Monthly Archives: June 2019

Relieving the heavy burden of survivor guilt

By Lindsey Phillips June 27, 2019

Patience Carter took a bullet in the leg during the 2016 mass shooting at Pulse nightclub in Orlando, Florida — the second deadliest mass shooting in the United States — and survived. In a poem she wrote while recovering, Carter captured the devastating effects of survivor guilt: “The guilt of feeling lucky to be alive is heavy. It’s like the weight of the ocean’s walls crushing, uncontrolled by levees.”

Some people are able to grasp and admit that they are suffering from survivor guilt. Others, however, don’t necessarily realize they are wrestling with it, or they struggle to acknowledge carrying a sense of guilt. Luna Medina-Wolf, president of Professionals United 4 Parkland, was part of the mental health response team after the 2018 shooting at Marjory Stoneman Douglas High School in Parkland, Florida. She says many of the teachers sought help for their trauma after the shooting and, through therapy, also found they were dealing with survivor guilt for not being able to protect all of their students or for living when a child died.

Thus, Medina-Wolf, a licensed mental health counselor and the owner of Helping Moon Counseling, advises other clinicians to pay close attention to subtle comments clients make that may indicate they are struggling with survivor guilt. Rather than directly stating “I shouldn’t have survived,” a client may say, “How is it that my friend died?” This question infers the thought “And I didn’t die,” explains Medina-Wolf, a member of the American Counseling Association. Counselors must sharpen their listening skills and not be afraid to ask questions and dig deeper, she adds.

“Even when people are admitting [their guilt], when the words are coming out, they’re not realizing what it is that they’re admitting,” says Melissa Glaser, an ACA member in private practice in Connecticut. “They don’t know as they’re saying it that this is survivor’s guilt and that they’re stuck in a place that they can’t navigate out of.”

Glaser, a community response and recovery leader, served as director of the Newtown Recovery and Resiliency Team following the mass shooting at Sandy Hook Elementary School in 2012. She says counselors can listen for telltale comments that clients are struggling with survivor guilt. For example:

  • “I can’t accept the help because someone else needs it more than me.”
  • “I keep thinking if only I had …”
  • “Other people were so much more courageous while I was just hiding under the desk.”
  • “I became frozen and immobilized, and I still feel like I’m in that place. I’m so angry at myself that I couldn’t move or do something more.”
  • “Why did my child come home while another [parent’s] didn’t?”

Glaser is a consultant, a public speaker on trauma and relevant clinical applications, and a licensed professional counselor (LPC) who specializes in trauma and posttraumatic stress disorder (PTSD). She says survivor guilt typically manifests when someone feels a sense of responsibility for a loss or traumatic experience or when someone is grappling with questions of why and how (e.g., Why did this happen? Why did I react that way? How can I enjoy life when others can’t?). This is especially true if they think they could have done something differently to prevent or change the outcome.

“It’s really important for clinicians to help individuals get to a place where they are able to understand that they’ll never have the answers [and] that they can’t stay rooted on the why. … You have to find a way to project those whys into or onto something else,” Glaser says. “Otherwise, it can consume you, and it can become such a part of your identity.”

Glaser often suggests that clients picture themselves throwing their why questions into the air and they don’t come back down. If clients value spirituality, they can imagine that God is going to deal with the questions for a while, she adds.

“Survivor guilt is complicated. … [A] lot of the time, people will not even seek counseling because … they feel they don’t deserve to feel better or they’re not worthy of getting relief,” Medina-Wolf says.

She had a client who was diagnosed with cancer at the same time a friend was diagnosed. When the client survived and the friend didn’t, the client said, “My friend was such a good person. I’m not a good person like her. She volunteered and was kind to everybody. I’m not kind to people. Why did she die?”

Shame is also often intertwined with survivor guilt, adds Courtney Armstrong, an ACA member with a private practice, Real World Therapy, in Tennessee. “When there’s an element of survivor’s guilt on top of [grief], they feel ashamed or guilty for having any joy … because that’s disrespectful to this other person,” she explains. For example, when a child dies, parents may not want to change the child’s room because they feel guilty about moving forward and seemingly “dismissing” their child.

Other clients have told Armstrong, “I can’t be happy if [my loved one] isn’t here. … I feel bad for enjoying my life when they’re not here.”

The ripples and waves of guilt

Survivor guilt can set in immediately, or it can make its presence known months or even years later. This past March, roughly one year after the Stoneman Douglas High School shooting in Parkland, two survivors — Sydney Aiello and Calvin Desir — took their own lives. Aiello’s family reported that she suffered from survivor guilt. A few days later, Jeremy Richman, who lost his daughter in the 2012 Sandy Hook shooting and who later served as one of the keynote speakers at an ACA Conference, also died by suicide.

Richman, along with his wife, had created a foundation to prevent violence and build compassion through brain health research. Up until his death, Richman was actively working with Parkland families. Glaser says Richman was the last person most people would have expected to take his own life, but she stresses the importance of being aware that everybody is in a different place. Counselors “have to be well-versed in [the] signs and symptoms [of PTSD and survivor guilt] and never hesitate to reach out, never hesitate to ask questions,” she adds.

John Super, coordinator of the Community Counseling and Research Center and a lecturer of counselor education at the University of Central Florida, has observed that a person’s proximity to the traumatic event may affect how quickly he or she feels survivor guilt. After the Pulse nightclub shooting, Super, along with two other colleagues, helped organize a grassroots collaborative plan to offer supportive counseling services to those affected.

Super compares trauma and the potential for experiencing resulting survivor guilt with throwing a pebble into a lake: “It ripples out. Those [who] are the closest feel it the quickest and the strongest, but that doesn’t mean that people on the outside don’t feel it.”

Working closely with media reporters after the Pulse shooting, Super witnessed how they also experienced a sense of guilt. “Generally, reporters tend to see themselves as hardened — ‘We’ve seen and heard the worst of life so, obviously, we can’t have any guilt or emotional response to this,’” Super says. “And they would be the ones who buried it the deepest.” Some reporters felt guilt almost instantly because they knew they were prying into people’s lives or pushing people to comment who weren’t ready. Super noticed the guilt appeared later for other reporters, such as when they were writing their stories, editing a video or doing a follow-up special.

According to Jeffrey A. Lieberman, who chairs Columbia University’s psychiatry department, adolescents are particularly susceptible to the after-effects of trauma, including survivor guilt, because they are already dealing with massive changes as they move toward adulthood.

One way that counselors can help survivors is to normalize the guilt they may be feeling after a loss or traumatic event. Glaser, author of Healing a Community: Lessons for Recovery After a Large-Scale Trauma and co-author of the chapter “Disaster Recovery in Newtown: The Intermediate Phase” in the fourth edition of ACA’s Disaster Mental Health Counseling: A Guide to Preparing and Responding, points out that part of the recovery process is simply understanding what is involved. After the Sandy Hook shooting, she noticed a sense of relief when she told clients about common physical and emotional responses to trauma. The clients would look at her and say, “Oh my God! That’s why I feel the way I do. That’s why I can’t do that [activity] anymore.”

During the first session, or when clients are otherwise ready to absorb information, Medina-Wolf will show them a “window of tolerance” infographic created by the National Institute for the Clinical Application of Behavioral Medicine (see nicabm.com/tag/window-of-tolerance/). The infographic helps clients understand that what they are experiencing is a normal reaction to a traumatic event.

A person’s window of tolerance is the ideal place for coping with stressors and triggers, Medina-Wolf explains. Hyperarousal (e.g., hypervigilance, anxiety, panic, fear, racing thoughts) sits at one end of the window of tolerance, whereas hypoarousal (e.g., feelings of numbness, emptiness) sits on the other. The infographic illustrates how a traumatic experience can narrow a person’s window of tolerance, causing the person to feel dysregulated. Although most people commonly associate trauma symptoms with hyperarousal, many of the symptoms of survivor guilt — such as feeling helpless, unmotivated, immobilized, numb or disconnected — are components of hypoarousal, Medina-Wolf adds.

Medina-Wolf says she has had clients cry upon viewing the window of tolerance infographic because they realize they are not going crazy. “A lot of what people need in the beginning is just that reassurance that what they’re going through is symptoms of trauma,” she says. 

In addition, recovery from survivor guilt and trauma isn’t a linear process. The guilt and grief of the loss comes in waves, not stages, says Armstrong, author of Rethinking Trauma Treatment: Attachment, Memory Reconsolidation and Resilience and Transforming Traumatic Grief. The reality is that people who are grieving typically move back and forth between loss-orientated waves, in which they feel emotionally and physically drained, and restorative waves, in which they become more task-oriented and don’t dwell on the pain, she explains. Counselors should reassure clients that experiencing grief and guilt in waves is a normal part of the recovery process, Armstrong says. Otherwise, clients who have been feeling better may wonder what is happening when they suddenly find themselves back in a loss-oriented wave.

Of course, as both Armstrong and Medina-Wolf point out, when clients start feeling better and moving through their grief, this can actually cause their survivor guilt to flare more intensely because they don’t think they should be “over it” this quickly or because they feel guilty about being happy again.

Medina-Wolf, who is certified in eye movement desensitization and reprocessing (EMDR), uses recent traumatic episode protocol (R-TEP) for early EMDR intervention with clients. If clients don’t have any underlying issues, this protocol often helps them feel better in as little as three to five sessions lasting 90 minutes apiece. This sometimes prompts them to ask, “How can I feel so good so quickly?” she says.

Of course, some clients may feel that they have their survivor guilt and grief under control, only to turn on the news and be faced with the reality of another traumatic event transpiring. This can throw survivors back into a sense of guilt, distrust and questioning why, Glaser says.

“It isn’t that [trauma] is going to be erased,” she says. “It isn’t that they are going to recover and never be triggered again or never have a day or moment where they’re feeling that extreme sadness, or they’re feeling dysregulated again, or they’re feeling things are foggy. They will experience times like that for the rest of their lives. Hopefully, it’s fewer and further between as they work through this.”

When you can’t talk away the guilt

Glaser is trained in cognitive behavior therapy (CBT), but when it comes to collective community trauma, she has found that CBT may not be the most effective approach — or not effective at all — until the client is grounded.

Medina-Wolf agrees: “Communal trauma requires specific brain-based therapeutic techniques to really be able to break some of the negative schemas that were created due to the trauma. Just doing talk therapy would really take a long time until you would be able to heal. … [A] lot of times, it doesn’t take care of it all. You just learn to cope with it, but the damage is done. And if you don’t make sure to really work on the underlying schemas, then [they] may stay with [you] for the rest of your life.”

With survivor guilt, clients experience a disconnect between what they feel and what they know, Medina-Wolf explains. They may realize on a cognitive level there was nothing they could have done to prevent someone’s death, but they still feel differently.

