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Counselors Audience

The self ish act of forgiving

By Lindsey Phillips April 26, 2017

A rabbi, returning home on a train, sat near a group of salesmen who were playing cards. Absorbed as he was in meditation, the rabbi refused to join the card game. One of the salesmen, annoyed by the rabbi’s aloofness but unaware of who he was, pushed the rabbi out of the compartment.

Upon reaching their destination, the men discovered that their companion on the train was a revered rabbi. This revelation prompted the salesman to ask for the rabbi’s forgiveness, but the rabbi refused. People then questioned the rabbi about how he could be so unforgiving. The rabbi explained that because the salesman had assumed he was offending a “common man” on the train, only that man, not the rabbi, could grant forgiveness.

This parable by Rabbi Abraham Joshua Heschel illustrates the complexities and power of forgiving and teaches that only people who have been wronged have the power to forgive. It also reveals the way that people’s thoughts about forgiveness shape their view of its utility.

There is also one perspective of forgiveness that might surprise many people: Forgiving is not a kind, selfless act. Rather, it is about self-healing, self-empowerment and self-liberation. As Desmond Tutu, South Africa’s former Anglican archbishop and a recipient of the Nobel Peace Prize, said, “We don’t forgive to help the other person. We don’t forgive for others. We forgive for ourselves. Forgiveness, in other words, is the best form of self-interest.”

According to a survey by the Fetzer Institute, 62 percent of Americans think that they need more forgiveness in their personal lives.

“We spend a lot of negative energy ruminating on parts of our lives that have been harmful,” observes Richard Balkin, assistant chair in the Department of Counseling and Human Development at the University of Louisville. “We have nightmares over this, we have flashbacks, we have memories that disrupt our lives.” Many people hold on to these negative or hurtful memories for years, he says.

The pressing question for counselors is how they can help clients move past the anger or hurt that is tied to these past events. And that leads to examining the potential role that forgiveness can play in the process.

Defining forgiveness 

Susan Stuntzner, the director of disability support services and a retention specialist at Southwestern Oregon Community College, describes forgiveness as “the ability to uncover [and] address any hurt and pain that one has.”

Through the process of forgiving, people usually “find that they hold feelings such as anger, anxiety, depression, some sort of betrayal or hurt,” adds Stuntzner, a member of the American Counseling Association. “It’s a process where as people uncover how they are feeling and thinking, they realize that they no longer want … the hurt or pain to control their life.”

Jan Lemon, a professor of counseling at Mississippi College, views forgiveness as a transformational approach in which clients correct their attitudes, beliefs and energy. For her, forgiveness is “an unconscious attitude or release of a toxic emotion. … It’s both letting go of the resentment [and] replacing the resentment with mindful awareness and empathy.”

Balkin, editor of ACA’s Journal of Counseling & Development, notes two different types of forgiveness. Interpersonal forgiveness is a relational process that involves forgiveness and reconciliation between the aggrieved person and the perpetrator, Balkin explains. He points out, however, that forgiveness doesn’t have to be relational, and this is where the second type of forgiveness comes into play. Intrapersonal forgiveness is an independent process in which the aggrieved person forgives by letting go of the hurt or pain caused by the perpetrator, or the perpetrator forgives by granting self-forgiveness for the pain he or she has caused others, Balkin says.

For Bryce Hagedorn, program director of counselor education and school psychology at the University of Central Florida, forgiveness is “a personal choice to release anger, the right for revenge [and] retribution for a wrongdoing. It can be both releasing that toward others who have wronged you as well as releasing yourself.”

There is growing evidence that the act of forgiveness is both physically and mentally empowering. In 2005, Harvard Medical School published an e-newsletter citing research suggesting that forgiveness reduced stress, lowered the risk of heart disease, strengthened relationships, helped lessen pain and instances of chronic illness, and led to greater happiness. A decade later, the scientific research on the topic had increased so much that Loren Toussaint, Everett Worthington Jr. and David Williams edited a book, Forgiveness and Health, that focused specifically on the health and well-being benefits of forgiving.

According to Stuntzner, forgiving improves a person’s coping and adaptation, reduces negative feelings and creates an overall better quality of life. Part of the power of forgiveness is that “there are multiple directions in which forgiveness can be applied,” she says. Counselors can use forgiveness as a tool to help clients with different situations, such as working toward self-forgiveness or working to forgive an abusive partner, she says. By coming to a new understanding of the past and how it affects a situation in their present, clients “are freed up emotionally and mentally to focus on more positive things,” Stuntzner says.

Overcoming resistance

When giving presentations to counseling audiences, Hagedorn often asks how many attendees have clients whose anger, depression, substance use, anxiety, relational discord or other issues are grounded in resentment or regret. Typically, 90 to 100 percent of the audience members answer in the affirmative, he says. Even though these two areas are central to forgiveness work, not many counselors are doing anything systemically with resentment and regret, adds Hagedorn, an ACA member and past president of the Association for Spiritual, Ethical and Religious Values in Counseling.

Furthermore, counselors can actually be resistant to using forgiveness strategies in their practices, Hagedorn says. In fact, he argues that assessing client-based and clinician-based resistance is one area that doesn’t get enough attention. Counselors may be resistant because they do not feel competent and do not know where to start or because they have not done their own work and would feel hypocritical using forgiveness techniques in session with clients, he says.

Another reason that some counselors hesitate to engage in forgiveness work in session is because they consider it to be a religious intervention, Hagedorn says. Many people — clients and counselors alike — view the topic of forgiveness as something that falls under the auspices of religious leaders, not counselors.

Stuntzner says that people’s beliefs about forgiveness, or even their beliefs about religion and spirituality, may hinder their ability to forgive. Yet she finds that the concept of forgiveness can be incorporated into multiple beliefs. She often asks clients what forgiveness looks like to them as a means of connecting forgiveness to their belief systems.

Other clients are resistant to forgiving for reasons that have little to do with religion or spirituality. Because clients often believe that forgiveness is relational, they may assume that forgiving someone is equivalent to pardoning the offender or condoning the offense that injured them, Hagedorn says. In addition, they may not recognize the connection between these old wounds and the presenting concern that brought them to counseling, he notes.

Counselors may assume that this resistance signifies that a client does not want to forgive. Instead, Stuntzner advises, counselors should interpret resistance as meaning simply that more work needs to be done before the client is ready to forgive.

At the same time, counselors should take care not to push clients before they are ready. Clients must initiate the process of forgiving. Both Stuntzner and Balkin emphasize the importance of counselors asking questions to understand clients’ thoughts on forgiveness. For example, Balkin asks questions such as “In a perfect world, what would you like to see happen?” and “What do you believe should happen?”

Because forgiveness is not universally defined, counselors need to be open to clients’ values and beliefs surrounding the concept. Sometimes this means “letting them come up with their own terms,” Stuntzner notes.

Readiness to forgive 

Hagedorn says one area that is missing in the practice of forgiveness is the assessment of client readiness. “We [counselors] tend to throw action-oriented interventions at clients across the board because we assume that when they come in for help, they are ready to make an active change,” he says. But that is not always the case.

Unfortunately, Stuntzner points out, there is no scale or objective measure that says clients are ready to forgive. “It’s a … subjective process,” she says. “That’s where a counselor’s clinical skills come into play.”

Stuntzner looks for possible indications that a client might be ready to work on forgiving. For example, does a particular event or person seem to rule the client’s life? Does the client spend a significant amount of mental and emotional energy rehashing the offense? Is it getting in the way of the client’s present life? Is the client in enough pain that he or she no longer wants to feel that way?

Lemon, an ACA member who frequently works on forgiveness with her clients, also looks for signs. In terms of needing to be forgiven, clients will typically show remorse, a desire to make it right or a desire to move on, she says.

