discomfort that people of color face as they navigate White cultural norms every day. Often, their culturally diverse ways of being are not reflected back by those around them. As a result, people of color are forced to learn all the nuances of White cultural norms, whereas White individuals know very little about the cultural norms of other racial/ethnic groups.

What would it be like to let go of the strong grasp we have on our own cultural preferences and enter into the preferences of others (despite the unfamiliarity)? “Different” doesn’t have to be synonymous with “negative”; different can be exciting, invigorating, enlightening. Can we create space for all people to be proud of their cultural identities and to express those identities in whatever ways they choose?

3) Do we acknowledge that multiple interpretations exist for past and current events? Education is an amazing gift, and the opportunity to learn is something we should never take for granted or outgrow. At the same time, we must acknowledge that the stories we’ve read and the accounts we’ve learned in school represent one perspective, one side of the story. Authors of textbooks and class curricula write from their own frames of reference — they are not neutral, blank slates who simply report the facts. These authors make interpretations, derive meaning and present information from their personal lenses. It is important to consider that authors from different cultural backgrounds may have different interpretations, derive different meanings and present information differently, simply due to their frame of reference.

Consider an example from history: the Pueblo Revolt of 1680. Depending on the perspective of the storyteller, this could have been a brutal uprising against the Spanish who were dedicated to bettering the community (Spanish as protagonists) or a liberating revolt in which oppressed Pueblo Native Americans took back the land that was rightfully theirs (Native Americans as protagonists). There are always multiple perspectives to every event, and it is important for us to consider differing viewpoints. Can we concede that what we think we know is only one perspective and that multiple, equally valid viewpoints exist?

4) Does defensiveness keep us from truly listening to people of color? It is important to consider what comes up for us when we hear people of color share their experiences of oppression. If our initial response is defensiveness, it is likely that our focus in that moment is off. Rather than focusing on the lived experience of the speaker, we are focused on what the information says about us. We are not attending to the oppression of our neighbors and how they feel; instead, we are attending to the impact of the information on our own sense of self.

One strategy that can help us maintain the proper focus is to listen with the goal of understanding rather than evaluating. Often when we listen, we are evaluating what we have just heard (Is this information right or wrong? Do I agree or disagree? What does this mean about me?) and simultaneously developing responses and counterpoints in our head. This process keeps the focus on us — our reactions, our beliefs and our assessment — and gets in the way of truly listening. There certainly are times when evaluation in conversation is necessary, but when people of color are sharing their experiences of oppression, it is more helpful to listen with the intent to understand, not to evaluate.

If we feel ourselves becoming defensive, we should do a quick mental check-in: “Am I evaluating what is being said and focusing on what it means about me?” If so, perhaps we should press pause and mentally switch our focus back to the speaker (“What was that like for her? How did she feel when it happened? How did this experience affect her life?”). When a person of color shares her or his experience, can we truly listen with the goal of understanding rather than evaluating?

5) We could do nothing about racial injustice, but do we want to? If we are honest, we all know that something is wrong with our social system. It is clear that people are treated differently as a result of their race. Consider two high school students (one White and one Black) who get caught with marijuana. Sadly, it is more likely that one of these students will be sent home with a warning (to a family who will “get him back on track”), while the other will be ushered into the criminal justice system. Or consider two identically qualified job applicants — one with the last name Jones and the other with the last name Hussain — who submit their résumés for an open position. Again, it is likely that one will get the interview because he seems like a “better fit,” whereas the other will stay on the job market.

We know, just by looking at the world around us, that inequity exists and that things are unjust. We also know that we can go our whole lives without saying or doing anything about it. We can choose to live in silent disapproval and never challenge the status quo, but is that what we want? Saying and doing nothing despite evidence of racial injustice likely means that we are living in opposition to our values (e.g., equality, justice, respect for the innate worth of all human beings), which can lead to incongruence and cognitive dissonance.

Also, if we allow our unjust system to continue, we likely will never experience the true joy that comes from living in a diverse community and celebrating cultural differences. We will not have the opportunity to see the world from different perspectives or to feel the excitement of experiencing new cultural norms. We may never form deep, meaningful relationships with those from different racial/ethnic backgrounds or experience the gifts that come only through diverse friendships. If we remain silent, we may be living life, but are we living it to its fullest? Those with privilege have a responsibility to leverage their unearned advantages to combat injustice and oppression. What does that look like for us personally?

There are many more talking points to consider, but these might help start conversations with White people in our spheres of influence. Let’s remember that as counselors, we have a unique set of interpersonal skills that can be extremely useful when facilitating conversations about racial injustice. We are primed to listen well, validate, and gently present alterative viewpoints. Perhaps we can all commit to using our skills to facilitate meaningful dialogue that could lead to lasting, systemic change.

 

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Amanda L. Giordano is an assistant professor in the Department of Counseling and Human Development Services at the University of Georgia. Her research interests include addictions counseling, multiculturalism, and religious and spiritual issues in counseling. She is a licensed professional counselor and national certified counselor. Contact her at amanda.giordano@uga.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.

