Monthly Archives: April 2021

The intersection of childhood trauma and addiction

By Shannon Karl April 13, 2021

Substance dependence leads to persistent negative consequences and the loss of human potential. These consequences often include chronic health problems, dysfunctional family environments, harmful economic impacts and premature death. According to the Centers for Disease Control and Prevention (CDC), 21.2 million individuals in the United States met the criteria for a substance-related disorder in 2018. Deaths from overdose have tripled in less than two decades, with over 70,000 annual drug overdose deaths in 2019, 70% of which resulted from opioids such as morphine and fentanyl.

Substance-related disorders include 10 classes of drugs: alcohol; caffeine; cannabis; hallucinogens; inhalants; opioids; hypnotics, sedatives and anxiolytics; stimulants; tobacco; and other/unknown substances. Exposure to childhood trauma increases one’s risk of addiction across classifications, along with deleterious factors such as physical health and socioeconomic challenges. The Adverse Childhood Experiences (ACE) study, originally conducted by Kaiser Permanente and the CDC from 1995-1997, identified categories of trauma that can occur prior to age 18. These include physical abuse and neglect, emotional abuse and neglect, sexual abuse, and household dysfunction — e.g., mother treated violently, household substance misuse, parental incarceration, parental mental illness, and divorce.

These factors make up the 10 components of the ACEs score, with research supporting higher likelihood of substance-related disorders as exposure to ACEs increases. According to the American Society of Addiction Medicine (ASAM), addiction has biological, psychological, social and spiritual manifestations. Given the deleterious nature of addictive etiology, professional counselors need to be aware of the vulnerability to addiction for those affected by childhood trauma. The intersection of ACEs and addiction holds pervasive negative impact across the life span.

The National Institutes of Health (NIH) asserts that traumatic events can serve as triggers for substance misuse. NIH reported that 38% of high school seniors admitted using an illicit substance in 2019, with marijuana being the most frequent substance utilized. Startlingly, 11.8% of eighth graders reported marijuana use. In addition, 11.7% of high school seniors reported daily nicotine use, and more than half acknowledged using alcohol in the prior year.

Exposure to ACEs can lead to toxic stress and myriad negative consequences, often including lifelong deleterious effects on physical and mental health. The high rates of individuals living with the trauma of ACEs is startling — 61% of individuals have endured at least one ACE, and nearly 25% of individuals report three or more ACEs. There appears to be specific vulnerability to addiction for those who have experienced four or more ACEs. The higher the ACEs score, the greater the negative health impact. More than half of adolescents who live with mental health concerns also have diagnosable substance-related disorders, which underscores the comorbidity of the issue.

Ramifications of ACEs can include addiction, reduced access to education, and vulnerability to sexual exploitation and trafficking. Tobacco and prescription drug use is higher among those with ACEs, and illicit drug use increases more than twofold with each positive ACEs category. Other lifelong instability factors that have been shown to correlate with ACEs are high-risk sexual behaviors, early pregnancy, suicide attempts, sleep disturbance, poor dental health and multiple physical health concerns. Both children and adults with extant mental health issues misuse substances at higher rates.

According to the U.S. Surgeon General, approximately 10% of children live with mental health concerns that rise to a clinical level, with major depressive disorder representing a leading cause of disability in children worldwide. Research supports the strong connection between experiencing adversity during childhood and the ensuing development of addiction. More than two-thirds of children will experience a traumatic event before the age of 16. And with the current pandemic, many children are in homes that are violent or otherwise unsafe. Alarmingly, domestic violence incidents were up 30% in 2020, exposing untold youth to at least one of the ACEs factors.

Treatment needs

Reports regarding heightened clinical levels of anxiety and depression among the general population suggest that stress related to the COVID-19 pandemic affects everyone. Adolescence already represents a critical developmental period for initial onset of mental health and substance-related disorders, so the vulnerability for this demographic is further increased. ACEs are a clear and extant risk factor, with survivors of childhood trauma 15 times more likely to attempt suicide, four times more likely to develop an alcohol-related disorder, and 2.5 times more likely to smoke cigarettes. For survivors of childhood trauma, physical and emotional issues often manifest in adolescence and follow into adulthood.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 21.6 million people ages 12 and older needed treatment for substance use in the U.S. in 2019, whereas only approximately 2.6 million people (or slightly more than 12%) received it. These are glaring treatment needs that crosscut demographics. Fentanyl, which can be lethal, is sold in multiple forms on the “street,” continuing the opioid crisis in our country. Tens of thousands of overdose deaths occur per year, with close to 11 million individuals disclosing inappropriate opioid use. Those with ACEs scores higher than 6 were over 1,000 times more likely to use injection drugs.

Chronic substance abuse, a clear risk factor for those exposed to trauma, leads to premature death in alarmingly high numbers. Adolescents with experience of major depressive episodes are more likely to use substances across categories. Coincidingly, 60% of U.S. youth with depression do not receive mental health treatment. Addressing the physical and mental health impact of substance use alone is estimated to cost Americans more than half a trillion dollars annually. The CDC has developed a resource that highlights the available research support for evidence-based prevention of ACEs at cdc.gov/violenceprevention/pdf/preventingACES.pdf. These strategies focus on systemic community-based information and training. Emphasis is also placed on physical health, positive behaviors and supportive environments.

Treatment considerations

Certain populations have increased vulnerability to substance-related disorders due to environmental and genetic factors. This stems from the neurobiological underpinnings of the addictive etiology to the effects of toxic stress. Individuals born into households in which they are exposed to ACEs are more vulnerable to addiction, including process addictions centered on gambling, internet gaming, sex, shopping, work, social media and so on. The use of trauma-informed interventions as early as possible can mitigate deleterious effects and provide protective measures against substance-related and other mental and physical health issues. The CDC offers trainings for those interested in learning more about the prevention of ACES (see vetoviolence.cdc.gov/apps/aces-training/#/#top).

All clients should be evaluated for trauma and addiction history. The concurrence of mental health concerns and substance abuse necessitates treatment that addresses these challenges. Trauma increases the already high comorbidity (upward of 50%) between mental health and substance use diagnoses. Prevention and early intervention services can examine frequency, severity and duration of both the trauma experience and the addiction. The conceptualization of substance use disorders occurring on a continuum (as detailed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders) underscores the importance of prevention and early intervention.

According to the CDC, research shows a propensity to self-medicate with substances to escape or numb negative thoughts and feelings. This suggests that escape from emotional pain triggers the onset of addiction. Women, adolescents and individuals from marginalized populations are most vulnerable to these effects, although anyone can experience childhood trauma and struggle with ensuing addiction.