Medina-Wolf uses a metaphor to explain to clients how trauma shapes the way they see the world and themselves in it. If they were to put on red-tinted sunglasses, she tells them, then everything would seem reddish; once they removed the sunglasses, they would realize it was just the glasses making things appear red. Similarly, being in a state of hyperarousal or hypoarousal makes it difficult to think rationally and process one’s thoughts and emotions, which may alter a person’s perceptions, Medina-Wolf says. Thus, bottom-up approaches such as EMDR, neurofeedback and brainspotting, which allow emotions to be processed at an unconscious level, work better to treat survivor guilt and other trauma-related symptoms than does a top-down approach such as CBT, which assumes that changing thoughts will change behavior and feelings, she explains.

With EMDR, the client and counselor first identify the negative self-belief (e.g., “I could have done something more to save the person’s life”). The client then thinks about this distressing feeling while the counselor uses bilateral simulation such as eye movement, tappers or bilateral music. This technique allows clients to open a door between their conscious and subconscious minds so that they are able to figure out what happened and rewire the way they understand it, Medina-Wolf explains. By identifying the negative self-belief and reprocessing and desensitizing what happened, clients can come to terms with what occurred in a more rational way and are more in control of their emotions when they are triggered, she continues.

For example, Medina-Wolf used EMDR R-TEP with a Parkland student who felt guilty for not saving another student’s life. First, they identified the client’s negative self-belief (“I should have done something more to save the student”) and the positive self-belief she wanted to work toward (“I did the best I could”). Medina-Wolf used tappers to administer bilateral simulation, and after three sessions, the client was able to reach that goal. Her thought process was more rational, she believed she had done the best she could, and she no longer felt guilty for the person’s death.

Individuals who experience survivor guilt, complicated grief or extreme trauma reactions may not be able to organize their thoughts to tell counselors what they need, Glaser says. For that reason, she also recommends using mind-body techniques such as meditation and music therapy to regulate and ground clients. This helps them to process their story and recover the vocabulary to talk about their experience. In many instances, clinicians may need to take a layered approach — for example, doing CBT in conjunction with tapping, art therapy or brainspotting.

Glaser often reverts to something rhythmic to help ground clients. For example, she may have them tap the side of a chair or their leg in a rhythmic way or take them on a walk outside (if they feel safe doing that). This simple rhythmic work helps get clients through the initial acute stage so they can begin to hear the counselor and produce the language they need to tell the counselor what they are feeling, Glaser explains.

In session, Medina-Wolf uses aromatherapy, meditation, breathing techniques and a box filled with fidget toys, pencils and squishy toys that clients can grab and play with while they are processing the event. She also encourages clients to supplement therapy with activities such as running, swimming or cycling that encourage bilateral simulation. 

Reimagining guilt

The attachment system often confuses what is imagined and what is real after a traumatic loss or event, points out Armstrong, founder of the Institute for Trauma Informed Hypnotherapy. Thus, she finds the imaginal conversation technique helpful for calming clients’ attachment systems and rewriting the negative thoughts connected to guilt.

With this technique, Armstrong has clients close their eyes and imagine what the person who died would say to them now from a place of enlightened awareness. Would the person want them to be tormented? Would this person tell them they don’t deserve to be alive? Imagining these conversations often helps clients obtain resolution, she says.

Armstrong allows clients to take the lead on these conversations. If they struggle, however, she might say, “I’m imagining they understand that you feel regret and they appreciate how much you care, but they think that being stuck in this depression and guilt isn’t the solution. It isn’t the best way to honor them.”

Armstrong had one client whose mother died by suicide and blamed the client in the suicide note. Because the client had a complicated relationship with her mother, she had a hard time being able to think with a clear, stable mind about her mother. Armstrong told the client she could instead imagine the way she would have liked her mother to be. With clients who are spiritual, counselors can have them imagine a conversation with God and God telling them everything is OK and they are not responsible for what happened, she adds.

Armstrong also has clients write letters to the deceased about their feelings. Then she has clients write an imagined response from the deceased (using their nondominant hand so they are less likely to edit it with their intellectual mind).

Counselors may also need to help clients address another common symptom of survivor guilt: recurring nightmares. Armstrong finds imagery rescripting helpful here. The technique involves rewriting or changing the ending of the nightmare. Clients first describe the nightmare to Armstrong, and then she asks how they would want to change it.

Armstrong had a client whose son died by suicide. The mother felt guilty for not somehow preventing his death — which she feared had caused him to go to hell — and for cremating him when she wasn’t sure he would have wanted that. This guilt culminated in a nightmare in which her son was asking for help as he was being rolled into a furnace, but she was unable to move her body to help him.

Armstrong asked the client, “What do you wish you could do in the dream?” The client responded that she wanted to move and go to her son. Armstrong then asked her to close her eyes and imagine a new ending — one in which her feet could move, she possessed the superpower to leave her body and go to her son, or her son was able to walk to her. The mother closed her eyes and reimagined the nightmare: The son got off the gurney and met her halfway. Then he embraced her and said, “I love you, Mom. I’m sorry I didn’t get to say goodbye. I’m going to be OK.” This revision brought an end to the client’s nightmares.

Counselors should have clients imagine their dreams and the new endings as vividly as possible, Armstrong advises. It typically requires going over this new ending several times in session and having clients imagine it again before bed. “If you just talk about the ending without imagining it as best you can, it won’t work because your emotional brain needs that imaginal experience,” Armstrong explains. The emotional brain learns through experiences, not reasoning, she says, so counselors must have clients create an experience that will allow them to heal.

Turning pain into power

According to Glaser, survivor guilt is rooted in pain. She advises counselors to help clients realize that “guilt in any of its forms is not really productive” — either for clients, for those around them or for those who are gone.

Medina-Wolf says clients often acknowledge being angry, depressed or anxious, even when guilt is the underlying cause of their problems, because it is more difficult to admit feeling guilty. “They feel like if they say it out loud, then maybe they are guilty,” she observes. “The guilt is so deep and they’re so [ashamed] of it because they’re so confident … in that negative distortion that it’s literally killing them from the inside.”

It matters where that guilt is coming from, Medina-Wolf continues. Do they think they didn’t do enough? Do they feel they are a bad person who shouldn’t have survived? Counselors can help clients process exactly what they are experiencing and identify the underlying cause of the guilt, she says.

Often, the guilt is based on a fear of not knowing how to go back into a world they no longer trust, Glaser says. So, instead, they hold on to the guilt and the awful feeling of responsibility. “When we understand that, we can start to make some inroads,” she continues. “We can help the client know where it’s coming from.”

Armstrong points out that pain is also a way for some clients to maintain a bond with their loved one, especially if they experienced the death of a child or someone’s death by suicide. Clients may assume that living without the pain would suggest their loved one’s life wasn’t important, she explains.

She encourages clients to honor their loved ones by letting their importance stay alive in a positive way. Armstrong provides a personal example: Her husband enjoyed watching Atlanta Braves baseball games with his mother, so after she died, he and Armstrong continued to go to games to honor her.

One of Armstrong’s clients had a son who died of an overdose. The client’s happiest memory was of camping in the Grand Canyon with his son, but after his son’s death, the father’s sadness and guilt stripped him of his motivation to hike and camp. Armstrong asked the client to imagine whether his son would want his father to stop hiking to prove his love for him or whether he might prefer that his father do something that served as a positive reminder of their time together. After the father’s perspective was changed through this imagined conversation, he took a small step forward by going hiking. Eventually, the father and his wife planned a trip to the Grand Canyon in their son’s honor and spread some of his ashes there.

Armstrong also recommends using the making living stories technique, in which she invites clients to bring in photos or share stories about the deceased. However, she has found that if she asks clients to tell her a story about the person, their minds often go blank. So, instead, Armstrong will ask about the deceased loved one’s favorite music or food, about a trip the client took with the person, or even what annoyed the client about the person. These silly or trivial questions often end up producing the best stories, she says.

Armstrong also prefaces this technique with the phrase “when you are ready” to ensure that discussing the loved one won’t create additional pain for the client. Counselors can put the invitation out there, and when clients are ready, they can work together to find ways to remember the loved one, she says.

There are times when the attempt to turn pain into something positive can result in others feeling even more guilt. For example, the media often praises survivors or those who have perished in mass shootings for their bravery, such as in the case of Kendrick Castillo, a student who died trying to subdue an active shooter in his school in Colorado this past May. Glaser acknowledges the desire to honor those who perform heroic acts, but she also notes this action can create something of an expectation among adolescents that it is their responsibility to react bravely and save others during a school shooting. It can also exacerbate survivor guilt among those who followed safety protocols and hid behind their desks.

Armstrong is impressed when survivors take a horrible situation and become empowered, such as with the Parkland students’ gun violence advocacy work. However, she also acknowledges that survivors sometimes need to work on healing themselves first.

One of Armstrong’s clients had a daughter who died of a childhood cancer. Soon after her daughter died, the hospital and cancer community approached the mother about having a fun run in honor of her daughter and to raise money to battle the specific type of cancer. Her daughter’s death was too fresh though, and the mother ended up experiencing survivor guilt for not wanting to help create a fun run in her daughter’s honor.

To help the client, Armstrong had the mother imagine what her daughter would say about the situation. Armstrong knew a little bit about the daughter’s personality, so she mentioned the daughter would probably say that even she didn’t have time for a fun run because she was still learning to navigate the afterlife. This helped the client put her guilt into perspective and focus her energy on healing herself.

“You don’t have to be a hero,” Armstrong often reminds clients. “If you decide to do something later, then that’s awesome. But [honoring a person’s life] may just be in little simple ways — I’m just going to take more time to appreciate a sunny day, be kinder to people or not take things for granted.”

Compassion for self, not just others

Often, it’s easier to offer compassion to others rather than to oneself. This may be especially true for counselors. Super, an ACA member who presented “The Shared Trauma of School Shootings and Their Impact on Counseling and Education” at the ACA 2019 Conference in New Orleans, admits he wasn’t good at self-care during the recovery after the Pulse shooting. As one of the coordinators of the grassroots recovery effort in Orlando, Super spent the majority of his time at different counseling centers helping survivors and supervising counselors, and at the end of the day, he often had nothing left in him to tend to his own self-care.

Months later, as he was researching and presenting on his personal experience with this large-scale traumatic event, he realized how it had affected him. “Those thoughts [of ‘it could have been me’] start coming to you, that guilt of ‘this young person … just lost their life and I didn’t.’ I think that is probably a quiet voice that sat in the back of my mind through the entire process.”

Super also witnessed counselors who experienced guilt over not feeling prepared enough or not knowing enough about trauma and the LGBTQ+ community. Other counselors felt guilty that they didn’t help with the recovery efforts because life got in the way or because they simply weren’t ready and needed to take care of themselves first, he adds.

