Monthly Archives: July 2021

Crisis counseling via text

By Bethany Bray July 22, 2021

People in distress send messages to the Crisis Text Line 24/7 looking for help and support. The organization has responded to nearly six million chat conversations since the nonprofit was established in 2013. Some people find the text line more accessible and comfortable than in-person talk therapy, notes Ana Reyes, a licensed professional counselor and bilingual manager of clinical supervision at the Crisis Text Line.

In crisis counseling, clients need a safe and empathic environment to disclose deeply troubling thoughts and emotions. But how can crisis responders create this same environment using text messages, which don’t allow the clinician and client to see or hear each other?

Reyes acknowledges that crisis counseling through text feels much different than in-person counseling and demands a different approach from the responder. Words sent via text must be chosen very carefully, with the intent of validating the texter’s experience and building rapport.

“During in-person [counseling] services, my face responds to someone’s sadness. In text messaging, my words have to be that mirror, have to communicate that empathy,” says Reyes, who does group and individual counseling at a private practice in Denton, Texas.

Reyes is among Crisis Text Line’s staff of licensed mental health practitioners who oversee the organization’s volunteer crisis counselors, who are located across the United States and come from a wide variety of backgrounds. These volunteers undergo more than 30 hours of training, a large portion of which is focused on ways to ensure safety and build rapport through text messaging, Reyes notes.

Responders are encouraged to frequently use “feeling words,” Reyes says, because they reflect the emotions a texter is describing and help them feel heard, understood and validated. “Perhaps a texter describes that they’re feeling frustrated,” she explains. “We would name that [in a text response]: ‘It feels like you seem frustrated because your mom didn’t respond in the way you hoped she would’ or ‘It sounds like you’re feeling stuck, and it’s normal to feel stuck when things aren’t going the way you hoped or planned.’” These types of statements not only validate what the texter is saying but also act as a gentle way to de-escalate the crisis, she points out.

Many of the aspects of Crisis Text Line’s response model mirror the work a crisis counselor would do in a traditional session with a client, either face-to-face or via telebehavioral health. Crisis Text Line responders begin by introducing themselves and sending the texter a confidentiality disclosure, Reyes says. They use a warm tone throughout the conversation and use open-ended questions to fully understand the texter’s situation and allow them to talk through the issue and emotions that prompted them to contact the organization.

The responders also assess for abuse, homicidal and suicidal ideation as well as self-harm or nonsuicidal self-injury. However, they don’t begin to weave risk assessment questions into the conversation until after report and trust is established. Letting the texter know that Crisis Text Line asks everyone these questions also keeps them from feeling singled out, Reyes adds.

“We acknowledge their braveness,” Reyes says, and continue to use warm tones and statements that communicate care and validation when determining risk. For example, a responder may text, “Thank you for telling me about the stress you’re facing. I just want to make sure you’re safe, and to make sure I’d like to ask, Do you have thoughts about ending your life?” If they answer in the affirmative, the responder would follow-up with more assessment questions, including whether the person has a plan, time frame or means to carry out their thoughts of suicide.

Crisis Text Line responders do not know the location, name or phone number of the person with whom they are texting, although some texters do choose to disclose their name, Reyes says. However, a supervisor does have access to a texter’s phone number and can arrange for external intervention if the texter is deemed a danger to themselves or others, she adds.

Supervisors monitor anywhere from three to 20 conversations happening live on their computer screen, and they can step in anytime a crisis responder needs additional support. They also triage the incoming texts to immediately assign those with the greatest need and queue other less urgent conversations to wait for the next available responder.

In addition to risk assessment and validation, Crisis Text Line responders help texters identify goals and next steps that could improve their situation in the short or long term, Reyes says. Responders then work collaboratively with the texter to explore the resources they have in their life, from self-care to community and social supports. If needed, they may also suggest resources to help texters with a limited or inadequate support system. They share links to national organizations that can direct them to support in their local area because they do not know where the texter is located, Reyes explains.

At the end of the conversation, the responder checks in with the texter one final time to assess how they’re feeling and validate the work they’ve done. They also summarize the next steps and resource options they discussed during the chat. Most importantly, the responder honors the courage it took for the texter to reach out and reminds them that the Crisis Text Line is available 24/7 if they need to chat again, Reyes says.

Many of the people who reach out to the organization in distress are younger, simply because younger generations are usually more comfortable with text messaging. Reyes, who recently completed a doctorate in the counseling program at the University of North Texas, notes that common presenting issues include anxiety, stress, depression, and feelings of isolation and uncertainty — many of which have been heightened during the COVID-19 pandemic — as well as bullying or academic or school-related pressures. There is also a subset of texters who struggle with sexual or gender identity issues, such as the decision to come out to family or friends, she says.

The organization hopes to reach more people with its upcoming launch of Spanish-language services, which Reyes is helping to plan.

Crisis Text Line isn’t meant to be a substitution for long-term counseling, Reyes notes, but it can be a big help to people in moments of despair. The organization does see an increase in text volume in the evening hours, which is often when people are experiencing acute moments of despair, she says. It can also be a first step toward connecting with a local counselor for long-term care.

“It’s beautiful to see how our volunteers learn and blossom through training and experience. This work is meaningful, and it is heavy, but there is also this deep knowledge that you’re helping someone who hasn’t otherwise received any support that day,” Reyes says. “The need at the center of that is decreasing the stigma of mental health services and increasing access to services regardless of financial need or language.”

Tero Vesalainen/Shutterstock.com

Crisis texting in 2020

In 2020, the Crisis Text Line engaged in 1.4 million conversations with 843,982 texters.

The organization began receiving a higher-than-usual volume of texts in March 2020, as the COVID-19 pandemic began to affect Americans’ daily life. Perhaps unsurprisingly, the most common struggles these texters identified were stress and anxiety. However, the Crisis Text Line reports that the volume of conversations in which texters disclosed feelings of depression or sadness dropped by 10% between 2019 and 2020.

