Monthly Archives: February 2020

Celebrating the role of rehabilitation counseling

By Sonia Peterson February 6, 2020

June 2 will mark the 100-year anniversary of what many of us in the field of rehabilitation counseling consider the inception of our specialty counseling area. On June 2, 1920, President Woodrow Wilson signed the Smith-Fess Act (also known as the Civilian Vocational Rehabilitation Act), which established the first vocational rehabilitation program for Americans with disabilities. It was modeled on an earlier law that provided for the rehabilitation of World War I veterans with disabilities.

Rehabilitation counseling is a unique specialty area of counseling focused primarily on disability advocacy and vocational rehabilitation counseling for individuals with disabilities. The field continues to grow, with new and expanding educational programs, opportunities for state licensure, and rewarding career paths. Certification is available through the Commission on Rehabilitation Counselor Certification (crccertification.com), and opportunities for counselor licensure are available in all 50 states. Recent developments in our field have further strengthened our relationship with the counseling profession at large and fostered opportunities for increased collaboration and education regarding disability inclusion in our profession as a whole.

Our history and specialty counselor education focus

The American Rehabilitation Counseling Association (ARCA) was established in 1957 and is a division of the American Counseling Association. ARCA’s mission is “to enhance the development of people with disabilities throughout their life span and to promote excellence in the rehabilitation counseling profession.” In 2019, the ACA Governing Council approved ARCA’s recommended Disability-Related Counseling Competencies (available on the ACA website at counseling.org/knowledge-center/competencies). ARCA invites all those in the counseling profession to review these competencies, to strive toward greater disability inclusion in the practice of counseling, and to consider ARCA their disability advocacy resource within our ACA fellowship.

Over the past several years, the rehabilitation counseling field has experienced a major shift in the accreditation of its education programs. As a result of the merger of the Council on Rehabilitation Education (CORE) with the Council for Accreditation of Counseling and Related Educational Programs (CACREP) in 2017, rehabilitation counseling is the newest counseling specialty included in the current 2016 CACREP Standards.

Rehabilitation counseling as a counseling specialty has existed in some form for more than 100 years. The history of rehabilitation counseling can be traced back to federal legislation in 1918 that initiated a program to vocationally rehabilitate veterans disabled during World War I. By 1920, additional legislation established the first broad-based federal program to provide vocational assistance to people whose disabilities were not the result of war. In the past 100 years, this state-federal vocational rehabilitation system has expanded its services and populations served to become the primary public service delivery system for all working-age youth and adults with disabilities in the United States. Each state has a designated vocational rehabilitation agency, and some states have an additional agency that serves individuals who are blind. The Council of State Administrators of Vocational Rehabilitation maintains a directory of all state VR agencies at csavr.org/stateagencydirectory.

State vocational rehabilitation agencies all receive federal funding from the U.S. Department of Education’s Office of Special Education and Rehabilitative Services under the Rehabilitation Services Administration (RSA) to provide services to individuals with disabilities. RSA’s mission is to “provide leadership and resources to assist state and other agencies in providing vocational rehabilitation (VR) and other services to individuals with disabilities to maximize their employment, independence and integration into the community and the competitive labor market.” All vocational rehabilitation services are individualized and generally include some combination of the following:

  • Vocational counseling and guidance
  • Job placement assistance
  • College or vocational training
  • Supported employment services
  • Skills training
  • Job coaching or tutoring
  • Transportation
  • Interpreter services for individuals who are deaf or hard of hearing
  • Services to assist students with disabilities in their transition from school to work
  • Reader services for individuals who are blind
  • Assistive and rehabilitation technology services
  • Referral services
  • Support, advocacy and follow-up services for at least 90 days following job placement

Currently, CACREP accredits more than 100 master’s-level rehabilitation counseling programs nationwide. Several of these institutions also offer doctoral degrees specifically in rehabilitation counseling education. The RSA regularly offers training grants to these institutions to support students who are pursuing graduate degrees in this counseling specialty area. Rehabilitation counseling students receive specialized training regarding the medical aspects of disability, legislation that affects individuals with disabilities, job placement strategies, and career guidance focused on workplace inclusion for multicultural individuals with disabilities. Over the years, the RSA’s definition of employment has expanded to support the efforts of people with disabilities to gain access to their communities, live independently, and direct the course of their own lives.