Super would pay close attention to how counselors were responding — for example, if they didn’t want to meet with clients or walked off by themselves — and check in with them. He and the other two organizers weren’t able to be in contact with all of the mental health providers offering assistance, so they also trained counselors to be aware of colleagues’ behavior and check in with them as needed.

People don’t often think about the need for counseling supervision during a collective trauma, Super points out. “But if you have counselors out there, you really need to have supervisors who are debriefing or helping process emotions for those who are providing services in the moment,” he says. He advises counselors and supervisors to make time for self-care. Talking about their feelings with another counselor, a supervisor or someone they trust will help counseling professionals recharge, and it will minimize the residual effects down the road, he notes.

Compassion also helps clients reframe their own guilt. Armstrong stresses the importance of providing psychological first aid — which includes making the person feel supported and safe — immediately after a traumatic experience. Armstrong has had sessions in which a client cried the entire time, and she felt guilty for not doing enough — only to discover that the client thought the session was extremely helpful. Outside of the counseling space, clients typically have to hold it together, she points out, so they often appreciate having a space where they can break down and not worry about others.

Armstrong also worked with a client who dealt with survivor guilt after the 2012 mass shooting in a movie theater in Aurora, Colorado. The client had been watching a movie next door and, on her way out, almost tripped over a woman who had been shot. She didn’t know how to help the woman, so she simply held her hand and called the woman’s mother. Discussing this with Armstrong, the client said, “All I could think to do for the gunshot victim in the parking lot was to sit there and hold her hand. I am in the health care field, and I felt completely incompetent.”

Armstrong reassured the client that she had done something valuable by offering the shooting victim compassion and psychological first aid, but the client still felt guilty for not doing more. While the client described the event again, Armstrong held her hand, which created an experience to demonstrate the power of compassion. When the client finished her story this time, she noted how the simple act of Armstrong holding her hand had helped her get through the story and made it seem less scary.

A few months later, the client ran into the woman she had helped after the shooting. The woman told her that the kindness of a stranger holding her hand was what replayed in her mind — not the horror of the event.

Armstrong acknowledges that counselors frequently worry about not doing enough, not knowing what to say to clients and not being able to rid them of all their pain. “At the end of the day,” she says, “it’s just us being able to sit with [clients] through all of the confusion and the heartache that heals them.”

For many survivors, the weight of survivor guilt is heavy. But counselors can operate as levees to prevent the weight of this guilt from crushing those who survive.

 

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Read more in an online companion piece to this article, “Doing the groundwork after a large-scale traumatic event

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist living in Northern Virginia. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.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.

Addressing intimate partner violence with clients

By Bethany Bray June 24, 2019

Licensed mental health counselor Ryan G. Carlson had just earned his master’s degree when he began working on a grant-funded project to provide relationship education to couples in the Orlando, Florida, area. Overseeing the intake process as local couples came into the university-based research center to participate, he quickly learned two things: Domestic violence “is very prevalent — much more prevalent than I realized — and it’s complicated,” says Carlson, an associate professor of counselor education at the University of South Carolina. “Every case was a little bit different than the next.”

The National Coalition Against Domestic Violence reports that on average, nearly 20 people per minute are physically abused by an intimate partner in the United States. On a typical day, domestic violence hotlines across the country receive more than 20,000 phone calls.

Approximately 1 in 4 adult women and 1 in 7 adult men report having experienced severe physical violence from an intimate partner in their lifetime, according to the U.S. Centers for Disease Control and Prevention. In addition, 16% of women and 7% of men have experienced sexual violence from an intimate partner.

Carlson’s experience led him to study domestic violence while earning his doctorate, and it remains a career focus for him as he conducts research, does interdisciplinary work and conducts trainings for mental health professionals. “We assume when there’s violence in a couple’s relationship, they will tell us [in counseling]. What I’ve learned is if we don’t ask the right questions, they won’t tell us, and you shouldn’t ask those questions if you’re not ready for their disclosure,” he says. “It’s really complicated and emotionally charged. … A victim’s safety should be at the center of every decision we make as counselors.”

Handle with care

Counselors who notice patterns of maladaptive behavior, self-esteem issues or what appears to be poor decision-making by clients may automatically want to roll up their sleeves and dive into goal-setting and other go-to techniques to foster change and growth. However, engaging in change-focused work when a client is experiencing IPV may be harmful, warns Taylor Cameron, a licensed professional counselor (LPC) and director of transitional housing at Denton County Friends of the Family, a nonprofit agency in Texas that provides support services to victims of domestic violence and sexual assault. It also offers an intervention program for offenders.

The tried-and-true counseling method of talking through clients’ life scenarios, behaviors and choices while asking questions such as “What could you have done differently?” or “What would you want to change if this happens again?” can be hurtful because a counselor may inadvertently be placing the responsibility for the abuse on the victim instead of on the abuser, Cameron says. She cautions that counselors must choose their language carefully to avoid making the client feel that they are somehow to blame for the abuse they have endured.

“Victims of domestic violence do many things to survive or to try to protect themselves within the relationship,” says Cameron, an American Counseling Association member. “However, the partner carrying out the abuse is solely responsible for the violence.” Ultimately, the client can’t control — and should never be made to feel that they shoulder the blame for — what their partner does, she emphasizes.

Carlson, who is also a member of ACA, agrees. He notes that it isn’t helpful for professional clinical counselors to identify client behaviors that could be changed or avoided when clients may have adopted those patterns as a means of self-protection.

“It’s important to be careful about how we phrase things with [these] clients,” says Carlson, director of the Consortium for Family Strengthening Research and coordinator of the Center for Community Counseling at the University of South Carolina. “Avoid anything that has to do with ‘what could you have done differently?’ questions, anything that would allude to how [the client] contributed to their current situation. … It’s a delicate balance, but it’s really important to avoid language that [even inadvertently suggests] a victim is somehow at fault for being in that relationship.”

“It doesn’t matter what they change about themselves because that is not going to change the other person,” says Margaret Bassett, an LPC and deputy director at the Institute on Domestic Violence & Sexual Assault at the University of Texas at Austin. Counselor practitioners must consider the entire context of a client’s behavior to fully understand why they’re making those decisions, she says. Decisions that victims of abuse make — often for reasons of safety — can appear maladaptive from outside the context of the abusive relationship.

Bassett recalls a client who talked about agreeing to meet her estranged husband at a public library. Without understanding the full context of the situation — that if she didn’t meet with him, he had a history of escalating — a counselor might assume that the client was complicit in maintaining the abusive relationship rather than appreciate her layered safety planning, Bassett says.

“It was a brilliant move. It was safe to meet there because he couldn’t escalate without drawing attention,” Bassett explains. “Not meeting him just was not possible. This was meeting on her terms versus his terms. … This ties into [a counselor] listening and really hearing what the person is saying and not judging it out of context. Really being able to say, ‘That is a brilliant idea that you had.’ It’s not a good or a bad choice. Instead say, ‘When I hear that, I hear the safety it creates.’”

Victims of abuse often adopt patterns and behaviors that are the best choices they can make in a bad situation, Bassett notes. Professional clinical counselors should listen carefully to understand the full context of clients’ lives and then validate the choices they are making to safely navigate abusive and potentially violent situations. “Respect that they’re making a decision and really understand their safety concerns so your intervention is helpful and doable,” Bassett says.

Power and control

IPV happens between partners of all cultures and backgrounds — couples who are married and unmarried, heterosexual and homosexual, wealthy and poor, religious and nonreligious, white, Asian, Hispanic, African American and every other race. In addition, IPV often intersects with sexual assault; homelessness or disruptions in housing, schoolwork or employment; financial trouble; parenting issues; and myriad other challenges that spill over into the mental health issues that commonly bring clients to counseling.

Although the terms domestic violence and intimate partner violence both include the word “violence,” the abuse doesn’t always have a physical component, or the violent behavior is combined with emotional, nonphysical manipulation. What defines a behavior or relationship as abusive is a common thread of power and control. In its simplest definition, domestic violence is an intentional pattern of behaviors used by the abuser to gain and maintain power and control over another person, Cameron explains.

“It’s important to recognize that abuse is not an anger management issue,” she says. “People who are truly experiencing an anger management issue will go off on their boss, their cousin, the random guy at 7-Eleven. Abuse is carefully targeted at one person.”

Controlling behaviors are one of the biggest red flags counselors should be listening for to determine if a client might be involved in an abusive relationship, either as a perpetrator or a victim. Examples include checking or monitoring a partner’s cell phone, email or social media, or insisting that a partner text when they arrive at and leave from work every day. Other cues for which Cameron stays alert include:

  • Clients who clam up in session or appear to be afraid of their partner
  • Clients who are isolated from friends and family
  • Clients who feel they can’t go to work, school or social engagements because it upsets their partner
  • If one partner is the sole decision-maker or in complete control of the couple’s finances
  • If one of the partners continually feels guilty for their behavior
  • A partner who exhibits extreme jealousy
  • Clients who mention “walking on eggshells” around their partners
  • Clients who are having thoughts of suicide or threatening to harm themselves or their abuser
  • A partner who pressures the other partner to use drugs or alcohol or to not use contraception (or who lies about their own use of contraceptives)
  • A partner who pressures the other partner to have sex or to perform sexual acts that the person is uncomfortable with
  • Clients who talk about a partner belittling or embarrassing them in front of other people

Control tactics often go hand in hand with perpetrators minimizing or placing blame for their behavior, Cameron adds. Perpetrators of abuse may tell a victim that they wouldn’t have to act this way if the person came home from work on time, paid the bills on time, didn’t talk back, etc. Or, Cameron says, they may tell a partner, “It could have been a lot worse. I only shoved you. I didn’t punch you.”

In counseling, perpetrators may make statements such as, “I didn’t hurt her. I just punched the wall.” The behavior implies, however, that the perpetrator could have hurt the person, Cameron points out.

“Someone who is abusive will try and deflect attention away from the abuse,” Bassett says. “They will try and name what is happening. Maybe they push or strangle or pull their partner’s hair. But they will say, ‘I am not abusive because I never hit you. Have I ever hit you?’ or [point out that] there was no bruise. There’s a lot of crazy-making behavior that goes on. They’ll deny it ever happened or focus on something else. Abuse is a pattern of behavior, and the abuser will rationalize those patterns as something else. Pay attention to that as a therapist and help them to name the behavior [for what it is].”

If a client mentions that they fight a lot with their partner or that the partner has a temper or a “short fuse,” counselors can prompt the client to explain the fights, Cameron says. For example, “Tell me what these fights look like. Are there times [when] it feels unsafe?” Victims may use phrases such as “sometimes he is rough with me” or he “put hands on me,” not fully recognizing the behavior as abuse, she notes.