Additionally, conversations in which texters expressed thoughts of suicide dropped by 20% from 2019. The Crisis Text Line supported 26,629 conversations in 2020 during which the texter was deemed to be “at imminent risk of suicide because they mentioned that they had thought about ending their lives, they had a plan, the means, and wanted to make an attempt within 48 hours.”

The Crisis Text Line has made this data publicly available in a report, “Everybody hurts 2020: What 48 million messages say about the state of mental health in America.” View the report, including data breakdowns by issue, demographics and state-by-state, at crisistextline.org/everybody-hurts.

 

 

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Related reading

Look for Counseling Today’s August cover story, “Crisis counseling: A blend of safety and compassion.”

 

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

Cultivating space for inclusivity

By Laurie Meyers July 21, 2021

S. Kent Butler says he’s an elephant in a world built for giraffes. And he is here to shake things up. 

This metaphor comes from R. Roosevelt Thomas Jr. and Marjorie L. Woodruff’s book Building a House for Diversity: How a Fable About a Giraffe & an Elephant Offers New Strategies for Today’s Workforce, explains Butler, who became the American Counseling Association’s 70th president on July 1. The elephant and giraffe are friends, but their relationship falters when the giraffe invites the elephant home. The house is not designed for the elephant. It’s tall and narrow, so the elephant has trouble navigating this space and often smashes into doorways and walls. Rather than accommodating his friend, the giraffe suggests the elephant change itself to fit in the giraffe’s environment by taking up aerobics or ballet.

Like the giraffe, the counseling profession hasn’t always created space for individuals in marginalized communities to hold leadership positions, Butler points out. In the past 70 years, ACA’s leadership has primarily been white, with Butler being only the second African American man to serve as president.

“Leadership can look different and still be good,” Butler stresses. 

As Butler notes, the counseling profession will have to continue to reshape itself to accommodate diverse leaders. “And this change will not be easy or comfortable,” he admits. “It will shake things up. Now we’re making way for other people to come into this counseling space and work together to build a better environment for all.”

Man meets moment

Cyrus Williams, a counseling professor and director of the counselor education and supervision doctoral program at Regent University in Virginia Beach, finds this era — one in which COVID-19 has laid bare this country’s health disparities, Black and brown people continue to lose their lives in acts of police brutality and racist attacks on Asian Americans continue to escalate — a perfect time for Butler to take the helm as ACA’s president. 

Facilitating difficult conversations about racial reconciliation, co-conspiratorship and the effects of racial injustice on communities is his area of expertise, Williams says. “He’s been working at this since we met, this has been his journey,” he says.

Williams was working in student services at the University of Connecticut while Butler was studying for his doctorate in counselor education and counseling psychology. “There weren’t a lot of Black men on campus,” he says. “We found each other and became friends.”

Because they both shared a passion for working with low-income, first-generation college students, they later collaborated on several work projects, including scholarly publications. 

Butler is a professor of counselor education and the former interim chief equity, inclusion and diversity officer at the University of Central Florida as well as a fellow of the National Association of Diversity Offices in Higher Education. 

He also is a past-president of the Association for Multicultural Cultural Development (AMCD), a division of ACA, but as Williams notes, his presence extends far beyond that. Butler has made myriad connections within the association — not just as a leader but through scholarship and professional collaboration, he says. 

It’s not just the many relationships that Butler has established that will make him an asset as president — it’s his commitment to what ACA represents, points out Ann Shillingford, his wife and colleague at the University of Central Florida. “He has a passion and dedication for the counseling profession — there’s no doubt that he takes it to heart,” she says.

Butler is also a people person, who is good at listening to people and getting to the heart of what they really want — “kind of like peeling an onion,” Shillingford adds. 

She says that Butler is an introvert until he gets to know you. Williams agrees, noting that Butler loves gathering with friends and family. During graduate school, Butler hosted a holiday party for graduate students and friends at the clubhouse of Williams’ condo. Butler spent the entire day before the party gathering supplies. At 1 a.m., he was still running errands when he got caught in a snowstorm. He walked toward the clubhouse, holding a large pan of his aunt’s famous macaroni and cheese, and slipped and broke his ankle. The macaroni and cheese went flying in the air, but unlike Butler, it remained unscathed. He then drove himself to the emergency room and still made it back in time for the party. 

“When Kent talks to you, he is fully engaged,” says Tony Crespi, a psychology professor at the University of Hartford and one of Butler’s former instructors. “You think you’re the only person in the room.”

Crespi also speaks of Butler’s sharp intellect and passion for learning. “I’m someone who gives written feedback on papers,” he says. “I want people to really write well, be persuasive.” Crespi says it’s not uncommon for students to groan over his rigorous standards, but not Butler. He would come to Crespi after class and ask him to go over the comments so that he could understand and make his articles better.

Because Butler came from a counseling psychology program, he could have easily chosen to become a psychologist like many of his peers did, Crespi adds. But instead, he was very intent on becoming a counselor. 

“I think my journey has been one in which I was led to counseling,” Butler says. “I was doing the work of counselor in many roles before getting into counselor education.” As an undergraduate, Butler mentored a number of other students, and then as a graduate student, in addition to his work with college students, he worked with Upward Bound, a federally funded program that provides academic support to low-income and first-generation high school students to prepare them for college.

“I was always working with young people and helping them to become their better selves,” Butler says. “It became really important to me in my degree program to strengthen my skill set in a way that fit with what I was already doing.”

