Tag Archives: Bullying

Addressing religion and spirituality in counseling with bullying survivors

By Elizabeth R. O’Brien and Amanda L. Giordano June 5, 2017

The alarming prevalence of bullying in the United States warrants continued education and dialogue among counselors regarding effective ways to serve clients who are survivors of bullying. One aspect in need of more inquiry is the ethical and effective integration of religion/spirituality in clinical work with clients who have experienced bullying.

Bullying, defined as unprovoked abuse in the form of physical, verbal, relational or cyber acts of aggression, can intersect with religion/spirituality in several ways:

a) The experience of bullying can affect clients’ own religion/spirituality.

b) Clients can experience bullying by religious groups or group members.

c) Clients can experience bullying as a result of their membership in marginalized religious/spiritual groups.

In this article, we briefly discuss counseling considerations for each scenario.



Bullying’s impact on survivors’ religious/spiritual beliefs 

Consider the case of “Sara,” a 16-year-old Caucasian high school student. Sara does not fit within the thin ideal that is so prevalent among American high school females. Because of her insecurity regarding her physical appearance, Sara wears dark, loose clothing and tries to hide behind her long hair. Sara’s appearance, coupled with her low socioeconomic status, makes her the target of bullying from her classmates. Her classmates call her degrading names (verbal bullying), and many of her female peers refuse to engage with her at all (relational bullying). The cumulative effect of these daily taunts and exclusion leads Sara to counseling.

Sara’s experience of verbal and relational bullying constitutes a traumatic event. Peer groups are extremely valued and influential during adolescence. Through exclusion by her peers and being a target of their verbal assaults, Sara has cultivated a sense of hypervigilance and feelings of perpetual danger. Additionally, Sara has internalized shame regarding her body image and low socioeconomic status.

During the initial counseling intake, Sara reveals that these experiences of trauma and shame have caused her to question aspects of her religious/spiritual beliefs. Sara identifies as a Christian and reports that she has prayed for relief from bullying. She feels as though her prayers have gone unanswered. She also is questioning her worth to God and ruminating on the thought that perhaps he does not love her.

Sara’s case highlights several counseling considerations. It is clear that her experience with traumatic bullying at school intersects with her religious/spiritual identity. Specifically, Sara has attempted to respond to the bullying by using a religious coping skill (prayer), but she continues to struggle with painful emotions and negative thoughts. Furthermore, she is pondering existential questions concerning the nature of God and her inherent worth but has been unable to find adequate answers.

Therefore, it is important for the counselor to fully assess Sara’s religious/spiritual identity. A thorough assessment in the form of unstructured dialogue regarding Sara’s religious/spiritual history, or the use of standardized spiritual assessment instruments, can help the counselor understand Sara’s Christian identity and worldview.

Through the exploration of Sara’s religious/spiritual identity, the counselor discovers that Sara is uncertain about the concept of prayer and how it applies to her current situation. Sara expresses a desire to learn more about various types of prayer and gain insight into the purpose of the practice. The counselor and Sara agree that she specifically is searching for spiritual direction within the Christian faith tradition regarding the practice of prayer. The counselor provides a menu of options for how Sara might meet this goal. These options include self-study (i.e., reading Christian books and listening to sermons/messages on prayer), meeting with a Christian religious leader or engaging in experiential learning through the practice of various types of prayer (ritual, conversational, centering, contemplative, etc.).

After exploring each option, Sara decides that she would most like to meet with a Christian pastor for an interactive conversation about prayer. The counselor is able to refer Sara to a Christian pastor in the community and helps her set up a meeting. Along with prayer, Sara and
her counselor explore other ways in which Sara can use religious/spiritual coping strategies — such as finding support in her faith community — in response to bullying.

Sara’s experience of bullying has also affected her religious/spiritual worldview by calling into question her perceived value to God. The counselor enters into Sara’s frame of reference to unpack the meaning of her victimization as it relates to her relationship with God. The counselor is careful to utilize the skill of bracketing to avoid imposing her own beliefs onto Sara. Bracketing consists of intentionally compartmentalizing the counselor’s personal values to impartially enter into the client’s worldview.

Through their dialogue, the counselor reflects one of Sara’s core beliefs — that inaction is evidence of dislike. Continued exploration reveals that this belief emerged from Sara’s childhood experiences with her mother. Living below the poverty line, Sara often did not have the same possessions and opportunities as other children her age. She concluded that her mother’s lack of material provision reflected a lack of love and care. Sara then generalized this core belief to her relationship with God: His perceived inaction to stop the bullying constituted evidence of his dislike toward her.

The counselor and Sara examine evidence for and against this belief until Sara develops insight into the limitations of such a dichotomous view. Over time, Sara adopts a more adaptive and nuanced perspective of the meaning of others’ perceived inaction, which helps resolve her spiritual struggle. Throughout this discussion, the counselor is careful to keep in mind models of spiritual development, such as James Fowler’s stages of faith development, to work within Sara’s appropriate developmental level.

These represent only a few examples of how the experience of bullying can affect a survivor’s personal religious/spiritual belief system. Counselors should be skilled and competent in assessing client religion/spirituality, referring or consulting with religious/spiritual leaders, bracketing personal beliefs and considering models of religious/spiritual development in their conceptualization of the bullying survivor.

Bullying by religious/spiritual groups or group members

Next consider “Jacob,” a 31-year-old Black male who identifies as gay. He is employed as an accountant for a trucking and transport company that is characterized by strong Christian values. Working for this company for the past three years, Jacob has continuously dodged questions about his personal life because he fears his co-workers’ reactions to finding out he is a gay man.

A few weeks ago, one of Jacob’s co-workers found a picture on social media, posted without Jacob’s knowledge, that showed Jacob and his partner kissing at a friend’s cookout. Jacob was quickly outed, and his co-workers’ attitudes have become difficult for him to manage. Although some co-workers’ attitudes toward him have not changed, others have become hostile (verbal bullying/aggression). And still other co-workers with whom Jacob had no prior relationship have since approached him to discuss their perceptions of the deviance of his behavior (emotional bullying). Because of recent comments from his boss, Jacob also has learned that his advancement potential in the company has been compromised. These instances are very disturbing to Jacob and trigger his own struggle with how his sexual orientation intersects with his religious faith — a topic he has been avoiding since adolescence.

Jacob’s experiences illustrate how clients might feel that they need to deny or hide aspects of their cultural identity in order to belong to the larger group. This experience becomes even more complicated when individuals are struggling with strongly held values that they perceive to be in direct opposition to each other. To elucidate Jacob’s situation, he grew up in a very religious, Christian household. He learned at an early age that members of his family and faith community believe homosexuality to be in opposition to biblical principles. Jacob continues to value religion and spirituality, but he has struggled to reconcile his affectual orientation and the principles of his religion. These seemingly opposing identities (religious and gay) create internal conflict for Jacob.

Jacob’s counseling journey begins by exploring his experiences with his family of origin and the messages he received regarding religion and sexual identity. His experiences of bullying at work have reignited Jacob’s long-held fears that he will be rejected by those he loves. Specifically, he fears that both his biological family and church family will disown him if he is truthful and open about his life as a gay man. In addition, Jacob’s multiple minority statuses (Black and gay) compound his fear regarding potential discrimination.

Through dialogue and reflection, Jacob and his counselor uncover Jacob’s core beliefs about himself, the world and others, including the notion that God’s love, like his family’s, is conditional and must be earned through correct behavior. Jacob’s counselor is trained in Bowenian family systems theory and works with him to create a genogram to begin assessing the nature of relationships between Jacob and those he identifies as family.

In addition, the counselor prompts Jacob to identify the messages he received from individuals in his faith community, family members and religious texts regarding sexual orientation. This begins Jacob’s process of critically examining the relationship between his religious identity and his sexual orientation. The counselor takes a nonevaluative, neutral stance to allow Jacob to wrestle with his prioritization of multiple aspects of his identity and how he can experience more personal integration. Additionally, the counselor helps Jacob consider how he would navigate situations in which his personal beliefs regarding religion and sexual orientation differ from the beliefs of those in his family of origin.

Through counseling, Jacob gains insight into how his current work situation is triggering emotional experiences of rejection from his adolescence, a time when he was not equipped to deal with those experiences. Jacob’s counselor empowers him to see that he has built the resources and skills over time to negotiate his current situation both at work and in his family. Through this collaborative effort, Jacob is emboldened to contact the human resources department at his work. His experiences of bullying are met with concern, and an intervention plan is created to help manage the situation.

Despite the action taken by the human resources department, Jacob discloses to his counselor that he is in a place of unforgiveness toward the individuals who bullied him at work. He describes feeling withdrawn and cold toward these co-workers, where he once felt they had a collegial relationship. His counselor is careful in addressing these emotions because they likely are the coping mechanisms that helped Jacob feel emotionally safe in the past.

Jacob’s counselor explains that experiencing unforgiveness is a natural part of the forgiveness process. His counselor also is very clear with Jacob that the process of forgiveness is about releasing the hold that negative emotions have on him; it does not mean that Jacob is denying that what happened to him was wrong. As Jacob works on his journey toward forgiveness, he relies heavily on prayer and Scripture. These have always been reliable sources of religious coping for Jacob and help him feel connected to both his religious past and his spiritual present.

Bullying related to one’s religious/spiritual identity

A final way in which bullying can intersect with religious/spiritual issues is being bullied because of one’s membership in a religious/spiritual group. Consider the case of “Malik,” a 22-year old Middle Eastern college student. Malik is a practicing Muslim who is a member of his university’s Muslim Students Association and regularly attends worship at a community mosque. Recently, as a result of growing suspicion of Muslims in America, Malik has experienced both physical bullying and cyberbullying. In one instance, while walking home from campus, he was physically assaulted by a group of male students. They called him a “terrorist” while punching and kicking him. Additionally, he has received threatening messages on social media telling him to leave the country. These experiences led Malik to seek services from his college counseling center.