Clinicians should develop individualized treatment plans and strong referral systems. Genetic and environmental factors work in combination. Thus, we need to gain understanding of these interactive effects. Long-term supports and provision of physical and dental health services can be important for individuals exposed to ACES, especially considering the likelihood of comorbidity with a physical health diagnosis. Increased rates of unemployment and job dissatisfaction represent additional treatment needs.

Relational challenges

Difficulty forming healthy relationships across the life span is a hallmark of surviving childhood adversity. Counseling professionals should thus incorporate strategies for strengthening the family and community. Holistic and family counseling services are beneficial. This includes the provision of psychoeducation and parenting education to address overall life skills, mindfulness and grounding techniques, positive coping strategies and career counseling services. Trauma-focused cognitive behavior therapy (TF-CBT) and multisystemic therapy have shown both short- and long-term benefit with these clients. This can be combined with addiction treatments such as medication-assisted therapy for alcohol or opioid use disorders. The combination of psychoeducation and supportive, trauma-informed and empirically based substance misuse treatments can span the broad needs of this population. All treatment modalities and providers should integrate trauma-informed care.

Early identification and intervention remain important to minimize risks and break deleterious family patterns. Removal of barriers to treatment includes addressing stigma and increasing education for families and communities. Larger scale prevention programs, inclusive of early intervention and postvention services, are indicated. The development of individualized treatment strategies that incorporate trauma-informed interventions are also vital.

Professional counselors are charged to advocate for clients and communities. Screenings in hospitals, clinics and public health facilities can help identify those at risk for substance misuse, especially those with trauma histories, and link them with treatment services. Psychoeducation in schools and community agencies also can improve outreach and access to care. Parenting education classes and life skills trainings are other examples of additive ancillary services. Incarcerated populations are particularly affected, with some studies suggesting a trauma history for nearly the entire population of female inmates. Professional counselors working across these settings should be aware of risk factors and assessment protocols that are culturally competent and inclusive of multiple demographics.

Effective treatments for individuals affected by trauma and addiction can include eye movement desensitization and reprocessing, motivational enhancement therapy, TF-CBT, dialectical behavior therapy, assertive community treatment and family behavior therapy. Psychotropic medication and psychiatric care may be indicated to fully address these complex issues. Some medications may benefit multiple issues (e.g., bupropion for both depression and nicotine dependence). Case management and occupational assistance represent important ancillary services for many clients. Community vouchers can be given for transportation and health care access and allow for possible employment opportunities.

Although thorough and comprehensive treatment can be expensive, it pales in comparison to the economic costs associated with addiction and premature death. With annual estimates for addiction and premature death as high as $740 billion, there is a need for legislation that funds prevention and early intervention services for those affected by trauma exposure and addiction. Given appropriate access to treatment and support, many individuals living with the effects of childhood trauma and addiction can make positive and lasting improvements. The cycle of intergenerational trauma transmission can be broken, providing positive ripple effects for future generations. Individuals can thrive and build healthy families despite their adverse experiences.

Community impact and integrated care

A multitiered approach to looking at immediate issues such as addiction is imperative for individuals exposed to ACEs. Addressing the trauma and providing familial services, social support and preventive measures remains imperative. All professional counselors can emphasize trauma-informed and integrative care. Here are a few simple strategies to tackle this complex issue: Listen with empathy, garner training in trauma-informed practices, develop a strong support and referral system, and provide specialty services to treat the trauma and the addiction. Working together, mental health professionals across disciplines can help survivors of childhood trauma manage life in healthy and productive ways.

The global health pandemic has increased utilization of distance-based services such as telemental health counseling. This modality can provide easier access to services for individuals in rural communities, those with transportation challenges and those with other impediments to treatment.

It remains important to highlight the team approach in addressing the complex issues of childhood trauma, addiction, and the ensuing physical and mental health sequelae. The pervasive nature of this challenge engenders a call to action. Data collection through thorough assessment can inform community decision-making and provide program funding. The Youth Risk Behavior Surveillance System assesses crosscutting data that are available at the local, state and national levels. The National Survey of Children’s Health and the National Crime Victimization Survey also collect data that can inform service provision.

The CDC provides information to promote safe childhood environments and mitigate ACEs exposure and subsequent addiction and disease. On a micro level, professional counselors can focus on parenting and family skills, mentoring, social emotional learning, job skills, and psychoeducation regarding healthy family and interpersonal relationships. On a macro level, professional counselors can promote community connection, mentoring relationships and positive social norms. The critical importance of trauma-informed interventions that are tailored to individual or family circumstances, along with communitywide prevention strategies, are necessary for addressing these serious and prevalent risk factors. These programs can assist children, parents and families beyond mitigation of symptoms.

Family-centered treatments for addiction can address the intergenerational impact. The deficits that come with trauma and addiction are offset by evidence-based interventions and prevention strategies. Access to programs should be available for all levels of care and can be implemented concurrently with ancillary services. Counseling settings can include the home, school or office, and often will involve multiple integrated health care professionals. Given the complexity of the challenge, comprehensive treatment services that include bridging home and school environments and the larger family system remain imperative. The widespread impact of ACEs and their intersection with addiction calls for coordinated care across disciplines. This includes effective tracking and coordination of prevention and intervention services across all aspects of service delivery.

Intergenerational patterns of trauma transmission represent a vicious cycle that professional counselors can help break. Prevention programs must address household dysfunction and adversity, especially considering that ACEs indicate earlier onset of substance consumption. The idea of numbing or comfort-seeking suggests that childhood adversity can lead to addiction through attempts to relieve distress. Quality mental health care can address and ameliorate these maladaptive coping mechanisms. ACEs are also correlated with substance use disorder in older adulthood, underscoring the lifelong ramifications of exposure to childhood trauma.

Addiction treatment facilities partnering with comprehensive and wraparound services can provide targeted interventions to address individual trauma experiences. Tackling the systemic nature of childhood adversity through family services and community advocacy provides additional resources for clients. Professional counselors are an integral part of the overall treatment team. Clients can and do learn new patterns of behavior and positive coping mechanisms that help them live longer, healthier lives. The benefits of prevention and early intervention should not be undervalued. Treatment is ameliorative for trauma and addiction and often engenders positive change in individuals and families.

Professional counselors can assist community members in locating resources and addiction treatment centers across the country via SAMHSA’s national helpline: 800-662-HELP (4357). Viewing survivors of childhood trauma who struggle with addiction or other maladaptive coping mechanisms from a strength-based approach is imperative. These struggles are not born of characterological weakness but result from the impact of lived trauma experiences. Empathy and care go a long way in successful work with trauma survivors.

Conclusion

Abuse, neglect and household dysfunction clearly lead to physical and mental health challenges. The risk of addiction, early death and intergenerational trauma transmission increases with each adverse childhood exposure. Use of alcohol and other illicit substances damages mental and physical health in numerous ways and often intersects with the trauma experience. Vulnerable children and adolescents can and must be protected. Professional counselors play pivotal roles now more than ever.