The emphasis on disability inclusion in rehabilitation counseling education programs provides students with specialized knowledge and skills related to the history of discrimination of individuals with disabilities in our society, the impacts of ableism in our society, medical aspects of disabilities, workplace accommodations, advocacy, and counseling ethics specifically related to disability inclusion. These skills are useful in a variety of settings, including state vocational rehabilitation agencies, the U.S. Department of Veterans Affairs system, county behavioral health systems, nonprofit agencies, return-to-work programs, human resources, legal settings, private rehabilitation hospitals, academia, and many other settings in our communities. Graduates of rehabilitation counseling programs find employment as vocational counselors, case managers, vocational evaluators, technology experts, forensic vocational experts, teachers, researchers, and private practice counselors in a wide range of work environments.

Social justice advocacy

Merriam-Webster’s online dictionary defines ableism as “discrimination or prejudice against individuals with disabilities.” Combating discrimination and the segregation of people with disabilities has been a long-standing principle and goal of rehabilitation counseling. Rehabilitation counseling scholars and educators have an established record of educating the public about the social construct of disability, the history of disability rights advocacy, and the existence of ableism in our society, and of combating negative attitudes toward individuals with disabilities.

The biggest barriers that individuals with significant disabilities encounter in our society are social isolation and poverty. According to the Bureau of Labor Statistics, 19.1% of individuals with a disability were employed in 2018. By contrast, the employment-population ratio for people without a disability was 65.9%. The depiction of individuals with disabilities in mainstream media is largely negative, and this has a huge impact on our attitudes toward disability as a society. Our institutions often seek to label individuals with disabilities as defective, different or “special,” with focus given to treating the person to fix their undesirable characteristic. Absent education and awareness, our society views disability as something being “wrong” with the individual rather than focusing on the attitudinal and environmental barriers that someone with a significant physical or mental impairment experiences as they navigate their way in the world. These negative and discriminatory attitudes are prominent barriers to financial independence and social inclusion for individuals with significant disabilities.

Mainstream media plays a major role in our societal attitudes toward individuals with disabilities. In film, on television and in the press, these individuals are often stereotypically depicted as being tragic, evil, heroic, objects of pity or objects of inspiration. They are rarely portrayed as people whose identities include the full range of human experiences and development, such as having intimate relationships, being family members, being students, working, traveling, enjoying hobbies, and engaging in other experiences that are normal parts of our lives and communities. Furthermore, characters with disabilities in films and TV shows are rarely portrayed by individuals with disabilities themselves. This is an additional form of discrimination experienced by actors with disabilities. Beth Haller, a prominent scholar who advocates for the positive portrayal of individuals with disabilities in mainstream media, makes a wide range of resources available at bethhaller.wordpress.com to those who are interested in exploring this topic further.

Our schools, public services and government institutions often perpetuate social isolation and poverty for individuals with significant disabilities through the various processes, regulations and financial restrictions that exist within programs designed to “help” individuals with disabilities. A main focus of rehabilitation counseling is advocating for people with disabilities and counseling our clients to reduce the environmental barriers that affect employment. Employment creates financial independence, provides a sense of purpose, and connects us in our communities. Rehabilitation counseling education programs focus on career development techniques, the Americans with Disabilities Act, and the impact of state-specific legislation on the employment of individuals with disabilities. Rehabilitation counselors help individuals navigate the complex public benefits system to avoid being penalized for earning income as they transition to work from dependence on public assistance programs.

Disability and cultural identities

Most individuals with disabilities have intersectional identities. More than half of those with disabilities are female, while individuals who identify as members of various ethnic groups or who identify as LGBTQ+ are also well-represented among those with disabilities. Individuals with disabilities live all over the world, and disability culture in itself is an aspect of multiculturalism. However, the disability experience is often overlooked or not included as an
aspect of multiculturalism in educational programs and staff development curricula.

The concepts of disability pride and disability culture have been emerging since the disability rights movement in the 1970s. Starting in the 1990s, a more formal construct of disability culture started to materialize in academic literature. Michelle Putnam, a professor of social work at Simmons University in Boston, explains that disability pride is an aspect of disability identity. It consists of claiming disability, acknowledging disability as a natural part of the human condition, advocating for the fact that disability is not inherently negative, and experiencing disability as creating the consciousness of a unique cultural minority group. Among examples of the disability pride experience are the Paralympic games, Deaf culture, and the recovery movement.