Malik’s religious/spiritual identity is an important part of his cultural makeup. His worldview is shaped by his understanding of Islam and his desire to adhere to the tenets of the faith. As a member of a marginalized religious group in America, Malik experiences oppression in both covert and overt ways, including the overwhelmingly negative portrayal of Muslims as antagonists on TV and in film, poor customer service at stores and restaurants, and being perceived as suspicious or dangerous by others. Additionally, he now is a survivor of various forms of bullying.

Malik reports to his counselor that he feels conflicted regarding his faith. On one hand, he is devoted to Islam, but on the other, he is ashamed of his religion because of the oppression he experiences. He reports feeling guilty for having negative thoughts about his faith and is struggling with feelings of hopelessness.

The counselor listens to Malik’s account with empathy and sensitivity. As a non-Muslim, the counselor also broaches the subject of this cultural difference. He asks Malik what it is like working with a counselor who does not practice Islam. Malik seems to appreciate this question. He acknowledges being nervous that the counselor will secretly be afraid of him as others have been. Broaching the differences between their religious/spiritual cultural identities and the potential impact of those differences on the counseling process helps provide a corrective emotional experience for Malik, who encounters acceptance and understanding from his counselor.

Within the context of this strong therapeutic alliance, the counselor enters into Malik’s worldview and validates his experience of feeling conflicted about his faith. By exploring his thoughts and feelings associated with his religious identity, Malik discovers that he is not ashamed of being Muslim (individual issue). Rather, he longs to be treated with respect and dignity by those who are not Muslim (systemic issue). This insight leads Malik and his counselor into a conversation about systemic oppression and advocacy.

The counselor describes Malik’s experiences with physical bullying and cyberbullying as barriers to his welfare and personal development on campus. As an advocate, the counselor discloses his responsibility to help remove these types of barriers and challenge injustice against oppressed groups. The counselor presents a variety of advocacy options, and Malik decides that he would like the counselor to act with him as he advocates for himself and other Muslims on campus. Malik and his counselor develop an advocacy plan that includes raising awareness regarding Islamophobia on campus, joining with other religious groups to develop a system of support (such as a buddy system to avoid walking alone at night) and alerting campus police to potential threats against Muslim students. The counselor works to empower Malik to develop the skills necessary to complete his advocacy plan.

As evidenced in this scenario, when addressing religion/spirituality among bullying survivors, counselors need a solid understanding of major world religions and the experiences of marginalized religious/spiritual group members in America. Additionally, counselors should have proficiency in the skill of broaching, defined as ongoing, genuine invitations for clients to explore their cultural identities in session. Furthermore, counselors should be able to recognize advocacy needs and be familiar with advocacy competencies and domains at the micro, meso and macro levels.

Resources for continued growth  

Given the many ways in which bullying and religion/spirituality can intersect, it is clear that counselors must be equipped to integrate these important values into the helping process. Although attention to clients’ culture is mandated by the ACA Code of Ethics and various counseling competencies, many counselors struggle to appropriately address aspects of clients’ religion and spirituality. The reasons for this struggle vary but can include counselors’ belief that they lack appropriate training, difficulty bracketing personal beliefs, countertransference issues regarding religion/spirituality and perceived setting constraints. Regardless of the reason, it is up to the clinician to engage in reflective practices and seek additional training as needed in this area.

Resources that are readily available to aid professionals in this task include the ACA Code of Ethics; the Association for Spiritual, Ethical and Religious Values in Counseling’s Competencies for Addressing Spiritual and Religious Issues in Counseling; and the Association for Multicultural Counseling and Development’s Multicultural and Social Justice Counseling Competencies. By increasing their knowledge and skills, counselors can feel competent to
address religion and spirituality with bullying survivors.




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

Elizabeth R. O’Brien is a licensed professional counselor and the immediate past president of the Association for Spiritual, Ethical and Religious Values in Counseling, a division of the American Counseling Association. She currently serves as the counselor education program director at the University of Tennessee at Chattanooga and is a UC Foundation associate professor. She has presented both internationally and nationally on issues related to wellness and beginning counselors, marriage and couples counseling, and spirituality and supervision. She recently completed a co-edited textbook titled Supervision and Agency Management for Counselors. Contact her at Elizabeth-O’Brien@utc.edu.

Amanda L. Giordano is a licensed professional counselor and an assistant professor at the University of North Texas. She specializes in addictions counseling, multiculturalism and religious/spiritual issues in counseling. She serves on the board of the Association for Spiritual, Ethical and Religious Values in Counseling and on the editorial review board for the Journal of Addictions & Offender Counseling. Contact her at Amanda.Giordano@unt.edu.

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.

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.

Bullying: How counselors can intervene

By Aida Midgett June 1, 2016

Bullying is a major problem today that affects individuals of all backgrounds. According to national data in 2015 from the U.S. Department of Education, approximately 25 percent of students between the ages of 12 and 18 report being bullied at school. In addition, bullying is a social phenomenon that often occurs in the presence of a peer audience, so most students

Aida Midgett

have been involved in bullying as bystanders. Therefore, it is important for counselors to be intentional about addressing bullying at school and when working with clients.

To address bullying at school, counselors first have to be able to identify it. The literature defines bullying as intentional, unwanted and aggressive behavior that is often repeated in relationships with a perceived power differential.

Generally, researchers classify bullying behaviors into four categories: physical, verbal, relational and cyberbullying. Physical bullying includes any type of physical assault on the target such as hitting, spitting, pushing or kicking. It can also involve taking or damaging another student’s property.

Verbal bullying includes verbal statements such as name-calling, teasing or making threats. Relational bullying includes indirect attempts to damage the target’s reputation by spreading rumors, ignoring the target or telling others not to be friends with the target. Finally, cyberbullying utilizes electronic media such as email, social media or texting to intentionally harm another student.

In addition to being able to identify bullying, it is important for counselors to understand the potential short-term and long-term ramifications associated with bullying. These negative ramifications can occur for all individuals involved in bullying, including students who bully, students who are targets and students who are bystanders. For example, students who bully others are more likely to have issues related to substance use in adolescence and other problems later in life related to criminal behavior, violence and disruptive behaviors. On the other hand, students who are targets of bullying can experience negative emotional states, increased rates of suicidal ideation and suicide attempts, and problems related to academic performance and school attendance.

The negative consequences of bullying are far-reaching, however, and go beyond those students who are directly involved either as bullies or targets. Students who observe bullying as bystanders also experience problems themselves, including emotional distress and substance use. In fact, in some instances, bystanders report greater problems than do the students who are directly involved. Therefore, it is important for counselors to be able to identify bullying in its various forms and to be aware of how participating in or observing bullying can clinically manifest in the lives of clients.

How school counselors can make a difference

Comprehensive, schoolwide intervention programs are considered a standard for practice in bullying intervention. However, meta-analyses and outcome studies evaluating the efficacy of comprehensive, schoolwide interventions show that the results, though generally favorable, remain mixed overall. Furthermore, these programs can be difficult to implement because of their related cost and required time allocation. Thus, school counselors can benefit from programs that are more accessible in terms of cost and time allocation, and that establish school counselors as leaders in program implementation.

A local school counselor reached out to me in 2013 as the faculty adviser for the Boise State University Counselors for Social Justice student group to help implement a bullying intervention program that wouldn’t place a high demand on her school in terms of time or financial resources. Along with two counselor education students, we worked together to adapt the bystander intervention component of the Bully-Proofing Your School comprehensive school safety program to develop the STAC training and strategies.

STAC stands for stealing the show, turning it over, accompanying others and coaching compassion. It is a brief intervention that can be easily implemented in schools and that establishes school counselors as leaders in implementation. The purpose of STAC is to train students as “defenders” to intervene when they observe bullying at school.

Our team conducted preliminary research indicating that the STAC program is effective in teaching elementary and middle/junior high school students bystander intervention strategies they can use as defenders. Specifically, after the training, students reported an increased ability to identify different types of bullying behavior, knowledge of the STAC strategies and general confidence with intervening in bullying situations. Furthermore, in a randomized controlled study conducted with elementary school students, we found an increase in self-esteem among sixth-grade students who were trained to act as defenders relative to a wait-list control group.

The STAC training

The first step in implementing STAC is for school counselors to select students who belong to different peer groups to be trained as advocates. The school counselor can provide the training, or he or she can partner with a local counselor education program to provide the training. The training can be part of a service-learning project in a school counseling course, part of an internship experience or a service project conducted by a student organization such as a local branch of Counselors for Social Justice.

The training lasts 90 minutes and includes didactic, experiential and concluding components. The didactic component involves an audiovisual presentation that discusses the definition of bullying, the different types of bullying behaviors (physical, verbal, relational and cyberbullying), the roles associated with bullying (bully, target and bystander), the negative consequences associated with bullying and the STAC strategies. Trainers incorporate several hands-on activities throughout the presentation to maintain the students’ attention.

The experiential component of the training includes student participation in set role-plays. Trainers divide students into small groups based on grade level and then invite them to act out a bully situation and practice using the STAC strategies. School counselors can develop role-plays that are applicable to their respective school settings, thus equipping students to intervene as defenders in scenarios that are relevant and meaningful. The training concludes with all students coming together and sharing their favorite STAC strategy, signing a poster board that says “the end of bullying begins with me” and receiving a certificate of participation.

After the training, the school counselor provides support to students trained as defenders through brief follow-up meetings. If counseling students provide the training, they can return to the school once or twice each month to meet with students in small groups (based on grade level) for 20 minutes.