To better understand his clients’ readiness to forgive, Hagedorn, the former editor of the Journal of Addictions & Offender Counseling, applies the transtheoretical model, which assesses individuals’ readiness to change their behaviors on the basis of the following six stages:

  • Precontemplation (denying there is a problem and only wanting to change others’ behaviors)
  • Contemplation (acknowledging the problem and the need to change but only thinking about it)
  • Preparation (planning how to change)
  • Action (modifying one’s behavior and environment)
  • Maintenance (maintaining the action)
  • Termination (coping without fear of relapse)

Counselors can assess client readiness by looking at how their behaviors match those stages of change (e.g., engaging in “other” talk, blaming others for their pain), Hagedorn explains.

But, ultimately, the decision to forgive lies with the client. Balkin stresses the importance of forgiveness being initiated by the client. Clients need to say that they are struggling with a situation and that they want to change it. Counselors must be careful not to impose forgiveness on clients before they are ready to forgive because the clients’ beliefs about forgiveness may hinder the process, he adds.

Learning to forgive 

People often assume that forgiveness is something that just naturally happens in the counseling process, Stuntzner says. However, forgiveness is not necessarily an intrinsic process. Forgiveness scholars, including Frederic Luskin, director of the Stanford University Forgiveness Project, and Robert Enright, co-founder of the International Forgiveness Institute, argue that forgiveness is a teachable skill that requires practice.

Hagedorn, an addictions counselor in Orlando, Florida, points out that one-third of the steps in 12-step recovery programs deal with forgiveness. He refers to Step 4 and Step 5 as “practice forgiveness” because they involve individuals taking inventory of the harm they have caused others and themselves and then seeking forgiveness from someone whom they have not harmed (e.g., a higher power, a counselor, a sponsor). In Step 8 and Step 9, individuals make a list of everyone they have harmed and seek forgiveness from them. Hagedorn has found that practicing forgiveness is also a good therapeutic technique for clients who need to learn how to be forgiven by others.

Stuntzner agrees that practicing forgiveness is a helpful technique. If a client cannot forgive a hurt because it is too painful, she advises counselors to restructure the session and ask the client if there is someone else he or she can forgive. Forgiving someone else can help clients experience the benefits of forgiveness and build confidence in the process, Stuntzner says, which might encourage them to readdress the previous hurt they were initially resistant to or at least apply forgiveness to other situations in their lives.

Clients must continue to develop the skill of forgiving because, as with any skill, it can get rusty without practice. Therefore, Stuntzner suggests that it might be beneficial for counselors to check in or have booster sessions with clients to see how they are doing with applying forgiveness in their daily lives.

Another common misconception is that forgiveness is relational. “Often people believe that reconciliation [has to be] part of forgiveness … and that is simply not the case. Reconciliation may or may not be part of the process,” says Balkin, an ACA member and past president of the Association for Assessment and Research in Counseling. In fact, sometimes, reconciliation is not possible.

Balkin offers an example from his own practice: A client is processing pain from the emotional neglect she experienced from her father growing up. He becomes terminally ill after she is an adult. While taking care of him, she tells him that she loves him, but he dies without ever returning the gesture. In this case, reconciliation is not possible, and the client must come to terms with the fact that she will never get what she wanted. In situations such as these, intrapersonal forgiveness is key, Balkin says.

The Jewish conceptualization of mechila, which means to wipe away debt, can serve as a helpful tool for teaching intrapersonal forgiveness, says Balkin, who finds this concept of forgiveness particularly empowering. By acknowledging that the person who hurt them no longer owes them anything or that they don’t expect anything from the person, clients stop spending time or negative energy on the hurt, thereby regaining control of their lives, he explains.

Because intrapersonal forgiveness does not require reconciliation and can be done on a personal level, people may assume incorrectly that it is easier, Balkin says. Admittedly, interpersonal forgiveness is difficult because a client must set aside the hurt and work on trusting the other person again, but intrapersonal forgiveness comes with its own set of challenges.

“Abandoning resentment toward someone who has not demonstrated remorse or change is hard to do,” Balkin points out. However, he adds, “Abandoning resentment doesn’t mean trusting that person. Abandoning resentment simply means, ‘I don’t wish the person any ill will, and I’m not going to allow this person’s actions and behaviors toward me to impact my
life anymore.’”

Integrating other approaches 

When Stuntzner initially started out, she viewed forgiveness work as atheoretical, but she quickly realized that counseling journals often wanted it tied to a specific approach. Even though she still believes forgiveness is a process in and of itself, she finds that it also works well with other counseling approaches. In fact, she views resilience, self-compassion and forgiveness as “a three-legged stool” because one can lead to another. “As people learn to forgive, they can experience more compassion and self-compassion and vice versa,” Stuntzner says.

Lemon believes that forgiveness work can be integrated into any type of therapy. After all, she points out, clients typically do not come to counseling just to work on forgiveness, so adjunct therapies are required. For example, she thinks there is a cognitive behavioral aspect to forgiveness. “Any type of spiritual approach works well with CBT [cognitive behavior therapy] because it is about changing thought patterns,” Lemon says. She adds that Adlerian therapy and solution-focused brief therapy (because it is goal-oriented) also work well with forgiveness. In addition, forgiveness meshes well with acceptance and commitment therapy (ACT) because of the aspects of self-acceptance and commitment to change, Lemon says.

Even so, Hagedorn cautions counselors against using ACT initially unless they are already familiar with it. ACT is not a stage-based or linear theory, so it requires counselors to possess a significant amount of experience with clients and the change process, he explains. Instead, he suggests that counselors begin with mindfulness-based interventions, which are an easy entryway to forgiveness work because they focus on getting people grounded and in the moment.

“Forgiveness is one of those things that we want to do but sometimes we don’t know how to do,” says Lemon, who has presented on the mind-body approach to forgiveness. Clients often resist cognitive approaches to forgiveness, she adds, which is why mindful forgiveness is so important. Mind-body techniques allow clients to “bypass the cognitive thinking and go to the unconscious” so they don’t have to focus on questions such as if they need to let the hurt or betrayal go or if the other person deserves forgiveness, she explains.

Approaching forgiveness from an energetic standpoint, Lemon aims to help clients rid themselves of toxic emotions such as anger and resentment by using forgiveness meditation. This method combines mindful breathing, affirmations (e.g., “I forgive you for all wrongdoing”) and positive visualization (having clients visualize someone they care for and then applying those same feelings to the offender and themselves).

Hagedorn refers to a mindfulness technique he uses as “the breakaway.” In this technique, a client recounts the story of his or her trauma or hurt. Partway through, the counselor has the client stop (or break away) to notice five things in the room. Afterward, the client picks up where the story left off. Through this technique, clients learn to “go in and out of the story and thereby gain some control and power back,” Hagedorn explains.

Lemon recommends another helpful mindfulness technique connected to forgiveness work that asks clients to imagine their situation from four perspectives: their own, a bystander’s, the offender’s and the client’s highest spiritual self. The technique involves more than just asking clients how they think the other person would feel, which often creates resentment, Lemon says. Instead, clients role-play and step into that other person’s perspective.

Forgiveness inventories and models 

In 2014-2015, Stuntzner conducted two pilot studies on a 10-module resilience intervention that taught people with disabilities about resilience and how to cultivate resilience-based skills. Throughout these pilot studies, participants reported that the module on spirituality and forgiveness was helpful and meaningful, but because of the difficulty of being able to forgive, they indicated that it would be useful to have more time to work on forgiveness. This finding, coupled with the fact that there was not a specific forgiveness intervention tailored to meet the needs and unique experiences of people with disabilities, led her to develop a seven-module intervention: “Stuntzner’s Forgiveness Intervention: Learning to Forgive Yourself and Others.”