Carlson also recommends that counselors use carefully worded questions to follow up on statements made by clients to further explore the nature of their relationship experience. For example, ask clients how they handle conflict with an intimate partner and then use leading questions to learn more: When there is a disagreement, is it safe to talk about the disagreement? Is there any type of pushing, shoving, hitting, use of objects, physical violence, threatening language or name calling? Is jealousy a motivating factor? Does one partner place blame on the other, making statements such as, “You made me do this”? Is the partner violent or hostile outside of the relationship?

“Ask questions that determine if there is regret or remorse [after conflict] or if they recognize that there are other ways of handling conflict,” Carlson says.

In sessions with individual clients, Carlson recommends that counselors preface some of their most direct questions — such as “Are you afraid of your partner?” — with dialogue that prepares the client. “Say, ‘I have some questions for you about how you handle conflict in your relationship. They’re going to be very direct, and I wanted to give you a heads up, but it will help me better understand what you’re going through.’ Really tap into your basic counseling skills, the relationship-building skills that we learn early on, and emphasize those when such important questions are being asked,” Carlson says.

At the same time, Bassett adds, clinical counselors shouldn’t be afraid to ask hard questions of a client when appropriate. “Ask not just, ‘Has your partner physically assaulted you?’ but ‘Are you afraid of your partner?’ and be willing to explore that. Explore the emotional piece of abuse.”

Counselors can also supplement their own questions by using a formal questionnaire — Carlson recommends Brian Jory’s Intimate Justice Scale — or including questions on intake forms. Keep in mind, however, that clients may answer “no” to questions that later turn out to be a “yes” when explored in therapy.

Perpetrators of domestic violence often use manipulation to gain and maintain control over a person and keep them in the relationship, Cameron says. When alone with a partner, perpetrators sometimes threaten suicide if the partner ever were to leave them, or they make statements inferring that the partner would be worse off on their own: “If you leave, you won’t get any money”; “You will lose the kids”; “No one will ever love you. I’m the only one who will put up with you.”

“One of the biggest power tools is fear — abusers wield fear,” Cameron says. “They use fear to control their partner. In addition, abusers will often apologize for the abuse and say, ‘It will not happen again,’ without being accountable. Then they continue using control tactics.”

This can be complicated further if the couple’s friends and family take sides or if the victim comes from a culture or faith community that emphasizes submission to a partner, views marriage as an unbreakable bond, or values reconciliation over safety, Cameron adds.

Manipulation by a perpetrator can also extend to sexual assault, which often overlaps with domestic violence, Bassett says. “It’s also common for an abusive person to force or pressure sex [with an intimate partner]. They will define the experience as nonabusive and lay the groundwork for the survivor to agree to sex so that they aren’t forced,” she says. “The abuser is [then] able to say that they agreed to sex, making them complicit in what is actually a sexual assault. The abuser defines the experience, and the survivor needs the space and safety to name their experience [in counseling].”

Hard questions, empathetic listening

Most of all, clients who are currently in or have been in an abusive relationship in the past need a safe space to feel heard and validated and to be connected to resources to address their safety, Cameron says. It’s no surprise that building a therapeutic bond is especially important with these clients.

“Communicate that you believe them,” Cameron urges. “The most restorative thing [for the client to hear is] ‘it’s not your fault, and it’s not OK that they are doing this to you.’”

“It’s incredibly important to be nonjudgmental,” agrees Carlson. “There are so many practitioners who have a personal connection to this topic, it can be an emotive experience. The time of disclosure is a very important moment for the victim and can be filled with a lot of embarrassment and shame. When they are deciding how much to disclose, it’s often based on how they feel it will be received. … It’s important to manage your emotions in that moment because it’s such an important moment.”

“You may leave the room and feel, ‘Oh my gosh, this is an emergency. I have to get this person out.’” Carlson continues. “But remember that this is their daily reality. They’ve been living with this [abuse] for a while. It feels like an emergency to you, but to act on that may put the victim in danger. It’s important that the victim drives the steps of what happens next.”

Bassett agrees: “Be very aware that your goal [as a counselor] is not that they should leave the relationship. That needs to be a goal they make themselves. They have to own it, because any decision they make will potentially have ramifications for them.”

Cameron notes that taking decisions out of the hands of clients is one of the worst mistakes counselors can make when working with victims of IPV. “They’ve already had someone control their life, and we don’t want to step into that role,” she says. “The victim has the best knowledge about what they need.”

It’s vital for practitioners to explore a client’s experience with genuine care, says Paulina Flasch, an ACA member and an assistant professor in the professional counseling program at Texas State University. “Really show concern and empathy and don’t sound like you’re interrogating them,” says Flasch, who runs a family violence research team at Texas State and worked at a domestic violence agency before and during her master’s program. “Focus on the counselor-client relationship, and ask [hard questions] because you really care. Share that what you’re hearing sounds abusive and that it must have been really hard [to go through]. … If you’re hearing that a past relationship was abusive, it’s important to call it that and identify its aftereffects. It can help validate their current experience and help them understand why they’re struggling. Help them look at patterns and how things tie together. … It’s a very powerful moment when the client connects the dots.”

“This is a person whose boundaries have been violated and who has not had safety and security — and we [counselors] have to be careful with that,” Flasch continues. “We have to let them know there will be a different response and they won’t be demeaned. If they went through that, they’re strong. Recognize that.”

All of the counselors interviewed for this article recommend using psychoeducation techniques and the Power and Control Wheel system (available at theduluthmodel.org) to talk through what a healthy relationship looks like (and does not look like) with clients who have experienced IPV. Bassett also stresses that work with IPV clients must be trauma-informed.

Emotionally focused therapy (EFT), expressive therapies, bibliotherapy or cinematherapy, grounding techniques and decision-making exercises can also help IPV clients, Flasch notes, as can attending support groups for IPV survivors in addition to counseling.

Victims of domestic violence often grapple with intense feelings of guilt or shame, sometimes made worse by harmful stereotypes and society’s general misunderstanding of the complexity of abuse. Victims can hear messages such as “Why didn’t you just leave him?” or “Why didn’t you get out sooner?” in both direct and indirect ways in popular culture, from family and friends, or in offhand remarks by acquaintances.

The reality is that it’s not that simple, Flasch notes. Victims of domestic violence are in the most danger when they are ending a relationship with their abuser (see sidebar, below). In addition, domestic violence often creeps into a relationship slowly over time in ways that are unrecognizable to the victim.

The relationship “hasn’t always been dangerous,” says Flasch, who has a private practice in Austin, Texas, and specializes in working with couples and individuals who have experienced trauma. “There have been a lot of pieces that have kept them in the relationship. If they had known this was going to happen, they would have never been in the relationship. Intimate partner violence is the breaking down of a human. They completely lose their sense of self and begin to believe everything the abuser has said about them. It happens smally and slowly.”

Pointing out this trajectory to the client emphasizes that it wasn’t their fault and helps them learn what to look for in future relationships, Flasch adds. “Normalize it with the client. This [IPV] is very common and very similar in the ways it comes to happen,” she says. “It’s a systematic breakdown of a person that happens in very small steps that no one would recognize unless you know what you’re looking for. Helping them understand what and how it happened can help take away some of that fault and blame. Then work on empowerment. Victims have had to ask their abuser for everything. It’s our job to get their voice back.”

Planting seeds

In addition to providing a safe space to be heard and empowered, counseling can be a place for victims of IPV to learn what a healthy relationship looks like. This is especially true for clients whose histories include past trauma (in addition to IPV) or who haven’t been exposed to healthy relationships in their life, Flasch notes.

“The counselor may be that first one, that first good relationship and having a feeling of being in a room with someone who cares,” she says. “Model that through your interaction with clients. Psychoeducation is a big part of working with [IPV] victims and survivors.”

Flasch suggests using the Power and Control Wheel while discussing what it feels like to be in a healthy relationship: What aspects are present? What does respect look like? How do arguments start and end? What does equality look like?

Making a list of the elements in a healthy relationship can also help, Flasch says. “It’s not tangible [to clients] sometimes. There’s so much self-blame and lack of trust of themselves and their own instincts. They often don’t trust themselves to make decisions or recognize if something [in a relationship] is dangerous.”

It can also be helpful for counselors to talk through boundary issues with IPV survivors, including what is and isn’t their responsibility in a relationship, Bassett adds.

“With someone who is abusive, that person will not accept responsibility [for abusive behavior]. The person who is being abused typically will accept full responsibility,” she says. “They may claim, ‘Oh, he’s Dr. Jekyll and Mr. Hyde. He’s so sweet, but when he drinks, or goes off his medication [he turns dangerous].’ That’s just not true: The good parts and the loving parts are part of the [control] strategy. Be very clear about that. … Help them not to buy into it, overtly or covertly.”

Couples counseling and safety

A relationship in which IPV is present has, at its core, an imbalance of power and control. This imbalance makes couples counseling an unsafe environment for the person experiencing the abuse, Carlson stresses. If a counselor is working with a couple exhibiting signs of IPV, he or she should take steps to terminate couples counseling as soon as possible while ensuring the victim’s safety, Carlson says.

“If power and control exist in the couple’s dynamic, it’s generally not safe to be in a setting [i.e., couples counseling] where they’re both on equal ground being asked to practice healthy behaviors and make changes,” he explains. “That can’t happen when there’s inequality.”

Cameron agrees. “Each session is posing a safety risk for the victim. In couples counseling, we’re asking both parties to be accountable for solving problems in the relationship, and part of the control tactics [of IPV] is making the victim feel that it’s their fault.” Perpetrators of abuse may retaliate against their partners after counseling sessions in reaction to what was said or disclosed, she says.

On the flip side, abuse victims may say only what they need to say to keep from “making waves” with their abusers during counseling sessions. In addition, “an abuser may be very charming and manipulate the counselor,” Cameron says. Counselors who don’t recognize the manipulation or other possible indicators of IPV can end up unintentionally colluding with the abuser, she points out.

Both Cameron and Carlson recommend that counselors — whether they work with couples or individuals — seek training on IPV to stay informed on best practices and forge connections with local domestic violence agencies. It is important to establish these working relationships ahead of time so that counselors can readily consult with specialists when they identify signs of IPV with a client (or a couple) on their caseload, Carlson says. “Consultation [with an IPV specialist] helps to create a methodical, well-thought-out plan for that point forward,” says Carlson, noting that any consultation must be done within ethical guidelines and without sharing any identifying details about the individuals involved.