Disability pride: It is a common misperception that the para in Paralympics means the events are for “paralyzed” athletes. In fact, it means that it is an athletic competition that “parallels” the Olympics. The Paralympics include athletes with many different disabilities, including athletes who use wheelchairs. According to the International Paralympic Committee (paralympic.org), Paralympic athletes celebrate diversity and show that difference is a strength. Paralympic athletes, who are pioneers for inclusion, challenge stereotypes, transform attitudes, and break down social barriers and discrimination toward persons with disabilities.

The magazine New Mobility was launched in 1989 to bring quality journalism to wheelchair users who wanted more information on how to lead active, healthy lives. Editors, writers and college interns with disabilities produce this unique resource that shatters stereotypes and tells real stories of living life on wheels. Paralympic athletes and the producers of New Mobility magazine are examples of individuals and groups who choose to build community, celebrate diversity, and advocate for disability pride.

Deaf culture: According to sociolinguist Barbara Kannapel, American Deaf culture includes the values, traditions and language unique to individuals who are Deaf. Deaf culture centers on the use of American Sign Language (ASL) and identification and unity with other Deaf people. ASL is a complete and grammatically complex visual/gestural language with no vocal component. It differs significantly from written and verbal communication in English. ASL is not a universal language; there are signed languages in other countries. ASL reflects the unique and beautiful culture of Deaf people in our country. Gallaudet University’s National Deaf Education Center (www3.gallaudet.edu/clerc-center/info-to-go/deaf-culture/american-deaf-culture.html) is a good resource for additional information.

The recovery movement: Self-help groups available through the National Alliance on Mental Illness (NAMI), 12-step, and other recovery-related organizations have created an ever-expanding, cohesive and diverse community of individuals living in recovery who provide hope, solutions and strategies for others struggling with mental illness and addiction.

The recovery movement can be traced back to the founding of Alcoholics Anonymous in 1935 by Bill Wilson and Dr. Bob Smith. The 12 steps of Alcoholics Anonymous have been adapted by numerous other 12-step programs, including Al-Anon, Adult Children of Alcoholics and Dysfunctional Families, Co-Dependents Anonymous, Sex and Love Addicts Anonymous, Narcotics Anonymous, Crystal Meth Anonymous, Gamblers Anonymous, and Overeaters Anonymous. This peer-led, self-identifying, self-help approach to treatment has generated many other recovery-related groups in our communities, including SMART Recovery, Women for Sobriety, Secular Organizations for Sobriety (SOS), Refuge Recovery, and the Buddhist Recovery Network. An estimated 23 million Americans are currently living in long-term recovery from addiction to alcohol and other drugs.

NAMI is the country’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. NAMI, which started as a small group of families gathered around a kitchen table in 1979, has expanded to include more than 500 local chapters throughout the country. The organization provides awareness, support and education on mental illness in our communities.

Although individuals with histories of mental illness and addiction continue to be affected by significant social stigma and discrimination, millions experience hope, healing, courage, support and pride as members of the recovery community. For more information on recovery, visit NAMI’s website (nami.org) or view the documentary The Anonymous People.

Solutions and recommendations for disability advocacy

Rehabilitation counseling is the social justice, multicultural and disability advocacy specialty. As rehabilitation counseling professionals, we advocate for outreach, education and awareness. The various ACA-endorsed counseling competencies (available at counseling.org/knowledge-center/competencies) and CACREP core curriculum standards emphasize multicultural awareness, education and advocacy. What follows are some solutions and recommendations for disability advocacy in our counseling profession at large.

  • Include the disability experience in all counselor education curriculum as a unique aspect of our diverse multicultural society.
  • Partner with ARCA and other ACA specialty divisions that promote social justice.
  • Advocate for disability inclusion. Don’t separate and segregate individuals with significant disabilities in our institutions, in our systems, and in our work as counseling professionals.
  • Help CACREP to integrate more disability-specific language into the core curriculum areas in its 2023 standards revisions. Connect with the Standards Revision Committee (cacrep.org) to express your ideas for the revisions.
  • Include works by multicultural disability scholars in counselor education curriculum.
  • Read autobiographies of individuals with disabilities.
  • Follow individuals with disabilities on Twitter.
  • Support the work of individuals with disabilities in the media.
  • Include scholarly articles written by individuals with disabilities in counselor education curriculum.
  • Create an information sheet with disability- and recovery-related resources to give to your clients
  • Increase your counseling competency by reading the Disability-Related Counseling Competencies on the ACA website (counseling.org/knowledge-center/competencies).