The goal of the small group meetings is to check in with the students and brainstorm how they can become more effective defenders. The meetings also allow school counselors to develop greater awareness of bullying at their schools from a student perspective and any associated safety issues for students trained as defenders.

STAC strategies

The first strategy students learn is “stealing the show.” This involves using humor to turn students’ attention away from the bullying situation. Defenders can implement this strategy in a manner that seems natural to them and that is in line with their personalities. Students report that this intervention feels authentic to them and doesn’t make them feel like they stand out in the peer group.

An example of “stealing the show”: A fourth-grade boy is teasing another child by making fun of his name in front of a group of students. A defender intervenes by making an appropriate and funny joke. Everyone’s attention, including the student who was teasing his peer, turns away from the target. Everyone laughs at the joke.

The second strategy is “turning it over,” which involves informing an adult about the situation and asking for help. During the training, students identify safe adults at school who can help. Students are taught to always “turn it over” if they observe physical bullying or if they are unsure of how to intervene. Students are also taught to print out hard copies of posts or other electronic evidence that suggests cyberbullying and to bring these to a safe adult at school to document the incident.

An example of “turning it over”: An eighth-grade student trained as a defender sees a demeaning posting on social media about a classmate. The defender prints out the posting and brings it to school the next day to show the school counselor. The school counselor can document the incident or take appropriate action that is in line with the school’s policy on bullying.

The third strategy is “accompanying others.” This involves the defender reaching out to the student who was targeted to communicate that what happened is not acceptable, that the student is not alone and that the student defender cares about him or her. This strategy can be implemented subtly by spending time with the student who was bullied and inviting him or her to participate in a shared activity such as playing basketball or going for a walk. The defender can also implement this strategy more directly by offering support and helping the student to process his or her feelings about being bullied.

An example of “accompanying others”: During recess, a defender observes a group of girls intentionally leave a fifth-grader out of a game by walking away and laughing. The defender approaches the girl who was left out and invites her to hang out. The defender then lets her know that what the other girls did to her was not OK.Branding-Images_bully_2

The last strategy is “coaching compassion.” This involves gently confronting the bully either during or after the incident and communicating that his or her behavior is not acceptable. Additionally, the defender encourages the student who did the bullying to consider what it would feel like to be the target in the situation. The aim is to foster empathy toward the target.

Defenders are encouraged to consider this strategy particularly when they already have a relationship with the student who is doing the bullying or if the student who is doing the bullying is in a lower grade level and the defender thinks he or she can gain the student’s respect.

An example of “coaching compassion”: A defender is having lunch in the school cafeteria with a friend. The friend intentionally trips another student who is walking by and then laughs at the student. After the incident, the defender talks with his friend and asks him what he thinks it would feel like to be in the target’s shoes. The defender also shares a story about when another student intentionally embarrassed him and how that negatively impacted him.

Addressing bullying isn’t just for school counselors

School counselors are well-positioned to address bullying at school by providing intervention strategies and support for students. However, all counselors can play an important role in addressing the problem.

Counselors can begin by engaging in self-exploration and becoming aware of their own attitudes and reactions to bullying. Research findings indicate that there is a discrepancy between students’ and adults’ perceptions of bullying at school, with students perceiving bullying to be a more significant problem than do school personnel. Considering that 1 in 4 students report being bullied, and whereas almost all students are bystanders to bullying at some point in their educational experience, it is likely that most counselors have had personal experiences with bullying, whether as a bully, a target or a bystander. This personal experience can influence their approach to addressing the problem, including the possibility of minimizing bullying behaviors.

Another strategy for counselors to follow is to reject the idea that negative, aggressive behaviors are developmentally appropriate or “just kids being kids.” This leads to a third strategy, which is for counselors to help educate school personnel that bullying is a legitimate issue that requires attention and intervention. Counselors can extend this effort further by advocating for funding at the state level or through the school board to provide an effective intervention such as a comprehensive, schoolwide program.

Outside of the school setting, counselors can also address bullying by being aware of how it can negatively affect their clients throughout the life span. For example, when working with children and adolescents, counselors can intentionally assess their clients’ participation in bullying, while being aware that being a bully, target or bystander can be associated with clients’ presenting problems. Questions assessing participation in bullying can be an ongoing part of working with these clients. Furthermore, counselors can educate parents and caregivers to ask their children about involvement with bullying at school.

Upon learning that clients are currently participating in or affected by bullying, counselors can assist them in developing alternative behaviors. For example, counselors can help clients who bully to develop skills to engage in prosocial behaviors aimed at establishing themselves within their peer groups. Counselors can work with clients who are targets of bullying to develop positive coping skills, reach out to others and stand up for themselves in a safe and effective manner. Counselors can empower clients who are bystanders of bullying to use the STAC strategies to intervene effectively.

If bullying is not addressed with clients when they are children or adolescents, it can have a residual effect later in life. Therefore, when working with adult clients, counselors can incorporate issues related to bullying in case conceptualization and treatment planning.


Bullying is a pervasive problem that affects youth today. It has associated short-term and long-term negative consequences. Although comprehensive, schoolwide intervention programs are considered a best practice, they can be difficult to implement because of the associated cost and required time commitment from school staff.

The STAC strategies are a promising approach that provide school counselors with a brief program in which they can be leaders in implementation. The program’s goal is to train students to intervene as defenders when they observe bullying at school.

Although school counselors are well-positioned to address bullying, all counselors have an important role to play. Counselors can implement intervention strategies in their clinical practices and get involved with advocacy.




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

Aida Midgett is an associate professor and associate chair at Boise State University. Her research agenda is focused on evaluating a brief bystander intervention program for elementary, middle and high school students. She is also passionate about helping counselor education students develop multicultural competence, social justice advocacy skills and group leadership self-efficacy through service learning. Contact her at aidamidgett@boisestate.edu.

Letters to the editor: ct@counseling.org

Fertile grounds for bullying

By Laurie Meyers April 21, 2016

Bullying isn’t just for kids anymore. In the past 10 to 15 years, recognition has grown that bullying goes beyond taunts in the schoolyard. Adults can encounter it at work, “traditional” bullying is now enhanced and magnified by online or cyberbullying, and those who identify as lesbian, gay, bisexual, Branding-Images_bullytransgender or queer (LGBTQ) can experience it at any age just for being who they are.

“Bullying and interpersonal violence are tragic experiences that far too many people undergo every day,” says American Counseling Association President Thelma Duffey, who has shined a spotlight on anti-bullying/interpersonal violence efforts as one of her main presidential initiatives. “People can be hurt in such devastating ways when they are bullied, and counselors are in prime positions to help.”

But to be effective, counselors need to increase their understanding of bullying in all of its forms.

Trouble in the schoolyard

The first place many people experience bullying is, of course, at school, and school bullying remains a complex problem. Researchers say putting an end to bullying and ultimately preventing it requires the involvement of everyone in the system, including not just teachers, counselors and students, but also staff such as janitors and bus drivers. Even without a comprehensive anti-bullying program in place, however, there are many steps school counselors can take to help those who are being bullied.

Although any student can face bullying, those perceived to be somehow “different” and, critically, viewed as easy targets most often find themselves in the crosshairs, says JoLynn Carney, an associate professor of counselor education at Penn State whose research focuses on bullying.

“Abusers of all ages seem to have an uncanny sense of who can defend themselves and who may be unable to self-defend,” she explains. “Youth who are isolated — meaning few to no friends — are often targeted. They may have poor social skills … or other qualities not valued in the peer social network such as disability, different sexual orientation, different religion/culture or socioeconomic background. Even just being the new kid can be the characteristic that has the person being targeted. Kids who are highly anxious by nature or depressed also often seem to be the students who are bullied.”

Regardless of the reason behind the bullying, being a target is very isolating. A first step for counselors to take is to listen to and to act as advocates for students who are being bullied to reduce their sense of isolation, says Carney, a member of ACA. But she cautions that counselors must not give the impression that students are passive participants in solving the bullying problem. “The worst thing I’ve seen done over the years is to inadvertently teach kids that the adults in the situation have to handle this, which yields a sense of helplessness in the targets,” Carney explains.

Instead, counselors should work with students who are being bullied to help them understand the situation they are facing and what actions they might take to change it, she says. “Actions for targets are meant to change the dynamics of the situation by changing the target’s conceptualization of the situation and the target’s actions before, during or after the situation,” she says.

Carney says counselors should focus on problem-solving, helping bullied students to:

  • Increase connections to others who can provide immediate or follow-up support. Counselors can help bullied students make connections in multiple ways.

“Whether elementary, middle or high school, the counselors know their students; they know the students they can count on who have the social skills and the empathy to be peer mentors [to the student being bullied],” Carney explains. “They also know about the groups of students — like what club could the target student join to form bonds, and so forth. The bridging the school counselor can do often makes a huge difference. Honestly, I’ve had students or parents tell me in clinical settings that having that one friend saved their child’s life.”

The more friends and support from others the student has, the less vulnerable the bullied student will be.

  • Change some aspect of their behavior so that they are less “predictable” for their abusers, thereby reducing the abusers’ confidence that bullying will produce the desired effect. Taking away the desired result can help shift the power imbalance that is inherent in all bullying situations. For example, students who are being bullied can work on reacting in a different manner or even simply changing their body language. Those who are bullied often display a classic posture — slumped shoulders, head down, perhaps crying. Shifting that submissive posture to a posture in which the body is held more upright sends a different message to all concerned — the abuser, the target and any bystanders.
  • Learn appropriate physical, verbal and social assertiveness. Having a sense of assertiveness allows bullying targets to understand their own power and influence in the situation.

