Monthly Archives: January 2023

What quiet quitting says about workplace mental health

By Samantha Cooper January 27, 2023

Closing the laptop at 5 p.m. Quiet quitting concept

Ivan Marc/Shutterstock.com

Everybody is exhausted. The COVID-19 pandemic, which started nearly three years ago, shows no signs of ending anytime soon. The disruption to the social norm has caused a lot of people to reevaluate their priorities, especially when it comes to the workplace.

In 2021, over 47 million people left their jobs, and this wave of voluntary quitting became known as the Great Resignation. Shortly after, people started hearing the phrase “quiet quitting.” This term is deceiving because it doesn’t refer to actually quitting one’s job. Rather it means “quitting the idea of going above and beyond” in the workplace, according to Zaid Khan, who’s viral TikTok popularized the phrase.

Quiet quitting is all about boundaries, says Kate Schroeder, a licensed professional counselor (LPC) at Transformation Counseling in Saint Louis. In fact, Schroeder says when she heard this term, her first thought was, “Oh, people are having boundaries.”

But the idea of having boundaries at work is not a new phenomenon at all. It’s just been given a name, notes Farah Harris, a licensed clinical professional counselor and owner of the private practice Working Well Daily in Flossmoor, Illinois.

“Your mom probably quiet quit on her job 40 years ago when she was like, ‘I’m pregnant. We need insurance. Let’s just get this job done,’” she says.

Who’s quiet quitting

This trend of quiet quitting is having a big impact on the workforce, with more people, particularly millennials and Gen Z workers, refusing to work beyond their basic job descriptions. A recent Gallup poll revealed that quiet quitters make up about half of the workforce.

Most quiet quitters tend to be white-collar, salaried workers says Briana Severine, an LPC at Sanare Psychosocial Rehabilitation in Denver. Of course, there are exceptions to this, she adds, especially in careers that expect employees to work far beyond the standard 40-hour work week to get ahead, such as a lawyer who wants to become a partner in the law firm.

And then there are careers, with workers who can’t quiet quit at all. People working in health care, for example, often don’t get to decide what duties they perform, when they work overtime or any number of responsibilities because somebody’s life depends on them doing their job and doing it well, Severine says.

Racism and biases further complicate one’s ability to quiet quit. People of color, members of the LGBTQ+ community, people with disabilities and other marginalized groups can’t easily quiet quit their jobs are because doing so would reflect negatively on not just themselves but the marginalized group they belong to.

In September 2022, The Washington Post reported that people of color were disproportionately affected by the layoffs at the start of the pandemic because of how they were perceived by management. Black, Indigenous and people of color individuals also reported higher rates of burnout than their white coworkers, according to a 2021 report from Hue, a nonprofit dedicated to building workplace equity.

As a Black woman, Harris knows too well the potential consequences: “If I show myself as just mediocre, I fall into the stereotype or biases about my race, so I actually need to be more hyper present and visible so that I can still be seen and hopefully not passed over for a promotion.”

Unhealthy work boundaries

People are tired, burnt out and they’re looking for some way to cope. Most employees are struggling to maintain a work-life balance. According to research by the Adecco Group, only 17% of workers take a sick day when they’re feeling mentally unwell or burned out and only 30% use all of their holiday time. The reason behind this is that workers often can’t afford to take off time or they’re afraid of the consequences they may face if they do, such as fewer opportunities to advance.

“In the height of the pandemic, the demographic that struggled the most were parents,” Severine says. “I think during this time it became impossible for many people to be able to go above and beyond at work, they just no longer had the capacity.”

Parents, mostly mothers, who would normally send their children to school or daycare had to take on extra childcare responsibilities at home while still being expected to maintain the same pre-pandemic level of success at work.

It became impossible for them to balance it all without majorly burning themselves out. Between advancing their career and caring for their families, it was already a challenge for mothers to ‘have it all’ before the pandemic, Harris notes. And the pandemic just provided the “perfect petri dish” for everything to go wrong.

Work stress is still an issue even for those who aren’t parents or part of marginalized group. In 2015, Deloitte conducted a survey of 1,000 full-time U.S. employees and found that 83% of respondents said work burnout negatively affected their personal relationships.

These findings indicate that something needs to change in the workplace. So how can counselors help people avoid becoming burned out, especially for those who can’t quiet quit?

Where to start

There are a variety of techniques counselors can use to assist clients and others struggling with workplace boundaries. Harris suggests using narrative therapy and having clients ask self-reflective questions about work such as

  • What are the stories I’m telling myself about the organization?
  • Where does work fit into my life?
  • Is my work identity my identity?
  • Is my work identity aligned with my personal one?

Asking these questions will help clients learn about themselves and find ways to define themselves outside of their career. Finding out the reason behind a client’s desire to quiet quit can also help counselors find the right way to address the issue.

Severine finds values work a useful tool to help clients. “Helping a person figure out their values, their strengths and their weaknesses can help them find a job that provides the highest amount of satisfaction,” she explains.

Severine also recommends counselors use acceptance and commitment therapy to help clients who can’t change their career find solutions. She says she often tells clients, “We have three choices. We can accept the situation as it is, we can change the situation that we’re in or we can leave the situation that we’re in.”

Schroeder cautions counselors against relying on cognitive behavior therapy (CBT), which isn’t enough to properly deal with burnout and the stress of the workplace. “Exploring our issues on a cognitive level is not going to get us to where we need to go. Feelings don’t happen in our brain. They happen in a much different part of us,” she says. “Feelings are not cognitive processes; they are energetic responses to what’s happening in our environment. Feelings happen in your body and in your heart, not your brain.”

“Since quiet quitting [and] burnout are essentially about someone who has blown through their own boundaries around what they need in their life to be happy and satisfied, we have to address these deeper issues in a noncognitive and experiential way,” Schroeder continues. Because issues with boundaries are related to childhood experiences, counselors need to be able to access these issues on a deep, somatic level so their clients can truly heal.

She finds Gestalt and somatic therapies to be more effective than CBT because they focus on clients accessing and connecting to feelings, which helps them integrate their feelings and transform.

“Transformation happens when someone can integrate on the energetic level what’s happened to them,” Schroeder explains. “And cognitive approaches will never be able to help someone integrate emotional experiences in the deep way necessary for transformation. … CBT approaches are strictly cognitive in nature and only address the rational, logical, linear thinking parts of your brain. …[They] are far more about understanding than about deep transformation.”

Learning how to communicate one’s feelings to coworkers and bosses may also help relieve some work-related stress. Sometimes counselors overlook simple solutions such as assertiveness training and communication skills in work-related situations, Severine notes. “We spend 40-plus hours a week with our boss and our coworkers so oftentimes if those relationships are unhealthy, it’s going to be dissatisfying,” she says.

When to quiet quit

One way counselor can determine why a client wants to quiet quit is to explore how intertwined clients’ work identity is with their own sense of self, Harris says. She finds that narrative therapy, as well as CBT, work well in unraveling these ties. For example, she may ask clients, “What are the thoughts about why you want to quit your job? What beliefs do you have around work? Where did that come from?”