Resources

Many resources are available for those interested in learning more about the rehabilitation counseling specialty and connecting with rehabilitation counseling educators and clinicians.

One of the most current, comprehensive resources for an overview of rehabilitation counseling is The Professional Practice of Rehabilitation Counseling, second edition, compiled by editors Vilia M. Tarvydas and Michael T. Hartley (2017).

The National Council on Rehabilitation Education maintains a directory of all the rehabilitation counseling programs in the country at tinyurl.com/NCRERCPrograms.

Also visit the ARCA website (arcaweb.org) for a variety of resources. We invite all readers to stop by the ARCA booth at the upcoming ACA Conference & Expo in San Diego in April. In addition, attend our presentations at the ACA Conference that have a rehabilitation counseling and disability focus. We look forward to connecting with you.

 

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Sonia Peterson is a licensed professional clinical counselor, a certified rehabilitation counselor, and an assistant professor in the Department of Administration, Rehabilitation, and Postsecondary Education at San Diego State University, where she serves as program director for the clinical concentration and certificate in psychiatric rehabilitation. In addition, she serves as the American Rehabilitation Counseling Association (ARCA) board chair of public policy, professional preparation and standards. Contact her at slpeterson@sdsu.edu or through the ARCA website at arcaweb.org.

 

Letters to the editor: ct@counseling.org

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

 

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

@TechCounselor: Navigating social media with teens

By Adria Dunbar February 5, 2020

I recently did a presentation for a group of high school parents on social media use. Instead of focusing on their children, I began by asking parents about their own use of social media sites like Instagram and Facebook. As a counselor, I believe my reflections on this experience might be helpful to other practitioners when working with adolescent clients or their parents. To begin our discussion, I asked the following questions:

  • How many of you use social media?
  • How many of you have thought about changing your habits around your social media use?
  • What keeps you from making these changes?
  • How often do you feel pressured to post, like, or comment on someone else’s posts?
  • How many of you have had similar conversations with your children?

This was one of the most eye-opening discussions of social media use I have ever had with parents. I had assumed parents periodically reflect on their own use of social media and were having conversations with their children about navigating the digital world. Every parent in attendance said they participate in social media sites. They all had considered leaving or changing the ways in which they use social media, but maintained their connections for a wide range of reasons, such as staying in touch with family and friends; using the marketplace; monitoring children’s use; getting news; or learning about events in the community. In addition, almost all of the parents had even felt pressured to participate in an online social media platform in order to maintain relationships, support someone in their social circle or avoid awkward interactions. However, none of them had considered having conversations with their children about their social media use. Why is that?

Many adults and parents assume that tweens and teens know more about social media than we do. And this may be true. But, at the same time, adults can help children process their experiences in these environments. Younger people may know how to post stories, use filters, and increase followers more than their parents, teachers, coaches, or counselors; however, this does not make them experts in social media. Young people need help navigating the uncharted territory these online environments create. Most counselors and parents are aware of safety concerns involving online activity, but there are other big-picture aspects they should also consider asking about, such as:

  • Tell me more about the social media platforms and apps you use. How do they work? What do you like about them?
  • What are your interactions like? Are they positive, or do you sometimes get caught up in negativity or conflict?
  • What kinds of pressure do you feel equipped to handle on your own? What types of pressure leave you feeling unsure how to handle?
  • How do you filter who you allow into your social media and who you deny entrance?
  • What is your ideal number of followers or likes? What would reaching that number mean to you?
  • What will you do if someone you know from school or work sends a follow or friend request, but you question their intentions? How would you feel about blocking or unfriending someone?
  • How would you react if you saw something inappropriate or unkind on one of the more publicly accessible platforms such as Instagram, Tumblr, Twitter or Facebook? Would your reaction change if you knew that your response could resurface in the future or in a different app?