Carney says it is also crucial for counselors to show students who are being bullied how, where and when to seek support when necessary. “Working clinically with targets and their families, I’ve helped with the smallest of shifts that [would] seem inconsequential but have yielded good results, such as helping the person being bullied [not to] see themselves as the ‘victim,’ [which is] a disempowering … view of the self,” she explains. “Instead, helping them see themselves as simply the current ‘target’ of an abuser brings a sense of empowerment because anyone can be a target, and it’s not an internalized sense of negative self-worth. Helping the student see themselves differently can make a big difference in the ability to make the changes to end the abuse.”

Those who are being bullied don’t always ask for help or talk in great detail about what they are experiencing, so Carney has identified several red flags that might indicate that a student has become a target. These include:

  • Changes in behavior such as not wanting to go to school or avoiding other social situations such as birthday parties or school trips.
  • Changes in eating habits such as consistently saying they’re not hungry or skipping meals at school (which might be the result of not wanting to face bullying behavior in the cafeteria) or even engaging in binge eating as a source of comfort.
  • Self-destructive behaviors such as running away and serious talk about (or even an attempt at) suicide.
  • Changes in physical symptoms such as frequent headaches or stomachaches, frequently feeling ill, trouble sleeping or an increase in nightmares.
  • Changes in academic performance such as slipping grades or a lack of interest in classes that the student used to enjoy.
  • Changes in emotional state such as feeling helpless, hopeless, depressed, highly anxious or worthless.

Students who are being physically bullied may also have injuries that can’t be explained or damaged personal objects such as clothes and electronic devices.

Carney believes that if bullying is to be fully addressed, a school culture must be developed that doesn’t tolerate bullying behavior. She and her colleague and fellow researcher Richard Hazler, a professor of counselor education at Penn State, are currently part of the research and implementation team for a major anti-bullying initiative called Project TEAM, which former school counselor Lindsey Covert created based on a framework she developed as a graduate student at Penn State. Covert had success implementing the program and then collaborated with another school counselor, Lisa Dibernardo, to expand the program in the Stafford Township School District in New Jersey.

Covert is the director of the program, which is now part of the College of Education at Penn State. Carney says the curriculum, which she and Hazler are currently implementing in several grade schools, teaches students to focus on the importance of teamwork and leadership in their daily lives. It emphasizes helping others, the concept of positive change, problem-solving and conflict resolution, resilience and leadership.

Individual school counselors can help prevent bullying by conducting professional development trainings that educate teachers, school staff and administrators about the behavioral indicators of bullying and victimization, says Rebecca Newgent, a professor of counselor education at Western Illinois University–Quad Cities. “Bullying can take on several forms, such as physical, verbal and relational bullying,” explains Newgent, an ACA member who researches school bullying and children who are at risk. “Signs that school personnel might notice in regard to physical bullying are hitting, pushing and kicking. Signs for verbal bullying typically include calling the other student names, threatening other students or teasing other students. Relational bullying is somewhat harder to recognize, but some typical behaviors include leaving other students out of activities, not talking to other students and telling rumors about other students.”

School counselors should also emphasize the importance of all school personnel teaching children to demonstrate empathy for the bullied classmate by imagining what the student might be feeling, says Newgent, a member of the Association for Counselor Education and Supervision, a division of ACA. Children should also be encouraged to report bullying and helped to understand that this differs from “tattling,” she continues. “Consistent support and encouragement from teachers and school counselors can reinforce this [reporting] behavior,” she says.

Newgent also urges counselors to reach out to parents via newsletters and parent workshops to engage them in anti-bullying efforts. “Counselors can help parents to work with their children on increasing social skills and assertiveness,” she says. “Parents can help ensure that the family environment is one where the child feels safe and understood.”

Workplace bullying

Bullying isn’t confined to childhood or adolescence. Adults can experience bullying too, particularly in the workplace. Bullying in the workplace involves less obvious behavior than does school bullying and can be almost intangible, says Jessi Eden Brown, a licensed professional counselor and licensed mental health counselor with a private practice in Seattle.

“Bullying in the workplace is a form of psychological violence,” says Brown, who also coaches targets of workplace bullying through the Workplace Bullying Institute (WBI), an organization that studies and attempts to prevent abusive conduct at work. “Although popular media theatrically portray the workplace bully as a volatile, verbally abusive jerk, in actuality, the behaviors tend to be more subtle, insidious and persistent.”

Instead of shoving and name-calling, Brown says, workplace bullying includes behavior such as:

  • Stealing credit for others’ work
  • Assigning undue blame
  • Using public and humiliating criticism
  • Threatening job loss or punishment
  • Denying access to critical resources
  • Applying unrealistic workloads or deadlines
  • Engaging in destructive rumors and gossip
  • Endeavoring to turn others against a person
  • Making deliberate attempts to sabotage someone’s work or professional reputation

“It’s the fact that these behaviors are repeated again and again that makes them so damaging for the target,” she explains. “The cumulative effects and prolonged exposure to stress exact a staggering toll on the overall health of the bullied individual.”

What’s more, those bullied in the workplace often stand alone, Brown notes. “While the motivating factors may be similar between workplace bullying and childhood bullying, the consequences for the bully and the target are unmistakably different,” she says. “In childhood bullying, the institution — the school — stands firmly and publicly against the abuse. Teachers, staff, students and administrators are thoroughly trained on how to recognize and address the behavior. Students are given safe avenues for reporting bullying. Identified bullies are confronted by figures of authority and influence — teachers, administrators, groups of peers, parents. When the system works as intended, there are consequences for the bully, as well as resources and support for the target.”

Brown continues, “In the workplace, bullying receives far less attention and focus. Management may fail to appropriately label the bully’s behavior as being abusive, especially if it doesn’t violate the law. Some employers recognize the problem and still choose to turn a blind eye. And even worse, there are some companies that actively encourage ‘weeding out the weak,’ whereby successful bullies are rewarded with promotions, bonuses, extravagant gifts and other incentives. After counseling and coaching more than 3,000 targets of workplace bullying over the years, believe me, I’ve heard it all.”

The consequences can be devastating. “There is a significant body of research linking workplace bullying to physical, mental, social and economic health harm for the bullied target,” Brown notes. “Hundreds of empirical studies have linked repeated exposure to stress, including stress originating from emotional and psychological sources, to severe physical ailments, such as cardiovascular disease, gastrointestinal problems, immunological impairment, diabetes, adverse neurological changes, disorders of the skin, higher levels of cortisol leading to organ damage, musculoskeletal pain and disorders, and more.”

Workplace bullying has also been linked to panic disorder, generalized anxiety disorder, major depression, substance abuse and posttraumatic stress disorder, Brown continues.

Brown began specializing in counseling clients who have experienced workplace bullying after going through the experience herself in two different positions. “Both times were painful and deeply confusing,” she says. “I seriously considered leaving the counseling profession after the second experience.”

However, a friend who was doing web design for WBI introduced her to psychologists Gary and Ruth Namie, the founders and directors of the institute. The Namies were looking for a professional coach and offered Brown the job. As she worked with those who had been bullied, she began to integrate her experiences into her private counseling practice.

“The vast majority of my clients present as capable, accomplished professionals with a documented history of success in the workplace,” she says. “At some point in their careers, they encounter the bully and everything changes. Under constant attack, belittled and sabotaged, the once-competent, assured worker may begin to question her abilities and role at work. She tries everything she can think of to remedy the problem but finds few working solutions. Mounting stress starts to take its toll and spills over into other areas of life. Throughout this process, many targets fall victim to self-blame. Deep confusion, shame, anger and exhaustion are common at this stage. … This seems to be when most clients discover my services.”

Brown says the first step toward helping clients who are being bullied is to identify what they are experiencing — workplace bullying and psychological violence. Naming the behavior helps clients frame and externalize their experiences by realizing that they are not creating or imagining the problem, she explains.

“Encouraging the client to prioritize [his or her] health comes next,” Brown says. “Working closely with other health care providers is essential in situations where the individual’s health has been severely compromised.”

“It is imperative that the counselor promote the client’s self-care and turn attention toward enhancing [his or her] social support network,” she continues. “This may mean helping the client figure out a way to take time off from work, teaching new coping skills and encouraging time spent with loved ones — time that is deliberately not focused on recounting the situation at work.”

“Targeted workers may choose to file formal or informal complaints to unions, the EEOC [Equal Employment Opportunity Commission], the bully’s boss, ethics hotlines or professional boards,” Brown says. “Although there is no legal protection against bullying in the United States, some workers find grounds for harassment, discrimination, constructive discharge, intentional infliction of emotional distress, wrongful termination or other legal claims.”

According to Brown, WBI research indicates that once targeted by workplace bullying, there is a 77.7 percent likelihood that the individual will lose his or her job due to resignation (voluntary or forced) or termination. A 2014 study conducted by WBI found that 60 percent of bullied workers were women and that men were more than twice as likely as women to act as bullies (69 percent versus 31 percent). However, when women exhibited bullying behavior, they were also more likely to bully other women — 68 percent of female bullies’ targets were also female.

Counselors can help clients who experience workplace bullying to consider their options, starting with whether to stay in their current job or leave. “Many targeted workers choose to transfer or quit just to escape the abuse,” Brown says. “The decision to leave on one’s own terms can be empowering and frequently results in better emotional health than being fired or laid off due to the bullying.”

Brown believes that counselors are in a unique position to help those who are bullied at work. “First, and most importantly, we can believe them when they tell us about the mistreatment at work,” she says. The stress and exhaustion that targets of workplace bullying endure are often isolating and paralyzing, Brown points out, adding that it is generally the bully’s goal to disempower the target.

“Even when they do speak up, targets of workplace bullying tell me that their employers, family and friends often do not believe them or understand their level of distress,” she says. “As counselors, we can listen to their story, convey a sense of belief and offer a distinctly different response than the target has received thus far. … Do not blame the client for the abuse [he or she is] experiencing.”