The idea is to use these therapies to figure out why the client feels the way they do. She really wants clients to dig into the why they’re quiet quitting, so they can figure out whether the solution is leaving one company for another or going down a different route completely. She sometimes asks, ““Before you send that resignation, do you really want to quit this company or do you just not like your job?”

“As clinicians, we really need to help our clients tap into naming those emotions, being able to recognize how that emotion is showing up in their body,” Harris says. Helping clients become more emotionally fluent and in tune with what their body is telling them (such as if they get a certain pain every time they pull up to their office) will help them make a decision.

Employees don’t quit jobs; they quit bosses, Severine stresses. Workplaces can help is by acknowledging that employees should be given a lot of say in how their workplace functions. In addition, giving employees more control over how and when they work will make them more engaged in the workplace and make them less likely to quiet quit.

What most employees need, Severine says, is flexibility. For example, if an employee has to drop their child off at school at 9 a.m. but they’re also expected to be at the office at the same time, then giving them an extra half hour to get to the office (and letting them work a half hour later) could fix an issue that is causing them stress.

Quiet quitting can have many benefits if people do it for the correct reasons, such as taking care of their health or of a family member, instead of just doing it because they hate their job, she adds.

Schroeder says that unless someone is in a toxic situation, quiet quitting should not be their go-to move. If someone is slacking off at their job because they feel the job is overwhelming or difficult, then that issue may still be there if they start a new job. Instead, they need to figure out why they’re slacking off and then address that issue, she says.

Often, the underlying reasons behind quiet quitting revolve around the need for people to set better boundaries, which can help them create a healthier work-life balance, Severine says. Setting boundaries takes a lot of effort. For some, it can mean improving time management skills, so they don’t have to work overtime, or it may mean they don’t do extra work on the weekends or holidays, she adds.

“If you are quiet quitting over hating your job, I think that quiet quitting will likely do nothing to improve that,” Severine says. “Getting clear about what is the problem and being able to effectively communicate that to leadership to see if there are solutions to be found would be much healthier. Or using that information to find a job that would be better suited and lead to more satisfaction.”

 


Samantha Cooper is a staff writer for Counseling Today. Contact her at scooper@counseling.org.


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.

Does your personality make you more vulnerable to abuse?

By Avery Neal January 26, 2023

Katherine (pseudonym) sits before me, meticulously dressed and exuding confidence. She makes great eye contact, and within minutes of our meeting, she has informed me of her high-powered position at one of the top law firms in the city. She is assertive in her responses, and I am left without any question that this woman is brilliant.

As our session unfolds, I find out that Katherine has come to see me after having left her husband following years of abuse and deceitful manipulations. As she described the last incident — how he pinned her against the wall, almost choking her, and then threw her across the room — I can hardly believe that this self-assured, outspoken and composed woman in front of me has been the victim of abuse.

After years of listening to clients share their stories about how they have endured aggressive and controlling relationships, it occurred to me that we’ve got to throw out our misconceptions of abuse and start paying attention to the reality of abusive patterns.

Most important, abuse is not just physical violence. Although physical and verbal abuse are usually the easiest to recognize, psychological and emotional abuse are more destructive to a person’s psyche, physical health and mental health. Psychological and emotional abuse mostly go unrecognized because the person is left without visible bruises. There are many abused people who have never been harmed physically, which leaves them to question themselves rather than identifying the abusive dynamic in their relationship.

And it’s not simply the insecure, meek woman who finds herself in the throes of an abusive relationship. It’s the woman who graduates with distinction from her Ivy League school or the selfless housewife who dedicates her life to her children. It’s the male executive who is ashamed to admit that his wife physically attacks him.

There is no way of telling if the person sitting next to you is being severely mistreated and manipulated by their partner. There are, however, some defining characteristics that make a person more vulnerable to being abused. It is important for people to know what personality traits make them more susceptible to being manipulated and abused so that they can begin to protect themselves.

Are you naive or inexperienced in relationships?

People who have not dated much or who have not had many romantic partners are more likely to end up in a controlling relationship simply because they don’t have other relationships with which to compare. They believe that what they are experiencing in their relationship is normal even if it doesn’t feel right.

The widely believed notion that only people who grew up in abusive families seek what is familiar and tend to end up with abusive partners gives many a false sense of security. Those who have not grown up in an abusive home think they will be equipped to know what to look out for in a partner. Although people from abusive homes are more likely to overlook abusive behavior in their partners, this is only part of the story — a very small part that has left many people falling unsuspectingly into the hands of abusive partners.

Because abuse occurs gradually, many people find themselves committed to their partners before they even have an inkling that something is amiss. Therefore, it is critical not only to know the early warning signs of an aggressive or controlling relationship but also to know how to protect yourself if you find that you fit the profile of someone who is at a higher risk for being abused.

Are you overly responsible?

People who take on more than their fair share of responsibility — be it bearing the brunt of financial burden, investing more in the family or carrying the emotional weight in the relationship — tend to be more likely to end up with partners who exploit their sense of responsibility and work ethic. It is not uncommon for one person to find that they’re doing most of the heavy lifting in the relationship while their partner sits back and watches, completely unconcerned.

In addition, those who tend to apologize even when they haven’t done something out of line are, in fact, taking responsibility for whatever mishap has taken place. While it is admirable to have the humility to apologize and “own up” if you’ve done something wrong, it makes it easier for an abuser to take advantage of you if you constantly apologize when you haven’t done anything wrong. So if you tend to be the overly responsible type, both in practice and emotionally, be sure to find a partner who contributes equally to the relationship.

Are you highly empathetic?

Highly empathetic people are more likely to fall for someone who plays the role of the victim, a common personality trait in most abusers. A person with a great deal of empathy accepts when their partner tells them that past childhood trauma is the reason for the abuse and that they simply can’t help it. The highly empathetic person is also more likely to cave after standing up for themselves when an abuser cries, apologizes, begs them not to leave or promises that “it won’t happen again.”

A person’s greatest strength can also be their greatest weakness, and this is certainly the case with empathy. If you’re an empathetic person, be aware that abusers know they can appeal to your empathy and compassion to get what they want. You must learn to protect yourself from being manipulated by someone who does not have your best interest at heart. Focus on relationships with people who do not exploit your empathy or coerce you into tolerating behavior that you should not have to withstand.

Do you avoid conflict at all costs?

Those who suppress their feelings to prevent others from getting mad at them are more likely to end up being abused. People who avoid conflict experience extreme discomfort if they believe that someone is mad at them. Their fear of disapproval or discord leads them to give up their need so as to avoid confrontation at all costs. These people, who typically describe themselves as peacekeepers, are far more likely to end up with an abuser because they are an easy target.

The conflict-avoidant person takes pride and feels settled when harmony is restored, so they work harder and harder to keep the abuser happy. The problem is that no matter how hard they work in their relationship, they alone cannot change the dynamic. Far more likely, they will completely lose their sense of self in the process of trying to change the relationship, eventually succumbing to keep harmony in the relationship.