Once a counselor has identified that IPV is present in a relationship, the steps to terminate couples counseling must be handled delicately. Counselors should never let the abuser know that they suspect abuse is taking place, Cameron emphasizes. At the same time, a fine balance must be maintained to ensure that a victim doesn’t lose contact with the counselor and is connected to resources before couples counseling is terminated.

“Never confront abuse head-on with both parties in the room. That will put the survivor at risk,” Cameron says. “Get creative for ways to get the survivor alone. … Come up with a reason to separate them and then check in with the survivor. Ask them if they feel safe at home. Just straight up asking if they are being abused — they are not going to recognize it that way. Often, the abuser has worked really hard to convince the victim that there is no abuse.”

Cameron has known counselors who separate the couple by asking one of the partners to fill out paperwork in the waiting room. Practitioners can also try to speak over the phone outside of session to clients who are suspected targets of abuse, as long as they ensure the client is alone for the call, Cameron adds.

Carlson notes that it’s not uncommon in couples counseling for a practitioner to meet with one of the clients individually to work on an issue. Counselors can fall back on that as an excuse to separate a couple when it is suspected that IPV is present, he says.

“When [you] first meet with a couple, separate them to fill out an intake questionnaire and speak with them individually. That way, you set a precedent of talking separately,” Carlson says. “Then, you can say later, ‘We are going to meet individually to follow up on some of the things we talked about’ [at intake]. There is precedence, and it doesn’t seem out of the ordinary.”

Flasch agrees and suggests that couples counselors do full individual sessions with both partners after the first two or three sessions, regardless of whether IPV is suspected. In these sessions, counselors should always assess for IPV. She suggests asking questions such as “How do you and your partner show respect for each other?” and “Tell me about your arguments: How do they start and end, and who initiates?”

A counselor’s next step should be to connect the victim with local support services. This must also be handled carefully, Cameron says. For instance, a client could put a domestic violence hotline number in their phone under another name, or the counselor could give the information verbally to the client to remember and look up later. Cameron also recommends that counselors leave pamphlets and other information about domestic violence resources in the lobbies and restrooms of their offices for all clients to see and have access to.

If appropriate, Cameron recommends that counselors also connect perpetrators with a local batterer or offender program.

“It’s important to work in collaboration with your local [domestic violence] agency,” Cameron says. “For us to address abuse in our communities, there needs to be community accountability for abusers, and that can’t just come from domestic violence agencies. It needs to come from all aspects of the community. You’re not going to end domestic violence just by dealing with the aftermath.”

Once clients are given information about IPV resources, it’s up to them to seek help when they are ready and feel safe doing so, Carlson adds. It’s not a counselor’s role to ensure the client has followed up with those resources.

“Sometimes nothing happens,” Carlson acknowledges. “You present resources and opportunities and they know they have options, and that’s the biggest step they want to take at this point in time.”

Relationships post-IPV

Dating and forming new relationships can play a part in the healing process for survivors and help them learn more about themselves, their boundaries and their limits, says Flasch, who co-authored the article “Considering and Navigating New Relationships During Recovery From Intimate Partner Violence” in the April issue of the Journal of Counseling & Development. Counselors should be aware that the risk exists for survivors of IPV to find themselves in another abusive relationship. However, forging new healthy relationships — with a counselor as a support and ally — can be a helpful step in the right direction, she notes.

“Survivors have to work through these issues for a lifetime, so waiting for the ‘right time’ to date post-healing may never come,” Flasch says. “A counselor can be a great support for a survivor. We know that most people continue to date. To say that you should be healed completely before you go out, it’s not realistic. And healthy relationships can be incredibly healing. Having a person who is safe and loving and accepting is a huge benefit. We [counselors] shouldn’t necessarily discourage dating but help them navigate the process. Educate them about red flags and warning signs, and celebrate the successes of milestones reached through dating. Also [process] triggers and things that get in the way.”

“Having experiences with other people and then processing it in counseling can be very powerful and helpful to healing,” she continues. “We can be great allies and celebrate with clients when they try something new.”

For the journal article, Flash and her co-authors studied the experiences of IPV survivors who went on to try new relationships, ranging from casual dating to marriage. Through these relationships, participants reported learning to trust themselves and their instincts and “reclaim parts of themselves lost during the IPV relationships,” Flash wrote with her co-authors, David Boote and Edward H. Robinson.

Dating post-IPV “can be a process for survivors to try and find corrective experiences and explore trust, make decisions that are theirs and be their own person, [and] learn about control and boundaries,” Flasch says. “But this is also a very scary process and one that has a lot of layers to it, so it can bring challenges. It can be hard to learn to trust when it’s been taken away from you in the past.”

 

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IPV: Need-to-know points for counselors

One of the most misunderstood aspects of intimate partner violence (IPV) is how complicated and dangerous leaving an abusive partner can be, says Taylor Cameron, a licensed professional counselor (LPC) and director of transitional housing at a Texas nonprofit that provides support services to victims of domestic violence and sexual assault. The power imbalance of abusive relationships often means that one partner has severely restricted the other’s access to finances, friends and family members, and community resources. Separating from an abuser often means starting life over, which is why there is an intersection of IPV and homelessness, she says. These factors are only exacerbated when children are involved or when the victim experiences other forms of systemic oppression such as racism, homophobia or classism.

“They are often trapped between violence and homelessness,” Cameron says. “The abuser has often messed up their credit and finances or totally controlled them, so they’re starting from scratch. The most dangerous time for a victim is during separation and when they are separated [because] the abuser is losing the power they have worked to gain and maintain.”

According to Cameron, IPV victims are at the highest risk of lethality under the following circumstances:

  • When the couple has separated or is in the process of separating
  • If sexual abuse or sexual coercion is present in the relationship
  • If an abuser makes threats of homicide or suicide
  • When a restraining order is filed
  • If the victim is pregnant
  • If strangulation is occurring
  • If violent behavior is occurring outside of the home (which indicates the abuser has escalated to the point where he or she does not care if other people see the behavior, Cameron says)
  • If there is involvement with child protective services
  • If the abuser has access to weapons
  • If the abuser exhibits stalking behaviors
  • If law enforcement is involved

Counselors should also keep in mind that even when victims leave an abusive relationship, they may still come in contact with their abusers — and be put at risk for retraumatization — through legal proceedings, child custody hearings or stalking behavior, adds Paulina Flasch, an assistant professor in the professional counseling program at Texas State University.

“Just because someone is no longer in an IPV relationship doesn’t mean they’re no longer in it. Remember that and equip them with tools [to cope],” Flasch says.

 

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Important resources

 

Margaret Bassett recommends the following books for practitioners:

  • Why Does He Do That? Inside the minds of angry and controlling men by Lundy Bancroft
  • Battered Women’s Protective Strategies: Stronger Than You Know by Sherry Hamby
  • Coercive Control: How Men Entrap women in Personal Life (Interpersonal Violence) by Evan Stark
  • Safety Planning with Battered Women: Complex lives/Difficult Choices by Jill Davies, Eleanor J. Lyon and Diane Monti-Catania
  • The Verbally Abusive Relationship by Patricia Evans
  • Domestic Violence Advocacy: Complex lives/Difficult Choices by Jill Davies and Eleanor J. Lyon

 

Related reading, from Counseling Today:

 

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

Letters to the editor: ct@counseling.org

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

Doing the groundwork after a large-scale traumatic event

By Lindsey Phillips

Finding and helping people suffering from survivor guilt, PTSD and complicated grief can be challenging after large-scale catastrophic events, which are becoming more common. According to Mother Jones, since 1982, there have been at least 110 public mass shootings across the United States.

John Super, one of the coordinators of the Orlando recovery effort after the 2016 Pulse nightclub shooting in Orlando, Florida, acknowledges the sad reality that it’s not if collective trauma happens but when it happens, so counselors need to be prepared and adequately trained for crisis response.

Super, coordinator of the Community Counseling and Research Center and a lecturer of counselor education at the University of Central Florida, points out that the underlying thoughts and feelings of survivor guilt are the same regardless of the type of loss. However, he adds, large-scale traumatic events carry their own additional stressors: the lack of privacy, communal trauma and the increased fear for one’s safety in public areas (such as being afraid to go to the grocery store).

Because people are in a state of pain, dysregulation, fear and distrust, they put up walls, notes Melissa Glaser, a licensed professional counselor (LPC) in private practice in Connecticut. Glaser, a consultant and public speaker on trauma and relevant clinical applications, served as director of the Newtown Recovery and Resiliency Team following the mass shooting at Sandy Hook Elementary School in 2012. “Lots of times people in helping professions, particularly clinicians, come into a situation like [a mass shooting] where there’s collective community trauma or even coming into situation where you’re working with individuals that are in the throes of their grief — complicated grief and trauma reaction — and you think that you’re going to be welcomed with open arms,” she says. “And often the opposite is true.”

Super was surprised that people weren’t showing up to the grief counseling centers after the Pulse shooting. Instead of getting angry, Super and his co-coordinators reconceptualized what their response would look like, and they literally started meeting the clients where they were. Counselors went to the blood donation lines and handed out water bottles. They attended the vigil and watched for people who were having severe emotional reactions.

The Pulse nightclub in Orlando, Florida, pictured after the shooting that killed 49 people and wounded 53 in June 2016.

They even went to local bars. A few days after the shooting, a local LGBTQ bar contacted Super asking for counselors to come to the bar because people were using alcohol to self-medicate. “Receiving that call was the lightbulb that went off,” he says. “What we found was some of our most productive counseling work happened in those environments.”

After the 2018 shooting at Marjory Stoneman Douglas High School, Luna Medina-Wolf, a licensed mental health counselor and the owner of Helping Moon Counseling in Florida, and the other therapists found themselves frustrated because they couldn’t access the survivors. The school system, with its background check and credentialing procedures, would not let them in. They decided to turn this frustration into action and figure out what they could do. Medina-Wolf, president of Professionals United 4 Parkland, reached out to Deb Del Vecchio-Scully, an LPC and trauma specialist who helped with response and recovery after Sandy Hook. Del Vecchio-Scully guided them through the process of organizing a recovery response and suggested they accumulate a list of mental health professionals who could help if the need arose.

Medina-Wolf reached out on social media to her connections and asked for trauma-trained therapists who could donate their time. Within three hours, she had 100 emails. To avoid being overwhelmed, she created a Google spreadsheet to track the names, specialties, credentials and phone numbers of the mental health professionals.

She discovered another therapist had started a similar list, so they combined their lists and eventually created the nonprofit Professionals United 4 Parkland. Through this collaboration, they have provided training sessions for therapists, parents, and educators and staff at Stoneman Douglas.

Medina-Wolf advises mental health professionals to come together, figure out existing gaps and ways that they can help, and reach out to community organizations to offer assistance. “This is a long-term healing process,” she says. “So, if [community organizations] won’t need you in the beginning, they will need you moving forward.”