In most cases, Brown says, the target has done nothing to deserve the mistreatment; the bully chooses the target, timing and tactics, and the targeted individual may have very little control or influence over these factors. The responsibility to stop the abusive behavior ultimately rests with the employer. In these instances, just teaching clients to be more assertive or to stand up to the bully is not the answer, Brown emphasizes.

Cyberbullying: Virtual environment, real bullies

Bullying is presumably as old as the human race, but one thing about the dynamics of bullying has changed dramatically during the past 10 to 15 years. Online, anyone can bully anybody anywhere, from next door to halfway across the world. Cyberbullying is often used to enhance the “traditional” bullying tactics that are taking place in a school or workplace, but it can also serve as a standalone method of harassment.

“Cyberbullying can take place via email, text, instant messaging, social media or any other digital form of communication or information dissemination,” Brown explains. “It may manifest as harassment, impersonation, defamation, stalking, manipulation, denigration or other types of abuse.”

Unfortunately, even people who might never consider participating in traditional bullying behaviors are often tempted by the anonymity of cyberbullying. “When people get on [an electronic] device, normal roles of civil interaction somehow become less relevant,” says Sheri Bauman, author of the book Cyberbullying: What Counselors Need to Know, which is published by ACA.

People who previously were afraid of getting caught for bullying or didn’t want to accept responsibility for their actions now feel free to indulge their baser instincts online, she says. “[They think], ‘I can be as nasty as I want to be; no one knows who I am.’ They don’t have to censor themselves and don’t have to follow social rules,” explains Bauman, a professor and director of the counseling degree program at the University of Arizona.

Researchers don’t know exactly why anonymity has this effect, but Bauman, an ACA member, speculates that it may in part be because online interaction doesn’t quite feel real.

Janet Froeschle Hicks, a licensed professional counselor and certified school counselor in Texas, posits a similar explanation. “Not being face to face with a person makes it easier to dissociate and reduce empathy,” she says. “Technology also gives the false impression that the person on the other end is an ‘object’ rather than a person.”

Young people appear particularly adept at cyberbullying, Hicks says. “Youth participate in cyberbullying several ways. They impersonate one another by stealing passwords, create fake social media pages and send cruel messages anonymously. Often they create pages for another person without that person’s knowledge. This is very damaging because several others can be harmed with one posting.”

“For example, Student A creates a page for Student B without Student B’s knowledge. Student A then uses Student B’s fake page to bully Student C. When this happens, Student C is now upset with Student B, and Student B has no idea what has happened. Rumors about others, gossip, humiliating pictures and rude comments can be posted by Student A on this fake page,” explains Hicks, a professor of counselor education at Texas Tech University whose research focuses on cyberbullying, social aggression and school, child and family counseling.

Many students also participate in a practice known as “sub-tweeting” on Twitter. “Anonymous tweeters comment on others’ tweets without identifying themselves,” Hicks says. “This means rude anonymous messages appear in the midst of a conversation.”

Cyberbullies can use a wide array of methods — from texting to social media to digital pictures — to torment their targets online. As a result, Hicks says, those who have been bullied may develop a fear of technology. “Since we live in an age where students need technology to complete homework, apply for college admission and succeed at a future job, it is important to teach that technology can be safe,” she emphasizes. “I teach parents and youth to use privacy controls, not to share confidential information and to avoid negative conversations [online].”

Although adolescents are typically assumed to be both the culprits behind and the targets of cyberbullying, experts say this isn’t always the case. Adults may be targeted as part of a workplace bullying campaign, a neighborhood grudge or simply at random.

Brown urges her clients to think about ways they can minimize the potential of being bullied. “I encourage my clients to be intentional about their online presence and reputation by actively reflecting upon the image they want to portray,” she explains. “What skills, attributes and experiences are important to highlight? Where do you want your information to appear? Who is likely to find and use your information based on how and what you choose to share? What are you most concerned about regarding your online persona? By exploring questions like these, [clients form] a picture and a plan of how they want to manage their online information.”

Brown also advises clients to thoroughly search their own names on the Internet to find out what information — or misinformation — is already out there about them. “I recommend they set up a Google Alert for their own name and any related identifying key terms. Using myself as an example, I’d set an alert for ‘Jessi Eden Brown,’ ‘workplace bullying counselor,’ ‘professional coach workplace bullying,’ etc. This way, I increase my chances of catching any references made to my name or professional identity. The more I know, the better able I will be to respond to online attacks.”

After clients have identified the details of their online presence, Brown talks with them about how to respond to damaging content and minimize future problems. For example, she advises clients to periodically review the privacy settings on their social media and web-based accounts. “For those being actively cyberbullied, it is wise to lock down all privacy settings or, in some cases, to delete or suspend accounts altogether to give the bully fewer points of access to the target,” she says.

Bauman, who is also a member of the American School Counselor Association, a division of ACA, says that given the prevalence of cyberbullying, counselors need to educate themselves about all social media and related online platforms so they can knowledgeably discuss the issue if a client brings it up.

No walking away

It’s certainly not an ideal option, but if all else fails, those who are bullied at school or work might be able to switch schools or change jobs. At the very least, those who are cyberbullied can choose to reduce their online presence or temporarily go offline. Simply being able to leave a bullying situation can provide precious relief.

But for those who are being bullied because of their sexual or gender identification, there is no walking away. “LGBTQ individuals are bullied in all facets of their lives,” says Tonya Hammer, an assistant professor of counseling at Oklahoma State University-Tulsa whose research interests include both bullying and the intersection of gender and sexual orientation. “We are socialized as a society to bully or reject that which is perceived as different. Unfortunately, it permeates so much of our daily lives.”

LGBTQ individuals usually start facing bullying behavior at a young age, regardless of whether the individual is already “out,” says Hammer, who adds that most bullying prevention efforts don’t start until middle or high school. By that time, according to the National School Climate Survey by the Gay, Lesbian and Straight Education Network (GLSEN), a majority of LGBTQ students are routinely hearing anti-LGBTQ language and experiencing victimization and discrimination at school.

The 2013 survey — the latest year for which statistics are available — found that of the 7,898 students between the ages of 13–21 who participated in the study, 55.5 percent felt unsafe at school because of their sexual orientation, while 37.8 percent felt unsafe because of their gender identity. In addition, 71.4 percent of LGBTQ students heard the word “gay” used in a negative way frequently or often at school; 64.5 percent heard homophobic remarks frequently or often; and 56.4 reported hearing negative remarks about gender expression (for example, not acting “masculine” enough) frequently or often.

Distressingly, 51.4 percent of the survey respondents reported hearing homophobic remarks from their teachers or other school staff, and 55.5 percent reported hearing negative remarks about gender expression from teachers or other school staff.

The effects of this widespread bullying are significant, says Hammer, who presented a session on LGBTQ bullying across the life span at the 2016 American Counseling Association Conference & Expo in Montréal. “Bullying results in feelings of shame and humiliation, which can lead to isolation, lack of emotional regulation [and] violence against self or others,” she notes. Hammer adds that it also increases dropout rates and negatively affects academic performance.

Although counselors cannot completely stop school bullying single-handedly, they can provide a refuge for LGBTQ students to feel supported and accepted, says Hammer, president-elect of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling, a division of ACA. “Counselors can create a safe space by a variety of means. It can be as simple as displaying an HRC [Human Rights Campaign] equal sign [the organization’s logo] in their office or a small rainbow flag somewhere. I know that sounds minor,” she says, “but small symbols can signify something to students.”

Hammer says counselors can also reach out to students who may be subject to bullying, but she emphasizes that counselors should not address sexual/affectional or gender identity unless the student brings it up. Instead, counselors could start by letting the student know that they have noticed a change in the student’s behavior that they think might be connected to bullying.

“You can also [just] ask them if everything is OK and if they need someone to talk with,” says Hammer, who during her time as a board member of the Houston GLSEN chapter trained school personnel in Texas using GLSEN’s anti-bullying program. “Sometimes it is also simply providing a space for them. When working with counselors or librarians, we often suggest creating an actual physical space in their office where students can come and just hang out. Make the space feel inclusive in the way you decorate it and in the material that you provide for them to read or occupy their time with.”

“Also understand that the students may still be questioning their sexual/affectional orientation or gender identity or expression and need people who they can confide in while doing this. Furthermore, their parents may not be that safe space,” Hammer says. “Give them time to feel comfortable and to trust you so that they will open up about what is going on with regard to the bullying and also about their sexual/affectional orientation or gender identity and expression.”

Hammer also cautions counselors not to assume that a student is gay simply because he or she is perceived as being gay. “The most important thing is the relationship,” she emphasizes. “Listen to them with respect and treat them with dignity, not as if they are abnormal. Let them know that they matter to you, to their family and to the world.”

Because eliminating bullying requires altering a school’s culture, counselors can also help students by offering schoolwide education on LGBTQ issues or sponsoring formation of gay–straight alliance groups, Hammer says. Additionally there are awareness activities counselors can help organize such as No Name-Calling Week, Ally Week and Day of Silence, in which silence is used to protest the silencing of LGBTQ people due to harassment, bias and abuse.

Workplace bullying based on sexual/affectional orientation or gender identification is also still very common, Hammer says. In fact, according to HRC, of the LGBTQ Americans who have experienced discrimination, 47 percent reported experiencing it in the workplace. To add insult to injury, HRC reports that only 19 states and the District of Columbia explicitly prohibit workplace discrimination based on sexual orientation or gender identity. A 2009 HRC study found that 51 percent of LGBTQ workers hid their identities from most or all of their co-workers. Strikingly, the report found that younger workers were even more likely to hide: Only 5 percent of LGBTQ employees ages 18–24 said they were completely open at work, compared with 20 percent of older workers.