Balkin and other researchers have developed a Forgiveness Reconciliation Model (FRM) that contains four stages:

  • Collaborative exploration (the counselor helps the client identify what his or her beliefs are about forgiveness)
  • Processing the role of reconciliation
  • Evaluating remorse/change from the offender
  • Determining an outcome (interpersonal vs. intrapersonal forgiveness)

Balkin urges counselors not to assume that reconciliation is a necessary part of forgiveness just because the word is in the model’s title. “[The FRM] is a process-oriented model, not one that eventually leads to a single conclusion,” Balkin says. Therefore, the model is a way to process forgiveness and helps counselors and clients decide if clients should reconcile or take a more intrapersonal route, he explains.

To aid in the process of choosing between interpersonal and intrapersonal forgiveness, Balkin, along with other researchers, also created a Forgiveness Reconciliation Inventory (FRI). The inventory contains four scales that measure each stage in the FRM.

With this inventory, clients can “see the conflict illustrated on paper,” Balkin notes. For example, when working with women in a domestic abuse shelter, Balkin found that some of the women wanted to reconcile with their partners even though the partners had not shown any remorse or changed their behaviors. The FRI helped the clients visualize the process and realize that in their situations, reconciliation would do more harm than good.

Balkin warns counselors not to think of assessments such as the FRI as labeling or diagnostic tools. No model or inventory will allow counselors to label someone as a “forgiving person.” Rather than being generalized to all issues, these tools are unique to each experience, he explains. In fact, similar situations can have very different outcomes. Therefore, the FRI “is not a labeling instrument, not a diagnostic instrument. It is a process instrument. It is designed to be used to enrich the session with the client,” Balkin says.

Scattering seeds of forgiveness

Forgiveness is often discussed in terms of difference. We talk about how religious, spiritual and cultural views or gender differences affect forgiving. But Balkin points out that it is more helpful to look at the commonalities of forgiveness. For example, we have all been hurt and we all have to figure out how to release that pain and not remain in the victim role, he notes. In addition, we all seek ways to find strength from what we encounter.

Another commonality is that “forgiveness is a freely chosen act,” Balkin says. Regardless of cultural views on whether someone should or should not forgive, we all choose to give or not give forgiveness — just as the rabbi on the train chose not to forgive the salesman because the rabbi was not the one who had been truly wronged.

Rabbi Heschel’s parable also reminds us that forgiveness does not have to be relational and that there are multiple ways of thinking about it. In addition, counselors should keep in mind that the act of choosing to forgive — being ready to forgive — can be a long process. “A lot of people live their lives in unforgiveness,” Hagedorn observes.

This means counselors may encounter clients who never reach a stage when they are ready to begin the work of forgiveness, and that can be frustrating. “Sometimes I’m just scattering seeds, and I’m hoping that someone else will come along and water [them],” Hagedorn says.

Counselors can play an important role in demystifying the process of forgiving and helping clients turn their anger, pain and shame into something empowering. Even if counselors never hear their clients utter the difficult words “I forgive,” they will have planted the seeds that might one day bring new life.




Moral injury and forgiveness

In some cases, clients must learn to live with certain hurts and wounds rather than simply releasing them. Military service members often deal with moral injury, which results in shame and hurt, whereas people with addictions often can’t forget the pain they have caused others and themselves.

In such cases, Bryce Hagedorn of the University of Central Florida advises counselors to shift from cognitive behavior therapy to acceptance and commitment therapy (ACT), thus changing the emphasis from eradicating the hurt to learning to live with the hurt. These clients must learn to “live in the ‘and,’” he says. This means learning to live with what has happened and still be a productive member of society, explains Hagedorn, who has conducted webinar training on
self-forgiveness, ACT and moral injury for the National Board for Certified Counselors.

With moral injury and addictions, clients often need to forgive themselves. But self-forgiveness can be particularly challenging. Susan Stuntzner of Southwestern Oregon Community College has found that “it’s easier for people to express and feel compassion toward others than [it is] to give themselves permission to be self-compassionate.”




Disability and forgiveness

Individuals with disabilities must often learn how to manage a whole range of factors, including changes in their life and relationships, unemployment or underemployment, bias, stigma and negative attitudes from society, says Susan Stuntzner, a counseling professional who has presented on disability and forgiveness interventions. In fact, she says, “Only one piece of forgiveness may be tied to the disability itself.”

There are other life experiences and new hurts or offenses that typically happen after the fact, and often people are not prepared to deal with them, Stuntzner explains. For example, these clients may be faced with a partner who is having a hard time adjusting to the person’s disability or has even decided to leave the relationship, or they might encounter barriers to finding a job, all of which can increase their anxiety or fear.

Stuntzner has found that forgiveness work offers an effective way to help these clients cope. For individuals with disabilities, rehabilitation is often thought of as physical, but there is an emotional component as well, especially for people with a traumatic injury that suddenly changes their lives, such as a spinal injury or stroke, says Stuntzner, a member of the American Counseling Association and the American Rehabilitation Counseling Association. Forgiveness provides these clients with an alternative to letting other people or situations control their view of themselves or their lives, she explains. The process helps them let go of their negative feelings and allows them to find a way to move forward toward a better quality of life, she says.




Lindsey Phillips is a freelance writer and content developer living in Northern Virginia. She has 10 years of experience writing on topics of race, immigration and health. Contact her at lindseynphillips@gmail.com or through her website lindseynphillips.com.

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

Becoming shameless

By Laurie Meyers April 25, 2017

You should be ashamed of yourself.” How many of us have heard — or perhaps even used — that phrase? Being on the receiving end of such a pronouncement is never pleasant. More important, experts firmly believe that attempting to wield shame as an instrument of change is both ineffective and harmful. In fact, many clinicians say that shame is intertwined with an abundance of issues that typically bring clients to counseling. Furthermore, it often stands as a significant barrier to healing.

In her book I Thought It Was Just Me (But It Isn’t), Brené Brown defines shame as “the intensely painful feeling or experience of believing we are flawed and therefore unworthy of acceptance and belonging.” The research professor at the University of Houston’s Graduate College of Social Work believes that shame has become a kind of silent epidemic in society that serves to isolate us and thus damages our sense of connection to others.

Thelma Duffey, the immediate past president of the American Counseling Association, agrees. One of her main initiatives as president focused on issues surrounding bullying and interpersonal violence, both of which can leave people struggling with a deep-seated sense of shame. “I see shame as a deeply painful feeling that people experience when they feel exposed, inadequate or especially vulnerable,” she says. “Unforgiving and powerful, shame can leave many people feeling unworthy and incapable.”

Bullied into shame

The practice of actively shaming others, particularly through bullying behaviors, is all too common in our culture, says Duffey, a practicing licensed professional counselor and licensed marriage and family therapist for more than 25 years.

“Bullying can trigger feelings of shame, leaving people feeling defenseless, embarrassed and confused,” she says. “Some feel such a strong sense of self-consciousness and become so preoccupied with avoiding shame-inducing situations that they withdraw from others, which can lead to an excruciating form of isolation.”

Without the consistent presence of love and support in a person’s life and the provision of a realistic viewpoint from others, there is no counterbalance to shame’s narrative.

“Imagine holding a broken mirror of yourself and believing that the distorted image is what you truly look like,” Duffey says. “Your perception would be off, wouldn’t it? Now imagine you are holding a broken mirror that reflects a distorted image of who you are as a person. If you believe this distortion, it won’t be easy to feel good about yourself or to connect with other people who love you. It will probably lead you to see the world as an unsafe place. In all likelihood, you’ll have to create ways of coping with these images just to survive. Too many times, these coping strategies ultimately keep us from the very connections we desire.”