Should we talk about politics? What we are missing in counseling sessions

By Cebrail Karayigit and Donna M. Nesbitt April 8, 2019

The 21st century has become a period of widespread refugee crisis. The Department of Homeland Security defines refugee as “a person outside his or her country of nationality who is unable or unwilling to return to his or her country of nationality because of persecution or a well-founded fear of persecution on account of race, religion, nationality, membership in a particular social group, or political opinion.”

According to The Guardian, in 2017, the number of people forced to flee their homes rose to a record high of 16.2 million. In recent years, individuals migrating from authoritarian countries has mainly been motivated by political instability. These countries are often structured in ways that allow the government to hold a majority of the power, while their citizens have restricted political freedoms.

Although there are many such countries, the failed coup attempt on July 15, 2016, in Turkey illustrates a worrisome example of deteriorating stability in a country that just a few years prior was being promoted as a model of democracy. The failed coup resulted in many academics, doctors, teachers and journalists becoming targets of persecution in their home country. Many of them fled to survive or to seek better lives, and in the process, they experienced extremely stressful events — e.g., losing their jobs, lost socioeconomic status — because of political oppression.

It is important to acknowledge the deep need these individuals have for freedom of thought and speech, especially knowing that they come out of a culture of silence and fear. As professional counselors, however, we have a natural tendency to avoid talking about political issues in our practices. We need to become aware that refugees who discuss these issues are not often looking to engage in a political debate; rather, they want to have their words and thoughts validated in a safe space.

Given that the lives of many refugees are complicated by the political turmoil in their home countries, avoiding political conversation with them in counseling would not seem to be genuine or authentic practice. In fact, allowing them to discuss how they have been affected by those political factors can offer a deeper understanding of their presenting problems.

As Elie Wiesel, the Romanian-born Jewish writer who eventually became a U.S. citizen, once stated, “Wherever men and women are persecuted because of their race, religion or political views, that place must — at that moment — become the center of the universe.” Thus, as counselors, we should understand that these struggles are a significant part of refugees’ lives and should be given the attention and respect they deserve.

 

Why this topic matters to Cebrail

While completing my internship at one of the largest public universities in the eastern part of Turkey, I encountered a client of Kurdish descent. In our first session, this client identified her issues with experiencing political oppression on campus and with being Kurdish in Turkey, especially given the oppressive political climate that continues even today.

My internship supervisor advised me to discontinue our session when this topic was broached, because at that time, it was considered unwise to discuss such political matters with a client in such an environment where some tension has always been apparent regarding Kurdish issues. Reflecting on this now, I realize that my supervisor was only trying to protect me. However, this was also the first time I began questioning the idea that discussing politics in session should be taboo.

As a counselor educator, I am now in a unique position to witness the power of practicing freedom of speech on campus here in the United States. As a professional counselor and educator who comes from Turkey, I am often invited to speak on topics such as diversity and counseling in Turkey, either through panel discussions or in classes.

Not so long ago, a colleague at Pittsburg State University in Kansas requested that I speak to a class about the political climate and turmoil in Turkey, in hopes that it would raise awareness about what has been occurring there. Once again, I was faced with the tension of engaging in a political discussion, but this time with future professionals. This created some inner conflict for me. Many academics in Turkey were dismissed from their jobs for injudicious reasons, such as suspicion of involvement in the coup, suspicion of association with a particular organization, or for being outspoken in criticizing the government. Yet, here I was, about to discuss these very matters in an academic setting.

As Elif Shafak, a Turkish-British novelist, once stated, “You do not have the luxury of being apolitical if you are from wobbly or wounded democracies.” Although I usually discuss such political issues privately, I have come to realize how difficult it is not to share these matters with peers and students in academic settings. In my experiences, many Turkish refugees are very occupied with wanting to discuss previous and current political issues in their home country because of their deep and unmet need for freedom of thought and speech. This suggests to me that our counseling clients who have already experienced many stressful events because of political oppression need to be given a real opportunity to tell their stories in full without being judged.

In recent years, one of the main reasons that Turkish refugees have been coming to the U.S. is because of the political instability in Turkey. As I have been helping some of them personally and professionally, it has become evident to me that political factors are always the center of discussions. Because most of their presenting problems are a result of their stressful experiences with political oppression back home, it made me question once again whether counseling can provide that safe space for them to practice free speech, express their struggles and have their unique stories validated. How can discussing political issues be taboo when most of their problems come from political oppression?

 

Why this topic matters to Donna

As a graduate student in the clinical psychology program at Pittsburg State University, I have been taught on several occasions to avoid discussing political or religious beliefs in session when possible because this can lead to issues of bias and an inability to remain objective. However, in my class on diversity that is required by the program, I experienced another perspective. We were taught that if you are working with a client who is seeking services due to political or religious persecution, you need to be ready and willing to see from the client’s viewpoint. This is especially true in the case of immigrants and refugees.

I was fortunate to be present for the class mentioned by Dr. Karayigit, and I learned a great deal from what he described in his discussion. It opened my eyes further to the possibility that clients I counsel may be experiencing similar distress, and I want to be as prepared as possible for those sessions.

In my current position as a case manager, I work with a diverse population. This often requires me to consider political or religious beliefs in terms of the reason the treatment has been sought and what I work on with a client. I have encountered political and religious beliefs both similar to and opposite from my own. This has not limited my ability to engage in discussions about either with my client, nor has it discouraged me from doing so. Rather, I consider it an opportunity to truly learn about my clients’ stories and how these topics have impacted their lives.