Unfortunately, leaving a hostile working environment and finding another job isn’t always possible — regardless of sexual or gender identity. And given the extent of bullying that LGBTQ workers face, leaving one job for another is far from being a surefire solution to the problem.

“Sometimes it is a matter of helping people to develop support systems outside of work that can help them to address the hardships of their daily life at work,” Hammer says. “If possible, it is our responsibility as counselors to help advocate for our clients. If legal resources are available, we help connect our clients to those resources. Organizations like HRC, the Southern Poverty Law Center and the ACLU [American Civil Liberties Union] can help in some situations, but not all. We can also connect them with career counselors or agencies that can help them see if there are options for them to change jobs or careers.”

Hammer also believes counselors have a responsibility to help lobby to change laws that make it legal for people to be fired because of their sexual orientation or gender identity.

“LGBTQQI clients, like all clients, want to know that they matter and that they are important,” Hammer says. “The therapeutic relationship may be the first and only relationship in which they experience that, and it may be the only place where they can truly be all of who they are. Providing that space and time for them to do that may empower them to be able to do it with other relationships in their life as well. You can help them to understand that they are worth [having] healthy growth-fostering relationships and provide them with the skills and resources to develop those relationships.”




To contact the people interviewed for this article, email:




Additional resources

For those who would like to learn more about the topics addressed in this article, the American Counseling Association offers the following resources:

Books (counseling.org/bookstore)

  • School Counselors Share Their Favorite Classroom Guidance Activities: A Guide to Choosing, Planning, Conducting, and Processing edited by Janice DeLucia-Waack, Meghan Mercurio, Faith Colvin, Sarah Korta, Katherine Maertin, Eric Martin, and Lily Zawadski
  • Youth at Risk: A Prevention Resource for Counselors Teachers and Parents, sixth edition, edited by David Capuzzi and Douglas R. Gross
  • Casebook for Counseling Lesbian, Gay, Bisexual, and Transgender Persons and Their Families edited by Sari H. Dworkin and Mark Pope
  • Cyberbullying: What Counselors Need to Know by Sheri Bauman


  • Working With Perpetrators and Targets of Cyberbullying presented by Sheri Bauman
  • Bullying in Schools: Six Methods of Intervention presented by Ken Rigby

Webinars (counseling.org/continuing-education/webinars)

  • “Children and Trauma” with Kimberly N. Frazier (part of the ACA Trauma Webinar Series)
  • “Counseling School and College Students” with Richard Joseph Behun, Julie A. Cerrito and Eric W. Owens (part of the ACA Trauma Webinar Series)

Podcasts (counseling.org/continuing-education/podcasts)

VISTAS Online articles (counseling.org/knowledge-center/vistas)

  • “Anger Management for Adolescents: A Creative Group Counseling Approach,” Carolyn O’Lenic and John F. Arman
  • “BEST Buddiez: A Programmatic Innovation in Early Child Mental Health Treatment for Physically Aggressive Preschool Children,” Rita J. Terrago
  • “Brief Solution-Focused Counseling With Young People and School Problems,” John Murphy
  • “Domestic Violence and Children,” Laurie Vargas, Jason Cataldo, and Shannon Disckson
  • “Making the Change From Elementary to Middle School,” Laura M. Hill and Jerry A. Mobley
  • “Solution-Focused Counseling in Schools,” John J. Murphy
  • “The School Counselor’s Role in Easing Students’ Transition From Elementary to Middle School,” Matthew Mayberry
  • “Empowering LGBT Teens: A School-Based Advocacy Program,” Matthew J. Mims, David D. Hof, Julie A. Dinsmore, and Laura Wielechowski
  • “School Climate Perception: Examining Differences Between School Counselors and Victims of Cyberbullying,” Megan M. Day, Lindsay R. Jarvis, Charmaine D. Caldwell, and Teddi J. Cunningham
  • “School Counseling for Systemic Change: Bullying and Suicide Prevention for LGBTQ Youth,” Jeffry L. Moe, Elsa Sota Leggett and Dilani Perera-Diltz
  • “School Shootings and Student Mental Health: Role of the School Counselor in Mitigating Violence,” Allison Paolini
  • “Sexually Active and Sexually Questioning Students: The Role of School Counselors,” Vaughn Millner and Amy W. Upton
  • “The Bullying Project,” Le’Ann L. Solmonson
  • “The Impact of Attendance at a LGBTQIA Conference on School Counselors’ and Other Educators’ Beliefs and Behaviors,” Aaron Iffland and Trish Hatch
  • “Using the Reflecting As If Intervention to Reduce Bullying Behaviors,” Gerald A. Juhnke, Brenna A. Juhnke, Richard E. Watts, Kenneth M. Coll, and Noreal F. Armstrong



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

Letters to the editor: ct@counseling.org


Fresh thinking on old issues

By Laurie Meyers April 23, 2015

Trauma, suicide and bullying are not new topics for most counselors, who at some point in their careers have likely worked with clients on each of these issues. However, as research and practice Paint-Splatter_Brandingcontinue to progress, some counselors are using emerging approaches or perspectives to tackle these problems.

At the American Counseling Association’s 2015 Conference & Expo in Orlando, Florida, Counseling Today attended several sessions that presented some of these fresh approaches. We then caught up with three presenters after their sessions to get a more in-depth look at their ideas so we could share them with readers.

Complex PTSD

As far back as the ancient Egyptians, the chronicles of war have noted trauma-induced psychological symptoms. Samuel Pepys wrote about them in the wake of the Great Fire of London. Historians think that the author Charles Dickens may have experienced them after a horrific train accident. We now know these symptoms as indicative of posttraumatic stress disorder (PTSD), but until relatively recently, the cause of trauma-induced behavioral changes was thought to be purely internal and was sometimes even referred to as cowardice.

Trauma-induced psychological symptoms were not officially labeled as a disorder until 1952, in the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which identified it as “gross distress reaction.” However, in 1968, as the memory of World War I and World War II faded, the diagnosis was dropped from the DSM. It wasn’t until scores of Vietnam veterans returned with severe psychological trauma that researchers began a deeper examination of the condition and its causes. The term PTSD officially entered the lexicon in 1980 with publication of the DSM-III. Defined, in essence, as a common set of symptoms brought on by extremely traumatic events such as combat, natural disasters, accidental disasters or personal catastrophes, PTSD has more recently gained greater recognition, both in mental health circles and the public eye, because of the struggles of veterans returning from the wars in Iraq and Afghanistan.

At the same time, many mental health experts have come to believe that another, more common, form of trauma exists that is often misdiagnosed as PTSD. Referred to as complex trauma or complex PTSD, this type of trauma is caused by repeated exposure to abuse or other traumatic events over time.

Despite the urging of many trauma experts, complex trauma was not included in the DSM-5. However, the disorder is very real and distinct from the current definition of PTSD, asserts Cynthia Miller, an ACA member who presented on “Recognizing and treating complex PTSD” at the ACA 2015 Conference.

Complex PTSD is typically the result of cumulative trauma and abuse that started in childhood. Miller’s interest in complex PTSD was first piqued when she was counseling women in the corrections system, where many of her clients — and many of the incarcerated women in general — had histories of trauma and childhood abuse.

“I got interested [in complex PTSD] in my work with the prison population, but even in my community work, I saw that histories of trauma were way more common than we realized and also at the root of so many things that we were treating,” she says.

Clients with trauma histories are often misdiagnosed not only with single-incident PTSD but also with borderline personality disorder, bipolar disorder or major depression, Miller says. These disorders — along with alcohol and substance abuse — can accompany complex trauma, but counselors need to understand that the trauma colors everything the client is experiencing, explains Miller, a licensed professional counselor with a private practice in Charlottesville, Virginia. At the same time, treating complex trauma by immediately turning to protocols for PTSD, such as eye movement desensitization and reprocessing (EMDR), prolonged exposure therapy and cognitive processing therapy, is not going to work as well and may actually result in retraumatizing the client, she says. Methods such as EMDR may be helpful for some clients later in the treatment process, Miller says, but only after they have been through an initial stabilization process.

“One of the most common mistaken impressions [when treating trauma] is that someone who has been through trauma needs to talk about and process it,” explains Miller, who is also an assistant professor of counseling at South University in Richmond. By doing this, she says, “counselors are trying to help clients, but they [may] open up trauma that neither the counselor nor the client is ready to deal with. When dealing with complex trauma, the first thing you need to do is to help them live in the present, not the past.”

Although PTSD and complex trauma share certain symptoms, they also feature significant differences — differences that are crucial for counselors to understand, Miller says.

PTSD is typically caused by a single or time-limited event. Its symptoms include intrusive thoughts, avoidance behaviors, negative alterations in mood and cognition, and alterations in arousal and reactivity.

Complex trauma, on the other hand, is caused by long-term traumatic experiences such as child abuse, intimate partner violence, community violence (including living in a society at war), experiences as a refugee or displaced person, trafficking and forced servitude, chronic illness and disability necessitating invasive treatment, and bullying. Symptoms may partially mirror those for PTSD but also feature additional severe problems such as:

  • Difficulty regulating emotions
  • Disturbances in attention and consciousness
  • Affect dysregulation
  • Altered self-perception, including feelings of guilt and worthlessness
  • Difficulty interacting with other people
  • Chronic dysphoria or dissociation
  • Engaging in self-destructive behavior
  • Difficulty with self-soothing

People who are experiencing complex trauma do not have the emotional skills necessary to address the issues they’re facing, so before moving forward, a counselor must first help the client to stabilize, Miller says. Stabilization begins with establishing a sense of safety, including addressing the client’s most basic needs.

“You really almost have to go through Maslow’s hierarchy with [these clients] to find out if food, clothing and shelter are concerns,” Miller says. “If so, how can you help the client address it? Because it’s hard for someone to build skills if they don’t have a place to sleep.”