In 2020, SAMHSA reported a 900% increase in call volume to its disaster distress helpline (800-985-5990). Nearly half of Kaiser Family Foundation respondents asserted that the COVID-19 pandemic is detrimental to their overall mental health. The global health pandemic underscores the burgeoning treatment needs for increasing numbers of vulnerable people. Experiencing trauma in childhood can hinder the individual in all aspects of life. The negative reverberations for families and communities should make this everyone’s issue. Professional counselors hold the potential to help effect positive change for innumerable individuals, families and communities. Let’s make an impact — now and into the future.

 

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Shannon Karl is a professor with the Department of Counseling at Nova Southeastern University, a licensed mental health counselor (supervisor) in Florida, an active member of the American Counseling Association, and a past president of the Association for Spiritual, Ethical and Religious Values in Counseling. Contact her at shannon.karl@nova.edu or linkedin.com/in/shannon-karl-phd.

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

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

Incorporating interprofessional education and practice in counselor development

by Judy Schmidt

As the complexity of care for people with mental health needs increases, more counselors are serving on interdisciplinary teams responding to the acute and chronic needs of their clients. Many people with serious mental illness may also have co-occurring physical disorders such as cardiovascular disease or nutritional/metabolic diseases (e.g., diabetes, obesity), as reviewed by Mark De Hert and colleagues in 2011. These individuals require increased medical care involving physicians, nurses, dietitians, and radiologic and clinical laboratory specialists. Social work also coordinates care with mental health teams for community resource support and with vocational rehabilitation counselors to assist with employment needs. Thus, counselors’ understanding of the role and function of interprofessional collaboration in providing care is vital for achieving quality outcomes.

As a counselor educator, I strive to create opportunities for students to develop strong communication and leadership skills during their clinical training. When I invite alumni to talk with students about different aspects of building their career, many discuss their work on community-based mental health teams. They explain having to learn to work with people outside the counseling profession — nurses, psychiatrists, physical and occupational therapists, speech therapists, social workers, pharmacists, police officers and others. I began to understand the need for our students to have better skills for team-based care. So, I worked with our faculty to offer more opportunities to expose our students to a wider range of care providers and delved into the research on interprofessional education and practice (IPEP).

During this time, I engaged with faculty from physical and occupational therapy in our Department of Allied Health Sciences who were involved in IPEP. Through them, I started learning more about IPEP in medicine, nursing and other health affairs schools on campus. My personal exposure to interdisciplinary care began in earnest when, as part of my clinical faculty duties, I started working part time as the rehabilitation counselor on the acute inpatient rehabilitation unit at our hospital located on campus. This fully immersed me in an interprofessional setting with providers from all health disciplines.

This required me to be a member of a team of varied professionals focused on quality patient care that depended on strong communication, an understanding of team members’ roles in providing care, and the use of best practices for supporting the team. I witnessed (and contributed to) interprofessional practice at its finest being carried out every day. I was hooked and worked with other allied health faculty to find ways for our students to engage with one another. With the support of our dean, I became the coordinator for IPEP for our department.

Two years ago, when our university leadership developed a campuswide initiative for intentionally integrating IPEP and created a formal office for it, I was ready to represent our Department of Allied Health Sciences as the director of IPEP. I work closely with other directors from all health disciplines as well as public health, social work, business and education to intentionally build IPEP across curricula. Student and faculty support have been tremendous. I see the need to expand knowledge of IPEP to counselor education as a whole and to build these endeavors into our programs to ensure that future counselors can easily transition to interprofessional care and become leaders on these teams.

Thus, counselor educators should be aware of current interprofessional teamwork practices and curriculum frameworks that provide opportunities for students to understand their roles on these teams, effectively describe and implement counseling services, and uphold the culture of interdisciplinary care. Establishing opportunities for counseling students to participate in IPEP with stakeholders was a critical need noted by Kaprea Johnson and Krystal Freeman in 2014 in their work on integrating IPEP into mental health counselor education. This knowledge will help new counselors understand their role in a variety of settings and learn appropriate communication strategies for sharing knowledge in team settings. IPEP trainings for graduate students also helps dispel preconceived ideas about other professional team members’ roles and highlights the importance of quality care.

Core competencies

In 2009, the Interprofessional Education Collaborative (IPEC) was formed by six national health profession education associations covering nursing, osteopathic medicine, pharmacy, dentistry, medicine and public health. Their goal was to advance interprofessional learning strategies to enhance skills in team-based care that promote quality health outcomes. The collaborative also established core competencies in providing interdisciplinary care for student clinical training programs. By 2016, IPEC had expanded its academic partnerships to include 21 health-related institutions. Its vision is to promote interprofessional teamwork and collaborative practice that reinforces quality, accessible, person-centered care that improves population health. 

IPEC has four core competencies that guide the development of curricular content:

  • Values/ethics for interprofessional practice to build and maintain mutual respect and shared values in patient care
  • Knowledge of roles/responsibilities in interdisciplinary teams to help assess and address health care needs
  • Interprofessional communication that is supportive and responsive to team-based care and treatment and prevention of disease
  • Teams and teamwork that uphold high values and principles recognizing different team members’ roles in planning, delivering and evaluating patient care, programs and policies

The overarching goal for IPEP is for health care workers to learn from, with and about each other.

These competencies also promote the principles of the “Quadruple Aim” in health care. Three of the principles were originally developed in 2007 by the Institute for Healthcare Improvement to promote health system reform to improve patient experiences, reduce costs and increase better outcomes. The fourth principle, improving the clinical experience for providers, was added in 2015, primarily to address and manage clinician burnout.

Counselor training opportunities that embrace these competencies help students understand their team roles, effectively describe and implement their services, learn appropriate methods for sharing knowledge in team settings, and uphold the culture of interdisciplinary teamwork. Overall, curriculum structures that promote opportunities that integrate the IPEP competencies help develop graduates who are leaders in their field. These graduates will possess the skills for teamwork that can address challenges in providing quality health care, including in the counseling field.

IPEP in relation to accreditation and licensure requirements

CACREP recognizes the need for counselor education programs to provide specific information and training to students about interprofessional care and their respective roles on these teams. On its website, CACREP states that it is a member of the Health Professions Accreditors Collaborative, which works to promote learning opportunities that prepare students for interprofessional practice. Requirements for interprofessional education opportunities are outlined in the 2016 CACREP Standards in Section 2, Standard F.1.c. and Section 5, Standard D.2.b.