Talking about racial justice

If Butler is the man for the moment, the moment almost missed its man. Violent racism nearly erased the possibility of his existence long before he was born. When Butler’s mother was just 10 years old, an unidentified group of white community members set fire to the house where she, her 14 siblings, her father and her mother — who was pregnant with her 16th child — were living. The fire, which started in the basement, was ignited in such a way that the family was unable to access the doors. The oldest siblings broke some windows, jumped out and caught the other family members as they leapt down from the second story of the dwelling. Miraculously, everyone survived. 

The family lived in a firehouse for a while afterward while Butler’s grandparents worked to make the barn on their property habitable. In an incident that was yet more proof of how much the neighbors didn’t want his mother’s family around, the barn was burned down before they could move in.

“Law enforcement didn’t pursue any leads even after my family told them about hearing voices in the basement before the fire started,” Butler says. And like so many other hate crimes, these cases of arson were never solved.

And yet Butler’s mother and father, who also grew up surrounded by signs that blatantly advertised society’s complete rejection of Black people, “still persevered,” he says. They saw the good in the world and made sure that Butler and his sisters knew that — despite the messages they might receive from society — they were in no way less than anyone else.

Butler says that over the years, his mother taught him not to spend his energy on causes that are unwinnable or to argue just to argue. He has used that lesson in his racial justice work as a reminder to meet people where they are. 

“Me going toe to toe with someone to try and solve an issue is not going to change anything if we aren’t listening to each other,” he says. “If I’m only speaking to hear my point and I’m dismissing yours, then I am not going to help change the narrative. If I want to make people understand where I’m coming from, I have to set a tone and create a space where people can hear me, and I have to speak with enough authority about what I know so that people will listen and take it in.” 

At the same time, Butler points out that it’s difficult to get white people to come to these conversations. “The false narrative of fragility gets in the way,” he explains. “To be truthful, racism was not perpetuated from or benefited by fragile people. So, in that vein, we should not legitimize that white people are powerless against dismantling racism.” 

“We need white people to recognize that this is not about them,” he says. “This is about racism and … systems that are in place. All of us have a role in that and so opposed to me having to come and cater to your guilt or fragility, what I want to do is come to the conversation.” 

“We already know what the issue is,” Butler continues. “I’m not here to hassle with you about whether or not you are racist. I’m here to highlight the fact that racism exists, and we need to change the system. So, get out of your own way. It’s not about you at this point, it’s about trying to change the fabric of America so that all people can be accepted and be a part of the American dream [and] the access to equity that I think all individuals should have.”

Butler asks white counselors to become not just allies but co-conspirators. Allies often are the ones who approach Butler after he speaks about social justice and racial issues or after a meeting and say, “I really like what you said,” leaving Butler to wonder why they didn’t speak up during the meeting. Co-conspirators, however, help pave the way for marginalized populations through education and anti-racism work and speak out against racism when people of color can’t be or aren’t in the room. 

In fact, what people say when he’s not in the room is just as important. “Say it in the room,” Butler stresses. “Be there and help move the narrative forward in the room. People who are willing to speak up, stand in the gap [and] help change the narrative, those are the co-conspirators.” 

Michael Brooks, an associate professor of counseling at North Carolina Agricultural and Technical State University, agrees that “it’s time for other [white] people to put action behind their words.” He and Butler met through AMCD and have forged a bond based not only on professional interests but also on the difficulties of being a Black man in counselor education.

“Kent is a large man with a dark complexion — he gets judged well before you get to know him,” says Brooks, who has a similar problem. Butler and Brooks often discuss how they have to be mindful of what they say and what gestures they use because they are constantly at risk of being misunderstood, misinterpreted and stereotyped. 

Brooks is excited that another Black man has been elected as ACA president, but as he points out, “the fact that Kent is [only] the second Black, African American male to be president should be embarrassing, and the counseling profession should be asking itself why it’s taken so long.”

Brooks is also aware that there is only so much one can do in a year, so he hopes the counseling profession has reasonable expectations of how much Butler can accomplish during his presidency.

Butler in Dubai in June 2016.

Football, family and far-flung places

Although Williams often has to remind Butler about maintaining work-life balance, ACA’s newest president does take time to relax. Shillingford says he’s a huge Dallas Cowboys fan and has assembled so much merchandise that she finally put her foot down about more memorabilia entering the house. She also admits to occasionally diverting Cowboys’ apparel to Goodwill. 

Butler also loves listening to music — particularly jazz, rhythm and blues, and gospel. He declares himself a night owl, which he admits is a problem when you have to get up early. He’s prone to staying up late doing work and occasionally watching shows he previously recorded. 

He and Shillingford love to travel — for work and pleasure. Some of their favorite places include Barcelona, Hawaii, St. Thomas, Dominica and South Africa. Butler says he would like to return to Africa and visit other countries, particularly Liberia because he discovered through DNA testing that he has family roots there. Butler and Shillingford also relish spending time at home with their 9-year-old daughter, Summer Joy, and Shillingford’s son, Justin, who is 21.

Butler with his wife (M. Ann Shillingford), stepson (Justin Ford) and daughter (Summer Joy Butler)

Presidential influence

One could say that Butler is now hoping to use his personal and professional life experiences to help the counseling profession become its best self. 

Because racial injustice and other inequities have imprinted themselves in such stark relief, “we have to pay attention to how systems are affecting different groups,” Shillingford says. Butler is hoping to use his platform to address issues of diversity linked not only to race and ethnicity but also to gender, disability, immigration and other intersections, she says. 

Butler’s overall goals for his presidency include helping the profession realize that people from varied groups and intersections can be leaders. “I think so often we look to a leader to be a certain type of person,” Butler continues. “We need to bring all people to the table. It’s about inclusivity.” He also plans to create leadership initiatives that help to develop future diverse leaders. 

Counselors should bring diversity to their client base as well, he adds. He urges his fellow counselors to consider what the profession is doing to dispel the stigma and distrust held by marginalized communities to help people see counselors as a supportive resource that can help them navigate life’s challenges and improve their mental wellness.