I think the persecution and conflict that clients have experienced due to their political or religious beliefs should be factored in to treatment because these events are a significant part of their stories. It is important to recognize that our clients are human beings, which means that we have to be willing to explore the topics that matter most to them — regardless of our own beliefs.

 

Why this subject is especially relevant

In today’s world, counseling requires an increasingly greater focus on immigrant populations. With refugees constituting an important part of this population, it is important to understand that their distress is often a result of their experiences with political oppression and a lack of freedom of expression.

Working as professional counselors in any capacity, we follow the ACA Code of Ethics, and we are expected to provide the best possible service to our clients. While we have an ethical responsibility to not impose our personal beliefs and values on our clients, we also need to create a safe atmosphere in which our clients can practice free speech and expression of their own beliefs and values. In that case, wouldn’t dismissing the subject of politics in session — especially if it is a significant part of the client’s story — be more harmful? Is it not exacerbating the hardship the client is already experiencing if the client is an immigrant or refugee?

That’s why we believe that allowing clients to express their feelings and thoughts about political factors in a safe, judgment-free space is crucial to remaining authentic and genuine in the service we provide as counselors. To work with this population more effectively, it is important to understand that discussing political issues with these clients can have a positive impact in their lives.

 

Strategies and implications for professional counselors

Although the counseling profession puts a strong emphasis on multicultural awareness and competence, political factors are not typically discussed in counseling sessions. This might be because clients are unsure about the appropriateness of discussing political factors, especially if they are coming from a culture of silence and fear. That’s why, when working with such clients, it is essential to understand their experiences with oppression.

Another barrier to the discussion of political factors is the counselor’s lack of understanding and knowledge regarding the political stance in the client’s home country. When counselors do not have enough information and understanding of different political structures as a whole, it will prevent them from entering the world of the client openly. Having or acquiring this basic understanding is a very important step in communicating with clients whose primary issues stem from a country’s political state. If counselors can provide an atmosphere for clients to openly discuss their experiences, clients will be able to practice freedom of thought and expression. Having such an open dialogue will reinforce these clients’ abilities to engage in freedom of expression.

Following is a composite of suggestions to work more effectively with refugees who have experienced political oppression:

  • Learn as much as you can about the basic political structure (e.g., totalitarian, authoritarian, democratic) of clients’ home countries.
  • Become knowledgeable about the history of oppression in both your own country and your client’s country. Where does your client fit within the political power structure? How is the client affected by his or her country’s history of oppression?
  • Recognize and acknowledge the negative impact of political oppression on individuals (e.g., lost socioeconomic status).
  • Recognize your own political biases to manage any countertransference (e.g., What is your political hot button? How do you feel about refugees coming to your country?).
  • Be a role model by encouraging your clients to practice freedom of thought and expression (e.g., clinically relevant self-disclosure).
  • Challenge your clients’ speech codes, especially if they hold faulty beliefs about political oppression. For instance, a client might say that if academics were dismissed from their jobs, then the government must have had a valid reason. It is important to challenge clients’ faulty beliefs by asking such questions as, “By what criteria have they dismissed people from their jobs? What is the measure here?”

 

 

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Cebrail Karayigit is an assistant professor in the Department of Psychology and Counseling at Pittsburg State University. He is currently teaching graduate and undergraduate psychology and counseling courses, and supervising practicum/internship students in the school counseling program. Contact him at ckarayigit@pittstate.edu.

 

Donna M. Nesbitt is a graduate student in the clinical psychology program at Pittsburg State University. She is currently working as a clinical case manager.

 

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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.

How can we truly help clients in a relationship?

By Chris Warren-Dickins April 4, 2019

Couples therapy has been around for years, so it is easy to believe that we know everything we need to know about its underlying principles. Assumptions can lead to an overly narrow perspective, however, so I’d like to offer 10 ideas on which to reflect when it comes to couples therapy.

 

1) “Couples” are actually “relationships”: Perhaps the first way to truly help couples is to stop using that very term — couples. That’s because the term assumes a monogamous relationship between only two people and therefore excludes polyamorous relationships and any other type of romantic relationship. It might be argued that the term leaks something about our personal values, much like an assumption that a “marriage” can be between only a man and a woman. For that reason, I prefer to use “relationships” instead of “couples work,” and I refer to “clients in the relationship” rather than the “couple.”

2) Leakages of personal values: Of course, there is a risk that as counselors, we also leak our personal values in individual work. But it seems to me that the greater the number of clients sitting in the room with us, the greater the chance for this leaking to occur. When we work with relationships, we often see the interaction between the different members of that relationship. In real time, we bear witness to the dynamics of that relationship, and it can be challenging to have that played out before our very eyes. 

In our training, we are encouraged to intervene a great deal more in our work with relationships than we might if we were working with an individual client. We are told that there are more opportunities to offer alternative ways of relating to each other, and if we do not seize these opportunities, then the relationship may end up following the same patterns and learning nothing from therapy.

The question is, what is informing our intervention? Is it what we are actually witnessing in the relationship, or is it our own personal values and assumptions? For example, if we are witnessing a male and female client in a relationship, are we inclined to assume that the male client will be more domineering than the female client? I have worked with a number of professionals who made assumptions about domestic abuse, sexual violence and domineering behavior in general. They often leaked their assumptions that the only possible victims in these scenarios were female and that the only possible perpetrators were male.