After the client’s basic needs have been addressed, the counselor should help the individual establish a sense of safety with “self,” Miller explains. This requires the counselor to probe for self-injurious behavior, suicidal behaviors or urges, risky sexual and other behaviors, and attendance to the health and integrity of the body. Assessing for self-protective behavior is also important, Miller continues. For example, is the client locking his or her house or bedroom door at night? Does he or she go running alone at night in crime-ridden areas? Safety with others is also important, she notes. For instance, is the client in a relationship in which he or she is being abused or exploited?

The third element of safety — without which the counselor cannot help the client with the first two — is feeling safe in therapy, Miller emphasizes. The client must feel that he or she is in control of what is going on.

“There must be a mutually designed treatment plan, informed consent throughout and the promise that the therapist is not going to do anything that the client doesn’t want to do or push them into doing something that they don’t want to do,” Miller says.

As the counselor and client address safety skills together, they should also work on other stabilization elements, such as reducing the acuity of trauma symptoms, Miller says. Symptom reduction involves developing coping skills and may or may not include medication, she adds.

Miller has found that dialectical behavior therapy (DBT) is particularly effective when teaching clients emotional coping skills. DBT helps clients learn that their symptoms are not their fault but rather a natural reaction to what has happened to them. This helps remove the attendant stigma and the clients’ sense that something is really wrong with them, Miller explains.

Because complex trauma causes dissociation, dysphoria, physical agitation and cognitive distortions, grounding skills — both physical and mental — are essential for reconnecting clients with themselves and their surroundings, Miller says. For instance, when a client’s nervous system is overloaded or aroused, his or her cognition is disrupted. To help these clients ground and re-engage, Miller directs them to say their ABCs backward, name the 50 states and state capitals, or name the different makes of automobiles.

To counteract physical disruption and the dissociation that sometimes accompanies it, Miller teaches clients grounding methods that engage the senses, such as touching physical items that have texture, describing what they see in their immediate physical surroundings or listening to soothing music. She also suggests physical stretching and movement, even if it’s just having clients stomp their feet while sitting down, or the sensory experience of running warm or cool water over their hands.

Miller also uses other soothing strategies such as safe place imagery with clients who have complex PTSD. Clients imagine a place, real or imaginary, where they feel safe, and Miller asks them to put themselves there by describing what they see, hear, feel, smell and taste.

Another soothing visualization technique involves picturing a nurturing and protective figure who has made the client feel cared for. Miller says this might be a relative, a friend, a pet or even a fictional or spiritual figure, just as long as the client can envision this figure during a time of need.

Clients with complex trauma also struggle with intrusive thoughts, so Miller asks them to visualize a container — whether it is a box, a safe, a vault, a dumpster or a tractor trailer — that is big enough to hold all of the things that disturb them. “It has to be as real as possible, and they have to be able to ‘lock’ it,” she says. Miller directs clients to visualize the container, set it aside and then walk away. “When they walk away, I have them walk to their visualized safe place,” she says.

Clients who are struggling with complex trauma also need to learn to relate to themselves and to others in different ways, Miller says. DBT can help in this area by teaching clients skills for managing intense emotions and interpersonal relationships. These skills include distress tolerance, emotional regulation, mindfulness and greater interpersonal effectiveness.

After clients are stabilized and feel safe, counselors can help them to integrate their traumatic memories so that the clients are no longer controlled by these memories, Miller says. She emphasizes that the aim of integration is to resolve the traumatic symptoms without retraumatizing the client.

Miller cautions that counselors should proceed carefully, helping the client to re-evaluate the meaning of the trauma and having the client demonstrate the ability to remember experiences while still remaining physically, emotionally and psychologically intact. The re-evaluation may involve an organized recounting of events using methods such as prolonged exposure therapy, cognitive processing therapy, narrative exposure therapy, traumatic incident reduction, EMDR and art therapy, she says.

After successfully stabilizing and integrating traumatic memories, the client and counselor can then work on enhancing the client’s relationships and planning for the future, Miller says.

Miller reiterates that complex trauma is more common than most helping professionals might realize, so she recommends that counselors screen for it routinely. “Counselors should be prepared. … Clients are not necessarily going to tell them [about their trauma] right away,” she says. Even if clients do bring up traumatic experiences on their own, it’s unlikely that they will reveal everything to a counselor initially, so counselors need to create a safe space and be patient, Miller says.

Miller adds that if a counselor suspects a client is experiencing complex trauma, the counselor should ask about it — but carefully. “Ask behaviorally,” she says. “Don’t ask clients if they were physically or sexually abused. Instead, ask them if anyone has ever punched, slapped, kicked or touched [them] in a way that [they] didn’t like or want.” Initially, clients struggling with complex trauma may not recognize or be willing to identify these behaviors as abuse, Miller says.

Because the trauma focus in counselor education is typically on PTSD and not complex trauma, Miller urges counselors to seek further training through continuing education and conferences. “It’s one of those things that you can’t afford not to know about and not know how to treat because, whatever work you do, you’re going to see it,” she says.

Understanding and assessing clients who are suicidal

It’s a counselor’s worst fear: a client who dies by suicide. Yet, as any counselor knows, there is no research that can definitively tell practitioners how to prevent suicide. But what if prevention starts with acceptance rather than assessment? What if connecting with a client who is suicidal requires accepting and understanding that there are circumstances under which many people might consider suicide? These are the questions that ACA member Eric Beeson explored in his conference session, “How do I know if someone is suicidal? A discussion of suicide theory, attitudes and interventions.”

Beeson, a licensed professional counselor and lecturer at the University of North Carolina-Greensboro, thinks that accepting the validity of such feelings is key to understanding why a client believes suicide is the answer. When faced with a client expressing suicidal thoughts, many mental health professionals instead focus on immediately shutting those thoughts down, he says. Although acknowledging there are certain cases that require emergency treatment such as hospitalization, Beeson says an immediate focus on preventing suicide may actually alienate the client and hinder treatment. He believes that approach is often based in the mental health professional’s fear — not only of losing a client but also of having to deal with and consider the subject of suicide. To understand and, hopefully, redirect a client’s suicidal urges, counselors must first examine their own attitudes, he asserts.

Beeson started asking such questions early in his counseling career during a four-year stint at a hospital, where dealing with death and the aftermath of suicide attempts was a regular occurrence. “Watching the way some of the staff interacted with people after a suicide attempt, some of the judgments I saw, got me curious about people’s attitudes toward suicide and then, eventually, how … that attitude influences practice,” he says.

With more than 41,000 reported suicides in the United States in 2014, these are urgent questions to answer. Beeson, a contributing faculty member at Walden University, began his presentation by asking attendees to consider the following questions as a way to examine their own attitudes about suicide and people who die by suicide.

  • How can I tell if my client is suicidal?
  • Why do people attempt or die by suicide?
  • Is suicide a singular event or a process?
  • Can suicide be rational and/or permitted?
  • What is my role when working with someone experiencing suicidal behaviors?
  • Am I capable of suicide?
  • Even though you would prefer another way to die, painful circumstances in life might lead to suicidal ideation. How do you estimate the probability that you sooner or later will die by suicide?

a) I am sure I never will die by suicide.

b) I hope I will never die by suicide, but I am not absolutely sure.

c) Under certain circumstances, I consider suicide as a possibility.

d) I consider suicide as a possibility for the future.

n  What suicide attitudes do you think are most helpful to counseling practice?

a)  More/less acceptance of suicide

b)  More/less condemnation of suicide

c)  More/less belief in the preventability of suicide

Beeson notes that even within the mental health field, the stigma and avoidance surrounding suicide remains strong. People who have died by suicide or attempted suicide are typically viewed as weak. This represents an empathy gap — one that counselors need to close, Beeson asserts. So, he challenges counselors to ask themselves about their personal suicide potential.

During his session, Beeson used humor to demonstrate circumstances that might cause a person to consider suicide as a viable option. In a clip from the old TV sitcom Cheers, four characters — Sam, Woody, Norm and Cliff — are preparing to sky-dive. But when the time comes to jump, they’re all petrified, realizing that they could die. Suddenly, skydiving doesn’t seem like such a good idea. However, for various reasons — to prove something, to not look like a coward, because everyone else is doing it — they each eventually jump. Cliff is the last and the most hesitant. Seemingly nothing will make him jump. But then the plane starts to sputter and the pilot says it’s going to go down. Cliff decides to take his chances — to, in essence, take control of how he will die — and jump.

Beeson asked the audience to think about which character they identified with. What might motivate them to get out of that plane? Beeson says he does this to help counselors recognize that under certain circumstances, anyone might consider dying by suicide. In turn, that helps them better understand why a client might consider suicide a viable — or even the only viable — option.

Beeson notes this is not just theoretical for him. During his time working with clients who were suicidal, he found that the more he focused on prevention, the less effective he was. However, once he started focusing on acknowledging the client’s struggle and the resilience it had taken to come this far, he was better able to take that resilience and direct it toward other methods of coping.

“I don’t know what it’s like for … any person to walk in their shoes, and who am I to say that they’re walking in their shoes wrong?” Beeson asks. “Who’s to say if I wasn’t in a similar situation, that my shoes might get a little uncomfortable? … And [if they] become more uncomfortable than I’d like to bear and I can’t find a new pair of shoes, then who’s to say that I might not take those shoes off?”

“I don’t believe that people just want to kill themselves,” he says. “It’s just that last-ditch effort to attain something that seems unattainable.”

Beeson believes counselors need to view suicidal intent on a continuum. “Suicidal is a misleading term. There’s no research to suggest that there’s any way to truly decide when someone is or is not — quote, unquote — ‘suicidal,’” Beeson says.