Although there are tremendous benefits to being a peacekeeper, the problem arises when you completely sacrifice yourself to keep your partner happy. It is important to practice asserting yourself and your needs and to have a partner who allows you to do so without punishment.

Trust your intuition

I encourage people to trust their intuition if something doesn’t feel right in their relationship. Far too many people suffer in silence because they are embarrassed to admit that they have ended up in an unhealthy relationship or that the cost of getting out of the relationship seems too great.

Remember, abuse is gradual, which makes it even more difficult to see objectively. People try to convince themselves that if they could just get the relationship back to what it was, everything would be all right. But it will not be because abuse escalates over time.

In the case of Katherine, her personal life now matches her professional one. It wasn’t an easy journey, but she has learned to recognize the early warning signs of an abuser, to speak up for herself and to not excuse bad behavior. Her life now is filled with people she respects and who respect her in return. And she has the freedom to make her own choices — without fear.

 


headshot of Avery Neal

 

Avery Neal holds a doctorate in psychology and is a licensed professional counselor, a practicing psychotherapist, and an international author and speaker. In 2012, she opened the Women’s Therapy Clinic, which offers psychiatric and counseling support to women. She is also the author of If He’s So Great, Why Do I Feel So Bad?: Recognizing and Overcoming Subtle Abuse, which has been translated and published in 12 languages. Contact her through her website at averyneal.com.

 

Read more about how counselors can recognize and treat psychological abuse in Avery Neal’s article “Identifying psychological abuse” in the February issue of Counseling Today.


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.

Generational trauma: Uncovering and interrupting the cycle

By Bethany Bray January 25, 2023

A young Black child sitting on a couch with her mother and father. The mother has her arm on the child's shoulder. A person sit across from them taking notes.

Prostock-studio/Shutterstock.com

Ashlei Petion, a licensed professional counselor (LPC) and assistant professor of clinical mental health counseling at Nova Southeastern University in Florida, noticed a common pattern in the counseling work she did with adolescents during her master’s internship. Her young clients would often talk in sessions about challenges and friction at home, but whenever Petion looped the clients’ parents into the discussion, they said they were simply parenting their child in the same ways their own parents had done with them.

Petion said she heard this over and over, and it made her realize that the challenges that her adolescent clients were facing were “bigger than the client who was sitting in front of me,” she says. “It’s part of their entire family and, in turn, their culture.”

This experience as a master’s intern sparked Petion’s interest in researching generational trauma, which eventually led to her doctoral dissertation and area of specialty as a counselor.

Generational trauma is complex, but counselors must remember that it doesn’t mean that there is “something inherently wrong with an individual [client],” Petion stresses. “It’s a collection of traumas that have been experienced by their ancestors, passed down, and it’s affecting them to this day. They are battling something bigger than them[selves].”

Taking a broader view of trauma

A common — and perhaps deserved — critique of the definition of trauma traditionally held by mental health practitioners and the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is that it is too narrow and doesn’t acknowledge the many different types of trauma, says Rachael Goodman, an LPC and associate professor at George Mason University whose area of specialty is trauma.

Counselors and society at large, including clients, may conceptualize trauma as the result of a single event or events that an individual has experienced personally. Trauma, however, can take many forms; it can be ongoing, vicarious, complex, generational and systemic, notes Goodman, the academic program co-coordinator and the Council for Accreditation of Counseling and Related Educational Programs (CACREP) liaison for the counseling program at George Mason University.

Because of this narrow definition, other types of trauma, including generational trauma, can be overlooked and outside the awareness of both clients and counselors, especially during the client assessment, diagnosis and treatment planning process, Goodman says. Also complicating the issue is the disparity that exists for clients from minoritized cultures, who are more likely to experience generational trauma based on systemic oppression and related issues, she adds.

For some clients and counselors, societal oppression and historical/cultural erasure may keep them from linking presenting issues, such as trouble in relationships or problematic coping, to challenges or trauma that clients haven’t experienced themselves, but which affects their family and community, Goodman notes. Counselors’ role “is to bring that [trauma] into consciousness and work with the client to address it,” she says. “It can be very powerful for the client to have their experience acknowledged and framed as a ‘legitimate’ source of trauma, when often systemic or ‘nontraditional’ forms of trauma are ignored or excluded from mainstream assessment and practice.”

“Clients often report that it feels like [a weight] sitting on their shoulders,” Petion agrees, “and they feel like they need to interrupt this and not pass it on.”

Like Goodman, Petion feels there is sometimes a knowledge gap among counselors regarding generational trauma. There’s just no way a counseling program can cover everything fully, including the complexities of trauma, in a two-year master’s program, she says. In addition, many of the textbooks and materials counselor education programs use to teach students about trauma have a Western viewpoint and do not cover historical and generational trauma, she adds.

This means that it’s essential for counselors to seek out additional training and information on generational trauma and best practices for treating it if it’s coming up within their client population, stresses Petion, a member of the American Counseling Association and co-author of the recent Journal of Counseling & Development article, “‘Battling something bigger than me’: A phenomenological investigation of generational trauma in African American women.”

Petion admits that it can be hard for those who haven’t experienced generational trauma to grasp just how challenging it can be to live with — or overcome — this type of trauma. “Changing just ourselves [in counseling] is really difficult, but then adding in other people and your whole family — it’s really difficult to ignite change,” she says, “but we know it’s possible.”

Identifying generational trauma

The first step to identify generational trauma is to ask the client to talk about their family history, including their relationship dynamics and how their family interacts with each other and the world around them, says Jordan Mike, an urgent care counselor at the counseling center at Vanderbilt University who is working on earning a professional counselor license in Tennessee. However, the most important thing a counselor can do during this process is to simply sit with and support them and “truly listen” as the client tells their story, he notes.

Generational trauma is an area of research for Mike, a third-year doctoral candidate in counselor education and supervision at the University of Florida, but it’s also something he personally witnessed growing up as a Black man. He says he also sees its effects in the concerns of the students, faculty and staff he counsels at Vanderbilt.

It can be an aha moment when a client realizes that an issue they are struggling with is actually something all of their family has suffered with as well, Mike says. And now as counseling becomes more available and accepted, he hears more clients are saying, “Hey, this is not a ‘me’ issue; it’s something that has been trending in my family for decades and hasn’t been addressed or helped.”

Clients who are affected by generational trauma may exhibit some of the same behaviors and symptoms as people who have experienced a traumatic event directly, including strong emotions such as anger, sadness or anxiety, notes Mike, an ACA member. Fear, including irrational fears, and distrust are common emotions among clients who are affected by generational trauma, he notes, particularly intense fear, anxiety, avoidance or distrust of places, communities, situations or systems that they’ve never experienced or have been to or through themselves.

The crux is to uncover where these feelings originate; if it’s something that they’ve internalized from their family or community, then it can indicate they have generational trauma that needs to be addressed, Mike says. For example, a client who expresses fear or distrust of law enforcement or medical care may not have a personal experience that prompts that fear. When asked where they think the fear originates, they may answer, “I’m not sure but this is what I’ve always heard; this is what my parents say and my community says,” he explains.