The ACA Code of Ethics is clear. Standard A.11.b. says that a counselor should not refer a client to another counselor simply because there is a conflict in “personally held values” between the counselor and the client. Instead, counselors should “respect the diversity of clients and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.” I would imagine that this can prove extremely difficult for some counselors, particularly if their personal (for example, religious) values conflict with the client’s goals. However, as we have seen from cases such as Ward v. Wilbanks and Keeton v. Anderson-Wiley, this does not give a counselor the right to refuse to work with that client. 

3) Formed alliances: If our own personal values are more in line with one of the clients than the other member(s) of the relationship, we could easily get dragged into an alliance with that client. For example, the counselor might share with one of the members of the relationship the personal value that a relationship must be preserved at great cost when there are children involved. But if this does not reflect the personal values of all members of the relationship, the counselor’s role is to remain focused on the goals agreed to by all the members of the relationship. To help with this, we can remind ourselves that the dilemma is not ours to resolve. We can work hard to help the members of the relationship resolve the dilemma, but we do not have to resolve it for ourselves.

Individual client work requires us to monitor the boundary between us and the client. But when we work with a relationship, the boundaries are multiplied. Yes, we monitor the boundary between ourselves and each client who forms that relationship, but we also monitor the boundary between each member of the relationship. Stephen Karpman’s drama triangle can take on an interestingly multidimensional feel to it because we can be one client’s Rescuer while simultaneously being another client’s Persecutor.

4) The blame game: Linked to the drama triangle, we also need to tread carefully as counselors so that we avoid the blame game. All relationships engage in the blame game to some degree, no matter how hard its members try to avoid it. To reduce the frequency, however, we should keep returning the relationship’s focus back to the present moment. The focus should be more on what is happening rather than on why — and who may or may not have caused it. Frequently, an opportunity exists to work together to resolve things, and the collaborative nature often can form a new bond.

One big step toward this is to adopt a relative perspective: There are no absolute rights and wrongs, there is only perspective. If each member of the relationship can show the other member(s) that they are willing to adopt this approach, it can allow for disagreement.

5) Commitment issues: I have often worked with relationships in which one individual was more committed to therapy than was the other(s). The shadow side of this is that sometimes the committed member of the relationship really wanted proscribed therapy for their “problematic” partner(s). They were not interested in looking at how each member of the relationship might have caused problems for the relationship and how that all interacted. This needs to be tackled early on if the work is going to continue. The party who appears “committed” to therapy needs to understand that all members of the relationship are clients, and all members need to examine how their processes may impact on the relationship.

6) Fine-tuning rather than replacing: Our job as counselors is to observe the relationship, witness reports by the clients in the relationship about interactions, create hypotheses about where things might be going wrong, and then help the relationship to establish a revised approach to these issues.

Often, members of a relationship will assume that the relationship is fundamentally flawed. After all, clients rarely seek help unless things have started to go seriously wrong. At this point of crisis, it is hard for them to see how different things could be with a simple fine-tuning instead of a complete replacement. Our job is to support them as they try this fine-tuning. We need to emphasize the strengths and resources that exist in the relationship.

7) Building foundations, not fighting fires: As we emphasize their strengths, we will help the members of the relationship look to the future by developing strategies to resolve their issues. To do this, to really build the foundations of a sustainable relationship, we need to avoid the temptation of looking to the present or the past and trying to fight every issue that erupts.

Instead, we can teach members of the relationship about assertive communication. Often, people don’t really understand the difference between assertive, aggressive and passive (or manipulative) behavior. Counselors should monitor their work for assumptions made about assertiveness, including gender assumptions. For example, I have worked with male clients who have reported quite damaging experiences with therapists who jumped to conclusions about the male member of the relationship, forming an alliance with the female member of the relationship and overlooking (or remaining unaware of) her bullying behavior.

Empathic listening is another key skill to teach the members of the relationship. When I focus on this, I really stress the words “understanding” and “support.” It can be transformative for members of a relationship to see that their partners are willing to try and see the other person’s perspective. It can also help because they are showing their partners that they are willing to support them and help them work it out as a union. The worst feeling is when someone is struggling and they feel they are struggling alone because no one is willing to try to understand and support them.

8) The whole is greater than the sum of its parts: Our clients bring their histories into the relationships they form, no matter how much they try to avoid this. There are parts of them that are made fragile — broken even — because of people from their past. The other members of the relationship might not even know this until they come across that part of their loved one and there is a subsequent explosion, withdrawal or threat of an end to the relationship. Our job as counselors is to help each member of the relationship gain perspective on this. Each member needs help in seeing that this wound is from the past and that agreement may need to be formed about how members of the relationship will approach this in the future.

One example is the wound of discrimination. Counselors should not underestimate the impact that the experience of discrimination has on a person’s ability to trust and form relationships. With members of the relationship who are ethnic or religious minorities or part of the LGBTQ+ community, counselors need to assess not only how much this discrimination affects their relationship now but also what experiences of discrimination each member of the relationship has endured in the past. For example, if one of the members of the relationship grew up as gay in the 1970s, they would have a vastly different outlook on their sexual identity and their relationship than would someone who grew up as gay in the ’90s.