Keeping up with the ways in which technology is changing our relationships and world can be a lot of work, but we cannot allow ourselves to take our hands off the wheel. Although not all counselors choose to participate in social media sites, such as Facebook, Instagram, WhatsApp, or Snapchat, it is crucial to stay up to date on the ways these social media platforms impact clients’ lives and relationships. For those who work with child and adolescent clients, it is equally important to find reputable resources to share with clients’ caregivers. Websites like commonsense.org can be helpful as a starting point. Local libraries and schools often hold workshops or sessions focused on navigating digital spaces as well.

Just as we cannot expect parents to navigate the digital world without guidance, nor can we expect that adolescents will understand all the social nuances of the online social world without our help. By partnering with adolescents, and allowing ourselves to find vulnerability in our lack of expertise, we may be able to help them think through some big questions about who they are, what they represent and how they want to show up in the world—not just online but IRL (in real life).

 

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Related reading, from the Counseling Today archives: “#disconnected: Why counselors can no longer ignore social media

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

@TechCounselor’s Instagram is @techcounselor.

 

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

Helping clients grow from loss

By Sherry Cormier February 4, 2020

Loss is a universal experience and an underpinning of many therapeutic issues. The client who has just lost a job, the parents whose son is addicted to opioids, the client whose long-term relationship unraveled, and the client who received a devastating health diagnosis all have loss in common.

As a professional counselor and bereavement trauma specialist, I am sensitized to the ways that loss informs clients’ worldviews and emotional struggles. And as a grief survivor, I am aware of the unique ways in which loss can serve as a catalyst for growth. An African proverb captures this sentiment when it says, “Smooth seas do not make for skillful sailors.” But this raises questions: Is growth possible for everyone, and how do counselors help clients grow after a traumatic loss?

Posttraumatic growth: What is it?

Posttraumatic growth (PTG) is an approach that informs our practice as professional counselors. Richard Tedeschi and Lawrence Calhoun, who pioneered much of the research and theory on PTG, define it as positive change that follows the struggle after some kind of traumatic event. PTG represents change that occurs after a life crisis rather than during it. It usually involves longer-term change that occurs over an extended period of months to years as individuals cope with crisis by developing ways of thinking, feeling and behaving that are different from what they relied on prior to the life-changing event.

PTG is not the same as personal development or maturity. It may be thought of as something that occurs somewhat spontaneously as the result of trying to cope with a challenging life experience of seismic impact. Evidence of PTG does not imply that the loss or traumatic event was somehow desired.

Approximately 10% of loss survivors stay mired in grief, guilt and despair for an extended period of time following their loss. Clients who experience these emotions, coupled with an intense yearning for who or what was lost, might be suffering from complicated grief, which requires a particular kind of professional treatment (see complicatedgrief.columbia.edu). The majority of loss survivors do not get stuck in acute grief, however, and report some measure of growth during recovery from loss. For many of these survivors, growth may coexist with distress.

Research summary: What do we know?

In 1996, Tedeschi and Calhoun’s research resulted in the Posttraumatic Growth Inventory, a 21-item self-report measure that yielded five empirically derived markers of PTG:

1) Improved relationships with others

2) Greater appreciation for life

3) New possibilities for one’s life

4) Greater awareness of personal strengths

5) Changes in spirituality

These five markers of growth have been reported by a variety of survivors, including prisoners of war, veterans with posttraumatic stress disorder, people diagnosed with cancer or other life-threatening illnesses, people who became paralyzed from accidents, and those who have lost spouses or life partners. Although much of the research has been conducted with people living in the United States, other studies have explored PTG with individuals in other countries.

Among current findings on PTG, Tedeschi and his co-authors cited the following in their 2018 book Posttraumatic Growth: Theory, Research, and Applications:

  • About 30% to 60% of survivors report some experience of PTG following a difficult life event.
  • PTG is both a process and an outcome.
  • PTG is generally a stable phenomenon over time.
  • PTG is more evident in those individuals who score higher on measures of extraversion and openness to experience and is also related to optimism.
  • There are both universal aspects and culturally specific characteristics of PTG.

Critics of PTG point out that self-reported or perceived growth is not necessarily the same as actual growth. Some of the conflicting findings on PTG seem to be the result of differences in how growth is defined and measured across studies.