Desiree Guyton, an LPC with a private practice in New Jersey, says that generational trauma can also cause clients to harbor feelings of shame and negative self-worth. She guides these clients to talk about their family of origin, and where their feelings of shame might have originated. Clients who are affected by generational trauma often find that they stem from cultural messages they have internalized, Guyton says.

Generational trauma can also become apparent if a client talks about what isn’t addressed, acknowledged, processed or talked about in their family, culture or community, Mike adds. Cultures of silence are often adopted as a protective or coping measure, he says, but this can also mean that “there are so many things that can go untalked about, unsolved and unresolved.”

Because this trauma often goes unacknowledged, coupled with the fact that clients may struggle to pinpoint or name their generational trauma, Mike finds that it can be helpful to prompt clients to think of major events in their family or community, including things that were “hard to get through,” such as violence or loss, in addition to asking about family dynamics. He often asks clients, “What are some things that you have come together for as a community or family?” or “What is something that left a lasting impression?”

The counselors interviewed for this article agree that delving into a client’s family dynamics and history, including the use of timeline exploration activities and genograms, is helpful to uncover and distinguish clients’ generational trauma from other trauma experiences or mental health challenges.

Goodman developed a genogram tool that counselors can use to screen for intergenerational trauma in clients, which she wrote about in an article published in Counselling Psychology Quarterly in 2013. It can be particularly helpful for clients to write out aspects of their history or express them visually (e.g., making a collage out of images) to help them “get it out of their head,” look at it, and find patterns of trauma as well as resilience and persistence, she says.

Go slow

Guyton and Goodman both stress that counseling work with clients who have been affected by generational trauma needs to be client led and only go as far and as deep as the client is comfortable.

“Give the client time to build trust with you. They may not be willing to share and talk about [this topic] right off the bat. They may need you to demonstrate that you are someone who can be trusted, someone who will believe them,” says Goodman, an ACA member and representative on the ACA Governing Council.

Goodman notes that some clients may want to do a deep dive into processing the historical origins of their trauma while others may simply want to acknowledge it and focus on other work, such as learning coping tools for everyday life. For some, healing and meaning making can also involve engaging in social action, supporting their own family members or embracing a helping role within their community, she adds.

“The goal is for our clients to be able to live the life they want to live,” Goodman continues. “It’s not up to me to tell them they have to revisit their entire family history. … I’m interested in finding out what ‘living a meaningful life’ means for each client and helping them get there.”

Similarly, Guyton, an ACA member and co-author of the workbook Healing the Wounds of Generational Trauma: The Black and White American Experience, has had clients who traveled to speak with extended family members to learn more about the trauma, context and life stories of their ancestors, whereas others are not comfortable doing so. She herself has found it healing to trace her own family history to its enslavement and connection to the descent of slave owners.

Counselors must also be sensitive to the ways generational trauma can dovetail with systemic issues such as racial trauma and oppression. For example, a counselor can help a Black client who is activated by news coverage, such as when George Floyd was killed by police in Minneapolis in May 2020, to process how they feel — including grief and loss — and how it connects to their trauma history, Guyton says.

“Not all grief is traumatic, but all trauma has some feelings of loss,” she adds.

Guyton, who also leads groups and does trainings on racial conflict, trauma and healing through the nonprofit Quest Trauma Healing Institute in partnership with Trauma Healing Institute, advises counselors to listen when clients talk about their family unit or abuse history “because for people of color there is often more to it,” she says. “There is usually a connection to what it is to be an American and how they feel as an American.” Also, the field of epigenetics, she adds, teaches us that the historical trauma reactions can be passed down to next generations.

Counselors may also need to work on multiple challenges with these clients at once, Guyton says. “For those whose [generational trauma] comes out in session, we need to take it very slow, because often they are struggling with another presenting issue or other trauma. Once it surfaces, I focus on it as much as the client leads and wait until they’re ready to process it. I want to also be sensitive to the other types of trauma” they’re dealing with, she explains.

Both/and approach

Guyton has developed an approach that uses a combination of cognitive behavior therapy, narrative therapy, genogram and some guided imagery work to help clients identify the generational trauma being passed down to them and gain the skills to interrupt transmission to the next generation. She also starts by offering psychoeducation on trauma (and generational trauma) and asks questions about how and where the client may be experiencing the effects of trauma physically in their body.

Goodman agrees that counselors may need to vary their counseling approaches to address the interrelated concerns and challenges these clients are facing. She encourages counselors to take a “both/and” approach to address clients’ immediate needs (i.e., coping mechanisms to calm down when activated or social services to address stressors of daily living) as well as deeper work to address their trauma from a culturally sensitive, intersectional perspective.

“There are a lot of different ways of approaching this, but I tend to believe that ‘one size fits all’ is not going to do it,” says Goodman, a past president of Counselors for Social Justice, an ACA division. “Instead, [counselors should] think broadly of a both/and intersectional model that addresses the underlying and systemic causes of trauma.”

Goodman has past experience doing community engagement and support work on a Native American reservation. Some parents that she worked with often expressed feeling like they did not have enough tools or knowledge on how to parent, which placed stress and strain on family relationships, she recalls. Some of these parents had been removed from their family home as children and sent to boarding schools where they experienced trauma, so they never had the experience of growing up in a supportive, loving family. The situation left many of the parents with intense feelings of shame, fear and generational trauma, Goodman says.

In turn, these parents and their children were living with generational trauma as they struggled to maintain family bonds, she adds.

She found that these parents wanted to learn parenting skills in counseling to meet their immediate needs and support their children, but they also needed deeper work to process the trauma of their experience at boarding school, where they weren’t allowed to speak their native language or wear their native dress and, in some cases, suffered abuse.

In addition to cultural sensitivity, Goodman urges counselors to keep a focus on hope with clients who are living with generational trauma. At intake, explore not only their trauma history and challenges but also their strengths, resources and things that give them hope, she advises.

“Hope and having connection [in relationships] is so important” for these clients, Goodman stresses. “These problems are huge and have huge impacts, so helping our clients persist in spite of these barriers is really important.”

Supporting clients

Counseling to help clients acknowledge and unpack their generational trauma must be culturally sensitive and tailored to each client’s different combination of needs. The counselors interviewed for this article offer the following insights to support clients in this process.

The miracle question. Mike finds that it can be helpful to start discussions by prompting clients to consider the “miracle question” and imagine or visualize a world where their challenge or problem (in this case, generational trauma) is completely removed. He suggests asking the client, “What would it be like if you didn’t hold on to these feelings, or this pressure wasn’t there?” to spark thought and discussion about the big picture and larger issues connected to their challenges.

A client, for example, may be the first person in their family to attend college and feel intense pressure about choosing the “right” major. Mike says he would support the client in their decision-making process and help them gain perspective and clarity by asking, “What would be different for you if everyone in your family had gone to college or if there was no pressure and you could do whatever you want?”

