Tag Archives: Counseling Connoisseur

Counseling Connoisseur: Children and grief

By Cheryl Fisher November 13, 2018

Nicolas was just under 3 years old when he attended his grandfather’s funeral. He wandered through the sea of adults, holding tight to his mommy and daddy’s hands as he made his way to the front of the line where his grandfather lay peacefully in the casket. His grandmother picked him up as he tried to climb into the casket. “Sleeping?” he asked his grandmother. “No, sweetheart. Your grandfather died.” Nicolas paused looking at the man in the box and back at his grandmother, “Sleeping?” he tried again. “No, he has died. He is not sleeping”, the grandmother replied softly. Nicolas looked around and attempted to contort his face — mimicking the adults around him. “They are sad, honey. When someone dies, we can feel sad,” his grandmother attempted to explain. Nicolas just watched, trying to imitate the adults around him as the man in the box continued to sleep.

 

According to William Worden, psychologist and grief expert, all children grieve regardless of age and stage of development. However, each stage provides a different understanding of death and loss. Grief can be experienced in a variety of ways. A child may experience a physical manifestation such as shock, or somatic ailments. They may feel anxious, angry, depressed or withdrawn. The children may act out behaviorally, resulting in biting or hitting. Additionally, there are critical periods where adverse experiences impact the neurological development of children in more critical ways. Having an understanding of how developmental stages affect the manifestation of grief can help counselors provide more effective support for children who have experienced a loss.

Infants and preschoolers: Infants and preschool age children experience life through their senses. Object permanence doesn’t become established until approximately 28 months. Therefore, children at this age may experience grief as the annihilation of existence: now you see me, now you don’t. Challenges resulting from loss at this age include a desire to connect to others but not knowing how, which may cause either clingy or standoffish behavior. A child may also exhibit a decrease in impulse control and tolerance, an increase in uninhibited behavior and poor emotional regulation, and possibly difficulty with toilet training. This is a critical period, neurologically. Neurons that fire together, wire together. Therefore, losses at this age have a higher chance of impacting children in significant ways.

School-age children: As children continue in their development, they are able to recognize attachment relationships, and they may experience loss as abandonment. School-age children may become preoccupied with death, which may become demonized during this stage, and children may experience anxiety related to the idea of mutilation. For example, children in this age group may talk of “blood and guts” and the Grim Reaper when referring to death. Children during this age are capable of conceptualizing loss as permanent and experience magical thinking. Grief may manifest as hyperactivity, emotional eating and/or somatic complaints. Children may withdraw or become argumentative and demanding. They may have difficulty concentrating and demonstrate a decrease in academic performance. Additionally, they may identify with the deceased by exhibiting similar behavior or experiencing symptoms of a loved one’s terminal illness. For example, Tony, an 8-year-old client came to me experiencing pain in his chest. A full pediatric work-up did not find a physiological etiology to his discomfort. However, in his intake, Tony stated that his grandfather had just died. When I asked his parents about Tony’s grandfather’s death, they indicated that he had died of lung cancer. Tony’s chest pain appeared to be a somatic manifestation connected to his grandfather, and after a few months in play therapy, Tony was able to work through his grief in a way that allowed him to find other ways to remember his grandfather.

Adolescents: Adolescents are capable of abstract thinking and struggle with the concepts of being versus non-being. While teens may feel immortal, they have increased awareness of the permanence of death. They may begin to think about death in terms of their own mortality. Teens may have experienced a variety of losses by now, and are better able to differentiate between types. The death of a distant elderly relative may feel different than the loss of a close friend.

Grief may manifest in a variety of ways including survivor’s guilt, a reduced sense of spontaneity, self-medicating (food, drugs, sex, etc.), social isolation and cyber mourning. Thanatechnology, or the use of media and technology to mourn, may be a way to seek comfort and connection through mourning sites, grief blogs and music playlists. However, it may also be a venue to glamorize loss in an unhealthy manner.

For example, I was working with a 16-year old girl who was devastated by the sudden death of her classmate by drug overdose. In addition to experiencing survivor’s guilt, she began engaging in high-risk behavior such as getting intoxicated at parties and offering sexual favors. This was a complicated situation as the client was not only grieving her classmate but also struggling with her own identity and self-worth. “Why should I live and she die?” We used an online memorial site to create a digital scrapbook of her friend’s favorite music, poems and pictures of special places they had gone together. I watched my client (and, with her permission, the memorial they had created) carefully. I started to get concerned as it remained a dark space for several months with little construction of hopeful meaning in sight. One day while the client was lamenting this loss, I asked, “Where would you have liked to go with your friend?” This led to a discussion about how the client and her friend had talked about hiking the Appalachian Trail when they graduated from high school. I grinned and said, “What a lovely tribute to your friendship to keep that promise.” By the next session, she had begun adding pictures and maps of the Appalachian Trail, marking the route she planned to take in a post-graduation trip to honor her friend.

 

Grief Work

It’s important to acknowledge that the deaths of family members or friends are not the only losses which can cause grief in children. For example, the death of a beloved pet, the divorce or separation of parents or a move to another school are all events that can evoke a significant sense of loss. It is vital to honor and understand these losses and ensure that children are allowed to express the accompanying grief.