The 2014 ACA Code of Ethics clearly states in Section D, Relationships With Other Professionals, the importance of being a part of interdisciplinary teamwork (Standard D.1.c.) and understanding the professional and ethical obligations as a team member (Standard D.1.d.). In 2017, the Code of Professional Ethics for Rehabilitation Counselors provided guidelines for certified rehabilitation counselors working as members of interdisciplinary teams that provide complex and comprehensive services to people with disabilities. Section E, Relationships With Other Professionals and Employers, outlines these ethical responsibilities in Standards E.1., E.2.a. and E.2.b.

Thus, counselor education programs are called to build relationships among all stakeholders (administration, faculty, students and community partners for clinical training) that are crucial for successful IPEP development and implementation, as noted by Daniel Kinnair and colleagues (2012) and Kaprea Johnson and Krystal Freeman (2014).

IPEP experiences for counselor education and development

Innovative ideas for incorporating IPEP experiences in counselor education include collaborative learning experiences with other professions, problem-based learning events and simulation activities. One of the best approaches for initially developing IPEP in counseling programs is to seek opportunities with other departments on campus that may have similar graduate-level introductory courses that include content on disability rights and current health care issues such as quality indicators of care, disparities in care, implicit bias and leadership development. These topics lend themselves to developing interdisciplinary journal clubs, case-based events for problem-solving and opportunities for students to talk about their different professions or why they chose their career path in graduate school. Most importantly, these activities will help students begin to understand and clarify their roles and how they fit in interprofessional teams. Their professional thinking may be challenged by understanding different viewpoints, decreasing the use of jargon, and building confidence and leadership for future teamwork.

IPEP events that are more intentional with specific learning outcomes require more planning. However, working with other health professionals on campus or in field placements to design opportunities will prevent reinventing the wheel and will model interprofessional collaboration for students. Examples of IPEP activities designed around specific learning objectives for students include case-based learning experiences, seminars with small-group discussions and debriefs, and clinical simulations that use videos or actors to play patients and portray different health issues and patient ages. Service-learning opportunities, particularly focused on rural health care, can bring students together from many disciplines, including business, education, legal care and faith-based organizations. These opportunities serve as excellent avenues for learning from, with and about each other to serve the community.

Field placements for clinical work offer built-in opportunities for IPEP in clinical agencies where interdisciplinary teamwork is provided. These preceptors will have practical knowledge to share about their teamwork and examples of interprofessional care that works and does not work. They can also offer opportunities for counseling students to incorporate counseling theory with IPEP practice and to reflect on potential ethical dilemmas for counselors when providing team-based care. These environments can help all students, not just counseling students, learn how to deal with complex issues and bridge theory to practice difficulties in providing clinical care as new professionals. Furthermore, these experiential learning opportunities are very important in IPEP because they offer environments in which professionals and students can interact and reflect on practices for improved care.

It is important to note that the four IPEC core competencies discussed earlier should always guide a program’s IPEP initiatives and curriculum. Students and faculty should be able to explain how the activity meets the competencies. Evaluation by participants for each event is critical to ensure that the goals of the training are being met and that it represents a valuable learning opportunity. Faculty development for counselor educators and other health disciplines and IPEP partners is critical to designing, developing, implementing and assessing successful learning opportunities.

In the planning of IPEP events, it is crucial to involve students from the beginning. They may have friends or contacts in other departments or community agencies that have resources or programs that can be used to help with planning and executing events. Encouraging students to take leadership roles in working with faculty to develop IPEP on campus is an excellent way to build their leadership skills and a commitment to interprofessional learning.

Value in counselor development

Incorporating IPEP into counselor education programs can increase opportunities for clinical participation with other related disciplines in a manner that helps counseling students develop a strong professional identity. Well-planned IPEP activities build on the knowledge being learned in the classroom and increase critical thinking skills by evaluating complex care needs from multiple perspectives. In addition, students see faculty and professionals from other disciplines working together during IPEP activities, modeling effective interprofessional teamwork that may not be experienced during training.   

IPEP training offers opportunities for students to better understand aspects of patient-centered care, holistic treatment and shared decision-making practices that guide teams in their goals for achieving outcomes. But most importantly, students enjoy IPEP events. They naturally form their own interdisciplinary groups for further discussion after participating in IPEP opportunities and develop friendships that can lead to building a better workforce in the future.

Our students have their own campuswide Student Executive Committee with representation from all the schools participating in IPEP. They plan formal and informal events that promote IPEP and serve as liaisons between the IPEP office and student groups across campus to increase awareness of interprofessional learning and collaboration as part of their academic experience. These students are leaders on campus and are also developing into our future leaders in counseling and in team-based community care. Actually, they are why we have a deep commitment to IPEP on our campus. And they are worth it.

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Judy Schmidt is the director of Interprofessional Education and Practice (IPEP) for the Department of Allied Health Sciences at the University of North Carolina at Chapel Hill. She is a member of the leadership team for the university’s Office of IPEP, which is dedicated to working collaboratively to transform health education and prepare professionals from different disciplines to work better together for quality patient care. She is a clinical assistant professor in the department and a certified rehabilitation counselor. Contact her at judy_schmidt@med.unc.edu.

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

Yalom discusses power of therapeutic relationships at ACA Virtual Conference Experience

By Lindsey Phillips April 12, 2021

Dr. Irvin Yalom, an American existential psychiatrist and emeritus professor of psychiatry at Stanford University, is renowned for his ability to probe into the human psyche and for his interpersonal therapy groups. During the keynote to kick off the second week of the American Counseling Association’s 2021 Virtual Conference Experience, he offered a peek into his own life, sharing how therapeutic relationships have helped him personally and professionally, including in processing his grief over his wife’s death.

As part of the keynote, Jude Austin, an assistant professor and clinical mental health counseling track coordinator at the University of Mary Hardin-Baylor and a private practitioner in Temple, Texas, spoke with Yalom about his early life, the beginning of his professional journey, his status as an icon of the mental health professions, and his latest book, A Matter of Death and Life.

Discovering existential therapy

After earning a Doctor of Medicine from Boston University School of Medicine, Yalom completed an internship at Mount Sinai Hospital in New York and a residency at the Henry Phipps Psychiatric Clinic of Johns Hopkins Hospital in Baltimore. Yalom said it was during his residency at Johns Hopkins that he discovered the field of interpersonal relationships and became “more interested in working with people rather than with medicine,” which set him apart from other psychiatry students.

He credits Existence, a book co-edited by Rollo May, an American existential psychologist, with introducing him to the interconnection between philosophy and psychiatry. It also prompted him to enroll in a yearlong philosophy course at Johns Hopkins while completing his residency.

At the time, psychiatry professor Jerome Franks served as an influential mentor to Yalom, who recalled spending hours during his training observing Franks’ therapy groups through a two-way mirror. This experience taught him that therapy was relational, he told the keynote audience. Franks’ therapy groups focused on how the group members related to one another. “It [wasn’t] about their parents and early life, etc. … It [was] looking at interpersonal relationships,” Yalom explained.