“This [miracle question] gives them permission to not have to consider all the things that weigh on them, for once,” he explains.

Communication and boundary setting. Petion led a support group for Black women who had experienced generational trauma as part of the research for her doctoral dissertation. One of the things the group members found helpful, she recalls, was building communication and boundary-setting skills that they could use with their family members. The group talked a lot about how to remain calm, manage their body language and keep a problem-solving (rather than blaming) focus when having “brave dialogues” with family members about behaviors and patterns that had been adopted because of generational trauma, she says.

Petion also equipped them with ways to use “I” statements to voice their feelings. Instead of saying, “You really hurt me when you did this” to a family member, a client could say “I was really hurt when you did this” or “I felt this way,” she says. The purpose of shifting from “you” language to “I” language is to minimize or eliminate feelings the other person may have of being attacked or blamed, Petion explains. “I statements help us to take accountability for our own actions and feelings, speaking for ourselves instead of projecting onto the other person,” she says.

One group member grew up with a mother who didn’t believe children should express their feelings, Petion recalls. Having her feelings dismissed throughout her entire childhood was chronically traumatic for her. In group, this participant was able to practice having an assertive yet productive conversation with her mother to explain that she was using a different method to parent her own child because she had been hurt by her mother’s approach during her childhood, Petion says.

Guided imagery techniques. When a client is processing their generational trauma, guided imagery, including the “empty chair” technique from the Gestalt method, can be a way to ask questions and speak to family members or ancestors who are no longer alive, Guyton says. This technique was beneficial for one of Guyton’s clients who described “harsh” treatment by her grandmother growing up, and now as an adult, she was struggling with feelings of shame and negative self-worth, poor choices of intimate male partners and parenting stressors. This client’s desire not to pass on her trauma reactions to her children, as well as her anxiety about being poor and abusive, is what led her to seek counseling, Guyton adds.

When the client began to explore her family history, including the pressures her grandmother faced as she emigrated from her Caribbean homeland to the United States, she realized “I need to talk to her,” Guyton recalls. (The client had recently traveled to her grandmother’s home island and spoken to extended relatives to learn more about her grandmother’s life story and context.)

Guyton used guided imagery with this client and began by asking her to picture her grandmother and describe what she was seeing. Guyton then prompted the client to talk to her grandmother and share how she was feeling. The client responded by saying, “I see you, Grandma. I see you in this context. I’m understanding more now, and I wonder what it was like for you to raise all of us through poverty, sexism, racism and physical abuse. I want to know what it was like.”

These types of conversations can help a client process their connections to trauma and find closure. For this client, “being able to close her eyes, breathe, remember and picture her [grandmother] in a different way” and think of her difficulties in context moved her toward forgiveness and healing, Guyton says.

Case management. Counselors sometimes shy away from conversations or tasks that feel like case management, such as helping a client enroll their child in school or navigate the bus system to commute to work, Goodman notes. However, this type of support can be particularly helpful and needed by clients who are affected by generational trauma, especially those with refugee or immigrant experiences, she says.

“You may get pushback from a supervisor because it’s outside of counseling,” Goodman says, “but what I’ve found is that these experiences are really important.”

Do your own work. Processing a clients’ generational trauma in counseling involves inviting them to talk about their experience, but the onus should never be on the client to teach the counselor about their culture and history, Goodman stresses. It’s vital for counselors to seek out consultation with peers or do research on best practices to treat a client who comes from a specific community or cultural group, she says. There are treatment methods that are tailored to meet the specific needs and trauma experiences of different cultures and that use culture-centered, decolonial and liberatory approaches, she notes. Counselors just need to seek them out.

Similarly, practitioners must do their own work to become comfortable broaching the subject and discussing cultural issues and generational trauma with clients who come from different — and possibly less privileged — backgrounds than their own, Goodman continues. She encourages counselors to gently name any differences that exist in the counseling room, using questions such as “When counselors and clients are different in their identities, it can be helpful to name that and to think through how we might work together. Since we have some differences in our identities, what challenges might we have in working together?”

Goodman urges counselors to broach this subject not only at the start of counseling work with a client but also with regular check-ins throughout the relationship. “We [counselors] each have to figure out for ourselves language that is genuine for us” to foster these conversations, she says. And counselors need to “be willing to say, ‘I’m hearing some hesitancy, and I wonder if you have any concerns about talking to me about this.’”

Don’t make assumptions. Counselors should be listening for the signs of generational trauma in each client, regardless of their cultural background, Petion adds. “Privileged groups can still have generational trauma, even though it’s not talked about as much,” she says. “Anyone who has experienced trauma can pass it down. … Don’t make assumptions. This affects us all in some way, shape or form.”

Healing in connection

In her book All About Love: New Visions, the late bell hooks wrote, “Rarely, if ever, are any of us healed in isolation. Healing is an act of communion.”

Petion says she shares this quote often when talking about generational trauma with clients and colleagues. The truth is that clients do not live in a vacuum; they can work toward healing individually in counseling but will ultimately return to live within their culture and family system, she notes.

“Generational trauma is just that — an individual whose trauma is perpetuated within family and culture,” Petion adds. So, with this client population, practitioners must “think beyond the individual sitting in front of us” in counseling, she stresses, and focus on how they are healing in connection to their family and community. “That’s really where we interrupt the transmission of trauma,” she says.

At the same time, counselors should remember that it may not be the client’s role to “fix” or heal their family or community, Mike cautions. “They may need to make peace with healing themselves without taking on entire systems,” he says.

Generational trauma “can be a biological thing, an emotional thing, a social thing. … Trauma changes our chemistry; it can change how we interact with other people, … who we are and even our gene expressions,” Petion says. But “counseling offers the space to relearn that [and] a space where clients are heard and validated.”

 


Bethany Bray is a former senior writer and social media coordinator for Counseling Today.


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.

Counseling Connoisseur: Brain science, courage and chronic pain

By Cheryl Fisher January 19, 2023

A young woman with wrist pain is holding her wrist and has a painful expression on her face

anut21ng Stock/Shutterstock.com

‘Courage doesn’t always roar. Sometimes courage is the little voice at the end of the day that says I’ll try again tomorrow.’ —Mary Anne Radmacher

It all began with the numbing of my hands. Too much time was spent holding my smartphone, I surmised. I went to my doctor after the tingling began to keep me up at night. Carpal tunnel. Wear a brace at night, and it should resolve. If not, a simple surgical procedure would fix the problem.

A year later, the numbing was replaced with swollen, painful joints that now included my shoulders and feet. Mornings were the worst — it took me twice as long to get anything done because of the stiffness and pain. As a self-proclaimed gym rat and former aerobics instructor, I was forced to modify my daily workouts, as I was committed to keeping a routine. Moving helped, and by midmorning, I was able to function relatively well most days. Still, something was terribly wrong, and it was impacting every aspect of my life.

The blood work continued to come back negative for an autoimmune disease, but my family history and presenting concerns all pointed to rheumatoid arthritis. I was immediately placed on a disease-modifying antirheumatic drug that carried its own side effects, including fatigue, which I was already experiencing from a lack of sleep.