That’s what is happening in Parkland now, she adds. After the initial shock, the community has had time to reflect on the long-term impact of this trauma, so they are reaching out to mental health professionals and figuring out a way to work together. For example, the first training they had for the teachers and staff at Stoneman Douglas was done independently from the school, but in January, the school reached out and requested that they host a training workshop as part of the school’s planning day. Medina-Wolf notes that they purposely called the workshop a retreat, not a training, to help reduce the stigma attached to mental health issues. The retreat included gifts, therapy dogs, breakout sessions on coping skills (such as meditation), and strategies on how to handle students and future drills.

Glaser, author of Healing a Community: Lessons for Recovery After a Large-Scale Trauma, also recommends collaborating with other professionals and organizations. “We have to get rid of the territorial aspect that the work can bring sometimes and bridge those gaps and be collaborative because one person or one organization can’t meet all the needs,” she says.

Glaser and her staff developed relationships with other professionals so they could appropriately direct those needing help. Providers would tell them when they had openings, the insurance they accepted and the therapeutic approaches they used, and new providers would provide a presentation on their services and even practice some of their techniques on Glaser and her team.

Glaser warns that clinicians can do more harm than good if they send clients to the wrong practitioner or if therapists promise things that they can’t deliver, which only undermines trust in all mental health professionals.

Glaser also stresses the importance of being hands-on and following up with clients. Because a traumatized brain can be extremely disorganized, counselors can’t simply give out phone numbers and a list of resources, she stresses. Sometimes, they have to make that call themselves and follow up with clients after they have had an appointment.

At the ACA 2019 Conference in New Orleans, Glaser spoke with school social workers from Parkland who were frustrated by their inability to help with the emotional aftermath after a lockdown drill because it wasn’t a priority to the administration. Glaser agrees that clinicians could do a better job with debriefings after a drill, and she also shared in their frustration with dealing with resistance from organizational leaders.

In fact, Glaser learned the importance of educating community leaders during her work with the Newtown community. She would invite the heads of organizations and school administration to participate when she brought in an expert or held a workshop on the importance of mental health efforts.

“We as clinicians now have the responsibility of educating from the top down,” Glaser says. “We can’t expect that the people that are following [safety] protocols and putting those measures together are necessarily well-versed in the clinical implications. So, part of our work now has to be to teach all of those involved.”

 

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Look for a companion piece to this article, “Relieving the heavy burden of survivor guilt” in the July issue of Counseling Today magazine.

Related reading, from the Counseling Today archives:

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist living in Northern Virginia. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.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.

Coalson, Mifsud earn top marks for counseling essays

June 20, 2019

Jessica Coalson and Anabel Mifsud, both of the University of New Orleans, were named grand prizewinners for essays that they submitted to the ACA Future School Counselors Awards and the ACA Tomorrow’s Counselors Awards, respectively.

Coalson received top honors in the Future School Counselors Awards, which recognize graduate counseling students who demonstrate exceptional insight and understanding about the school counseling profession and the work of professional school counselors who interact with elementary, middle school or high school students. The awards are open to counseling graduate students in master’s-degree or doctoral-degree programs who are working toward a career in school counseling. The awards are sponsored by the Roland and Dorothy Ross Trust and the American Counseling Association Foundation.

Mifsud, a doctoral student, was judged to have the best essay among entrants for the Tomorrow’s Counselors Awards. These awards recognize graduate counseling students who show exceptional insight and understanding about the counseling profession and the work of professional counselors in mental health, private practice, community agency, agency, organization or related counseling settings. The awards are open to any counseling student in a master’s-degree or doctoral-degree program who is taking one or more graduate courses at an accredited college or university. The awards are sponsored by Gerald and Marianne Corey, Allen and Mary Bradford Ivey, and the ACA Foundation.

Note: The grand-prize and first-prize essays for each competition are presented here as written. They have not been edited.

 

ACA Future School Counselors Awards (top essays)

Grand prize: Jessica Coalson, University of New Orleans

First prize: Rachel Corso, Edinboro University of Pennsylvania

Second prize: Meghan Bradley, Monmouth University

Honorable mention: Kami Blakeman, Walden University; Feixia Wang, Carson-Newman University

 

Future School Counselors grand prize essay

Jessica Coalson

Jessica Coalson is a student at the University of New Orleans working toward a master’s degree in counselor education with a focus in school counseling. She currently works as a child care provider and has a passion for working with children and supporting them in their development. Jessica has worked with New Orleans students in various academic support capacities during her time with College Track and AmeriCorps. She plans to continue this work as a school counselor providing students with the social, emotional, academic, and career tools and supports they need to overcome barriers and achieve their potential.

 

The effectiveness of school counseling is directly tied to student outcomes. What is the most desirable outcome that counseling can produce in schools, and how can professional school counselors demonstrate that it is happening?

Having worked with students with diverse backgrounds, experiences, abilities, and exceptionalities, I constantly question the ways in which schools support and, at the same time, fail to support all students in reaching their full potential. However, full potential neither begins nor ends with student academic and career achievement. These outcomes, while important indicators, are narrow and incomplete measures of student potential that tend to be more indicative of inequitable access to opportunity and resources than ability. School supports often focus primarily on higher level academic and career goals by tracking student achievement data and post-secondary success rates, before attending to students’ most basic and essential social and emotional needs. By equitably promoting and building social and emotional well-being, students will be well-equipped to reach their potential within and beyond the classroom.

The key foundation for establishing and maintaining well-being is resilience. Resilience is defined by the American Psychological Association [APA] as “the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress.” (APA, n.d.) As more and more studies show the prevalence of childhood stress and the insidious effects it has on wellness and success across the lifespan, the moral and ethical imperative for school counselors to address this issue is paramount. Considering this, increased student resilience may be the most desirable outcome school counseling can produce to mitigate the effects of trauma, teach positive coping skills, and promote well-being.

In order to demonstrate student resilience as an outcome, school counselors must define and measure this multifaceted set of thoughts, behaviors, and actions. The goal is for students to be able to sustain an overall sense of well-being through developing the following key resiliency factors: having caring and supportive relationships, the capacity to make and carry out realistic plans, a positive view of self, confidence in strengths and abilities, communication and problem-solving skills, and the capacity to manage strong feelings and impulses (APA, n.d.).

Using the ASCA model, school counselors can translate primary factors of resilience into measurable skills and competencies to inform the development of effective and evidence-based comprehensive school counseling programs. It is important that school counselors gather and analyze program data to demonstrate correlational, causal, and predictive links between resilience factors and various student success measures in and beyond school. Through these methods we can advocate for systemic changes at local, state, and national levels to better promote the well-being of our students in all aspects of their lives.

School counselors should always be leaders in advocacy and systemic change. However, the immediate task is to equip our students with the skills and competencies to meet and overcome the multitude of systemic barriers and individual adversities they will unquestionably face in order to thrive.

 

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Reference: American Psychological Association. (n.d.). The Road to Resilience. Retrieved from: https://www.apa.org/helpcenter/road-resilience.aspx

 

Future School Counselors first prize essay

Rachel Corso

Rachel Corso received her bachelor’s degree in psychology, with a minor in sociology, from Eastern Connecticut State University (2015). During her time as an undergraduate, she held a position as student leader for the university’s community engagement program, as a mentor for multiple Windham public schools, and as a volunteer for the university and Windham community. She completed her internship at the Joshua Center, where she worked with adolescents in a partial hospitalization program. After graduation, Rachel was a mental health worker on the adult psychiatric unit at Johnson Memorial Hospital and is now a rehabilitation counselor at Community Health Resources in Connecticut. Rachel has experience in suicide prevention training and is an avid advocate for suicide awareness. She is currently pursuing her master’s degree in school counseling from Edinboro University of Pennsylvania. As a graduate student, Rachel was inducted into Chi Sigma Iota, the international honor society for counseling students. In her free time, she enjoys traveling, cooking, and being with her family and two dogs.

 

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A main purpose of a school counselor is to help students be academically successful and to support the educational piece in schools, all while being culturally competent and ethical. From that aspect, the most desirable outcome for a student would be to excel in class and meet their educational goals and the school’s needs. However, often times there are environmental and mental health barriers that prevent students from achieving these successes, taking the counseling field by storm. The purpose of a school counselor digs into various types of development, social advocacy, treatment, and the removal of systemic barriers. A school counselor’s role goes beyond academics, which is why the most desirable outcome that counseling can produce in schools is a student’s overall well-being, otherwise known as the state of being healthy, happy, and comfortable.

Well-being has been newly acknowledged by counselors and other providers due to a better understanding of mental health, burnout, and the importance of self-care. It differs from wellness which focuses on physical health, but we as professionals know that our state of health includes more than just physical fitness; it takes on a holistic approach. Well-being is the most desirable outcome, contributed by autonomy, constructive relationships, self-acceptance, sense of purpose, and growth. Without these, our youth will underachieve academically which ultimately affects the purpose of a school. School counselors provide guidance and support to allow these variables to mature, and offer resources and opportunities that their students may not have otherwise. They advocate for students whose voices have been lost in oppression or stigma, their main goal being to promote the development of students but to also provide a safe, inclusive, and productive learning environment. Gone are the days where counselor’s make class schedules and wait while a crisis brews. School counselors are the mental health specialist in a school system and are on the front lines of student development/well-being.

School counselors can demonstrate that student well-being is being achieved by developing students into leaders, educating them on how to properly communicate their feelings and needs, aiding in attaining personal and education goals, and encouraging them to make positive transitions into their new stages of life. In order to accomplish this, school counselor must continue to advocate for their students, and provide knowledge, support, and referrals to outsides sources for additional assistance, as well as apply their clinical knowledge and skills and collaborate with the community and other treatment programs. Attending conferences and trainings to further their education, as well as being up to date with current research is also important as there is a huge flux in the mental health field, student needs, and cultural competency. Finally, school counselor’s must be responsible for the recurrent change of their role and the challenges they face as society vicissitudes with it, all in order to adequately serve every student and allow them to develop confidently, to remain happy and healthy individuals as that is not only the most desirable outcome for schools but for life too.

 

 

ACA Tomorrow’s Counselors Awards (top essays)

Grand prize: Anabel Mifsud, University of New Orleans

First prize: Jim Minthorne, California State University, Fullerton

Second prize: Leslie Preveaux, Mercer University

Honorable mention: Jennifer Toof, Chicago School of Professional Psychology; Madelfia Abb, Wake Forest University

 

Tomorrow’s Counselors grand prize essay

Anabel Mifsud

Anabel Mifsud is a doctoral candidate in the counselor education and supervision program at the University of New Orleans. She has a master’s degree in health psychology from University College London and King’s College London, UK. Most of her clinical work has been with people with HIV and people who are homeless. Anabel’s research interests include intergenerational/historical trauma, the internationalization of counseling, social justice and advocacy, the role of counseling in community development and peace building, and psychosocial services for migrants, refugees and people with HIV. She has conducted research with counselor educators, migrants and individuals with HIV, and has presented at conferences in the United States, the United Kingdom and Malta.