Yalom said that a mistake he made with a client years later served to remind him again of the importance of the client-therapist relationship. He found that he couldn’t connect with this particular client during their session. He felt disappointed and considered it one of the least successful sessions he had ever had, which he mentioned in his session notes. Then he committed a therapist’s worst nightmare: He accidently emailed his session notes to the client, not himself.

The client wrote back, acknowledging that she was hurt by his comments. In their next session, however, things changed because she opened up. Yalom learned that she was training to be a social worker and was reading his group therapy textbook in her class. “I interpreted her behavior in the here and now as being indicative of her inability to relate to people, but in fact it was something else entirely. All these people were praising my textbook, and she just felt very intimidated by me,” he said.

“Working on the here and now is working on the space … between me and patient,” Yalom noted. He explained that when he does single-session consultations, at some point, he will say, “Let’s take a look at how you and I are doing in this session. What’s that like for you?” He finds that the relationship between the therapist and client is often a microcosm of their relationships with other people.

Finding his way through grief

Yalom told the keynote audience that he and his wife, Marilyn Yalom, who was a world-renowned scholar in gender studies and a professor of French and comparative literature, were inseparable from the time they met when he was 15 years old. When they discovered that she was dying of cancer, she asked him to write about the experience with her. He agreed, and they wrote A Matter of Death and Life, which provides a candid description of how she prepared to die and how he struggled (and continues to struggle) to live without her.

After Marilyn’s death in November 2019, Yalom found himself rereading his own books, which he acknowledged has been very good therapy for him. He recently reread his 1999 book Momma and the Meaning of Life: Tales of Psychotherapy, particularly the chapter “Seven Advanced Lessons in the Therapy of Grief,” with renewed interest.

He recalled a former patient who repeatedly complained that he had a “perfect life” and couldn’t relate to how she felt. Yalom said that he would argue with her and ask, “Do we have to be the same for me to treat you?”

After losing his wife, Yalom said, he has reflected on that past experience with the patient. “Now, going through this, I think she’s right,” he admitted to the audience. “I know how she feels. I could do a better job with her now.”

Advice to new professionals

Austin observed that it takes courage to be in the here and now with clients and asked Yalom if he had any suggestions for counselors who are struggling to be present with clients. Yalom’s advice: Go to group therapy.

“Group therapy is an enormously good way for you to really look at how you can present yourself to other people. And if you’re being evasive [and] you’re not letting people in, the group will let you know,” he said.

He also encouraged counselors to enter therapy because it allows them to experience various therapeutic approaches firsthand. That is a great way to learn how approaches work and how they each offer something different, he asserted.

Yalom also shared a technique that he has applied with his own groups. He dictates summaries of what happens in group sessions and emails those notes to the group members so they can discuss that perspective in the following session. Yalom noted that the group members often argue with him about how he got it wrong, but such conversation leads to deeper discussion and insight about how we relate to people.

Yalom told the audience that he has been in and out of therapy several times and is currently in therapy as he processes his grief over the loss of his wife. His honesty about his experiences — both in his professional life and his personal life — is a comforting reminder of the humanity of therapists. It sends an inspiring message to other mental health professionals that they too are still growing and learning, and that is how it should be.

Dr. Irvin Yalom gives the opening keynote address in March 2017 at ACA’s annual conference & Expo in San Francisco. (Photo by Paul Sakuma Photography)

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This keynote address is part of a month of virtual events, including hundreds of educational sessions and three additional keynotes, that lasts through April 30.

Find out more about the American Counseling Association’s 2021 Virtual Conference Experience at counseling.org/conference/conference-2021

Registration is open until April 30; participants will have access to all conference content until May 31.

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

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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.

Money on the mind

By Laurie Meyers April 7, 2021

Money is the dirty little secret of American society. The unspoken social contract is that, like Voldemort, it shall not be named. We may joke about winning the lottery, but we don’t reveal the strained financial circumstances that underlie that pipe dream. Modern life is not cheap. Unfortunately, many workplaces and professions do not reflect this reality. Could we be making more money? Who knows? Many companies forbid their employees to discuss salaries with co-workers.

Meanwhile, our consumerist culture makes it easy for money to fly out of our wallets and onto our credit cards. Financial experts (some of whom sound a bit like scolds) urge us to maximize our contributions to our retirement plans and have savings sufficient to sustain us for six months or more of unemployment. These are worthy goals, but most Americans find them challenging to achieve.

A 2019 survey by the personal finance company Bankrate found that approximately 28% of Americans had no emergency savings and only 18% had enough to live on for six months. And a 2019 report by the U.S. Federal Reserve revealed that 25% of nonretired workers possessed no retirement savings at all. Surveys show that a large share of Americans — including those who earn higher salaries — live paycheck to paycheck. Many people get by with the help of a credit card — or three or four. A recent poll by CreditCards.com showed that almost half of Americans (47%) currently carry credit card debt. And even though being in hock to credit card companies is so common, carrying that kind of debt is still associated with a lack of financial responsibility. 

Just set a budget! Track your spending! Stop buying that daily Starbucks latte!

It’s not the latte. And the one-size-fits-all financial advice on offer by cable talking heads and in best-selling books doesn’t typically work. Not just because people’s financial obligations are different, but because managing money isn’t only about the numbers. The way we spend — and save — is tightly entwined with emotion and driven by learned behaviors and beliefs whose existence we are frequently unaware of, according to experts who study neuroeconomics. These factors can prevent us from effectively managing our money.

The mental health consequences of financial difficulties can be significant. Even before the recession caused by the COVID-19 pandemic, Americans frequently rated financial worries as one of their top sources of stress. This past October, the fourth in a special pandemic-oriented series of “Stress in America” surveys from the American Psychological Association revealed that nearly 2 in 3 adults (64%) said money was a significant source of stress in their lives.

Financial difficulties can cause stress and depression. Stress and depression make it harder to tackle money problems. It becomes a vicious cycle — particularly for those who are already living with mental health problems.

Enter financial therapy, which the Financial Therapy Association (FTA) defines as “a process informed by both therapeutic and financial competencies that helps people think, feel, communicate and behave differently with money to improve overall well-being through evidence-based practice and interventions.”

Financial therapists primarily come from the mental health, coaching and financial fields. Some of them are mental health professionals who realized that money plays an important role in overall well-being and decided to become trained to offer financial therapy in addition to their regular practice. Others are financial professionals who realized that they needed to be able to handle the emotional aspects of money and received additional behavioral training or, in some cases, became licensed mental health practitioners.