There were many days that I questioned how I was going to manage a private practice and a demanding academic career, while just barely having the energy to feed the dog, get dressed and eat breakfast. But there were even more mornings that I put on a smile, cringed through the pain and focused on the possibilities of the new day ahead.

Chronic pain

According to R. Jason Yong and colleagues, in their 2022 article published in the journal Pain, 1 in 5 adults in the United States experience chronic pain. Using data from the National Health Interview Survey, the researchers found that the experience of chronic pain negatively impacted the participants’ quality of life. Previously enjoyed activities were forfeited due to restrictions in mobility.

In addition to physical discomfort, there were psychological effects to living with chronic pain and illness. These included an increase in anxiety and depressive symptoms. Let’s face it — pain can sabotage even the best of days. I knew that from my own experiences. Therefore, imagine my excitement when I found research that completely changed my understanding of pain and offered real tools to cope.

Neuroscience advancements

Over the past decade, the science regarding the etiology of pain has evolved to a biopsychosocial model. This approach examines not only physical injuries but also the role that our thoughts and beliefs about pain and injury play in our overall experience of pain. Therefore, most models are antiquated in that they dismiss the brain’s function in assessing and moderating pain. Additionally, newer pain science research examines individual histories around trauma and childhood experiences as they have been found to be associated with a decrease in pain threshold and more frequent bouts of pain. In addition to the roles of trauma, childhood experiences and cognitive appraisals, pain science has also adopted the following tenets.

Pain is not purely physical. While pain is designed to protect the body, it is not purely physical. According to Robert Edwards and colleagues, in a study published in The Journal of Pain in 2016, pain is a “multidimensional, dynamic interaction among physiological, psychological, and social factors that reciprocally influence one another.” We often think that pain is related to an injury or tissue damage, but research indicates that chronic pain is often unrelated to physical injury. There are neurological changes that occur to create the sensation of pain even when there is no physical damage to the body. Therefore, when we focus solely on the physical aspect of pain, we miss so many other elements that contribute to coping and recovery.

Pain is processed in the brain. The brain sends biochemical messages to the cells in the body, and they in turn provide the brain with a status report. While injury can certainly be read by this process, stress also accounts for changes in the body that can register as pain (e.g., nerve pain or migraines). When activated, the body’s own analgesics (e.g., endorphins) are released to attempt to address the symptoms.

Everyone’s nervous system response is unique and can be altered. Additionally, with chronic pain, individuals can become sensitive to the possibility of pain. For example, initially, I experienced tremendous pain in my hands and wrists — so much so that even after my swelling and pain had significantly subsided, I was fearful of trying to do a pushup or yoga poses such as downward dog. I would cringe just thinking about it.

Neurologically, the brain keeps track of our pain threats, and it begins to anticipate the threat to the point of significantly decreasing the pain threshold. It is like a hypersensitive alert system that may even “sound the alarm” prematurely. This should sound familiar. It is a conditioned response. My brain became conditioned to anticipate pain in my wrists and hands, and anything that might pose a threat was received with a pain rating that exceeded that actual discomfort (if any). The good news is that anything learned can be unlearned.

Neural pathways can be reprogrammed. Individuals with chronic pain are prone to hypersensitivity. They have learned to expect pain, and their neurology is now wired to react even when the injury or stimulus no longer exists. In addition to the reactive neural pathways, the brain interprets each experience with cognitive appraisals of the pain sensation and situation. For example, a person may avoid activities that previously triggered pain or discomfort with the appraisal “I can’t do this activity without feeling pain.” However, David Seminowicz and colleagues’ study, published in The Journal of Pain in 2013, found that using cognitive behavioral tools to confront and reframe thoughts and beliefs around pain changed the brain and reprogrammed neural pathways, resulting in a decrease of pain sensation.

Implications for counselors

Counselors can play an instrumental role on a pain management team. Utilizing cognitive and meaning-centered approaches, counselors can help clients recognize the thoughts and meaning they ascribe to pain and illness that maintain or even increase the pain sensation. Conversely, challenging and changing those thoughts and beliefs can alter the neuroprocessing that results in the reduction of the experience of pain. Here are a few techniques for your toolbox when working with clients with chronic pain:

  • Word swapping (reframing). Language matters. It conjures images, and the brain (in particular, the amygdala) responds to these images. Swap out words that conjure fear with words that are more comfortable. Substitute the word “pain” for “sensation” or “pressure.” Use phrases such as “not as cool” or “not as loose” when describing the experience of heat or tightening sensations. This will reduce the amygdala’s engagement and help the brain create new neural pathways.
  • Meditation. Meditation can help retrain the brain and nervous system to process pain sensations. There are numerous guided meditations that specifically address chronic pain.
  • Positive self-talk. Often, we succumb to our fear of the pain and catastrophize the scenario. This increases the amygdala and stress response. Try talking to the pain. Whether it’s with a determined voice (e.g., “OK, I’m not going to miss out on this event because you [pain] are presenting. You are just going to have to leave me alone today.”) or a softer approach (e.g., “I know we can feel better. I’m going to make tea and do a brief meditation, and we will feel much better.”), be intentional and empowered in your self-talk.
  • Journaling or expressive writing. First pick a situation and write down your feelings and thoughts about it. Don’t hold back. For example, the first time I had to ask my husband for help opening a container during a flare-up was horrific. I hold the belief that I am independent, strong and capable. This is part of my identity; I see myself as Wonder Woman! So I hated asking for help. I felt vulnerable and scared. Now write another version of the narrative. In this scenario, my rewrite would be that after many years (decades) of believing that I had to be strong, I was shown that I have support and do not need to be physically strong. It is wonderful to be cared for, and opening jars also allows my husband opportunities to feel needed.

Courage

In her 2019 Netflix special The Call to Courage, Brené Brown says, “Courage starts with showing up … and letting ourselves be seen.” As counselors, we know that it is no small feat to show up and face the uncomfortable. It can be scary to be vulnerable and shed that superhero mask. We can validate and normalize the challenges of living with chronic pain, and we can bring our Adlerian pom-poms and cheer on our clients’ bravery. We can remind clients that not only can they live satisfying lives with chronic pain, but as they engage in the work of pain management, they are doing it.

 


Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is director and associate professor for Alliant International University California School of Professional Psychology’s online master’s in clinical counseling program. Her research interests include examining sexuality and spirituality in young women with advanced breast cancer, nature-informed therapy and geek therapy. Contact her at cyfisherphd@gmail.com.


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.

Unexpected lessons and connections in sex offender counseling

By Lavinia Magliocco January 16, 2023

A person with their back to the camera sits at a table with a man. They are engaged in a conversation. Two notebooks are on the table in front of them.

In my final year of graduate school, I interned at a nonprofit agency where I was fortunate to have a great supervisor and experienced colleagues. They asked me whether I would feel comfortable working with Steve (pseudonym), a client who was on parole for sex offenses and was seeking additional support beyond mandated treatment.