Because the presidency is only for one year, Butler has spoken with Williams about how he hopes to create initiatives that will continue to thrive long after his term ends. Butler “wants to be able to replace himself,” Williams says, with leaders who will continue the work of fighting injustices and eliminating disparities within mental health care systems. 

He also wants to make sure that the counseling profession maintains the current momentum for diversity, equity and inclusion. He hopes to help counselors begin to engage in difficult dialogues and become social justice advocates.

Butler is at a point personally and professionally where he is ready to speak his truth. “This is my story, my narrative,” he says. “I’m coming to expose you to my experiences. I’m going to be truthful about who I am. I’m not here to step on toes, but if your toes are in the way, move.”

S. Kent Butler, ACA’s 70th president

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Read S. Kent Butler’s first presidential column from the July issue of Counseling Today: “Shaking it up and tapping you in

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Laurie Meyers is senior writer at 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.

Counselors as agents of change

By Laurie Meyers July 19, 2021

Bernadine Craft was the only female senator during her time in the Wyoming legislature. Photo courtesy of Bernadine Craft.

Counselors speak for the least, the lost and the lonely, says American Counseling Association member Bernadine Craft. That advocacy, she believes, should extend beyond office and classroom walls.

Craft has worn many professional “hats,” including former school counselor, licensed professional counselor, volunteer lobbyist, former Wyoming state legislator and ordained Episcopal priest, and she reflects on her innate passion for advocacy and the path to policymaking that started with her involvement in ACA governance.

A counselor takes the stage

Craft’s journey as an advocate began on the stage, so to speak. “I started out as a piano performance major, but I figured out that they didn’t eat so well,” she jokes. So, she switched her undergraduate major to speech and theatre with the intent of getting her teaching certification and continuing on to graduate school.

A chance conversation with the director of one of the plays Craft performed in set her on a course to become a counselor. Knowing that Craft had set her sights on a master’s degree, the director asked her what her area of study would be.

“I have no idea,” Craft told him. And he replied, “I think you should go into psychology. I think you’d make a hell of a counselor — you interact so well with people.”

Although psychology did intrigue her at the time, she wanted to work in a school setting. Craft’s director suggested she take a few classes to see if she liked it. The more Craft thought about it, the more the idea appealed to her. She loved talking — and listening — to people, so she took some psychology courses and ended up loving it. Craft went on to get her master’s in educational psychology and became a school counselor.

Speaking up

While working as a school counselor, Craft became active in ACA at the regional level as chair of the Western Region and president of the Wyoming Counseling Association, where she found her passion for advocacy in the push for counseling licensure. She also served on the Governing Council as president of the Association of Humanistic Counseling. Craft credits her training in speech and theatre as well as her experience on her high school debate team for giving her the confidence to campaign so passionately.

“I wasn’t afraid to speak in front of others,” she says.

Craft decided to continue her education by earning a doctorate in professional psychology. At first, she intended to become a counselor educator, but a severe illness kept her from pursing this career path. Instead, she maintained her private practice and started lobbying for educational issues as a volunteer. In 2004, Craft became the executive director of the Sweetwater Board of Cooperative Educational Services, an educational co-op created between Western Wyoming Community College and Sweetwater County School Districts 1 and 2 to provide educational services not otherwise available to community members.

Working for Wyoming

In 2006, in a move Craft describes as “out of the blue,” a former schoolmate approached her about filling an upcoming vacancy in the Wyoming legislature.

“I responded almost exactly the way I would have responded if someone had said they wanted me to run down the street nude,” Craft says. Although she’d always been interested in current affairs and advocating for issues that she cared about, the thought of running for political office had never occurred to her. Craft’s friends and colleagues urged her to run because they saw something special in her. It took a long time for her to decide, but in the end, Craft realized that if she didn’t do it, she would spend the rest of her life wondering what it would have been like.

“I decided to be the voice of the voiceless,” she says. “Big lobby groups can make their voice heard because they have the money.”

Craft was particularly passionate about women’s rights and the protection of children and animals. During her time in the Wyoming House of Representatives (in 2006) and later as the only woman serving in the Wyoming Senate (from 2013 to 2017), Craft helped sponsor bills such as the 2011 Wyoming Safe Homes Act, which allows people who are experiencing sexual or intimate violence to break their leases without penalty. She also worked to protect survivors of intimate violence and helped make strangulation a felony in Wyoming.

Counselors as natural advocates

Craft ran as a Democrat, but during her ten years as a legislator, she was able to hammer out agreements with her colleagues on both sides of the aisle. She believes that counselors are uniquely qualified to build consensus.

“Counselors are particularly good at listening [and] seeing both sides of issues,” she points out. They’re also good at going beyond binary thinking, or as Craft puts it, “not falling into the pit of black and white-ism.”

“I wish more counselors would consider elected office,” Craft says. People go into counseling because they care about people and want to make life better for them in whatever way they can, so she asks, “Who better to advocate for ‘the average citizen’ than counselors?”

“Granted, not everyone is comfortable running for office,” she acknowledges. “Not everyone is comfortable standing up speaking, but I bet you are comfortable identifying someone who is.”

There are other ways counselors can engage in political advocacy. Craft notes that everything she accomplished was through the help of an “army” of people who sent out emails, made phone calls, knocked on doors and coordinated mailings.

Legislators also need people to research, she says. Craft and a colleague who was a women’s studies professor worked together on legislation involving human trafficking, which is a broad and complex topic, she notes. The colleague’s aides were invaluable when it came to doing background research, Craft recalls.

“If you’re interested and really do want to be an advocate at some level, don’t let anything stop you,” she urges. “What can you do in your hometown? I think you can find a niche at whatever level you’re comfortable with, whether it be local, state or national.”