All of the sources Counseling Today spoke to for this article are licensed counselors who offer financial therapy to existing clients who express interest or as a stand-alone service. They use a variety of tools to help clients understand their internal money narratives, identify behavioral patterns, and process the emotions that are getting in the way of setting and working toward their financial goals.

The field developed out of a body of research on neuroeconomics. Psychologists Ted Klontz and Brad Klontz and financial planner Rick Kahler are widely considered the “grandfathers” of financial therapy.

Early lessons learned

Research by Klontz, Kahler and Klontz suggests that people begin developing money beliefs — and potential future problems — in childhood. These attitudes are often developed through experience and observation rather than parental instruction.

That’s because many families don’t talk about money, notes American Counseling Association member Elaine Korngold, a licensed professional counselor in Portland, Oregon. Children grow up in families not knowing how much money their parents make, how much (or how little) different jobs pay, and what level of income is necessary to cover basics such as rent/mortgage, utilities and food — let alone how to set up and follow a budget, she says.

Although parents usually talk about and teach their children essential life skills such as driving, anything to do with money is often kept secret, says Korngold, who worked in the financial sector before she became a counselor. This not only leaves children uninformed and unprepared but also reinforces the societal perception of money as a taboo topic. As a result, many adults who struggle to manage their finances simply don’t know how to seek help or are too ashamed to ask for it, she says.

But even when parents don’t explicitly teach their children about money, they are still imparting lessons, says Kathy Haines, an LPC in Marietta, Georgia, who is training to become a certified financial therapist through FTA.

An integral part of Haines’ financial therapy process is exploring the financial beliefs held by a client’s family of origin. Haines, an ACA member, asks questions regarding whether money was ever discussed, who managed finances in the family and how. “Were there fights about money?” Haines asks. “Spoken or unspoken messages such as don’t have credit debt? Work hard so that you can take care of yourself?”

Similarly, Korngold asks clients about the spending behaviors they observed growing up. Did it seem like the family was always just making it until payday, or was there any financial cushion? If the family found itself with more money than usual, what did they do with it? Put it in the bank? Take a vacation? Buy a TV?

Jennifer Dunkle, an LPC in Fort Collins, Colorado, whose specialties include financial therapy, asks her clients to write their “money story” by answering a variety of questions: What are your earliest memories concerning money? What did you learn from your family about money? Specifically, what did you learn from your father? From your mother? What experiences did you have with money as a young adult?

These messages and experiences contribute to what Klontz, Kahler and Klontz call “money scripts” — unconscious beliefs that shape our financial behavior.

Money narratives

Dunkle, like many financial therapists, also gives clients the Klontz Money Script Inventory (KMSI) assessment.

“Most adult money scripts are based on earlier life experiences,” she says. “In order to make lasting changes to budgeting, spending, savings and investing plans, it is very helpful to learn more about our underlying beliefs and values in regard to money.”

The most common money scripts include beliefs such as:

  • More money will make things better.
  • Money is bad.
  • I don’t deserve money.
  • I deserve to spend money.
  • There will never be enough money.
  • There will always be enough money.
  • Money is unimportant.
  • Money will give my life meaning.
  • It’s not nice or necessary to talk about money.
  • If you are good, the universe will supply all your needs.

Dunkle explains that Klontz, Kahler and Klontz group money scripts into the following types:

  • Money avoidance: Avoiding dealing with money and rejecting personal responsibility for one’s financial health.
  • Money worship: Believing that a financial windfall or increased income will be the solution to all of one’s problems; being focused on the inward value of the accumulation of money.
  • Money status: Being overly concerned with the idea that self-worth equals net worth; believing that money conveys status; wanting to always have the next new, big-ticket item; and being interested in the outward display of one’s wealth to others.
  • Money vigilance: Being watchful, alert and concerned about one’s finances. Those who are money vigilant are much less likely to avoid their financial matters, overspend, gamble and engage in financial enabling.

Klontz, Kahler and Klontz say that the scripts themselves are not “good” or “bad.” Rather, they are simply indicators of behavioral influences.

“For example, someone who has the belief that ‘I deserve to spend money’ might run up a lot of credit card debt despite not being able to actually afford their purchases,” Dunkle explains. “The script, ‘It is not nice or necessary to talk about money’ could lead to money secrets between spouses. Believing that ‘If you are good, the universe will supply all of your needs” may result in not doing adequate planning and saving for retirement.’”

Working toward change

Dunkle uses motivational interviewing to help clients recognize the adverse effects their financial habits are having on their lives.

“The goal of motivational interviewing in financial therapy is to elicit ‘change talk’ by using the skills of open-ended questions, affirming, reflective listening and summarizing,” she explains. “When clients hear themselves talk about potential changes, they start to believe that change is indeed possible. For example: ‘Getting my finances under control would help me sleep so much better at night.’”

To facilitate the process, Dunkle might ask someone who is money avoidant an open-ended question such as, “What is that like for you, seeing those unopened credit card statements pile up on your desk?”

For someone whose script is money worship, she might make an affirming observation such as, “It sounds as though working 70 hours a week in order to earn more income is really starting to get to you. It’s no wonder that you feel worn out.”

With a money status case, Dunkle says she could listen and reflect back by stating, “What I hear you saying is that you believe that your value in the family comes from showing your relatives how much you earn and how much you own, not from who you are as a person.”

For a client whose script is money vigilance, she might observe and summarize with a statement such as, “Wow, it sounds as though you feel exhausted, thinking that you need to check your accounts every night before you can relax and go to sleep.”

Haines also uses the KMSI as one of her tools for uncovering the narratives that drive clients’ financial behaviors. She breaks down narratives into thoughts about skills or situations and core beliefs about worth.

“Step one for both is to become aware of those narratives,” Haines says. “This can be difficult because they run so quickly in the background that we often don’t even know they are informing our behavior. Slowing down and becoming curious about our own thoughts and beliefs can be difficult, but [it] is a necessary first step.”

Haines asks clients to write down their thoughts — which she reminds them are not facts. When reviewing their collection of thoughts and beliefs with them, she asks clients to consider the following questions:

  • “What leads me to believe this is true? Is it from my own personal experience or maybe from some other influential person in my life who has told me this?”
  • “Is it always true? Is there evidence to the contrary?”
  • “If I can’t see evidence of it being true, can I hold the possibility that it’s not true?”
  • “If there is evidence of it not being true, how are those instances different, and how can I intentionally bring more of that?”

For example, many clients believe that they will never be able to manage money, Haines says. “I would ask, ‘What leads you to believe this is true? Are there instances where you have made good financial decisions that align with your values and what you want? What was different about those times? What prevents you from doing more of that? Are there skills that you need to learn? Do you need to ask for help? Is there fear involved?’”

“Once we go deep into the genesis and meaning of the narrative, it can go in any direction,” Haines says.