Duffey says there is an antidote. “I believe that developing a sense of self-compassion is at the core of conquering shame,” she says. “Unfortunately, self-compassion is not always easy to come by, particularly when a person has been mistreated, publicly mocked or hurt, as is generally the case with any bullying situation. In fact, introducing the idea of self-compassion can actually make people wince when they live with feelings of shame, because it sheds light on their self-loathing perceptions.”

Counselors can use a variety of methods to help clients develop self-compassion, but a strong therapeutic bond is the most essential ingredient in that process, says Duffey, who is also a professor and chair of the counseling department at the University of Texas at San Antonio. One of the interventions she uses is Emotional Freedom Techniques (EFT).

“EFT has been described as a type of psychological acupressure that can help unblock distressing situations,” Duffey says. “The idea is to restore balance to the body’s energy field to move negative emotions that can keep us stuck. I also see it as a way for people to center themselves when they are in their uncomfortable emotions and to connect with themselves in a more soothing way.”

Duffey says that EFT in its traditional form has a sequence that involves identifying the problem — for example, shame — and then having clients ask themselves how they feel about the problem right now. Clients then rate the level of intensity of the problem, with 10 being most intense and zero being least intense. Next, the counselor and client come up with a “setup” statement that acknowledges the problem and follow that with an affirmation. Clients then repeat the statement and affirmation while performing a kind of “psychological acupuncture” that involves taking their hands and tapping five to seven times on the body’s “meridian” or energy points.

“A person experiencing shame and with memories of bullying might say something like, ‘Even though it is not always easy for me to see my own value, I deeply and completely love and accept myself,’” she says. “Or, ‘Even though I can still remember the horror of being made fun of, excluded and shunned, I can be on my own side now. And I am not alone. In fact, I am working on loving and accepting myself.’”

Once a person connects with the problem and the idea of loving, self-compassionate affirmations, he or she can use those affirmations to process all sorts of experiences, Duffey says. “The idea, of course, is not about thinking positively or practicing self-delusion,” she notes. “Rather, it is about really being honest about what hurts and confronting these feelings, [and then] offering affirmative statements of hope and compassion while tapping into the body’s energy using acupressure points.”

Duffey recommends the website thetappingsolution.com for those who would like to learn more about EFT.

The trauma-shame connection

At the ACA 2017 Conference & Expo in San Francisco this past March, licensed mental health counselor Thom Field presented “For Shame! The Neglected Emotion in PTSD.” In the session, he explained that shame is a significant component of posttraumatic stress disorder (PTSD), particularly in cases of interpersonal trauma, such as child abuse and intimate partner violence.

Because PTSD’s most common symptoms — hypervigilance, nightmares, flashbacks, intrusive memories and physiological hyperarousal — are all related to fear of external danger, experts in the trauma field have traditionally focused on fear as the primary emotion in PTSD, noted Field, a member of ACA. Using this assumption, therapy techniques for PTSD have focused on methods such as exposure therapy, he said. In exposure therapy, clients are asked to revisit the trauma multiple times because repetition has been shown to help lessen the physical and emotional effect of these memories.

However, new research suggests that trauma survivors often also fear being rejected and exposed as weak. This fear engenders a sense of shame, said Field, an associate professor and associate program director of the counseling master’s program at the City University of Seattle. He explained that the shame is fueled by a persistent negative self-appraisal in which clients who have experienced interpersonal trauma often berate themselves with statements such as “I am weak — an easy target”; “Something is wrong with me if I can’t prevent these things from happening”; or “Why didn’t I do something?” Trauma survivors often feel inadequate, inferior or powerless to affect their own environments, he added.

Field believes that counselors must understand the role of shame to help many of these individuals who are living with PTSD. “Shame is an emotion that arises when a person feels inadequate or corrupted by an irredeemable act or a contaminating event,” Field explained. “The person feels undesirable and unattractive and fears the perceived judgment of others.”

It is also important for counselors to differentiate shame from guilt, Field noted. He defined guilt as regret for a specific action that is bound to external circumstances. It is a feeling connected to what one has done rather than — in the case of shame — what one is, Field emphasized. Whereas guilt can motivate prosocial actions such as reparation, shame usually motivates self-protective actions such as withdrawal or lying to protect secrets, he pointed out.

Among the factors that increase feelings of shame in those who are experiencing PTSD or interpersonal trauma are the attribution of responsibility (such as the perception that having HIV or AIDS is that person’s “fault”); the level of visibility and an inability to “hide” (because of circumstances such as physical disability or disfigurement); and being marginalized, Field said.

Feelings of shame may prevent some people with PTSD from seeking counseling, and even those who do seek counseling may deny the presence or impact of trauma if a counselor asks them about it directly, Field said. Harboring a sense of shame may also make it difficult for clients to trust others, he added, so counselors must take care to proceed slowly and focus on developing the therapeutic alliance. These clients need to be made to feel safe enough to reveal their secrets and process their fear of rejection, humiliation and judgment by others, he emphasized.

An important step in the process is for counselors to facilitate client autonomy with what Field termed “pre-questions.” For instance, a counselor might say, “It seems like it might be helpful to revisit this event. How ready are you to face that?”

“If you dive in [yourself as the counselor], it feels [to the client] like it’s not voluntary,” Field explained. When counselors press the processing of shame before clients are ready, it can cause clients to, in essence, feel shame about their shame.

Counselors should also let clients know what to expect when they decide to share their trauma. For instance, Field said, “The client is going to feel physiological symptoms.”

Through client mirroring and active listening, counselors can help establish a sort of holding container for these clients’ emotions. This takes away the pressure of having to “do” anything with those emotions, allowing clients to feel safe simply “sitting” with their feelings until they are completely ready to process them, Field explained.

Like Duffey, Field thinks that self-compassion is essential to overcoming shame. The ultimate goal is to teach clients to accept their current and past experiences without self-judgment, he said. Field recommended that counselors use some of the exercises developed by psychologist and self-compassion researcher Kristin Neff. These include having clients imagine how they would treat a friend who was in the same circumstance, writing letters to themselves from a place of compassion, changing critical self-talk through reframing, keeping a self-compassion journal and practicing loving-kindness meditation.

The lasting shame of abuse

For clients who were sexually abused as children, the sense of shame is almost primal, says ACA member David Lawson, who has worked with trauma victims for more than 25 years. Time after time, women in their 30s and 40s have sat in Lawson’s office and insisted that it was somehow their fault that they were sexually abused as children.

“They say, ‘There must be something wrong with me.’ ‘I’m bad.’ ‘I’m contaminated,’” says Lawson, a counseling professor at Sam Houston State University in Texas who has conducted extensive research on trauma. “I’ve even had several people say, ‘I must be evil in some way for this to happen to me.’”

When parents are the perpetrators of sexual abuse, the abuse survivors’ sense of shame is particularly strong, Lawson says, because humans are wired to seek attachment with parental and other caregiving figures. To maintain this attachment, child victims must rationalize the abuse. As a result, these children often tell themselves that they are bad rather than accepting that the parent is not good, Lawson explains.

Another factor that contributes to these children’s feelings of shame is the perceived “benefits” they received from their abusers, Lawson says. He recounts the story of a female client in her 20s.

“She was abused from the ages of 5 to 16 by her father [until] her mother finally left the father. Years later she came into therapy, and I said, ‘Tell me about some of the best times in your life.’ She said that they were with her father: ‘At times I felt like I was my father’s girlfriend.’ There were benefits for her. He would buy her things and take her places, which he did not do with her siblings. Then, at night, the abuse would happen.”

The woman went on to confide to Lawson that the worst times in her life were also with her father. “He would tell her, ‘No one else will love you. You are worthless. No one will have you but me,’” Lawson says.