Craft notes that people often think that if they can’t make a big and splashy effort, they can’t do anything at all. But there are so many things counselors can do that will still move issues forward. Even two hours a week researching or contacting legislators can go a long way, she says.

“Don’t say, ‘I don’t have any time; [I] don’t have any money,’” Craft advises. “Don’t do the big stuff. Do what you can at the level you can.”

Craft is pictured at the Wyoming capitol building sitting at the feet of another pioneering Wyoming woman, Esther Hobart Morris, the first woman to hold judicial office in the modern world. Photo courtesy of Bernadine Craft.

 

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On March 11, Bernadine Craft was a featured speaker for Mapping a Courageous Leadership Journey, a professional development webinar cosponsored by ACA and She Should Run.

 

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Laurie Meyers is senior writer at 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.

Game, set, mental health

By Lindsey Phillips July 13, 2021

Naomi Osaka in 2015. Mai Groves/Shutterstock.com

Tennis superstar Naomi Osaka joined the growing list of athletes who are putting their mental health first when she decided to withdraw from the French Open in May, a few days after being fined for refusing to participate in post-match news conferences with the media. She shared on social media that her decision was made to protect her mental well-being, noting that she has suffered with depression since 2018 and experiences anxiety over speaking with the media.

In a recent New York Times article, Alan Blinder says that Osaka’s decision to withdraw from the French Open was “a potent example of a movement among elite athletes to challenge the age-old notion that they are, and must be, as peerless in mind as they are in body, untroubled by the scourge of mental illness.”

Osaka also decided not to participate in Wimbledon and will instead focus on representing Japan at the Tokyo Olympics later this summer.

Athletes are often held up to unobtainable standards and viewed as superhuman because of their amazing physical talents, says Michele Kerulis, who is a licensed clinical professional counselor with a private practice in Illinois and holds a doctorate in counselor education and supervision. People expect them to be “perfect, excellent, exquisite and all those unbreakable things,” she explains. “But athletes are people who have the same spectrum of feelings that we all have. They feel anxiety, depression, guilt, shame, embarrassment, and so on, and … they are put under a microscope when they have any kind of a feeling that the media or the public doesn’t perceive as fitting within that sport.”

Overcoming the stigma

The stigma attached to depression, anxiety and other psychological conditions often prevents athletes from discussing their mental health needs out of fear they will be seen as weak. And for some college and professional athletes, there’s an added worry that their mental health may cost them their scholarship or contract, points out Kerulis, a professor of counseling at Northwestern University who specializes in sports, exercise and the impact of media on sport psychology.

This fear is not unfounded. Taunya M. Tinsley, a licensed professional counselor and owner of Transitions Counseling Services in Paoli, Pennsylvania, has heard coaches refer to players’ struggles with mental health in a critical or belittling way by making comments such as, “What’s wrong with you? Are you not on your medications?” This attitude further discourages athletes from being open about their mental health.

“Just because somebody has strong athletic skills does not mean they’re not going to suffer from mental health challenges, so [counselors] have to help put the humanistic aspect back in,” stresses Tinsley, a member of the American Counseling Association who specializes in sports counseling, multicultural and social justice issues, and spiritual and Christian interventions. Clinicians must help “athletes and those who work with athletes understand that … we can’t separate the mental and emotional wellness from the physical wellness.”

Mental training

Athletes often ask Kerulis, an ACA member and an Association for Applied Sport Psychology fellow, to help them “get in the zone” a few days before a big game or event, and she lets them know that mental training takes time.

Coaches help athletes with the physical and strategic techniques, Kerulis notes, and trainers ensure athletes’ muscles are strong and prepared for the movement required in their sport. “The next piece is practicing those physical techniques [and] developing the muscle memory. When they are learning new skills or techniques, part of it is understanding they’re not going to ace this the first time they try it, and that’s part of what practice is — repetition and trying over and over,” she says. “And it’s the same thing with any psychological skills that athletes are learning. You integrate that into their practice setting.”

Like a strength trainer, Kerulis slowly works with clients using therapeutic approaches such as mindfulness, cognitive behavior therapy, imagery, relaxation and arousal control to help them improve their mental focus.

A basketball player, Kerulis explains, spends most of the game sprinting up and down the court, sweating and elevating their heart rate. But when the player gets fouled, they must quickly transition from this accelerated state to a calm one to successfully hit the free throw. That process requires mindfulness and body awareness, Kerulis notes. She might work with the basketball player for a few weeks to develop a progressive muscle relaxation (PMR) script (slowly tensing and relaxing muscles throughout the body) and help them learn how to scan their body and notice bodily sensations. Then, when they are at the free-throw line, they can do a quick body scan, release any tension and shoot.

“What you might see in a split second could takes weeks of preparation,” she points out.

Anxiety and interpersonal skills 

It’s common for athletes to suffer from performance anxiety. Kerulis, the Association for Multicultural Counseling and Development (AMCD) Midwest Region representative and outgoing chair of the Midwest Region of ACA, once worked with a teenager who was a runner. Before every meet, he felt nauseated and dizzy, and no matter how he did, he felt distraught after it was over. He had already been medically cleared to participate and wanted help overcoming these physiological responses to his anxiety.

In session, they used the cognitive behavior therapy technique of thought stopping to help the client disrupt the negative thoughts he often had a few days before each meet and replace them with positive mantras or statements.

Kerulis’ client was scared to tell his coach about his anxiety because he thought the coach might not let him race. Kerulis asked if the coach had noticed his anxiety and the change in his behavior, and the client said, “Yes, absolutely.” So, they discussed how the coach was probably already wondering why the teenage runner was behaving differently.