 

As integrated care takes hold in the delivery of mental health services, discuss the role of professional counselors in an integrated care system.

As society’s perspective on health and wellness continues to shift toward a more holistic orientation, clinical mental health counselors are increasingly called to be part of multidisciplinary teams in integrated care settings. I believe that counselors can offer a unique and invaluable contribution in integrated care systems. Primarily, as mental health care providers, we have the clinical expertise to work with diverse clients with emotional and mental distress. Furthermore, our approach toward mental health is grounded in wellness, healthy development, optimal functioning, and prevention. All these values are consistent with the precepts of integrated care, whereby individuals are placed at the center of care and treated as a whole by attending to their multiple healthcare needs.

As counselors, we work with individuals with emotional and mental health problems, who at times may be suffering or are at risk of developing chronic illnesses, or who may be faced with situations that adversely affect their welfare, such as unemployment or poor housing. In an integrated care system, counselors have the benefit to collaborate and draw on the expertise of medical and other behavioral health specialists to maximize clients’ overall health outcomes. In this new capacity, we are required to hone our assessment and consultation skills, and to build on our knowledge of psychotropic drugs and their side effects, and signs of physical illness.

On the other hand, because integrated care is inherently a bidirectional process, counselors may work with clients affected by chronic medical conditions, such as diabetes, rheumatoid arthritis, or HIV infection, or individuals suffering from physical disabilities following a medical incident or accident. Individuals coping with these conditions are usually forced to grapple with the psychosocial sequelae of their physical ailment, or may have behavioral health issues that can undermine their recovery. In an integrated care setting, our role as mental health counselors can involve supporting clients with the management of their chronic medical condition, including helping them adjust to a new lifestyle, dealing with the stress, loss, and grief precipitated by their illness, or addressing comorbid mental health challenges such as anxiety and depression. In integrated settings, counselors have the opportunity to engage in prevention and early intervention work.

Working within an integrated care system can open up new possibilities to impart our knowledge on multicultural competency to healthcare professionals in other fields. We can rally the support of new allies to advocate for the health and wellbeing of vulnerable groups and underserved populations.

Integrated care enables counselors to take a seat at the table with different healthcare practitioners to ameliorate the quality of life and health of clients. We have the chance to educate other professionals in what we do as counselors and advocate for our profession. Similarly, we have the opportunity to gain insight into how medical and other behavioral health practitioners contribute toward the holistic healthcare of clients. Such an interdisciplinary teamwork can foster respect and trust among different professionals.

 

Tomorrow’s Counselors first prize essay

Jim Minthorne

Jim Minthorne has been a graduate student in the master’s in clinical mental health counseling program at California State University, Fullerton, since 2017. He is completing his practicum at the City of Brea Resource Center, where his clientele consists of adults, minors, couples and families. Populations that are of special interest to him include transitional age youth, men, and individuals who use substances. He prefers to utilize a Gestalt theoretical framework to help clients feel completer and more fulfilled. Jim’s long-term goals include starting a private practice, earning a doctoral degree and teaching at the university level.

 

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“Treatment team” and “continuity of care” are ubiquitous phrases in my work. Prior to becoming a full-time graduate student, I worked as a case manager for a nonprofit mental health agency. I shared an office with a team of peer support specialists, nurses, doctors, and counselors. Sometimes my clients received third-party services. In these cases, I obtained authorizations to communicate with probation officers, homeless shelters, and drug treatment centers. As a case manager, I recognized a fundamental truth which I’ve carried into my work as a future counselor: I’m not the only person my clients will ever know. I cannot expect, therefore, to be the only person involved in my clients’ treatment. I’m only one cog in the proverbial wheel, and I need to collaborate with other care providers. Clients achieve maximal results when gray areas are minimized and all facets of their care are seamlessly integrated.

When I think about conventional integrated care, I think about my role as part of the treatment team to which I’ve alluded. In an effective integrated care system, I need to interact with the various direct service providers involved in my clients’ lives. If clients have symptoms which might be attributed to an organic cause, I need to collaborate with medical doctors to rule out diagnoses which are beyond my scope of practice. If clients present with psychosis, I need to consult with psychiatrists to address medication management. If clients require access to community or government resources, I need to work with case managers to provide linkage services. If clients don’t have access to the aforementioned providers, I need to advocate for them and help them seek additional assistance.

Advocacy, however, shouldn’t just include direct service. I believe we need to engage in broader, institutional advocacy to be the most effective counselors we can be. Such actions can include writing to legislators to support increased mental health funding, serving on committees to implement new ethical practices, supporting initiatives to destigmatize mental health discourse, or conducting research into innovative treatments. These actions don’t directly involve clients; however, institutional advocacy can expand services to traditionally underserved populations and change attitudes about seeking treatment. If we make treatment easier for everyone, we make treatment easier for existing clients in the process.

Although conventional and institutional integrated care are valuable, we need to experience integrated care ourselves in order to care for others. Even the most seemingly well-adjusted counselors are at risk for burnout; if we neglect ourselves, we won’t be present for our clients. We should seek support from our own “treatment teams”: personal therapists, families, friends, significant others, pets. Clients aren’t involved in these relationships, but we bring our own support (or lack thereof) into the therapeutic relationship. We shouldn’t expect clients to seek support all from one source; likewise, we should integrate various sources of care into our own lives. We should personally embody what we aspire to offer lest we offer it ineffectively.

Integration is: collaborative, personal, political, aspirational. It’s nuanced … and necessary.

 

 

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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.

 

Using reality therapy to help military families

By Nicole M. Arcuri Sanders June 14, 2019

Military children are the “Children of the world, blown to all corners of the world. [They] bloom anywhere.” Just like dandelions, military children never know where they will go and where they will grow.

Diane Townsend Davis is credited with creating the dandelion motto for military children. Understanding this motto is imperative for any counselor who wishes to work with military children, but especially for school counselors. The Department of Defense Dependents Education (DoDDE) estimates that 80% of military children (approximately 1.2 million) attend public schools.

Counselors who work with military children must understand the unique stressors that these children face, but counselors also must be prepared to help meet these children’s needs in a short amount of time because their families move often. To avoid having these children slip through the cracks, school counselors must be knowledgeable about rapport-building strategies with this population and meet their needs in a realistic time frame.

 

Reality therapy

Working with clients from their worldview is not a new concept for counselors. This is particularly important when working with a population connected to the military because these clients’ perspectives differ drastically from those of the civilian population. Being knowledgeable about the unique needs of the military culture is a necessity for effective counseling work. For instance, often as military children begin to find their niche in a school, their families will receive orders for relocation. Military families relocate 2.4 times more often than do civilian families (on average, military families relocate every two to three years).

Reality therapy offers this population an honest evaluation of their current choices and behaviors to determine if change is needed to obtain their desired outcomes. This modality offers something that is very important to consider for this population —an emphasis on what aspects of life the client has control over.

As noted, military children move often and therefore tend to be the new kid in school quite frequently. But these children are not like most other new children in school. These children:

  • Have parents who are willing to sacrifice their lives for the well-being of the nation and to safeguard its people
  • Have parents who often leave for extended periods of time to either train for combat-related situations or as part of combat-related missions
  • Know that a great deal of risk is associated with their parents’ jobs
  • Don’t always know whether their mom or dad made it back safely from work
  • Can go for months without being able to see their parent(s)

In an age of social media, these children may at times be able to connect with their parents, but they also might see or hear reports of attacks on the news. When a member of a military unit is killed in action, all communication is cut off at their deployment station to ensure that the family of the service member is notified prior to receiving any other communication. When military children are unable to connect with their parent, the fear of the death being their father or mother is very real. All of the above noted aspects are the reality for military children, and all of these aspects are out of their realm of control.

Reality therapy offers these clients the opportunity to form a relationship with their counselor based on understanding and nonjudgment. Clients have a voice when working with counselors who use reality therapy. The clients become empowered by being afforded the idea of having control over their behaviors and actions.

A basic tenant of reality therapy is aiding clients in having their basic needs met. Creating a safe place in which clients do not feel judged but do feel empowered is therapeutic in itself.

Reality therapy is founded on the idea that everyone is seeking to fulfill five basic needs:

1) Love and belonging

2) Power or sense of worth

3) Freedom or independence

4) Fun or a sense of pleasure

5) Survival (which is based on knowing that one’s basic needs are being met)

When one of these needs is not being met, mental health issues can arise.

For clients connected to the military, feeling loved and belonging might look different than it does for other clients. Because these clients are frequently separated from loved ones and move often, meeting their need to feel loved and belong can be challenging. Reality therapy provides these clients with the understanding that they cannot change or control others. So, the practical approach will be to solve problems through their ability to control themselves and their own behaviors and thus make choices that support their needs and desired goals.

Within the military, very little power is offered to the family or the service member. Ultimately, the family and service member follow orders from a multitude of levels within the Department of Defense (DOD). Yet each military-connected member can feel a sense of accomplishment through actions they choose to control. For instance, helping clients make a list of goals that they want to accomplish while living somewhere (i.e., making the best out of each duty station) can be empowering to them.

Gaining knowledge of a new area through exploration can also be empowering. Helping clients identify their interests (and what makes them unique) can further support their independence and wellness. Fun can also be part of that experience.

Of course, with each transition that military-connected clients face, their survival needs will be tested. For instance, they may need to realign their thoughts regarding shelter (housing). Yet helping these clients differentiate what is out of their control and what is in their control can aide them in pursuing actions that support the desired outcomes that are within their control. Clients may still be angry, confused or saddened by aspects that are outside of their control. But counselors can help clients see that rather than blaming others or relying on these aspects as an excuse, they can focus on and take ownership of their present time and actions.

Reality therapy sessions are structured around the WDEP system — the client’s wants, doing, evaluation and planning. The counselor meets the client in the here and now and explores what the client wants. This realistic exploration of attainment notes what is in the client’s control and what is not. Clients then share what they are doing to help themselves achieve their wants. Next, the counselor helps clients evaluate whether what they are doing is supportive of or detrimental to their goals. Then, together, the counselor and client plan ways to change detrimental behaviors and fine-tune supportive behaviors to allow for the client to obtain his or her wants.

As the client is faced with new areas of need, the same WDEP system can be applied. Military-connected clients are faced with many hardships fostered by their culture. But reality therapy offers this population a real chance to be resilient by adapting to change and overcoming challenges.