When I worked at an LGBTQ+ organization in London, we encountered a number of Muslim asylum seekers who were fleeing homophobia in countries such as Uganda, Pakistan and Bangladesh. The wounds they brought to a relationship were vastly different from those experienced by their partners who had grown up as Christian gay men, or even Muslims, in London. 

9) Basic structuring: As I have outlined, there are additional complexities to working with relationships. There are multiple layers of boundaries to manage; there are in-person, live playouts of the dynamics within the relationship; there are greater opportunities for our personal values to be leaked; and there are greater opportunities to unintentionally form an alliance with one member of the relationship over the other(s). As a result, the basic structure of a therapy session with a relationship should be different. Sessions will tend to be longer than the typical “therapeutic hour,” and counselors should offer to see each member of the relationship separately as part of the assessment process. 

10) The healing power of play: To help the relationship develop open channels of communication, counselors might consider offering clients an exercise or two to try outside of session. There are a wide range of exercises available, including the Johari window (developed by Joseph Luft and Harry Ingham) and the various exercises (even card games) available via the Gottman Institute. Games and exercises can loosen things up a bit, opening the possibility for people to release the roles they may have been adopting in the relationship. The Johari window helps people discover their own, and other people’s, blind spots. With greater self-awareness, and greater awareness of the other people in the relationship, it is easier to communicate feelings and needs. Without open communication, mistrust is inevitable, and a relationship without trust is like trying to grow a flower without light.

 

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Chris Warren-Dickins is a licensed professional counselor in Ridgewood, New Jersey. Before becoming a counselor, he practiced as a lawyer and taught law at the postgraduate level in the United Kingdom. Contact him at chris@exploretransform.com or through his website at exploretransform.com.

 

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an 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.

Interventions for attachment and traumatic stress issues in young children

By Cirecie A. West-Olatunji, Jeff D. Wolfgang and Kimberly N. Frazier April 2, 2019

Although mental health professionals acknowledge that clinical issues often look different in young children, treatment practices continue to rely heavily on adult literature. These mostly miniaturized forms of adult treatment are often scaled down using more basic language and vocabulary, but they still depend on discovering ways to encourage the verbal communication of children. Furthermore, major deficiencies exist in the mental health care delivery system for children. General neglect and fragmentation of services create obstacles to effective service provision for this population.

Over the past decade, scholars have begun exploring early childhood development and effective counseling interventions, the role of traumatic stress in the presentation of emotional and behavioral symptoms, and the prevalence of attachment issues for young children. In this article, we aim to provide a brief overview of these key advances in what we have named “pediatric counseling.” We also offer 10 evidence-based counseling interventions that stem from our work with young children over several decades.

Early childhood development and counseling

Children are not miniature adults, meaning a paradigm shift and specialized skills approach are required to help them most effectively. Children also go through rapid developmental stages, strengthening the argument that therapy with children should be vastly different from therapy with adults. Thus, professional counselors and other mental health professionals must consider various concepts, issues, techniques and interventions that are cognitively, emotionally, psychologically and developmentally appropriate for children.

During early childhood, defined as birth to age 5, rapid development of gross motor skills (running, climbing, throwing) occurs. Fine motor skills (drawing, writing, manipulating small objects) are slower to develop at this stage, but children should be able to copy letters and small words sometime during the latter half of early childhood. Cognitive development at this stage is based primarily on preoperational thinking. Hence, children in this stage rely heavily on what they see. They can now recall past events and anticipate future experiences that may be similar. At this stage of development, children are very egocentric, commonly overestimate their abilities (e.g., thinking they can carry things that are too heavy for them), and gain increased control of their impulses.

Play is extremely important to social development during early childhood. At about 3 or 4 years old, children engage in associative play in which they learn how to share and interact with one another. During associative play, there are no clear goals for the play and the roles of those engaging in play are not assigned. At about age 5, children begin to create games, form groups and take turns. Children are expanding their vocabularies at this stage, but the words and phrases used to express feelings and emotions remain limited. Because of their limited emotional vocabulary at this stage, children are more prone to act out their emotions behaviorally.

Deficiencies in service delivery:
Some of the major deficiencies in the mental health care delivery system for children include:

  • How children are categorized (i.e., poor conceptualization of children within their ecological context, including culturally marginalized children being overrepresented in the most severe clinical categories)
  • Environmental factors (such as racism and poverty)
  • Lack of empirical data
  • Fragmentation of services

First, children are typically placed in categories of clinical, subclinical and at risk, and they are often in need of services such as remediation and prevention. However, they are largely neglected within the system. This is partly due to clinicians’ lack of training to provide developmentally appropriate clinical care for this age group. Lack of adequate funding and poor communication between providers (such as pediatricians, child care workers, parents/caregivers, social services personnel and professional counselors) are also factors.

Second, some environmental factors associated with higher rates of mental health problems include poverty, racism, abuse and familial problems. Systemic oppression is also linked to both behavioral and affective problems. However, insufficient research has been conducted with young children to provide adequate information about how these environmental factors affect them. 