Abusers often use this technique, aware that if their victims feel there is nowhere else they can go and be accepted, there is a greater chance they will stay in the only place they seem welcome. This “acceptance” increases victims’ sense of connection to their abusers, Lawson says.

These patterns are distinct and specific to what Lawson calls the “trauma subculture.” The behaviors and beliefs of survivors of sexual trauma are so antithetical to most people’s expectations that outsiders — including many counselors — often find their reactions difficult to understand, he says.

“One of the hardest things for my students to get over is the way that [sexual trauma survivors] look at the world and the way they think about themselves,” Lawson says. “We just want to run over and hug them, but that just ramps up their shame because they don’t believe that they’re worthy.”

Early in his career, Lawson learned how premature sympathy and acceptance could backfire. He told a client that the abuse the client had suffered was not his fault, and the client got quite angry with Lawson, rejecting his help because he genuinely thought that Lawson didn’t know what he was doing.

What Lawson learned with that experience is that in immediately trying to correct clients’ beliefs about their abuse, counselors threaten to take away a major part of the identities that clients constructed as a way to survive. Today, Lawson urges counselors to move slowly with these clients and first work toward establishing a strong therapeutic bond.

“It may take many sessions just for them to feel comfortable,” he says. “These people don’t trust anyone, so to think that they’re going to trust in a few sessions is naïve and counterproductive.”

Start by accepting these clients where they are and reflecting on the dilemma they are facing, Lawson advises. “On the one hand, they feel an enormous amount of allegiance. On the other hand, they have strong feelings of hate,” he explains.

After counselors have established a relationship, they can introduce the idea of talking about the client’s experience. A counselor could say, “Talk to me about your relationship with your father and how you came to the conclusion that you’re not worthy of anyone else’s love,” Lawson suggests. He adds that counselors must give clients time to reflect and reconstruct how they came to their conclusions about self-worth.

Lawson says that once he asks those kinds of questions and lets clients unpack and narrate their experiences at their own pace, they are usually able to begin seeing how their erroneous, negative self-beliefs were shaped by what happened to them. He cautions, however, that intellectual understanding is not the same as emotional acceptance, which can take additional time. Lawson notes that some experts view this kind of shame as an annihilation of self. Survivors may feel that there is no part of themselves that is worth forgiving, he explains.

In the process of helping clients see themselves as redeemable, fully acknowledge the abuse that happened to them and grieve what was lost, counselors should be supportive, but they must also modulate their affirmation to a level that the client can handle, Lawson cautions. “If we’re too warm and nurturing, the client takes that and rejects it and sees us as incompetent because we don’t understand,” he says.

For that matter, trauma (and shame) may not be the stated concern that brings survivors of sexual abuse into counseling in the first place. Instead, the presenting issue may be depression, anxiety, relationship difficulties or something else, Lawson says. “I deal with whatever they present with and try to help them get some relief from those things,” he says.

But along the way, Lawson introduces the idea of addressing and processing the trauma with clients. He may approach it in a very general way at first, perhaps by asking clients to talk about the trauma as if it happened to someone else.

Lawson may also use a “lifetime line.” He starts by asking clients to pick a year of their lives and talk about everything they can remember about it — good and bad. By doing this, clients are not only processing trauma, but also remembering that there were positive events in their lives too, he says. Lawson also has clients write down all the positive memories to help remind them, as they construct their life narrative, that the abuse does not encompass their entire life.

Lawson says he finds narratives, either written or spoken, vital in treating clients’ shame. By showing compassion for their narratives, counselors can help clients start to feel compassion for themselves, he says.

Shame beliefs

Gray Otis, a licensed clinical mental health counselor in Cedar Hills, Utah, believes that shame is typically a component in traditional mental health disorders such as depression and anxiety. In fact, he says, shame likely underlies most issues for which clients come to counseling.

“Typically, the individuals who come for treatment have strongly held negative core beliefs about themselves,” says Otis, who has extensive postgraduate training in trauma treatment. These negative core beliefs are not just about behavior, he adds, but actually inform people’s sense of who they are.

Otis, whose counseling approach is centered on positive behavioral health, thinks that these beliefs stem from incidents that evoke a sense of shame in the person. Such events typically take place in childhood or adolescence, but adults can experience them too. These incidents may or may not be described as “traumatic.” Negative core beliefs can be caused by an accumulation of painful events, such as consistently being criticized as a child or going through a divorce. The resulting beliefs can take many forms, Otis says, but they generally revolve around reinforced themes — for instance, a person growing to believe that he or she is stupid, unworthy, undeserving and unlovable.

Otis believes the key to addressing clients’ mental health issues is uncovering and dispelling their shame-based negative core beliefs. The difficulty counselors may face in unraveling a client’s core beliefs will vary depending on the person and the complexity of his or her presenting issues. However, Otis says he finds it relatively straightforward to uncover many of these beliefs. When he asks clients to identify some of the things they believe about themselves that are not positive — Otis directs them to use “I am” statements — they can usually identify five or more negative beliefs, he says.

What is particularly potent about the beliefs underlying these “I am” statements is that people tend to perceive them as being inherent, unchangeable personal traits, Otis says. Many of these core beliefs are subconscious, he adds. By helping clients bring them to the surface and recognize that they are beliefs, not traits, counselors can assist clients in replacing negative beliefs with positive core beliefs.

Otis does this by having clients explore the origins of one of their negative beliefs, asking them when they started believing this internalized truth about themselves and what happened that contributed to that belief. Otis then asks clients to focus on one of their most distressful experiences and “freeze” it, as if it were a photograph. He then urges them to describe the emotional sense of the experience, identify their degree of distress and state the shame-based negative core belief (such as “I am never good enough”).

The next step is for clients to specify the positive core belief they desire. Otis then helps them identify life events that reinforce the new, positive core belief. He asks clients to remind themselves of these reinforcing events daily as a way to continue strengthening their positive belief. Next, Otis has clients revisit the experience that engendered the negative belief, and he talks with them about how the event was misinterpreted.

Otis says he also uses methods such as sand tray therapy, eye movement desensitization and reprocessing, and cognitive behavior therapy not only to help clients develop more positive beliefs but also to become more resilient. He emphasizes, however, that the most important factor when working with shame-based negative core beliefs is a strong therapeutic alliance.

Ultimately, he says, helping clients rid themselves of persistent shame is what opens the door to healing.




Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@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.

The case for including animals in counselors’ duty to report

By Troy Gregorino April 12, 2017

This past year, the American Counseling Association Governing Council endorsed formal competencies for the practice of animal-assisted therapy in counseling. The authors of the standards, and the coordinators of ACA’s Animal-Assisted Therapy in Mental Health Interest Network, contend that the competencies (available at counseling.org/knowledge-center/competencies) represent a key step forward in both the protection of clients and the promotion of therapy animals’ well-being. My own contention is that the adoption of these competencies additionally points to a need for ACA to endorse a “duty to protect” that applies to animals.

As a doctoral student in counselor education and supervision at University of the Cumberlands in Williamsburg, Kentucky, one of my areas of interest is animal-related counseling issues. I have become increasingly convinced that the human-animal bond is for many people an integral aspect of wellness, recovery, purpose and hope. Furthermore, I contend that it is misguided for the counseling profession to advocate for the protection of animals that we happen to use in our interventions but to take no stance in the protection of other animals whose lives are intertwined with the people we serve. Anecdotally, I have encountered significant support for this sentiment, both within and outside of the counseling profession. I offer a rationale for it here, not merely as a philosophical concept to be considered hypothetically, but as an invitation and a call to action for ACA decision-makers.