The better question, he asserts, is how likely is someone to die. Dying is painful and goes against the natural human instinct to preserve life. Beeson explains that research by psychologist and suicide expert Thomas Joiner posits that suicide requires overcoming that instinct and becoming capable of killing oneself. When that capability is combined with circumstances that seem intolerable, the risk of suicide is very high, Beeson explains.

Some people, such as those in high-risk, high-intensity jobs, including police officers, firefighters and emergency services personnel, already have a greater risk of death because they are regularly exposed to and habituated to it, Beeson contends. In addition, people in these jobs are routinely exposed to others’ experiences of pain. This engenders a certain comfort level with pain that also increases the person’s likelihood of dying, Beeson says.

But working in one of these high-intensity professions is not the only way that people habituate themselves to pain and the risk of death. Nonsuicidal self-injury, prior suicide attempts, intravenous drug use and prostitution have all been linked to suicidal behavior, Beeson says.

He adds that research by Joiner and others has shown that suicidal risk factors fall under three main categories.


  • Mental disorders — particularly mood disorders, schizophrenia, anxiety disorders and certain personality disorders
  • Alcohol and other substance use disorders
  • A sense of hopelessness
  • Impulsive or aggressive tendencies
  • History of trauma or abuse
  • Some major physical illnesses
  • Previous suicide attempt
  • Family history of suicide



  • Job or financial loss
  • Relational or social loss
  • Easy access to lethal means
  • Local clusters of suicide that have a contagious influence



  • Lack of social support and sense of isolation
  • Stigma associated with help-seeking behavior
  • Barriers to accessing health care, especially mental health and substance abuse treatment
  • Certain cultural and religious beliefs (for instance, the belief that suicide is a noble resolution of a personal dilemma)
  • Exposure to suicide, including through the media, and the influence of others who have died by suicide

Beeson says counselors should evaluate clients for these risk factors and also look for the following warning signs.

Talk: The client talks about killing himself or herself, having no reason to live, being a burden to others, feeling trapped, having no hope or being in unbearable pain.

Behavior: New or increased episodic behavior, especially if related to a painful event, loss or change; increased use of alcohol or drugs; looking for a way to kill themselves, such as searching online for materials or means; acting recklessly; withdrawing from activities; isolating from family and friends; sleeping too much or too little; visiting or calling people to say goodbye; giving away prized possessions; and displaying aggression.

Mood: Displaying depression, anxiety, rage, irritability, humiliation or sudden calmness.

Beeson also explained that there are five levels of risk for suicide:

Nonexistent: No or few risk factors, no previous attempts and no suicidal behaviors.

Mild: A previous attempt but no other risk factors, or no previous attempts but demonstrating short-term, mild suicidal behaviors.

Moderate: A previous attempt with other notable risk factors, or no previous attempts but exhibiting ambivalent plans or preparation, suicidal desire or two other notable risk factors.

Severe: Previous attempt with two or more notable risk factors, or no previous attempts but having moderate or severe symptoms of resolved plans and preparation.

Extreme: Previous attempts with severe symptoms of resolved plans and preparations, or no previous attempts with severe symptoms of resolved plans and preparations and two or more other risk factors.

If a counselor has a client who is displaying suicidal risk factors, the first step is to ensure immediate safety, which in some cases may require hospitalization. Otherwise, the counselor and client can work to develop emergency plans that the client can follow if he or she is feeling suicidal, Beeson says.

It’s also important for counselors to establish a rapport with these clients and listen to their stories without judgment, he emphasizes. Counselors should then help clients manage their feelings by acknowledging their pain and encouraging them to use the session as a time to consider all options, including suicide, Beeson says.

Another critical factor is to guide clients in exploring alternatives to suicide by helping them envision future possibilities. Beeson says counselors should emphasize future plans by asking questions such as: How are you going to stay alive in the next week? Will you be back to see me next week? He adds that helpful behavioral strategies include drawing up a short-term positive action plan and using safety or wellness plans.

Beeson gives presentations on suicide frequently because he feels the topic is so important. “I just want to foster tough conversations about what we believe about suicide and the implications for practice,” he says. “I want people to live. That’s my goal. But I also believe in autonomy and the client’s right to choose. I think as we acknowledge that autonomy, we are better able to connect with people. I just think that one of the best ways to promote those types of interventions is to address what it is that we believe so that we can promote life-giving conversations. Then maybe we can promote that hope that the unattainable might just be attainable in some other direction.”

A playful approach to bullying prevention

Bullying prevention often focuses on punitive measures. The bully is identified, chastised and punished — with little or no consideration given to why the bullying occurred in the first place, says ACA member Ruth Ouzts Moore. And if counselors, teachers and other educators don’t address the underlying reasons, the likelihood of preventing bullying over the long term is low, she adds.

But how can counselors and educators learn the real reasons for bullying? Those who bully and those who are bullied often are too ashamed, scared or just plain angry to talk honestly about what is driving the bullying, Moore notes. That’s why she has come to believe that play, not punishment, is the best way to address and reduce bullying.

As a licensed professional counselor, counselor educator and part-time school counselor in the Savannah, Georgia, area, Moore has implemented this creative approach with young students and found it to be very effective. She described her experiences in a session at the ACA 2015 Conference.

Moore, an ACA member, began her presentation by clarifying the definition and different types of bullying. At its root, she said, bullying is an intentional, abusive act or attempt to inflict injury or discomfort on another person. She further explained that bullying can take the form of physical, verbal, relational or cyber abuse.

Bullying is fueled by the imbalance of power between the person doing the bullying and the person being bullied. Moore, a core faculty member in the mental health counseling graduate program at Walden University, noted that research suggests targets of bullying are at a disadvantage in this power differential for various reasons, which include:

  • Being perceived as different or weak and defenseless
  • Experiencing depression, anxiety or low self-esteem
  • Being less popular
  • Being perceived as annoying or attention seeking

Bullies, on the other hand, are generally students who are easily angered or frustrated, have family issues or are overly concerned with popularity.

For the targets of bullying, the gap between them and their tormentors must seem huge, but Moore notes that the bully and the bullied usually have similar backgrounds. For instance, children who come from abusive or violent backgrounds, grow up in neglectful environments in which there is little parental involvement or are caught in the middle of a high-conflict divorce face a higher likelihood of being bullied and bullying others, she says.

Bullying has serious and long-lasting effects on both the bully and the bullied, Moore points out. These effects include anxiety, low self-esteem, depression, suicidality, fear, mistrust, truancy, academic decline and nonsuicidal self-injury. In addition, the bully and the bullied are not the only ones affected. Bystanders, teachers, parents and siblings also suffer the consequences, directly or indirectly, she says.

Counselors face myriad challenges with both populations when working to address the issue, Moore says. Research has found that those who bully:

  • Often minimize or deny their aggressive acts and behaviors
  • Can be reluctant or resistant to disclose sensitive issues such as family violence or emotional problems that may be at the root of the bullying
  • Are sometimes repeating behavior that is intergenerational
  • Are often handled punitively and therefore may be distrustful of counselors

Similarly, research has found that those who are targets of bullying:

  • Often won’t tell anyone they are being bullied
  • May present in counseling with other issues such as depression, anxiety or school avoidance that may complicate or obscure the bullying issue
  • May have difficulty verbalizing their feelings
  • May not want to disclose bullying because they are ashamed and humiliated
  • May not disclose family problems that are at the root of or complicating the bullying

In her private practice, Moore has worked extensively with adolescents who bully or who have been bullied. She recently took on a school counseling position that allows her to address bullying with prekindergarten-age children through eighth-graders, both from a group and individual perspective. She notes that early education and intervention are the most effective means of preventing bullying.

Moore was hired specifically to address bullying at a private school that was having serious problems. Her goal was to help prevent bullying through identifying the sources of the problem, providing education and implementing active classroom strategies.

Moore presents weekly classroom sessions in which she combines educational sessions and activities in the form of games. She says the students enjoy the activities because they’re fun and provide a break from classroom work. The games also give Moore an opportunity to observe the classroom and identify the children who act out. She will often follow up by providing individual therapy to the most disruptive children.

Her activities focus on neutralizing bullying by increasing self-esteem and developing anger management skills. The self-esteem building activities include things such as a written quiz with 10 questions: 1) What’s good about you? 2) What’s good about you? 3) What’s good about you? And so on, with the same question repeated 10 times.

“It makes them laugh,” Moore says. “Kids often get stuck and can’t think about what’s good, so we’ll talk about how it’s hard to say good things about yourself because people will think you’re bragging, but it’s really important.”

In another game, Moore hands out Riesens caramels when students tell her the reasons or “Riesens” they like themselves.

During her presentation at the ACA Conference, Moore handed out balloons to audience members to demonstrate another activity she conducts for anger management. She asks the students to blow into the balloons to represent how stressful their day has been. The balloons end up being anywhere from just a tiny bit full to completely blown up.

“We talk about how amazing it is [to see] how quickly the balloons can fill up,” Moore says. She then goes on to talk with the students about how to moderate anger.

Another activity, “Bullying Bingo,” has helped students learn about the different types of bullying. Moore has also led students in activities to strengthen their sense of collaboration, such as by working together to build a peanut butter sandwich without looking at one another.

The activities seem to be having an effect. In the two years since Moore started working at the school, it has witnessed a huge decline in incidents of bullying.

Moore credits the creative approach for the results. She believes it works because the approach is nonthreatening, allows kids to express things they have trouble verbalizing and helps to build their confidence. On top of that, the activities are fun.

Moore encourages counselors to explore the creative approach when addressing issues of bullying. She also urges counselors who want to learn more to join the Association for Creativity in Counseling, a division of ACA for which Moore currently serves as secretary.

“Be open to new approaches,” she concludes.




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

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