Third, there is a lack of empirical data on effective treatment for young children. Although the literature is replete with community agency programs and hospital-affiliated programs designed for young children and their families, there is insufficient support for the effectiveness of the treatments and interventions provided.

Finally, there is fragmentation of the services that exist for this population. Mental health services for young children should be initialized by a social service agency or primary care physician. However, this rarely happens. Even when it does, it is unlikely that these professionals have included or interacted with counselors. Thus, many children slip through the cracks and remain unidentified until a crisis arises, meaning they are most likely to receive psychological first aid via psychiatric services.

Counselor training: Experts stress the need for counselor trainees to acquire foundational skills that serve as underpinnings for effective counseling of this population. The major challenge within the discipline of counseling is how to transform these base-level skills into effective techniques and interventions for young clients. Many beginning counselors feel ill-prepared and are often frustrated when they encounter child clients — and preschool-age children in particular. Most counselors begin their training by practicing their counseling skills on classmates and never encounter younger client populations until they are out in
the field. 

Traumatic stress issues

Researchers have suggested that symptoms of traumatic stress in early childhood include interrupted attachment displays of distress such as inconsolable crying, disorientation, diminished interest, aggression, withdrawing from peers, and thoughts or feelings that disrupt normal activities. Traumatic stress, a condition caused by pervasive, systemic external forces, can result in physiological, psychological and behavioral symptoms that negatively affect everyday functioning.

Symptoms of traumatic stress can include hyperarousal or hypoarousal, avoidance and re-experiencing. Hyperarousal in early childhood is often observed through displays of inconsolable crying, flailing about, arching the back and biting. Hypoarousal involves emotional numbing that may be observed as a child who sleeps excessively, displays a dazed expression or averts his or her eyes. Avoidance is characterized by withdrawal, which is often demonstrated as displaying less affection, consistently looking away or avoiding facial contact. Other observable features of avoidance include a fear of being separated from caregivers, refusal to follow directions, disorientation and extreme sadness.

Re-experiencing is often the most subtle of the three symptoms, but it can be observed through the presence of rigid and repetitive patterns. These patterns can include common play leading to outbursts or withdrawal if the pattern is changed or interrupted. The play or reenactments have a noticeable anxious quality to them, or the child appears to space out when engaged in these patterns. One of the most consistent observations of re-experiencing is the presence of nightmares.

Neurological responses to traumatic stress include:

  • Increased levels of adrenaline (activation of the sympathetic nervous system)
  • Decreased levels of cortisol and serotonin (a reduced ability to moderate the sympathetic nervous system or emotional reactivity)
  • Increased levels of endogenous opioids (which result in pain reduction, emotional blunting and memory impairment)

In addition, chronic stress can interrupt cognitive functions such as planning, working memory and mental flexibility. Hence, it is important to systematically assess how children use relationships, interact with others and interact with their environment. Furthermore, when traumatic stressors deplete the coping resources of caregivers, they can become neglectful or show signs of chronic danger, leading to the potential disruption of the attachment system for young children.

Attachment issues

Attachment research describes children’s behaviors along a wellness spectrum from secure attachment (most well) to insecure attachment (where children are at highest risk). With secure attachments, caregivers display relaxed, warm and positive interactions involving some form of direct expression of feelings or desires and the ability to negotiate conflict or disagreement. In this manner, caregivers are encouraging, sensitive, consistent and responsive. With insecure attachments, the child loses confidence to varying degrees in the caregiving system, believing that the caregiver lacks responsiveness and availability during times of distress or trauma.

Securely attached children typically display the following healthy behaviors during the different phases of growth:

  • Phase I (0 to 3 months): Newborns often seek out connection (eye contact and touch) and respond to familiar smells, sights and sounds.
  • Phase II (3 to 6 months): Infants begin to orient to familiar people (preferring those who are familiar to them while avoiding those who are not familiar) and are emotionally expressive, responding to others’ emotional signals.
  • Phase III (6 months on): Infants become wary of strangers and actively seek out familiar caregivers. Additionally, they begin practicing verbal and nonverbal displays of happiness, sadness, anger and fear.
  • Phase IV (from the second to third year on): These young children notably gain increased abilities to negotiate with caregivers (sometimes resulting in short-lived tantrums), are better able to coordinate goals with others (showing adaptable and responsive goals), display increasingly empathic responses to others, and progressively develop greater walking and complex verbal communication skills.

Insecure attachments styles are divided into three categories: avoidant, resistant and disorganized-disoriented. Avoidant attachment styles often can be associated with caregivers who minimize the perceptions of young children, are emotionally unavailable, and assign care of the child to others. This results in young children becoming indifferent to the presence of the caregiver, displaying detached/neutral responses to others, and minimizing opportunities for interaction with others.

Resistant attachment styles are associated with caregivers who resist distress (showing avoidance verbally or physically) and often wait for the child to get highly upset before attempting to sooth. This conditions young children to maximize distress, to resist or display difficultly in being soothed, and to under-regulate their emotions (e.g., responding dramatically to change and acting out dramatically when expectations are not met). Additionally, these children readily perceive experiences as threatening, get frustrated easily, and often approach life anxiously or as if helpless. These children initiate their interactions with others through their distress.