When a client’s narrative is about worthiness or “deserving” something (such as money or a higher paying job), Haines uses a similar, but less structured, process. “I usually ask those clients to slow down, take a few breaths, close their eyes and ask internally, ‘Whose voice is this?’ Is it yours, or is it someone else’s?” Haines notes that it is almost always someone else’s voice, such as a parent or caregiver or another figure who holds meaning for the client into adulthood.

“We then will unpack whatever comes up,” she says. “I might suggest that those who gave [the client] the message of unworthiness around something — either directly or indirectly — were struggling with their own sense of self and meaning in the world and [it] has absolutely nothing to do with my client.”

“I often will use the visual of newborns in a hospital nursery,” Haines continues. “Are some of those newborns born worthy and others unworthy? This helps them to see that feeling unworthy of something is just an internal narrative, not an absolute truth. I might ask, ‘What will it take for you to feel worthy? How will you know when you are worthy? Think of someone you care deeply about. Now decide when and what they are worthy of.’ That usually feels really uncomfortable for them [the client]. Then I reflect back that’s exactly what they are doing to themselves.”

Haines adds another common belief about money and success is that people who are rich are greedy and achieved that higher position because they didn’t care what they had to do to get there. “In essence, not having integrity,” she continues. “I have seen this a lot. An individual feels strongly about honesty, integrity and not being greedy. They want to succeed, but the people in the positions they want don’t seem to personify integrity. So, the position is out of alignment with their values, and their behavior will not support moving up. We then work on how they can create their own visual of how to be in that position from a place that aligns with their own values.”

Where does the money go?

Overspending is a problem that financial therapists see frequently. Clients show up at Haines’ office wondering why they are always in debt despite making an adequate salary. She helps clients identify what kinds of things they are purchasing and why.

“I’ve had clients who wanted to participate in getting together with friends, perhaps for dinner and drinks, concerts, plays, etc.,” Haines says. “They couldn’t really afford to do these things, but as humans, our need for belonging is so strong that we will do almost anything to fit in. I try to help my clients identify what they get out of these activities. It may be good conversation, advice, laughing together, intellectual stimulation or just not feeling lonely. We then brainstorm other ways to get these needs met, but without having to spend money they don’t have.”

“For instance,” she continues, “instead of expensive dinners, they could meet for coffee and have the same connection and conversation without the cost. If it’s intellectual conversation, maybe starting a book club. One idea that came up was to meet at a park and bring a lunch. The atmosphere is better than a restaurant, and it doesn’t cost anything.”

A possible downside is if the clients’ friends don’t want to make those changes. Then comes the difficult decision of whether the client will commit to living within their means and risk losing the relationship(s) or continue to overspend and remain in the safety of the relationship. This adds another layer of exploration about whether those relationships are, in fact, healthy and reciprocal, Haines says, but the overarching theme remains identifying what those dinners or other expensive activities are providing to clients and how some of those needs might be met in other ways.

“I will add that knowing and having a visual of the ‘why’ [the necessity] of changing financial behavior is always present,” Haines says. “Coming back to that assists with getting over the hurdles of change.”

“Keeping up with the Joneses” is another common spending impetus. Society encourages competition, such as having a nice car just because “everyone else” drives a nice car. But Haines asks clients if that really fits their core values.

“If you value a nice car and if you have one, that’s great, but if you buy a nice car because everyone in the neighborhood has a nice car, that’s going to create turmoil,” she says. For Haines, financial therapy is all about helping clients achieve what they want, not what other people think they should want.

ACA member Edward Kizer, an LPC whose specialties include financial therapy, says many of his clients are aware that they are engaging in compulsive shopping as a method of self-soothing or self-care. He teaches them simple techniques such as belly breathing to reduce their anxiety and also asks clients to think about what shopping gives them.

“If I’m expressing a need through retail therapy, what is that, and how can I feed that?” he asks. “What feeds you? Is it being creative? Is it the outdoors? How do [you] get back to nurturing yourself?”

Impulsivity is a significant driving factor in compulsive spending, says licensed professional clinical counselor Denise Kautzer, who is also a certified public accountant and specializes in financial therapy. She has clients track their spending and encourages them to follow the “24-hour rule,” which involves waiting for 24 hours after seeing something that they want to buy. In the end, they may still end up purchasing the item after giving it more consideration, but adopting this approach cuts down on impulse buys, she says. In addition, because spending often makes people feel good, at least temporarily, Kautzer helps clients identify other things that bring them joy.

Seeing the whole picture

Clients can’t manage their money if they don’t know where it’s going — or where it’s needed. Part of the financial therapy process is identifying expenses and assets: money in and money out.

Brian Farr, an LPC in Portland, Oregon, whose specialties include financial therapy, introduces what he calls a “snapshot” in the first session. “It’s a simple expenses and income and debt worksheet, not a budget or spending plan. Just a snapshot of what a typical month looks like,” he says. “It’s to help introduce them to the reality of their household finances.” Farr’s clients tell him this exercise helps give them clarity and motivation.

Like the other financial therapists Counseling Today spoke to for this article, Farr does not see himself or offer himself to clients as a financial planner. Instead, he helps clients understand their finances and develop a system to help them meet their goals.

“The freedom around money is coming up with some method that makes it visible,” Farr says. Once clients have that picture, he helps them be realistic about what they can and cannot do. That involves identifying how much money comes in and then giving each dollar a “job.”

He finds the youneedabudget.com website useful because it offers helpful videos and allows people to categorize not just their everyday expenses, but also infrequent but large expenses such as holiday gifts, a pet’s yearly checkup at the vet or car maintenance. Clients can then look at the money coming in and evaluate where it needs to go.

“If 60% already has a job to do, stop thinking that it’s yours to do with what you want,” Farr tells clients. He advises them that when they know how much of their money is discretionary, then they can make more realistic choices.

Asking clients about financial health

Many counselors don’t like asking about money. In fact, several of the professionals interviewed for this article noted that counselors often fall under the “avoidant” category when it comes to money scripts. But financial therapists say that it’s essential for counselors to be aware of money stress.

“We all have money stress,” Haines says. “I don’t know a person who doesn’t have money stress at some point in their lives. … It affects everybody.”

Counselors need not create an elaborate process to uncover a client’s money worries, Haines says. “It could be as simple as putting a question on your intake form such as: Are there financial concerns that are impacting you?”

Haines also urges counselors to listen for nuggets of information, such as clients mentioning that they hate opening their mailbox because it’s always full of bills. “You can just ask the question, ‘What impact does that have on you?’” she says. Money troubles are something that most people don’t talk about, even with their friends, so counselors can serve as that trusted person clients share those fears with, Haines emphasizes.

Haines and Kautzer both say that one of the most critical parts of their work as financial therapists is giving people hope.