Tracing back to the Hippocratic oath, doctors and mental health counselors are required to maintain the confidentiality of information disclosed to them in the context of the therapeutic relationship. An exception for counselors is their “duty to protect” potential victims from the anticipated violent behavior of a client. I’d like to make the case that a client’s anticipated violence toward animals ought to be included on the counseling profession’s list of actions that require mandatory reporting.

Applying counseling’s code of ethics to animals

Animals are already protected by existing state, national and international laws, and I think that adapting the ACA Code of Ethics to reflect adherence to those laws is both a logical extension of our ethical framework and in keeping with the spirit of our duty to report.

The intention of mandated reporting, dating back to the California Supreme Court’s landmark 1974 Tarasoff ruling (amended in 1976 to replace “duty to warn” with “duty to protect”), was to impose a legal obligation on psychotherapists to notify individuals who might potentially become victims of violence perpetrated by a counselor’s client.

The ACA Code of Ethics names “serious and foreseeable harm” (Standard B.2.a.) as an exception to maintaining confidentiality. In full, the standard reads: “The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed. Counselors consult with other professionals when in doubt as to the validity of an exception. Additional considerations apply when addressing end-of-life issues.”

To elevate that standard to afford protection to nonhuman victims, it could be amended to read, “… clients or identified others, including animals protected from cruelty by applicable state laws …” Imagine the profound impact our profession could have on alleviating undue suffering with the addition of those nine words. Our responsibilities as counselors would remain essentially just as they are, but without a pass for ignoring instances of “serious and foreseeable harm” to animals protected by law. The ACA Governing Council’s endorsement of competencies that, in part, safeguard the comfort and well-being of animals used in therapeutic interventions is laudable; extending those concerns to protect the most defenseless victims from the most egregious acts of cruelty seems to me to be a reasonable and much-needed next step.

It is worth noting that animal protection laws vary considerably from state to state. For instance, according to the Animal Legal Defense Fund, all but two U.S. states impose felony-level penalties for severe forms of animal abuse, and some states allow for the inclusion of animals in domestic violence protection orders. Additionally, some states require mental health evaluations or counseling for animal-abuse offenders. My proposed amendment to our ethics code is intended to be both comprehensive and flexible enough to accommodate the multitude of variations in state laws.

A likely objection to this suggested modification to our code of ethics might involve concerns about damaging client-counselor rapport. However, the same philosophical justification that applies to our current “duty to protect” mandate applies here too. The amended code would simply reflect the standard established by existing law by identifying and protecting those against whom acts of violence constitute legal violations. As it stands now, the ACA Code of Ethics does just that by protecting humans from illegal acts of violence, but it in effect flouts the law when it comes to protecting animals.

In addition to reconciling this disparity in our duty to report, this amendment would be congruent with our duty to take seriously behaviors that are likely to place both the client and the victim in harm’s way. After all, as counselors, we would be hard-pressed to conceive of the therapeutic value of not intervening in the commission of a violent crime. In the case of child abuse, for instance, it would neither contribute to the protection of the victim nor to the progress of the perpetrator to not treat the crime as being of paramount and urgent importance. The same can be said for the significance and immediacy of animal cruelty.

Extending our duty to report to include acts of animal cruelty is a logical and consistent next step because, unlike with other criminal acts (knowledge of which does not warrant breaching confidentiality), animal cruelty is a crime that involves intentional bodily harm. From that perspective, our failure to include it in our duty to report would seem an ethically arbitrary exclusion.

Clinical implications of animal cruelty

Entities such as the U.S. Department of Education, the National Crime Prevention Council and the American Psychological Association agree that cruelty against animals is a warning sign for at-risk youth. Since 1987, the American Psychiatric Association has included animal cruelty as a symptom of childhood conduct disorder in its Diagnostic and Statistical Manual of Mental Disorders. It defines the disorder as a “repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.” According to the American Psychiatric Association, additional implications of such tendencies include an increased likelihood for exhibiting similar symptoms in adulthood, sometimes resulting in meeting the criteria for antisocial personality disorder.

Dating back to the early 1960s, researchers have strived to clarify the role that childhood animal cruelty might play as a predictor of subsequent violence against humans. John Macdonald sampled 48 patients with psychotic symptoms, and 52 without. He determined that three primary characteristics — fire setting, enuresis and childhood cruelty toward animals — were consistently discovered among the individuals considered to be the most sadistic. Although he concluded that this combination of traits could serve as a strong predictor of homicidal behavior, he noted that the presence of this triad alone was of minimal value in foretelling such acts.

More recent scholarly literature has increasingly suggested evidence for a connection between animal abuse and either co-occurring or subsequent forms of interpersonal violence. Researchers are divided over the legitimacy of this supposed link. In 2001, Frank Ascione published a thorough overview of psychological, psychiatric and criminological research linking animal abuse to acts of violence against humans. He asserted that animal abuse is an often overlooked warning sign that, in addition to helping to identify youth who are themselves victims, “could help identify youth at risk for perpetrating interpersonal violence.” In 1997, Ascione and colleagues also examined the prevalence with which victims of domestic violence report various forms of cruelty perpetuated by their abusers toward their pets. In 2008, Christopher Hensley and Suzanne Tallichet emphasized an exploration of the motivations behind animal cruelty by interviewing inmates about their childhood animal cruelty crimes.

These and myriad other studies have been met with a range of criticisms, from failing to establish a verifiable link between human and animal violence to applying flawed methodologies. Regardless of what one may think of the reliability or validity of the research to date, a wholesale dismissal of the apparent relationship between animal cruelty and violence against humans seems unwise. More important, however, is that the strength of this proposal does not rest on the legitimacy of such data. Reliance on the supposed link unnecessarily detracts from the central argument that a wanton act of cruelty against a defenseless other is, on its face, egregious enough in my opinion to trump a counselor’s duty to protect a client’s confidentiality.

Why amend our duty to report?

The most obvious beneficiaries of this change in the short term would, of course, be those animals who stand to be spared from enduring abusive acts. But is it not also in the long-term interest of the perpetrator, at least potentially, to have the opportunity for reform sooner rather than later? Cultural anthropologist Margaret Mead famously commented in 1964 that cruelty toward animals “could prove a diagnostic sign, and that such children, diagnosed early, could be helped instead of being allowed to embark on a long career of episodic violence and murder.”

Furthermore, is it not ultimately in the interest of the counseling profession as a whole to err on the side of empathy for the most vulnerable and to draw an ethical distinction between the importance of confidentiality and the urgency of violent crime? Are we not all made better by extending and explicitly endorsing the reach of our ethical consideration to protect even (and, indeed, especially) those with no voice in the matter? Although none of us is currently prohibited from reporting acts of animal cruelty, I have no doubt that adding the amendment proposed here to the ACA Code of Ethics would over time contribute to the prevention of incalculable instances of undue harm.

As counselors, we are called to reflect on the broader implications of our work and on how the changes we help to facilitate contribute to a healthier quality of life. That means considering broadly the wellness of people and, from my viewpoint, the animals with whom people’s lives are so frequently intertwined. ACA’s historic endorsement of competencies for animal-assisted therapy is a heartening step forward as we adjust continually to the social, cultural and philosophical shifts of our times. I hope we will seize on the momentum of this achievement by embracing an amendment to our ethics code that is consistent with our recent progress.

This proposed amendment is consistent with our profession’s historically responsive adjustments to the societal implications of our work and to our forward-thinking recognition of the impact it can have on the world around us. As with past adjustments made to our ethics code, it is incumbent on mental health professionals to remain at the forefront of measures aimed at cultivating justice and advocacy in our service to others. The amendment proposed here would be one more step in the spirit of that legacy.