The third and most unhealthy attachment style is disorganized-disoriented. It is associated with caregivers who are often confrontational, helpless, frightened or disengaged (avoidant). These caregivers often passively place children at risk due to the caregivers’ lack of involvement or preventive parenting skills. Their children respond by attempting to adapt to the caregivers’ emotional needs — either caretaking or avoiding. These adaptive behaviors are often observed as consistent displays of confusion, hostility, freezing responses or caregiving responses (e.g., reassuring, pleasing, cheering up).

Counselors’ role: As counselors, we are uniquely trained to meet the needs of young children because of our emphasis on human development, prevention, ecosystems and wellness. Counselors can use three main restorative skills to intervene with young children experiencing attachment issues related to traumatic stress. We can:

  • Set up a safe and warm environment in our clinical settings
  • Display trust through culturally sensitive gestures, tone of voice and facial expressions
  • Nurture a nonjudgmental understanding of young clients while focusing on exploration, empowerment and acceptance

By engaging in these three practices, professional counselors should be able to aid young children in working through a variety of social, emotional, behavioral and learning challenges. Counselors can foster warmth and vitality by employing mutuality and relational socio-dramatic play experiences. Additionally, counselors can create mediated learning so that young children can develop the ability to self-define, contextualize and transform their reality into healthy developmental journeys. This gentle, nonthreatening rebalancing of the energy can create restorative opportunities.

Ten evidence-based interventions

In 2000, Cirecie A. West-Olatunji (one of the co-authors of this article) and a colleague created a program called the Children’s Crisis Unit, in partnership with a local YWCA rape crisis unit, to provide clinical services to young children in a five-county area when referred for allegations of child sexual abuse. Over a four-year period, the Children’s Crisis Unit provided assessment and intervention for children and provided consultation to clinicians, law enforcement, medical professionals and legal professionals, both locally and nationally. During this time, training was provided for counseling, psychology and social work graduate students who learned how to work specifically with clients from birth to age 5.

The following techniques were used systematically with hundreds of clients. Although these interventions may be similar to those used with nonsymptomatic children, in working with young children, there are several unique features, including:

  • Assessment for degree of severity
  • Remediation
  • Involvement of the caregiver
  • Bookmarking for interventions at later developmental periods

1) Popsicle sticks: This intervention can be introduced in the first session with the primary caregiver and the child. One of the appealing things about the use of Popsicle sticks is that they are very inexpensive, meaning nearly any family can afford them. Counselors can use nontoxic crayons or markers and other craft tools such as glitter, buttons, yarn and nontoxic glue. Counselors direct the caregiver-child dyad to use the Popsicle sticks to create individual members of their family as dolls. This activity can be continued at home between sessions. This intervention facilitates bonding and trust, decreases anxiety, is client-centered and culturally appropriate, and allows children to tell their story.

2) Feeling faces: This activity provides easy access for the counselor because various versions can be downloaded from the internet. Use of the feeling faces allows children to identify with other children and their facial expressions. In the exercise, the counselor directs the child to select those faces to which he or she is drawn to determine thematic links between the selected faces. The counselor then hypothesizes and contextualizes the presenting problem. This activity is useful in remediating flattened affect, with the counselor directing the child to mimic faces that match a range of emotions.

3) Storytelling: Narrative activities allow children to tell stories of their own choosing or give a particular recounting as directed by the counselor. Storytelling also allows the caregiver to recount or read the child a story that represents some resolution to the problem. Additionally, this activity permits the counselor to a) read the child a story representing some resolution to the problem and then engage in dialogue about feelings or b) collect pre- and post-observational data regarding the child’s responses.

4) Puppets: This intervention is helpful in allowing children to use dramatic play to express their feelings, recount a story or “restory” prior negative events. It can be particularly useful when the caregiver is actively involved in the puppet intervention. Puppets can be of the caregivers’ own making or ones that are available in the clinical room. Smaller and isomorphic puppets work better with infants and toddlers, whereas 3- and 4-year-old children are more likely to respond to animal-shaped and larger puppets.

5) Anatomically and culturally correct figurines: These figurines can be useful in cases of physical and sexual abuse because children are more likely to provide an accurate accounting when directed to engage in dramatic play. This intervention allows children to reenact situations that they have experienced. Additionally, it offers opportunities for children to point to parts of the body on the figurines as well as on themselves. This activity can provide the counselor with an assessment of the child’s developmentally appropriate knowledge about sexuality.

6) Dollhouse: This intervention offers a physical example of the home that can be used to explain what happens in the home from the child’s perspective. Use of a dollhouse can aid in accessing the child’s memories more easily based on familiarity with household items rather than starting from scratch. This activity allows counselors to be either:

  • Directive with the child, using prompts such as, “Tell me what happens in this room” (while pointing to a specific room in the dollhouse)
  • Nondirective with the child, permitting the child to have free-flowing play with the items in the dollhouse (while making observational notes)

7) Play dough (modeling clay): Modeling clay provides a kinesthetic, moldable medium that children can use to contextualize and express feelings involving sensory experiences. This intervention permits children to create representations of their family members by providing definition to body parts and facial expressions, and thus connecting emotions, experiences and people to the critical event. Play dough activities allow counselors to direct children to mold important people (both family members and nonfamily members) in their lives.