Several factors emboldened me to say yes. First, I would be this client’s ancillary counselor; he was already working with another clinician with expertise in this population. The fact that his issues were beyond my competence would have precluded my working with him except for this contingency.

Second, at 58 years old, I’m not easily intimidated. Still, I was conscious of my limitations as a new counselor with no experience with this population and no training specific to this type of client. But ultimately, my support among a team of solid practitioners and a great supervisor made me think, “If not now, when?” So I took the leap and said yes.

This opportunity to work with a person who had committed sex offenses confirmed my trust in the power of a strong therapeutic alliance. Although this client tested me and I struggled at times, I discovered a capacity within myself that I had not experienced before. I learned about the barriers this population faces in rehabilitation from incarceration and developed a unique approach to help him regain a sense of connection to others. In the process, I gained a deep appreciation for the client. The following is the story of my experience working with Steve, who gave me permission to share his story, and what I learned.

Meeting Steve

I started working with Steve in the middle of the pandemic. Because Steve had spent the last several decades incarcerated, he was not up to speed with computers and was unsure about how to do telehealth. I arranged to meet him at a local Starbucks so I could help him set up Google Meet or Zoom on his computer. As a clinical rehabilitation counselor, helping clients with accessibility issues is important to me. Steve’s physical health and mobility were challenges for him and critical considerations in our work together.

When I walked into Starbucks, I saw a large man seated in a corner, arms crossed over his chest and a guarded expression on his face. It was Steve. He offered me a coffee, which I declined, but I told him I needed to visit the restroom before we started. I purposely left my jacket and handbag on the table where we sat. This was not a preplanned gesture but an instinctive response to his body language. Establishing trust would be crucial to working together. And what better way to gain trust than to give it?

In those 45 minutes, we focused on practical issues and had a few laughs around computer frustrations. I later learned Steve spent most of his life in various prisons. The last stint meant he’d entered prison before personal computers were common and the social media that we know today was not invented yet. He told me later that my willingness to help him with his computer in person was a deciding factor in his ability to let me into his confidence.

Finding the right approach

Another clinician worked with Steve on his sexual impulses, and I consulted with her once a month. We developed a good working relationship, and her support and expertise allowed me to focus on other issues Steve had. Steve’s stated goal for our work together was socialization. This posed some challenges, however, because his opportunities for socializing were severely restricted by his parole. At the very least, our counseling sessions provided the much-needed human contact he craved.

I scoured libraries, the internet, and the Association for the Treatment and Prevention of Sexual Abuse for articles on working with people who commit sex offenses to glean recommended evidence-based treatments. Several articles recommended using cognitive behavior therapy (CBT), motivational interviewing, self-regulation and other skills-based interventions. I knew Steve’s other therapist was working with him on self-regulation, so I consulted a colleague who encouraged me to use motivational interviewing.

I also received support from our agency’s psychiatric nurse practitioner who identified that most of Steve’s issues stemmed from complex posttraumatic stress disorder. It took months for Steve to trust me because of traumatic experiences with mental health clinicians who, 40 years ago, had tried to “cure” him of his attraction to men and had deemed him “incurable.” Steve signed a release of information form so that his two mental health clinicians and psychiatric nurse practitioner could communicate with each other about his case.

During his counseling sessions with me, Steve vented his frustrations about his parole officer and expounded on how he had been victimized by his family, friends and the system. He was initially unwilling to take responsibility for his predicament, but he provided me with opportunities to validate his feelings: He had been victimized early in his life like many who later commit sex crimes. His experiences included traumatic attachments, early seduction and sexualization, assault, and traumatic brain injury. It took months before he could admit that he was responsible for his subsequent actions. But through the use of CBT interventions, he was able to understand that just as adults had taken advantage of him sexually without his consent, he had replicated that behavior with others because it was all he knew.

In a 2013 article, “Treatment of sex offenders: Research, best practices, and emerging models,” published in the International Journal of Behavioral Consultation and Therapy, Pamela Yates said that counselors can help maximize treatment gains with this population by “demonstrating empathy, respect, warmth, friendliness, sincerity, genuineness, directness, confidence, and interest in the client.” Yates also noted that establishing a positive treatment environment contributes to positive outcomes, meaning clients are less likely to reoffend. After reading Yates’ list of characteristics, I felt reassured that the best approach with Steve was to lean into cultivating unconditional positive regard.

I asked permission when offering interventions. For someone who has been stripped of power in repeatedly traumatizing ways and who then acted out by traumatizing others, using this motivational interviewing protocol dramatically changed the tenor of our sessions and created a more collaborative environment.

Mindfulness, on the other hand, which is a clinical approach I often use with clients, was not something Steve could tolerate yet. I learned that many people with complex and chronic trauma find somatic mindfulness, which puts them in intimate touch with their bodies, to be overwhelming. Steve had difficulty connecting with mindfulness exercises and said he preferred to talk instead.

Using art to build connection

I was aware that society’s implicit assumptions around people who commit sexual crimes were influencing me negatively even before meeting Steve, so I knew I had to be mindful of my own biases or prejudices. To avoid any personal biases, I approached our sessions with curiosity and empathy.

As I got to know Steve, it was easy to feel warmth for him. He was affable and gallant in an old-fashioned way, and he longed for connection. Some of his affability did seem manipulative at times, yet I was moved by his vulnerability. He hungered for attachment. He was a fundamentally social person who enjoyed interacting with many kinds of people, so he found his inability to interact easily with others because of his strict parole conditions to be especially difficult.

His traumatic history often led him to objectify and sexualize people he was attracted to. He regularly mentioned young men he had seen on the bus or at the store that he found sexually attractive. During one session, Steve was telling me about his attraction to a young man who was a cashier at the supermarket he frequented. I listened, at first inwardly groaning at the repetitive, seemingly reflexive nature of his attractions; he didn’t really differentiate between one object of lust and another. In an attempt to understand and distinguish this particular attraction from the others he had mentioned, I decided to try to help him become more aware of and specific about his sexualization of these men, so I asked, “What do you find attractive about this man?” Steve became poetic as he described the cashier’s physical beauty — his face, hair, hands, posture and smile. I could picture this cashier vividly, and I could feel vicariously how this young man affected Steve.

Struck by this, I blurted out, “You’re a lover of beauty!” Steve looked startled. I explained, “You’re moved by beauty. That’s a value.” As a professional ballet dancer, I am also moved by beauty and understand viscerally how someone can be aesthetically driven.

That exchange sparked an idea of a way to help him feed his longing and loneliness. If he could not find connection with the humans that were off limits to him due to stringent parole, maybe he could find it in other kinds of beauty such as art, films and photography.

I began to share movie recommendations with him. I first recommended Wim Wenders’ documentary Pina (a film about the German dance choreographer Pina Bausch) because of the way this film handles topics such as attraction, desire, power and violence. I knew Steve may be titillated by the dancers’ beautiful bodies, but I hoped it also spurred a deeper dialogue on difficult interpersonal dynamics. I also hoped he might feel nourished by the sheer splendor of the film.