 

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Laurie Meyers is a senior writer for Counseling Today. Contact her at lmeyers@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.

Opening keynote underscores a holistic approach to self-care

By Lindsey Phillips April 5, 2021

ACA’s 2021 Virtual Conference Experience started off strong with a keynote panel on self-care.

We all know self-care is important, but it can be difficult to define because there is no “correct” way to engage in self-care.

Gerald Corey, one of the four keynote panelists, stressed the importance of reflecting every day — even if it’s just for a couple of minutes — on how your day is going and what changes you want to make.

“Think of self-care holistically, and not just [as] physical exercise. Think of it in terms of relationships, meaning in life, having fun, recreating our existence, engaging in life rather than pulling back and disengaging,” says Corey, professor emeritus of human services and counseling at California State University at Fullerton.

Michelle Muratori, a senior counselor at the Center for Talented Youth at Johns Hopkins University, finds when she is tending to her self-care needs, her own internal boundaries are stronger, which allows her to be emotionally present with clients in session and let them have their own pain.

Gerald Corey, Michelle Muratori, Jude T. Austin II and Julius A. Austin, co-authors of the ACA-published book Counselor Self-Care, presented the opening keynote of the American Counseling Association’s 2021 Virtual Conference Experience on April 5. The theme for the first week of the monthlong conference is self-care.

Create a self-care plan that works for you  

Counselors can have insight and awareness, but if they don’t have their own self-care plan — one that’s simple and realistic — then change won’t happen, asserts Corey, an American Counseling Association Fellow. This plan provides counselors with an opportunity to reflect on ways they can change what they’re doing to function better personally and professionally, he notes.

“It does help to have [the self-care plan] in writing and [to] talk to somebody about it and be accountable. Think of a way to get support to carry out your plan when it becomes difficult,” Corey adds. One useful exercise may be to think about what change you want to see six months or a year into the future, he suggests. Maybe you want to make more time for a hobby or write in your journal more often.

Jude T. Austin II, an assistant professor and coordinator of the clinical mental health counseling track in the professional counseling program at the University of Mary Hardin-Baylor, advises writing this action plan in pencil because obstacles will arise that force you to readjust your plan. He loves to work out in his garage, but when it’s cold outside, he has to find another way.

Counselors can also incorporate their self-care plan into their current routines, notes Julius A. Austin, a clinical therapist and the coordinator for the Office of Substance Abuse and Recovery at Tulane University. For example, they can check in with family or listen to an audiobook during their hour-long commute to work.

Muratori, co-author of Coping Skills for a Stressful World: A Workbook for Counselors and Clients, reminds counselors that they don’t have to do self-care perfectly. Often, doing their best is good enough, she says.

Get to know your stress

Jude Austin shares advice he received from a supervisor: “Make … stress [and] anxiety your best friend. Sit them next to you and get to know them. Understand what stress does to you [and] how it influences you. What are your triggers? How do you deal with it? Who are the people around you that it affects?”

Considering these questions allows people to be intentional about how they approach self-care because they better understand their unique kind of stressors, he explains.

This reflection should also extend to one’s relationship with other people. Carefully consider who you want to be around professionally and personally, advises Jude Austin, a licensed professional counselor (LPC) and licensed marriage and family therapist associate in private practice in Temple, Texas. It’s OK to fire a supervisor or not to be friends with every colleague if the relationship isn’t working for you or makes you feel bad.

Finding ways to cope with stress can be challenging. The keynote speakers, co-authors of Counselor Self-Care, share some activities that help them better manage their stress:

  • Find some type of physical activity that you enjoy doing and that fits within your lifestyle and do it relatively consistently, Corey says. And it doesn’t have to be time consuming, he adds. You can take the stairs rather than the elevator, for example.
  • Learn something new. When graduate school became overwhelming, Jude Austin started growing bonsai trees to help him cope with the stress of having things outside his control. He still finds learning something new every year helps him manage his stress and fosters his curiosity.
  • Connect with others. Julius Austin, an LPC and adjunct professor at Southeastern Louisiana University, takes time to check in with his family, friends and colleagues. Even just a five-minute phone call with his family gives him a sense of warmth and calm after a stressful day.
  • Muratori watches late-night comedy as a way to decompress.
  • Enjoy nature. Corey advises counselors to step away from their desks and spend at least 30 minutes outside in nature every day. Jude Austin sometimes finds it challenging to leave his office, so he brought nature inside by adding a few plants to his workspace.
  • Find meaning and purpose in your life. Think about what makes you want to wake up in the morning, Corey says. He notes that spiritual involvement and service to others can often be a source of meaning for many people.
  • Go to counseling. All the speakers stressed the importance of counselors seeking their own counseling throughout their lives.

Revising self-care plans

Each new career stage presents new stressors that require counselors to constantly adjust and revise their self-care plans.

Julius and Jude Austin, co-authors of Surviving and Thriving in Your Counseling Program, are in the early stages of their professional careers, and they’ve noticed new professionals often quickly say “yes” to every professional opportunity because they are building their careers and gaining self-confidence. But this behavior can lead to burnout, so they caution new professionals to be more intentional with the job responsibilities they assume.

Corey suggests counselors say, “Let me think about it,” when approached for a professional opportunity. And then they really have to consider if that opportunity is a good one for them in that moment.

Jude Austin also finds it challenging to balance all of his daily responsibilities between his work and personal life. “Your career and family are sometimes growing in parallel,” he says. And juggling these roles is often when he feels the most out of balance.

Mid-career is often a time when people assume more work-related responsibilities, Muratori says. And they may need someone to hold them accountable and ensure they aren’t taking on too much. She also points out it’s a time when counselors may experience new family stressors such as a child going off to college or caring for older parents.

Corey credits his long, productive counseling career with two things: 1) He took the time to create a self-care plan that worked for him and encompassed all facets of wellness, including physical, emotional, relational and spiritual health. 2) He took the time to reach out and connect with colleagues. “This can be a lonely profession,” he notes. “Don’t wait for somebody else to … reach out. … It’s important for us to reach out to those friends and colleagues and take the initiative.”

Counselors shouldn’t feel guilty for taking time to care for themselves. “Pay attention to yourself; listen to yourself; allow yourself to guide you through this [self-care process],” Jude Austin says. “If something doesn’t feel right, doesn’t feel comfortable, then reevaluate. … Self-care is flexible. It’s not selfish. It’s responsible. So, just be kind to yourself.”

 

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This keynote panel kicked off a month of virtual events, including hundreds of educational sessions and three additional keynotes, that lasts through April 30.

Find out more about the American Counseling Association’s 2021 Virtual Conference Experience at counseling.org/conference/conference-2021

Registration is open until April 30; participants will have access to all conference content until May 31.

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

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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.