Growth-promoting practices with loss survivors

There has been less research about specific interventions and techniques that might facilitate PTG in survivors, although a predominant feature of a growth-oriented therapeutic approach involves working with client stories or narratives. The following practical strategies can be used to help facilitate growth with loss survivors.

Create a safe therapeutic environment. Traumatic loss erodes a sense of security and thrusts survivors into the middle of unfamiliar circumstances. Social support is crucial, yet many people in survivors’ social networks may be uncomfortable with grief or may offer well-intentioned comments that feel offensive to the survivor. Counselors’ first task is to provide a safe container that is comforting and companionable for loss survivors. Creating a therapeutic environment in which we listen closely and hold up a mirror to reflect these clients’ experiences will help loss survivors feel known.

Use self-care practices. Traumatic loss may disrupt the rhythm of survivors’ connections. One way to help loss survivors reestablish bonds with others is to encourage them to grow a new relationship with themselves. We can help clients do this by recommending effective self-care practices such as movement and exercise, adequate sleep, and the intake of nourishing food. In the 2012 book The Emotional Life of Your Brain, Richard Davidson points out that a lack of consistent self-care practices sabotages our ability to regulate our bodies and emotions. Mindfulness and self-compassion are additional self-care practices that can be used by loss survivors who feel emotionally flooded with anger, guilt or anxiety. Teaching self-compassion and mindful meditation to these clients can help them reestablish a connection with themselves and, ultimately, with others. These tools also enhance clients’ equilibrium, making further work toward growth possible.

Explore client narratives. An important part of therapy with loss survivors involves exploring their narratives or stories. PTG occurs most often with clients who create an adaptive narrative in which they are able to see themselves as survivors rather than victims. The following items play integral roles in exploring client narratives.

Timelines: Initially, clients can construct a timeline of their lives with significant events marked at various ages. Timelines provide critical clues about pre- and post-loss stressors as well as the loss event itself. Clients who have been subjected to many pre-loss stressors often have more difficulty discovering growth. Using strength-oriented queries when asking clients to review their timelines is useful. For example, “Juanita, I noticed you had a miscarriage when you were 20. How did you cope with that? What tools did you find that helped you through that loss?”

Clues of growth: Many clients are so affixed to the trauma of the event that it’s hard for them to detect anything positive about their story. Counselors can be most helpful by noting clues of growth and healing in clients.

For example, James, an African American in his mid-20s, is discouraged because he has been through multiple losses. The house he once lived in with his grandmother was recently obliterated by a tornado, and now she is in the hospital with multiple injuries. In addition, the business he started just folded. In recounting his narrative, James mentions that a local church has offered to help rebuild the home, and a nearby car dealership just offered him a job. He says having others reach out to him with offers of assistance feels so unfamiliar that it’s starting to change his opinions about the world and other people. Although he doesn’t identify this as an indicator of growth, his counselor does by pointing out ways in which James’ views of himself, other people and the world are shifting in a new direction.

Cultural context: Exploring client narratives within a cultural context is also crucial. Some clients may present narratives of cultural losses rather than individual losses in instances in which they have faced significant discrimination based on their race, ethnicity, gender, age, ability status or sexual orientation. It is important for counselors to be aware of the ways that clients’ cultural affiliations affect their lives and their views of traumatic loss and healing.

For example, James reveals that he has been working odd jobs since he was 14 to support himself and his grandmother, whose only source of income is a small Social Security check. James confides that this elevated level of financial stress and the recent losses he has experienced make him feel more vulnerable as a black man living in a predominantly white rural community.

Journaling: Counselors can also facilitate client narratives by encouraging the use of journaling as an adjunctive therapeutic intervention. Therapeutic journaling is a tool developed by James Pennebaker, who says that writing about traumatic events reduces stress and strengthens immune cells. Consistent journaling is most effective, but 15 to 30 minutes of journaling several days a week can be more productive than daily journaling, which may produce more rumination than growth, according to Pennebaker. When working with survivors of loss, counselors typically instruct these clients to write about their deepest thoughts and feelings regarding their loss.

Case example: Sharon

Sharon is a 62-year-old woman whose live-in partner of 40 years died of a sudden heart attack. Sharon resides in rural Appalachia, where she had lived with her now-deceased partner for many years. She has no children, and her one brother lives hundreds of miles away. Sharon stopped working in a dental office seven years ago to help take of her partner, who had uncontrolled diabetes. She has no real friends and reports that she has rarely been out of the house in the past seven years. She says that she has no neighborhood acquaintances or memberships in any social groups.