After the first time he watched the film, his comments were superficial yet enthusiastic. But his observations became more nuanced with each viewing. The film inspired him and awakened in him a love of performance, especially musical theater, and he started finding musicals and other theatrical performances to watch on his own. I found myself wondering if he might have had a career in the arts if his life had worked out differently. It also amazed me that my previous career as a professional ballet dancer enabled us to share a connection, and I began to think about how to spark a desire in him for self-cultivation and expression.

We looked at photographs of muscular, kinetic statues such as Gian Lorenzo Bernini’s Apollo and Daphne because I wanted him to see that sensuality and beauty can be found and fed in ways besides sex. I justified this clinically with the idea that sublimation is an effective, mature defense mechanism where his unacceptable impulses could be transformed into socially allowable behavior.

With my supervisor’s permission, I asked Steve to watch the classic Luchino Visconti film Death in Venice and used his identification with both characters — the older Gustav von Aschenbach as well as the young boy Tadzio to whom von Aschenbach was drawn — to explore his difficult history. Steve had been objectified like the young boy Tadzio. Steve often talked about how attractive he was in his youth and how older men had preyed on him. But now he identified more with von Aschenbach, the older, dying character who becomes longingly obsessed with Tadzio. The film allowed him to externalize his narrative and see himself portrayed in these characters. The poignancy of the film, which takes place during a cholera plague in Venice, also did not escape Steve. In his strict parole during the COVID-19 pandemic, he was as isolated as von Aschenbach was by the social restrictions of the early 1900s European society during the cholera epidemic.

Identifying with the beautiful youth and the dying man awakened an existential awareness in him that I believe helped him take responsibility for his actions. Sharing my passion for art and performance helped me connect with Steve, which then helped him see that beauty, sensuality and connection can be found in the arts. In this way, I believe he felt less alone.

People who commit sexual offenses in the United States, those labeled “registered sex offenders,” become pariahs. They cannot easily find work or places to live. On parole, they are subject to random lie detector and drug tests for which they must pay. Their crimes end up defining them for the rest of their lives. Imagine the worst thing you’ve ever done. Now imagine that is all anyone ever sees you as for the rest of your life. This negative stigma that follows people who commit sexual offenses can make it more challenging for them to change or for others to notice if they do change. By engaging Steve’s aesthetic side through the arts, I offered Steve a different way to experience himself — one that contrasted with the negative stigmas he often faced.

Doing no harm

My desire to help Steve also led to one crucial mistake. After the holidays and a health crisis, Steve became deeply depressed. I became concerned for his mental and physical health. His parole officer had forbidden his attendance at 12-step meetings and prevented any possibility of him joining a support group for LGBTQ+ individuals at a local center by divulging his entire history to the director, who decided they did not want to have him anywhere near the center.

Although Steve was no longer in prison, his current living situation resembled it: He lived in a one-room apartment, which was the size of a prison cell, and he had no contact with people other than his various doctors, mental health team and pastor. This isolation was a factor in his depression, so I met with his parole officer, the other mental health counselor and the psychiatric nurse practitioner to discuss ways to address this issue. I hoped to advocate for more lenience in allowing him outlets and contact in the community. I wanted his parole officer to understand that Steve’s depression and loneliness could lead to his reoffending because prison offered a built-in community and opportunities for sex.

The result of this meeting, however, was that the parole officer felt she was being attacked and became defensive. And Steve paid the price. She cracked down on him and told him in no uncertain terms that she believed he had manipulated me. I chastised myself for being so naive as to mistake my agenda as a mental health clinician advocating on behalf of my client for the parole officer’s agenda. Her job was to safeguard citizens from someone who was perceived as a dangerous criminal. Steve’s feelings were irrelevant to her. In retrospect, I see now that this situation was a parallel process where I experienced the parole officer’s stringency alongside my client. In my zeal for and identification with Steve’s plight, I did not think to put myself in the parole officer’s shoes and see how she might feel when confronted with three mental health practitioners petitioning for leniency.

I apologized to Steve saying, “I thought I was helping but instead I made things worse for you. I am so sorry! I was naive. Let’s try to repair this situation.” Acknowledging my mistake was crucial for the repair, and from Steve’s perspective, it vindicated his own experience by having me come up against the restrictions he faced. By the end of my internship, we had recovered from my mistake and our alliance was stronger because of it. Saying goodbye was emotional for both of us. We had forged a relationship in which, I believe, Steve felt seen in a way he never had been, and I was moved that he allowed me into his confidence to the extent that he did.

It’s important to note that Steve successfully navigated another nine months of parole without reoffending. He recently wrote to me and said, “Our trust didn’t begin because you left your purse at Starbucks — it happened because I connected with you and your willingness to step out from behind a desk and meet me where I was comfortable.”

Lessons learned

At the end of my time working with Steve, I asked him what he gotten out of therapy with me, besides having someone to vent to and meet with once a week. He said he had learned to trust more because of our relationship. In particular, he mentioned our first meeting at Starbucks as being pivotal in building this trust because I took the time to meet him in person and help him with his technology. He also said he felt I cared for and understood him, and that made him feel like a human being.

This experience working with Steve taught me a few lessons as well. I learned how being curious and willing to take risks are essential components of this profession. If I had allowed Steve’s status as a “sex offender” to prejudice me, I would not have been able to engage with him with as much spontaneity and enthusiasm as I did.

I learned that motivational interviewing and asking for permission before using a clinical intervention helps empower the client. Steve appreciated every opportunity to feel that therapy was his choice rather than an imposition, and this empowerment helped disarm his defenses and enabled his trust to grow.

I learned the critical importance of consultation. I not only received essential guidance and support but also gained confidence through clinical consultation. It took a village. I would like to thank my colleagues Sarah Williams, Casey VanHoutan, Krista Fuqua, Marisa Monahan, Marie Mellberg and the other colleagues who provided advice, consultation and guidance while I worked with this client.

I learned the importance of doing no harm and how easy it is to lose my perspective in countertransference. Even the best of intentions can hurt in situations with conflicting agendas.

Finally, I learned how leaning into the therapeutic alliance is both challenging and rewarding. It enabled me to care deeply about someone whom our society judges and condemns. Ultimately, recognizing that Steve has a love of beauty was the linchpin that evoked his humanity, strengthened our connection and was profoundly moving for both of us. At our last session together, Steve wept because we would not be able to continue working together; I think he felt truly seen by me. I was also moved to tears by his willingness to come on the journey with me, a new counselor. He trusted me in spite of my inexperience and offered me the opportunity to deepen my own humanity.


Lavinia Magliocco is a clinical rehabilitation counselor and licensed professional counselor associate at Three Firs Counseling LLC. The practice specializes in working with chronic illness/disability and complex trauma. Prior to becoming a counselor, she was a professional ballet dancer in New York City, a professional writer and therapeutic Pilates teacher at her studio Equipoise — Enlightened Exercise LLC. Contact her at lavinia@threefirs.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.


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.