This conversation helped the client realize that asking for help was a sign of strength, not weakness, and would show his desire to improve, Kerulis says. With her help, the client prepared talking points to lessen his anxiety around having that conversation with his coach.

The teenager also improved his communication with his parents by explaining that he wanted to have more positive thoughts going into his races. His parents were supportive and checked in with him before each meet, asking, “How are you feeling today? How’s your mantra?”

Identity development

It’s important for counselors to assess where athletes are in terms of their identity development and tailor treatment plans to help them explore identities outside of their sport, says Tinsley, the clinical director of the Mount Ararat Baptist Church Counseling Center in Pittsburgh.

Some individuals may have a foreclosed identity and only see themselves as an athlete without exploring other aspects of their identity, she says. Then a career-ending injury or retirement will cause them to question their identity: Who am I without this sport?

Kerulis finds that if someone’s sole perspective of themselves is being an athlete, they tend to have a more detrimental response when something upsetting happens in the sport. Whereas an athlete with a foreclosed identity may feel extreme disappointment after losing a game, for example, another athlete who has a more open identity would not be as devastated because they have other interests in life and feel more balanced.

In other cases, athletes may have discovered additional interests outside of their sport, but their primary identity as an athlete prevents them from pursuing those interests, says Tinsley, a past president of AMCD. For example, an athlete might want to major in health sciences in college, but their sport schedule hinders them from taking the required classes or putting in the necessary work.

Tinsley begins her sessions by asking questions unrelated to the client’s sport so she can get to know the person, not the athlete. She may ask, “What are your interests when you aren’t playing the sport? Who do you have a good relationship with in your family?”

Kerulis also encourages athletes to maintain diverse interests unrelated to sports. “That’s not to decrease the importance of preparing mentally for [their] sport,” she says. “It’s to help create a more well-rounded individual so if and when they experience difficulties, tough times or roadblocks in their sport, they have this balance … and [can] reset.”

Prevention

Counselors should focus on the prevention of mental health problems with the athlete population, Tinsley stresses. Part of that involves creating life-skills programs that help athletes plan for retirement before it happens so the transition is not a shocking, traumatic event.

Tinsley has worked with the National Football League (NFL) and the Pittsburgh Steelers to provide mental health services to athletes and to train former NFL players to serve as transition coaches between current athletes and mental health professionals. This work introduced her to LaMarr Woodley, a former linebacker for the Steelers who had already started thinking about his transition from the NFL by launching a Sack Attack Program in 2009. Through pledges, every sack Woodley made raised money for youth charities in Pittsburgh and his hometown of Saginaw, Michigan.

Woodley explains in a recent interview with Tinsley how despite some people’s insistence that he focus solely on football, he knew he needed to start preparing for life after his NFL career. He notes how parents and coaches are pushing kids to become professional athletes at younger ages, and this pressure can lead to burnout, stress, anxiety, substance use and other mental health concerns.

Counselors can help prepare athletes for these transitions, Tinsley says. She worked with Woodley to consider his next career options, and eventually, he decided to earn his master’s in sport management studies with a sports counseling concentration and continue to help athletes as they navigate the internal and external pressures that can affect their mental health.

In a Time magazine essay, Osaka stresses the importance of athletes (like other career professionals) being able to take mental health days without scrutiny or explanation, and she reminds us that “it’s OK not to be OK.” Going forward, perhaps more athletes will follow Osaka’s example of putting her well-being above her sport.

Kerulis applauds Osaka’s choice to prioritize her mental health. “It’s so hard for people to admit difficulties,” Kerulis says. “Some people are calling [her decision] a failure, but … it may be one of the biggest successes of an athlete’s career to be able to put themselves first and say, ‘I understand the importance of this competition, and at the same time I know that I need to take care of myself or else I cannot be the outstanding athlete that I know I am.’”

 

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American Counseling Association members: Interested in exploring connections between sports and mental health? Join ACA’s Sports Counseling Interest Network.

 

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Lindsey Phillips is the senior editor for Counseling Today. Contact her at lphillips@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.

A hero/heroine’s journey: A road map to trauma healing

By Federico Carmona July 8, 2021

American mythologist Joseph Campbell dedicated decades to studying ancient texts and oral stories told in different cultures around the world. Campbell realized that most mythological quests in every culture followed a pattern he called the “monomyth.” 

This thematic tool was conceived with the notion that all of humanity, in all its diversity, reflects similar existential pursuits and living experiences. They are all part of an unknown larger universe or state of existence. In this pattern, a hero embarks on a journey to slay a monster, recover a precious artifact or rescue someone — the main objective always being to save the world from the end of times or from a great evil. 

This journey is full of challenges that threaten both the hero’s known inner world and the present mission, whatever that may be. Each obstacle the hero overcomes thematically shows a different lesson from which one can learn. The hero thus grows in skills and self-awareness as the journey continues. By the time the hero confronts the problem, or whatever serves as the primary antagonist of the story, they have evolved into a more superior version of themselves, a progression that doesn’t stop as the hero returns with the prize. This evolution holds the hero in an enlightened state of grace, able to understand and deal with the mundane and transcendent way of life.

Campbell described this idea in the book that made him renowned in the literary and artistic communities, The Hero With A Thousand Faces. Published in 1949, Campbell’s three-part presentation of the hero’s journey encompasses departure (embracing the journey), initiation (confronting and accepting change) and the return (maturing and moving forward). This echoes the stages of development of the human psyche, which involves transitioning from childhood to adulthood to the individuation or full realization of Carl Jung’s vision of the human psyche’s developmental climax — emotional maturation and connection with the transcendent.