Troy Gregorino is a licensed professional counselor and certified wellness counselor.
He is a doctoral student in counselor education and supervision at University of the Cumberlands. Contact him at tgregorino@gmail.com.

Letters to the editor: ct@counseling.org

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

The Counseling Connoisseur: Pet loss: Lessons in grief

By Cheryl Fisher April 11, 2017


“Until one has loved an animal, a part of one’s soul remains unawakened.” — Anatole France




On Jan. 22, following a three-week whirlwind diagnosis and decline, my husband and I said goodbye to our 6.5-year-old goldendoodle, Lily. Her disease had rendered this Frisbee-catching superstar unable to stand or walk. She needed to be carried outdoors to “get busy,” and she no longer had the stamina to stay awake for extended periods of time.

The author, Cheryl Fisher, with her dogs Max and Lily.

We spent the entire last weekend with Lily in the emergency room as she struggled against various gastrointestinal issues and, finally, internal bleeding. Her vet and neurologist felt that the disease had progressed and her prognosis was bleak. It was then that we made the most difficult decision we have ever made — to let her go. We took time lying with her, holding her, reminiscing … and stayed with her until her last heartbeat.

On the first day without our Lily, I kept tripping over my grief as I called out to see if she needed to go outside or wanted to lie by the window and watch “her birds.” Max, our 9-year-old goldendoodle, moped around the house, trying to sniff Lily out without success. He looked at me as if begging, “Bring her back, OK?” I canceled my clients for the day. I couldn’t imagine sitting with their pain as my pain continued streaming from my eyes.

I found myself returning to the little Catholic girl inside of me and lighting a candle next to a picture of our Lily that I had placed on the fireplace mantle. I wrote, announcing our loss to all 210 close friends on social media. I started a scrapbook and printed pictures long held captive in my iPhone. I cried continuously, as if the floodgates had been lifted and years and layers of grief came pouring out. All the losses in my life appeared to be resurrected with Lily’s death. My heart ached and my stomach hurt.

My attempts to prep for my classes that week proved futile. I just couldn’t concentrate. I kept reading the same sentence over and over again. Mostly I was just tired. Tired from three weeks of relentless caregiving, painstakingly attempting to keep the horrific disease at bay — the disease that stripped my beautiful bird-watching, tail-wagging, never-had-a-bad-day rescue pup of her mobility, energy and dignity. In the end those soulful eyes would beg me to end her suffering, and in keeping the promise I had made to her, I mercifully did, holding her till the end.


Tips for coping with the loss of a pet

Experiencing the death of a pet can be painful and devastating. Our pets are often our most vulnerable family members, relying on us completely for their care. This includes end-of-life care, which may involve making very difficult decisions about treatment and finally letting go. This adds complexity to grief because we may struggle with questions surrounding the decision to stop treatment and euthanize: Did I do enough? When is it time to let go?

1) Grief comes in waves. Initially the waves may be intense and relentless, pummeling us to the ground. We may feel that we will never breath (or stop crying) again. But with time and some work, the waves gradually recede, allowing us to stand and take tentative strides toward a “new normal.” Still, the waves will come and go, often crashing near a special day or at a moment when our dear fur-family member comes to mind.

2) Grief is brain work. Grief affects our neurology. It makes it difficult to concentrate. We forget things. We are easily irritated. We definitely are not on our A game. We may even feel like we are in a dream (or nightmare). Neurologically, we have taken a hit and require time to recover. Don’t worry. The grief fog will lift eventually. In the meantime, be gentle and kind with yourself.

3) Grief is an ever-changing chameleon. Elisabeth Kübler-Ross identified stages of grief related to dying that can also be applied to our experiences of grief and loss. These stages are no longer thought to happen in a linear manner. Rather, they are common experiences that can occur moment to moment as the result of grief.

Anger: Initially, I felt anger at the sudden deterioration of Lily. She had been running and playing catch just days before her back legs began to buckle under her body. Following an MRI and spinal taps, she was placed on a steroid treatment that quickly led to weight loss and gastric-intestinal discomfort. I was angry at the doctor. I was angry at the disease. I was angry at God.

Guilt: Although I knew I had responded quickly to Lily’s symptoms, I was plagued with self-doubt around the decision to use steroid treatment. Should we have gotten a second opinion? Should we have taken her to a holistic veterinarian? Ultimately, I ruminated over our decision to stop all care and put her to sleep. Was there more that we could have done? It was profoundly clear that the disease had progressed and Lily’s quality of life had suffered drastically, but I still experienced pangs of guilt.

Denial: The first few days were the most grueling. Walking in a daze, I still held some hope that this was all just a nightmare, and as I tripped over Lily’s misplaced toy, I would awaken to find both of our dogs curled at the foot of the bed.

Sadness: It is immensely sad to lose a love one — even a curly headed, wet-nosed, tail-wagging one. I am free with my tears in general, so I just let the emotions stream down my cheeks. Sadness, like grief, looks different for each individual. I am an emotional griever. I emote. My husband is an instrumental griever. He does research on the internet to seek answers. He walks our dog, schedules doggie play dates and arranges activities to help our other dog, Max, with his grief.

Acceptance: Ultimately, the hope is that there will be a sense of peace and understanding at some point and time. This may be experienced in fleeting moments rather than in an arrival at a destination, however.

4) Grief is individual. For me, Lily’s death overshadowed any other event occurring in the world. My Lily had died. Nothing else mattered to me. I crafted my coping strategy selfishly without concern for the feelings or needs of anyone else, including my husband, who had experienced the same loss.

It quickly became apparent that my grieving was more expressive and ritualistic. I made a scrapbook, displayed sympathy cards on the mantle with Lily’s urn, wrote blogs and lit candles in memory of our little rescue. My husband’s grief was more privately experienced, with an occasional shared story and shed tear. It was important not to trip over each other’s grief experience.

5) Grief grows out of a relationship. Some people (and even some therapists) may dismiss the death of a pet as a lesser loss. However, as with any relationship, it is important to understand the meaning ascribed to this relationship. Often a pet serves as a companion who provides unconditional love and affection. Many clients have told me stories of the richness and depth that surrounded their interactions with their pets. For me, Lily was the piece that completed our family puzzle.



The death of a pet can be such a huge loss. These fur-family members may serve as faithful friends and playmates, enriching our lives with their magnificent and comical personalities. It is important to honor their story as it intertwines with our own narrative.

I still tear up every time I hear Eva Cassidy’s version of “Somewhere Over the Rainbow.” I imagine my curly white bundle of pure love bounding across a green field to greet me … just around the Rainbow Bridge.






Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland, and a visiting full-time faculty member in the Pastoral Counseling Department at Loyola University Maryland. Her current research examines sexuality and spirituality in young women with advanced breast cancer. She is working on a book titled Homegrown Psychotherapy: Scientifically Based Organic Practicesthat speaks to nature-based wisdom. 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.


Career counselors: On the front lines of battling student stress

By Neil O’Donnell March 27, 2017

It won’t be news to most readers that undergraduate students everywhere encounter an incredible amount of stress throughout their college years. Colleges and universities offer a considerable range of services and programming to address a variety of stressors, including test anxiety, financial hurdles and personal struggles.

Even with all that focus on helping students to mediate stress and anxiety, I think one source of stress often gets overlooked: career stress. After nearly 15 years serving as a career and academic counselor for undergraduates, I am disheartened that such an oversight remains prevalent, both nationally and internationally, among administrators in higher education.

In a recent survey of 131 undergraduate students, I found that only 12 percent remained undecided regarding what major they wanted to pursue. To assume that only 12 percent of these students remain stressed is misguided, however, especially when learning that 56 percent of respondents to the survey were still uncertain concerning the career path they wanted to pursue. From firsthand experience, I know that this uncertainty causes considerable stress and anxiety for undergraduates.