8) Freehand drawing: This activity offers children the opportunity to creatively express what is happening for them in the moment. Tools for this activity are based on the child’s developmental level and might include crayons, markers, pens, pencils or chalk, depending on the child’s age and motor skills. Counselors can use this activity to promote comfort, connection, nurturance and fun for children.

9) Kinetic family/human figure drawing: Kinetic family drawing is a more directive technique that allows children to articulate how they see themselves in relation to other family members. This activity allows for dialogue between the parent and child in terms of perspectives of the family. The counselor offers paper and drawing instruments and directs the child to draw a picture of her or his family. (Note: Try to avoid stick figures, depending on the age of the child.)

10) In vivo parent-child observation and feedback: This intervention permits the counselor to assume an observer role as the parent and child interact. It can be either directive or nondirective. This activity allows for a real-time view of the interaction quality between the parent and child, providing insight into parenting style and skills as well as attachment issues. In vivo observations afford counselors the opportunity to prepare the clinical room with play materials and direct the parent to engage with the child (or, in a nondirective way, allow the parent and child to interact without instructions). Thus, the counselor can step back to observe (either in the clinical room or in an adjoining room with a one-way mirror). If the counselor is in the room, she or he can provide instant feedback and redirection, if necessary.

It should be noted that when working with preverbal children, counselors should rely on nonverbals such as body language, facial expressions, physiological responses and the child’s attention and focus. Also, be aware that children’s comprehension develops earlier than their language abilities. It is important to remember that children understand more than they can communicate.

Extending our reach

The counseling profession is poised to serve as a leading provider of much-needed services to young children. Our focus on prevention, environmental context, development and wellness makes us uniquely trained to assess, intervene with and investigate clinical issues in early childhood. The benefits for us as a profession are numerous and extensive.

First, by incorporating a focus on young children, we can increase our role definition by providing psychological consultation to children, parents, and child care providers in day care centers (such as Head Start) and preschools. Second, we move from the implicit to the explicit. Many practicing counselors are already working with young children in their agencies, schools and private practices. However, without counselor educators and policymakers explicating guidelines for practice, the profession lacks a systematic response to ensure application of evidence-based interventions. Third, we can expand our involvement in addressing the needs of this clinical population by securing grants from federal agencies and private foundations; attending think tanks and conventions where other health professionals are gathering to discuss the needs of young children; and advocating for increased coordination of service providers across all service delivery platforms and agencies. Finally, we can advocate for ourselves by becoming more visible within the larger health care community.

Recommendations: Existing courses in counselor education need to incorporate a paradigm that includes training specifically geared toward clinical populations from birth to age 5. The major challenge within this discipline is how to transform base-level skills into effective techniques and interventions for young clients.

School counselors especially need to have specialized skills and training so they are equipped with tools that acknowledge characteristics and cultural nuances that are specific to child populations. Allowing graduate students to become familiar with the pediatric population early in their training begins the process of conceptualizing young children in the context of a holistic, strength-based and culture-centered approach.

Some professionals have offered a solution to this dilemma by suggesting a framework that incorporates exposure to a variety of populations or the use of various subspecialties. In such a framework, counselor educators systematically incorporate broad content knowledge of specialized populations that is applied throughout the curriculum. Family courses could focus on the specific issues that pediatric members of the family system face and how these issues affect the entire family’s functioning. In addition, family courses could focus on interventions geared toward young children that incorporate the entire family, hence aiding the family to function more effectively. Counseling courses on theory and technique might add discussions on how to incorporate young child development and issues into concepts and interventions that are specific to various counseling theories.

Finally, to further develop our understanding of what practicing counselors actually do when working with young children, it is important to perform additional counseling research. One way of advancing our knowledge in this area might be the use of a Delphi study. This systematic approach, which would gather a panel of experts through a nominations process, could be used to generate ideas, gain consensus and identify opinions of a wide range of counseling professionals without face-to-face interaction. This method could provide a means of bridging research and practice to reach a common understanding of what steps can be taken to explore our conceptualization and assessment of and intervention with young children.

In sum, counselors have the ideal training to work closely with young clients and to provide culturally appropriate interventions to address the unique needs of this client population. Use of developmentally informed and ecosystemic frameworks will allow counselors to be accurate in their conceptualization and treatment of young children.

 

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Cirecie A. West-Olatunji serves as associate professor in counseling at Xavier University of Louisiana (XULA) and as director of the XULA Center for Traumatic Stress Research. She is a past president of the American Counseling Association and the Association for Multicultural Counseling and Development (AMCD). Internationally, she has provided consultation and training in southern Africa, the Pacific Rim and Europe. Contact her at colatunj@xula.edu.

Jeff D. Wolfgang is an assistant professor in the Department of Counseling in the College of Education at North Carolina A&T State University. His research focuses on multigenerational effects of trauma on young children and their families. Contact him at jdwolfgang@ncat.edu.

Kimberly N. Frazier is an associate professor in the Department of Clinical Rehabilitation and Counseling at the Louisiana State University Health Sciences Center-New Orleans. Her research focuses on counseling pediatric populations, cultured-centered counseling interventions and training, systemic oppression and trauma. She is a past president of AMCD and has served as an ACA Governing Council representative. Contact her at kfraz1@lsuhsc.edu.

 

Letters to the editor: ct@counseling.org

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

 

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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.