In her book The Post-Traumatic Growth Guidebook: Practical Mind-Body Tools to Heal Trauma, Foster Resilience and Awaken Your Potential, Arielle Schwartz introduces the idea of looking at trauma recovery as a hero/heroine’s journey. Schwartz describes Campbell’s hero’s journey as a classic plot structure that has inspired a variety of literary and cinematographic works for generations. Schwartz contends that Campbell’s hero’s journey can also be applied to trauma healing. People can relate to this journey as they find themselves triggered into a crisis due to a traumatic event, the accumulation of stress or memories of abuse or neglect. 

Emotional crises usually take us into dark and painful places. The hero’s journey, Schwartz argues, encourages people to transform that pain and fear into a guiding wisdom toward self-awareness and emotional growth.

Healing is a journey

We tend to perceive and pursue healing, happiness, meaning and self-fulfillment as a linear and clear destination. However, these quests are meant to be experienced as a journey and not as one’s end goal. In the progression of the journey, one can experience healing and continue to pursue it. That is because there will always be something to heal in our physical, emotional and spiritual selves. Life never stops giving us challenges that provide us with valuable experiences.

Overcoming psychological trauma, while growing emotionally, intellectually and spiritually, is a journey that can be viewed as both challenging and rewarding. I would go so far to say that healing from trauma is a sacred journey. It requires venturing into the deep self to plant the seeds of healing, ultimately bringing forth a better version of one’s self. However, this journey requires a hero. The person affected by trauma is the one who embarks on this journey, and there is no vicarious substitution for the journey.

Venturing into the unknown is scary. Worse, becoming a hero is a terrifying task and a huge responsibility. Thus, many people would prefer to decline the invitation or call to healing because there is something comparatively cozy about that state of trauma. People who have lived parts of their lives in trauma are used to that state because it provides familiarity. Therefore, some will embark on the hero’s journey on their own, others will do so at a time when they have more support, and others will never respond to the call.

Therapeutically speaking, counselors walk along with clients who decide to take the journey of healing from trauma. Counselors also patiently prepare and encourage those clients who are doubtful about embarking on the journey because of its tremendous responsibility. Likewise, counselors understand and comfort those clients who refuse the journey because they are terrified of the pain and paralyzed by fear of the unknown.

Trauma-informed counselors understand that trauma is a neurobiological and emotional response to a frightening and upsetting experience. Trauma can be either a one-time or prolonged experience that affects a person’s outlook, beliefs, emotions and behaviors in their day-to-day life. Treatment plans include goals that deal with the most distinctive consequences of trauma:

  • Sense of powerlessness
  • Nervous system dysregulation
  • Self-devaluation
  • Disconnection from self

Clients who make the adventurous yet painful decision to embark on this journey will notice that they are building resources and improving their self-awareness with every step. This emergent growth is critical when confronting inner and outer obstacles while embracing change. As clients grow in resources and self-awareness along the way, they will also notice a developing improvement in the way they see themselves, others and the world. People living in trauma are reactive to life’s circumstances, whereas people living beyond trauma are proactive to life’s circumstances.

What kind of hero is needed?

Campbell set the record straight for doubters. The hero archetype is for anyone who finds the strength to embrace the call to the journey and perseveres in it, despite the overwhelming circumstances that may be facing them. This is because they believe in the healing purpose of the journey or are looking for something that is more significant than themselves. 

The hero is expected to learn an important lesson from the journey — that life is a constant and contradicting experience of good and bad things, all of which must be lived through willingly. Campbell also depicted the archetypal hero in different roles: as a warrior, lover, emperor/tyrant, redeemer and saint. Each of these roles represents a stage of the cosmogonic cycle, a mystical realm in a pure spiritual form transitioning to a physical manifestation and returning to the beginning.

The hero-warrior slays the monsters and tyrants of the hero’s past and present, ushering the hero’s community into the future. This hero-type promotes the renewal of life as the living God does. The hero-lover represents the connection with the transcendent, the relationship of humanity and the divine. The hero-emperor rules the earth as the living manifestation of the mystic realm. Human after all, the emperor becomes a tyrant as he learns to love flattery more than the relationship with the divine. The new hero-tyrant then is no longer the mediator between the human and the divine. The hero-redeemer bears more than a likeness to the divine, as they are one. In this oneness and incarnation with the divine, the redeemer is above the typical temptations of the flesh and ego. This hero’s mission is to save the world by confronting the divine tyranny that the hero-tyrant imposed on the world. After teaching “a new way of being in the world,” the hero-redeemer confronts such tyranny by sacrificing themself. The saint is a spiritual role and is the highest calling of a hero. This hero’s story is the beginning and end of the cosmogonic cycle — the spiritual creating the physical, which in time returns to its source.

The journey of trauma healing is a mixed bag of the mythic (fighting the beasts in the unconscious), the spiritual (believing and trusting in something bigger than oneself), the emotional (knowing and loving oneself), the intellectual (understanding and embracing change) and the practical (living beyond trauma). Every hero’s role is an aspect of the archetypal hero in Campbell’s monomyth. But do we need them all to achieve enlightenment?

This healing journey requires slaying the monsters and tyrants (one’s ill attachments) of the past and present so that one can move forward with renewed life. Love is also needed to connect with the self and the transcendent. This connection brings wisdom, order and redemption to the chaos of the unconscious. Whatever the task may be — e.g., healing from the wrongness of others or the self, rescuing the child-self frozen in time, healing from intergenerational trauma — the journey of trauma healing requires specific qualities and steps. These are:

1) Determination to let go of insecure attachments and tendencies.

2) Love to connect with oneself in the emotional and transcendent.

3) Wisdom to understand and integrate the self.

4) Pragmatism to live sensibly yet realistically beyond trauma.

A road map to healing

Living in trauma is living in emotional extremes, which is an impairment to one’s self-regulation. Thus, overcoming trauma requires two basic things: 

1) Regaining nervous/emotional self-regulation, which is the ability to face and make sense of one’s feelings and emotions rather than avoid them or shut them down.