 

Resilience

Military child resiliency largely resembles how well the stay-behind parent is doing. If the parent is unable to cope or transition with the needs of the family when the service member is not available to assist them, then a domino effect will occur. Children will have to fulfill adult responsibilities in the absence of the service member. The parental stressors will then be placed on the children’s shoulders.

For some parents, missing a spouse may be too much for them to handle. Other parents who are left behind may not be married or may not currently be together with the service member, but they may still rely on the service member for support with the children.

When there is a lack of available support, the additional stressors put these families at risk. A 2008 report from the Military Family Research Institute found studies to support that since 9/11, when the number of deployments for service members increased, military families experienced increased rates of marital conflict, domestic violence, child neglect or maltreatment, parenting stress, anxiety and depression.

On the opposite side, when the parent left behind is able to successfully juggle the transition and continue meeting both personal and family needs, children experience less turmoil. These children are better able to continue on as normal with minimal changes to other aspects of life. However, having resources available to these parents to support them in filling roles for which the service member parent was typically responsible is imperative.

Civilian school counselors and community mental health counselors should consider that the resources that military families rely on may not be readily available. For instance, counselors should note whether additional family support is local versus distant and how long the family has called its current community home. Again, reality therapy can provide these clients with a realistic perspective of addressing their needs. Therefore, it is important for counselors to know what additional supports are available to these families.

 

School counselors

According to the National Center for Education Statistics, children across the United States spend an average of 6.64 hours a day and a 180 days per year attending public schools. As noted previously, 80% of military children attend public schools.

Public schools have a duty to be aware of the needs of military children. In its 2012 national model, the American School Counselor Association (ASCA) asserts the necessity for school counselors to understand their students’ culture in order to provide effective support for students’ academic, career and personal/social development. ASCA further proclaims in its 2012 executive summary that school counseling programs can be effective only when a collaborative effort exists between the school counselor, parents and other educators, thus creating an environment that promotes student achievement.

School counselors who use reality therapy can support students’ academic, career and personal/social development. For each of these areas of development, the school counselor can address the student client’s wants and doing while also aiding the student in evaluating such efforts and making plans that support success. Yet without understanding the unique needs of the military lifestyle, school counselors will be unable to support these children in the schools or locate appropriate community resources to provide support outside of school. Therefore, when assessing the student client’s wants, a realistic perspective of the stakeholders involved will aid in developing goals that the student client has control over.

 

Community counselors

The same notion of understanding the unique needs of military children and military families is true for civilian community counselors. According to the ACA Code of Ethics, the primary responsibility of a counselor is to respect the dignity and promote the welfare of clients (Standard A.1.a.). This notion alone requires counselors to take the specific needs of their clients into consideration.

To best do this, counselors should not impose their own values on clients (A.4.b.) but instead should honor the diversity of clients and their uniqueness within their social and cultural contexts. Reality therapy promotes this understanding by developing a therapeutic relationship that embraces the client’s worldview and operates from that perspective in developing realistic goals.

 

Realistic intervention

As military children, family members and service members are blown to all corners of the world, professional counselors should be asking themselves a question: “How can we best serve these clients so that they can bloom?”

All counselors should have the same mission when working with this population — namely, devising goals that are realistic and attainable for these clients. Counselors must make themselves knowledgeable of the specific resources that are available to this population to promote therapeutic growth rather than presenting yet another barrier that these clients must face. There are many resources available exclusively to service members, veterans and their families of which civilian counselors may not be aware. When working with military families, it is imperative that counselors do their homework regarding these resources before leading clients blindly with an analysis of client control in establishing wants or goals.

Toward the end of this article, I will share a number of resources that are available to assist military families living off base. But let’s next consider what civilian counselors can do.

For starters, civilian counselors will want to build rapport with the military-connected client while being mindful of their cultural worldview (just as they would with any other client). This will require the counselor to be knowledgeable about the military population and the client’s role within the military family. As noted earlier, this is a unique culture, and being able to understand this lens of perception will be helpful when clients are processing and trying to navigate scenarios for realistic solutions or coming to terms with aspects that may be troublesome (again, following the tenets of reality therapy).

Second, whether working with the service member, the child or the stay-behind parent, consider infusing into the treatment plan the power of resiliency. Due to their lifestyle, military-connected clients are typically used to a great deal of adjustment in various aspects of their lives on a regular basis. Helping clients build off of their past successes to navigate new challenges can be empowering. Reality therapy supports counselors in evaluating with clients what is working and what is not.

In 2008, the Military Family Research Institute found that the following stressors were considered normative for military children but not for civilian children:

1) Regular, and at times lengthy, separations from parents

2) Lengthy parental work hours

3) Permanent changes of station

4) Deployments for multiple and various purposes

5) Exposure to combat-related activities and equipment, including training

Just because the stressors are considered normal for the population, the events and circumstances experienced are not to be inferred as easy for military children to manage. Just like with any stressor for any client, the more sudden, serious, ambiguous or traumatic the loss, the more difficult the stress will be to manage. Many of these same stressors are applicable both to the parent who is left behind and to the service member.

It is common for military couples to experience marital distress due to a multitude of these stressors. Commonly seen mental health issues in the military population for the service member and veteran include mood disorders, trauma/posttraumatic stress disorder, sexual assault, suicide, addiction, adjustment issues and relationship concerns. Commonly seen mental health issues among military spouses and children include mood disorders, trauma, adjustment issues and relationship concerns.

To explore an issue that may plague any member of a military family, we will focus on working with a military-connected client who is experiencing relationship issues. Guiding these clients in exploring how to communicate with their families despite the physical distance between them and how to involve family members in their life even from afar can help with feelings of detachment. Reality therapy offers clients the ability to come to terms with aspects of their lives that are in their control as well as outside of their control.

Finding ways to help clients embrace the family dynamic even when changes occur can help sustain the idea of their family system. Highlighting previous resiliency efforts to help clients explore this new change, come to accept it, and adapt how they now fit into their family system can reinforce the idea of maintaining relationships. WDEP analysis for each consideration posed by clients offers not only a realistic evaluation of their current circumstance, but also celebrates their small victories and offers opportunities to modify aspects that are not supporting their desired wants.

Navigating the change within the family while assessing client strengths and processing their feelings regarding the change (as well as the realistic desires of the client, while still being mindful of the military lifestyle) can aid the client in managing more healthy relationships. This can be extended to other relationships outside of the family as well.

The idea of resiliency and understanding military culture is at the core of helping these clients. Reality therapy offers counselors the ability to seamlessly integrate into each session regardless of how much time they ultimately have with these clients.

 

Resources for all

To provide additional effective supports when working with children and families connected to the military, it is necessary to know where to turn. These additional supports are very important because these clients move frequently and are often far from family and friends who might normally offer assistance. And counselors cannot do it all by themselves.

The resources mentioned below are only a few of the many available to military families. However, they are a great place to start, whether you counsel military-connected children and their families in the school setting or in the community.

American Red Cross: Offers support with emergency communications with service member while deployed, financial assistance, information and referral services, deployment services, and Reunification Workshops.

Exceptional Family Member Program (EFMP): Program is intended to support service member dependents who have ongoing medical, mental health or special education needs (on both spectrums — gifted as well as challenges). To enroll, service members should complete and submit 1) DD Form 2792, the Family Member Medical Summary or 2) DD Form 2792-1, the Family Member Special Education/Early Intervention Summary to their installation EFMP office.

MIC3 (mic3.net/): This is the official website of the Military Interstate Children’s Compact Commission. The goal of the interstate compact is to replace the widely varying policies affecting transitioning military students with a consistent policy in every school district and in every state that chooses to join.

Military Child Education Coalition: The coalitions three goals are the following:

1) Military-connected children’s academic, social and emotional needs are recognized, supported and appropriate responses provided.

2) Parents, and other supporting adults, are empowered with the knowledge to ensure military-connected children are college, workforce and life ready.

3) A strong community of partners is committed to support an environment where military-connected children thrive.

Military family life counselors: Intention is to support service members, their families and survivors with nonmedical counseling worldwide. Counselors provide face-to-face counseling services, briefings and presentations to the military community both on and off the installation.

Military and Government Counseling Association (MGCA): MGCA is a division of the American Counseling Association with the mission of servicing those who serve. Its website says, “The purpose of MGCA is to encourage and deliver meaningful guidance, counseling, and educational programs to all members of the Armed Services, their family members, and civilian employees of Local, State and Federal Governmental Agencies. … Develop and promote the highest standards of professional conduct among counselors and educators working with Armed Services personnel and veterans. Establish, promote, and maintain improved communication with the nonmilitary community; and conduct and foster programs to enhance individual human development and increase recognition of humanistic values and goals within State and Federal Agencies.” MGCA publishes the peer-reviewed Journal of Military and Government Counseling. The journal publishes articles on all aspects of practice, theory, research and professionalism related to counseling and education in military and government settings.

Military Kids Connect: Military Kids Connect is an online community for military children (ages 6-17) that provides access to age-appropriate resources to support children dealing with the unique psychological challenges of military life.

Military OneSource: Military OneSource offers a range of individualized consultations, coaching and counseling services for many aspects of military life. Services include confidential nonmedical counseling, spouse education and career opportunities, document translation, financial and tax consultation, special needs, spouse relocation and transition, and education.

U.S. Department of Defense Education Activity school liaison officers: The purpose of this position is to serve as the primary point of contact for school-related matters; represent, inform and assist commands; assist military families with school issues (to include providing parents with the tools they need to overcome obstacles to education that stem from the military lifestyle); coordinate with local school systems; and forge partnerships between the military and schools.

Many of the resources available to military service members and their dependents (spouse and children) are free of charge. Noting this may be the difference in whether military families seek these resources out.

 

Summary

I hope this article has provided some insights regarding the needs of military children and their families. In order to provide effective school and community resources for this population, it is important to be aware that these children are not located only on military installations; they are also on public school campuses and in civilian communities. To safeguard the well-being of these children and their families, it is also imperative to understand the uniqueness of military culture.

Currently, there is a gap in services for military families living in the civilian realm. The purpose of this article is to build confidence among civilian school counselors and community counselors by suggesting realistic resources that will help them to better support this population. You never know if a dandelion will blow into your community and need assistance to bloom.

 

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Nicole M. Arcuri Sanders is a licensed professional counselor and core faculty at Capella University within the School of Counseling and Human Services. Clinically, she engages in practice with the military-connected population. Within this specific area of focus, she has also completed research, published, and presented at local, regional and national conferences to advocate for effective clinical services to meet this population’s needs. She has previously worked as a DoDEA district military liaison counselor, substance awareness counselor, school counselor, psychiatric assessment counselor, anti-bullying specialist and teacher. Contact her at Nicole.ArcuriSanders@capella.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.