As for the survey? Of the students who participated, 49 percent indicated that they endured stress over deciding on a major or career path.

Why are so many students battling this stress? We certainly have incredible assets in place to provide undergraduates with career guidance. Most four-year colleges and universities have

career centers staffed with career counselors to help students research majors and career paths. In addition, career centers often offer enrolled students access to free career assessments, including the Strong Interest Inventory, FOCUS, Myers-Briggs Type Indicator or an array of other assessments based on the Holland Career Codes. But even with all these resources available, students rarely utilize career centers for much beyond getting help writing a résumé or cover letter during their senior years (admittedly, I was guilty of this too). Therein lies the problem.

Fellow career counselors and coaches know the following advice all too well, but for other counselors who are working with undergraduate students, I’d like to offer some insight into helping them navigate their career research and mitigate the stress that all too often accompanies that search.


1) Get students to visit their campus career center during their first semester at college. I understand students have a lot to contend with as they enter their first semester of college. Between getting comfortable with the layout of the campus, the location of their classes, college-level course work and the campus food, the first two weeks of the semester are not an easy time for students who are seeking to begin their exploration into majors and career paths. By the third week, however, I find that students are ready to invest time into career research, and a visit to the career center is a good first step. Before sending my students to the career center on campus, I provide them with an overview of the center’s resources and the services the staff provides to undergraduates. Additionally, I discuss career assessments with my students and the information they can glean from assessment results.

Counselors familiar with the career assessment used by a student’s campus career center can provide students with background on the assessment, including information on the assessment’s format and how to access the assessment online if that is an option. Additionally, it is a good idea to stress the importance of seeking a full interpretation of the assessment results by one of the career specialists at the campus career center. In some instances, students can receive assessment results without having to speak with a career counselor or career coach whose expertise includes interpreting these assessments. As I tell my students, they will undoubtedly be able to gain insight from the assessment themselves, but I also stress that there are a multitude of intricacies they will likely overlook. These are bits of information that a career specialist would be able to identify and interpret for the student — information that could be crucial in helping a student identify an appropriate major or career path to pursue.

To avoid a lot of the hesitation and accompanying stress that students have with visiting a career office, I find it helpful to provide students with a few questions to ask the career center staff. In particular, I advise students to ask about the center’s career assessment and how to set up an appointment to go over the results. For those students with majors already in mind, advise them to ask if a particular career center counselor has experience helping students in that major.

A final step is to make certain students know where to find the career center. Yes, it is relatively easy in most cases for students to determine where on campus the career center is located. However, I find that providing the contact information to the students increases the likelihood that they will follow through and visit the career center. Take the extra minute or two to show students the career center’s website, and then email students the center’s contact information, including room location, email and phone number.

2) Seek a follow-up with the student. Before I end my initial meeting with students, I ask them to meet me after their meeting(s) with career center staff. I find that doing so encourages students to follow through on the guidance and their career research. These follow-up meetings offer the opportunity to mediate any stress that arises from visiting the career center. Specifically, students are often stressed that one visit to the career center did not help them immediately decide on or discover the best major and career path for them.

During these follow-up meetings, I help students develop (or adjust) their career research plans. Those counselors who are certified and proficient in the career assessments their students have taken can use these meetings to address student misunderstandings about their assessment results and expand on any feedback the students received from career center staff.

3) Seek additional follow-up after the student completes the assessment. In the event the student took an assessment but did not review the results with a career specialist at the college career center, advise the student to return for a review from the career center staff. It is critically important that students receive that feedback from those who are trained to interpret the results. I have found that the majority of students who meet with career center staff for guidance report that these meetings help reduce their stress and anxiety related to career concerns. In my current survey, 78 percent of respondents indicated that their meetings with a career counselor helped them decide on a major or career path. Furthermore, 69 percent of respondents indicated that meetings with a career counselor helped reduce their stress surrounding career and educational planning.

4) Advise students to communicate with professors on campus whose specializations match the students’ career interests. Even the most experienced career counselor has limited knowledge of the diverse job opportunities afforded by every major and degree. For example, from my personal experience, none of the career counselors on my college campus knew the array of specialties within anthropology, a field that leads to careers beyond professorships, museum curators and forensic specialists.

This is where campus professors are so vital to a student’s career research. The professors in each department likely possess a wealth of knowledge regarding job opportunities and career specializations that a given major affords students. Unfortunately, students often fail to seek career guidance from department professors earlier on (i.e., freshman or sophomore year).

As career counselors, it is incumbent upon us to direct our students to department professionals. Again, drawing from my own experience, speaking with department professors helped me to identify and focus on short-term and long-term careers, which ultimately reduced my stress (especially when many individuals asked me what in the world I was going to do with an anthropology degree).

5) Advise students to communicate with professionals in the communities surrounding the college campus. Connecting with campus professors/professional staff is often not enough to provide college students with a full understanding of the potential (career-wise) that each major offers. To that end, it is important to encourage students to reach out to community professionals to gain an extensive understanding of the possibilities that exist. Another benefit to reaching out to community professionals is that students may learn of unadvertised job opportunities during these discussions, all while expanding their professional networks. What’s more, engaging with professionals who have already put the student’s major into practice often helps to put the student’s mind at ease.

6) Encourage students to seek field experience during summer breaks. Summer vacation is a time for college students to reenergize. That said, there is no reason why students can’t use the summer months to further investigate their major and the career opportunities the major offers. Finding part-time, full-time or volunteer employment opportunities is a great way to gain firsthand experience in the field. Encourage students to speak with their professors and the community professionals with whom they connected to determine what jobs or volunteer opportunities exist that would provide related experience and help students gauge the appropriateness of the major they are currently pursuing.

Such summer experiences are more prevalent than most students and counselors might realize. It comes down to asking the right people what opportunities exist. In addition to giving students related experiences to include on their résumés, such jobs could provide money for college and help students expand their professional networks. Based on my own undergraduate experience, such opportunities reduced student stress by helping them gain a better understanding of the course material from the major, while also revealing hidden career paths not often attributed to the major.

7) Remind students that it’s OK to change their minds regarding their career goals. So what happens when students follow the above advice and determine that they are pursuing a major or career path that is unsuited to their interests, strengths and long-term career goals? Changing a major can be extremely stressful for students because they often feel it is a sign of failure. I remind students that changing a major is a common occurrence. At the same time, I also remind them that it is better to change directions with their newfound knowledge of their major and themselves now than to wait; it is a decision that could save them considerable time and money later on. It is also important in such moments to congratulate students for their efforts. This is encouragement that will help them tackle the stress and worry that often follow a change in major.


Collectively, these strategies have aided me in reducing my students’ stress, while simultaneously helping them determine a worthwhile career and gain valuable field experience prior to graduating. It is especially rewarding when one of my advisees follows through on this advice and has a full-time job lined up before graduation because of connections that he or she has made with community professionals. It is even more rewarding when graduates from years past return to say they still love the major and career paths they pursued after completing the aforementioned research. I believe other career counselors might find similar results as they assist students in managing stress related to choosing majors and career fields.



Neil O’Donnell is a senior counselor for SUNY Buffalo State’s Educational Opportunity Program, where he provides personal, academic and career counseling to undergraduates. O’Donnell is also the author of The Career-Minded Student, a book that provides a plan of action that helps undergraduates succeed in class while preparing to compete for jobs immediately after graduation. Contact him at odonnenp@buffalostate.edu.




Related reading

From the Counseling Today archives: “Unprepared, undecided and unfulfilled

Anxiety, confusion and questions of identity greet many college seniors as they consider their impending graduation and the necessity of determining their next steps in the ‘real world.’ wp.me/p2BxKN-3PD





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