2) Understanding and accepting one’s inner self rather than ignoring it. 

One-third of trauma work is teaching clients what trauma does and how the human body responds to it. The second third is reconstructing clients’ lost sense of safety, even in the face of uncertainty, and fostering reconnection with the self to reclaim control over it. As this process develops, clients grow in trust and self-compassion, which are key elements in overcoming self-imposed isolation due to the negative perception of self, others and the world around them. The final third of trauma work is integrating the traumatic experience by changing the narrative of the adverse experience in the here and now.

The proposed road map to trauma healing works well in 12-week psychoeducational groups of 90-minute sessions. The idea is to empower qualified participants with a concrete structure and strategies to do the work on their own. Each session is designed to introduce group members to new coping skills and life strategies to help them:

  • Establish a sense of safety
  • Achieve emotional regulation
  • Integrate traumatic experiences
  • Move beyond trauma

In his book Modern Man in Search of a Soul, Jung wrote, “The shoe that fits one person pinches another; there is no recipe for living that suits all cases.” The same holds true for various trauma treatments. Thus, this road map to trauma healing is adaptable. It is based on a variety of experts’ work in the interdisciplinary field of interpersonal neurobiology, which seeks to heal trauma by stimulating the brain’s neuroplasticity with positive persuasion and support.

Stage I: Establishing safety and competence

>> Step 1: Understanding oneself and one’s world. Clients are introduced to a short self-assessment and the art of journaling. The six-domain self-assessment is to be filled out with short phrases or single words to provoke enthusiasm for journaling. Clients are encouraged to revisit it as needed throughout the journey. Find the assessment at https://tinyurl.com/3yumcynf.

>> Step 2: Understanding the journey of healing. Clients learn about what trauma is and does and how the body responds to it. The Adverse Childhood Experiences (ACEs) study is introduced so that clients can find their ACEs score. The positive power of resilience is introduced to bring hope and direction to such a complex topic.

>> Step 3: Changing one’s story. Clients are introduced to the unhelpful thinking styles that prevent them from envisioning a better version of themselves and to the ABC model (adversity or activating event, beliefs about the event, consequences) in order to challenge and modify their cognitive distortions. Clients are also introduced to setting meaningful goals based on healthy personal values and beliefs. They learn that it is better to depend on new healthy habits than on motivation alone.

Stage II: Establishing self-regulation

>> Step 4: Learning to relate to others healthily. Clients are introduced to the topic and practice of healthy boundaries. They learn the degree to which setting healthy boundaries can ease their inner conflict in saying “no” while boosting their self-esteem and improving their relationships.

>> Step 5: Improving self-reflection and introspection. Attachment theory is introduced to foster self-reflection on patterns of thinking, behaving and relating to others and self. Identification with a dominant attachment style is critical to understanding what is needed to move toward a more secure attachment adaptation. Dan Siegel’s concept of “mindsight” is also introduced.

>> Step 6: Learning self-regulation (body and emotions). Clients are introduced to the skills of tracking, resourcing, grounding and others from the Community Resiliency Model to become familiar with their bodies, emotions and resources. Clients are also introduced to the practice of mindfulness. This step requires two group sessions.

Stage III: Integration of the traumatic experience

>> Step 7: Composing the narrative of trauma. Clients are introduced to the process of creating a coherent narrative. Techniques from narrative therapy, narrative exposure therapy or trauma narratives can be tailored to the group’s need (type of trauma) in this step.

>> Step 8: Reframing the trauma narrative. Clients are guided to see their narratives from the vantage point they have in the here and now. At this point in the journey, clients have grown enough in knowledge, self-awareness, skills and coping strategies to make favorable comparisons and lower the intensity of their fears and other negative emotions.

>> Step 9: Building self-acceptance. Clients learn to accept and integrate their reframed adverse experiences while facing the emotional consequences of trauma (e.g., shame, guilt, self-loathing). Strategies from acceptance and commitment therapy, cognitive processing therapy, transactional analysis or internal family systems can be helpful depending on the group’s need. In individual counseling, consider referring clients who feel stuck processing their negative emotions to a therapist trained in eye movement desensitization and reprocessing. This step requires two sessions.

Stage IV: Consolidation

>> Step 10: Transcending trauma. Clients learn that helping others is self-care. Love and connection with oneself and the transcendent facilitate acceptance and integration. Clients are invited to reflect on their journey from victim to survivor. Siegel’s mindsight levels of integration are lightly introduced to motivate clients to persevere in their healing journey to thrive in life.

Conclusion

Everyone faces and grieves their adverse circumstances in their own way. Some people become more resilient and wiser the more hardships they face. Other people become trapped in trauma and the victimizing sequel of their adverse circumstances, even after those circumstances have passed. 

People who overcome trauma grow emotionally, intellectually and spiritually from their adverse experiences. They are better prepared to face life circumstances and make better choices. They understand that helping others is critical to their own healing and well-being. People trapped in trauma remain focused on surviving their recurring adverse circumstances and their ensuing cycles of emotional turmoil. 

Applying this road map to healing also works well in individual counseling, although it takes much longer because clients’ current circumstances tend to dominate the sessions. In any case, therapy is an art. Counselors can help clients link their current and past experiences and do the work suggested in the steps that target their needs. Thus, individual counseling can use the road map as it fits clients’ needs and expectations. Consider that Stage I is the foundation of the work ahead and that trust, not rush, is the foundation of a successful therapeutic relationship.

 

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Federico Carmona is a certified clinical trauma professional working as a trauma therapist at Peace Over Violence in Los Angeles. Federico works with survivors of domestic and sexual violence and child abuse who are experiencing the devastating effects of posttraumatic stress disorder, complex trauma, trauma bonding and related psychological afflictions. Contact Federico at fcarmona@mac.com.

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.