In the first several counseling sessions, Sharon sobs and indicates that she has no idea how she will go on after losing her partner. She has limited income but no real expenses other than rent and utilities. She insists that she does not want to return to work and has sufficient income to meet her monthly obligations. She presents herself as something of a loner and describes herself as isolated.

Sharon came to the community counseling center at the urging of her brother, but she is unsure that grief counseling can be helpful to her. Short of bringing her partner back to life, she doesn’t know how talking and crying about her loss will accomplish anything. She is not having trouble sleeping but feels compelled to get out of the house during the day. She drives around randomly and visits local discount stores just to have someplace to go.

Sharon becomes more interested in counseling when a grief support group is offered, and she attends several sessions. She returns to individual counseling in a much more animated state and is even able to laugh. Having made several friends in the grief support group, Sharon reports that the group has helped her feel less alone. She is able to construct a grief timeline in counseling and is amenable to doing occasional journaling when she has bursts of grief. Over time, she pursues recommendations for joining a local gym and a book club at the public library.

Four months into individual counseling, Sharon becomes interested in volunteering at a local animal shelter and starts doing so on a weekly basis. Several months later, she feels like a different person. She says she is ready to stop coming to individual counseling sessions but will continue attending the grief support group.

Not all grief survivors experience the kind of growth that Sharon experienced — or so quickly. Even though she continued to miss her partner terribly, her life as a caregiver for the past seven years had precluded her from developing much life satisfaction for herself. Her ability to make friends and develop social connections and her volunteering activities with the animal shelter gave her a great deal of self-efficacy and provided positive ways to deal with the absence of her partner.

Some people will not cope with loss as effectively as Sharon did. Those who experience losses associated with violence or who have coexisting diagnoses such as depression, anxiety or substance disorders are more likely to go through an extended recovery period for healing. In addition, many grief survivors feel guilty for experiencing any kind of satisfaction, as if it amounts to some kind of betrayal of the person who is no longer here.

At the same time, it is not uncommon for grief survivors to reevaluate and shift their priorities in life, in part because their life circumstances have changed. For example, Emilee lost her spouse Roberto, who was a retired military officer and active in veterans’ affairs. Roberto had spent his retirement years traveling internationally in support of this cause. Emilee had rarely accompanied him because of her fears of terrorism and plane crashes. After Roberto’s death, however, Emilee decided to engage with the same veterans’ foundation that Roberto had been active in and found herself traveling all over the globe. Emilee wanted to preserve her spouse’s legacy and share her own gifts with a larger number of people. Loss survivors such as Emilee and Sharon who find ways to give back or volunteer are more likely to report narratives of growth.

Being attuned to growth

Potential for growth exists when clients uncover meaning from their loss and construct narratives that fit into their worldview and sense of self. Skilled counselors can serve as guides to help survivors make sense of what has happened. No survivor should ever be pushed to grow, but having a counselor attuned to growth may be the missing piece that helps clients become more resilient in the face of traumatic loss.

In my own experience as a grief survivor following a series of personally devastating losses, awareness of my growth sneaked up on me. It was as if a dimmer switch got turned up again as my outlook and mood shifted in a positive direction. I include this because being attuned to indices of growth may be one of the best ways that we can help clients recognize growth possibilities and emerge from the darkness of a traumatic loss to find light again. As Jon Kabat-Zinn, founder of mindfulness-based stress reduction, has said, “You can’t stop the waves, but you can learn to surf.”

 

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Sherry Cormier is a licensed therapist, certified bereavement trauma specialist, and former faculty member at the University of Tennessee and West Virginia University, as well as being a public speaker, trainer and consultant. She is the author of Counseling Strategies and Interventions for Professional Helpers (ninth edition), senior author of Interviewing and Change Strategies for Helpers (eighth edition), and co-producer (with Cynthia J. Osborn) of more than 100 training videos for Cengage. Her newest book is Sweet Sorrow: Finding Enduring Wholeness After Loss and Grief. Contact her through her website, sherrycormierauthor.com.

 

Letters to the editor:  ct@counseling.org

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

 

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