Recognizing the varied symptoms of grief in children is essential as it may be masked in a variety of behaviors resulting in misdiagnosis and treatment. Even the most well-intentioned clinician or educator may misread and pathologize a child’s lack of concentration, fidgeting and restless behavior. This was the case for 5-year-old Andrew whose grandmother died suddenly from a heart attack. Andrew was very close to his grandmother, and even though his parents provided him with age-appropriate information around her death, Andrew began eliciting restless and inattentive behavior at school. Even though [his teacher was] aware of the death, notes were still sent home daily indicating that Andrew was disruptive in class. On the last day of the week, and the day before Andrew’s grandmother’s memorial service, the teacher’s note read, “Andrew is exhibiting signs of ADHD.” Andrew had not previously experienced difficulty in class. This is an example of a misdiagnosis. Andrew did not need medication or treatment for attention deficit hyperactive disorder (ADHD), but support during his grieving process.

After all, the goal of grief work, according to Worden, is to emotionally relocate the deceased loved one in a way that allows the child to move forward. In this way, children discover ways to remember the loved one in a healthy way. This involves helping children create connection to self, to others and to the sacred.

 

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Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is director and assistant professor for Alliant International University California School of Professional Psychology’s online MA in Clinical Counseling.  Her research interests include examining sexuality and spirituality in young women with advanced breast cancer; nature-informed therapy; and geek therapy. She may be contacted at cyfisherphd@gmail.com.

 

 

 

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

The Counseling Connoisseur: Enough: A call to action

By Cheryl Fisher July 20, 2018

“Thou shalt not be a  perpetrator, thou shalt not be a victim, and thou shalt never, but never be a bystander.” ― Yehuda Bauer

 

The sun warmed my body. Blissfully fatigued following several laps around the pool, I stretched out on the chaise lounge chair. I sipped my cool lemonade and haphazardly lifted my phone which had been vibrating endlessly. Who on earth was trying to reach me? I had prepared my clients for weeks regarding my vacation. I had set my away message on my phone. Who could possibly need me right now? My eyes squinted at the list of messages. “Are you ok?” “Where are you? I am worried?” “Please tell me you are safe?!”

My lazy summer mental fog abruptly dissipated as I sat up in my chair and began to read through the barrage of inquiries. What on earth is going on? I quickly tapped my responses. “I am fine. At the beach. What is happening?” I read the responses over and over waiting for the punch line, but there was none. My beloved community of Annapolis joined the ever-growing fraternity of gun violence and those men and women who reported the daily news were the target this time. The Capital Gazette was under attack with several fatalities and multiple injuries.

Reaction

I have been a counselor for twenty-plus years. I am a volunteer for the American Red Cross disaster mental health team and Maryland Responds Medical Corps. I have been deployed and provided crisis intervention to victims, and offered crisis debriefing to first responders. Professionally, this work is not new to me. However, to watch the devastation and suffering of my community from one hundred miles away was excruciating. I watched as the first responders whom I had brought homemade cookies to during the holidays risked their lives to enter the building under attack. I witnessed people I know being escorted from the building — the same building I had visited a week earlier for an endodontist appointment. I observed the swift and definitive execution of the emergency plan play out on national television. including scenes of the ambulance taking victims to the emergency room where I had served as an on-call counselor for 10 years. These were my people! The agony was palpable even from the safety of the beach. Rumors flooded social media, and I waited for news of missing persons.

I took inventory of my internal status. I am, after all, a therapist. I felt frightened for the families who had to sit with so many unknowns about the well-being of their loved ones. I felt helpless being so far away. I felt angry that we continue to experience this type of violence. Enough is enough! It is past time for counselors to make decisions and act.

Action

Counselors have a unique role following a disaster in that we are called to help heal a community’s trauma. We counsel survivors and families and debrief first responders. We help bring agency back to a community that may feel disempowered and devastated. The safety once experienced, crumbles and we aid in the creation of a new normal.

My first act was to contact Maryland Responds to see if we were going to deploy. The local Warmline — a non-emergency helpline that offers immediate counseling or referral services — had begun advertising grief counseling services and I knew that the first responder employee assistance programs would soon reach out for aid in debriefing the responders. However, like many communities, the Annapolis area is tight-knit, so the traumatic effects of the tragedy would be widespread. One of the local mental health networking groups spearheaded the creation of a list of providers willing to volunteer both medical and mental health services over the next several weeks. Clinicians from all over the county responded, zealous to do their part to help in the recovery effort. As clinicians, we know that initially there are rituals, memorials, vigils and casseroles that remind us of the solidarity of experience in these losses. However, when people attempt to resume their previous lives, they trip over metaphorical landmines that they don’t expect. Counselors can help clients to anticipate and disarm the mines.

Change

On February 27, ACA adopted a resolution supporting and highlighting the role that school counselors and other professional counselors play in addressing the anxiety, stress and trauma students experience after a school shooting.  The resolution also calls for adequate federal funding for research into the public health impact of gun violence and evidenced-based strategies for preventing and addressing gun violence.

In an Annals of Epidemiology article published in 2015, researchers Jeffrey W. Swanson, E. Elizabeth McGinty, Seena Fazel, and Vickie M. Mays reviewed research on the relationship between violence and mental illness. They found that the presence of mental illness is not an effective predictive factor for violence against others. Instead, they advise policymakers to focus on evidence-based risk factors such as previous violent behavior. They advocate for “time-sensitive risk assessment for violence as the foundation of evidence-based criteria for prohibiting firearms access, rather than focusing broadly on mental illness diagnoses and a record of involuntary psychiatric hospitalization at any time in one’s life.”

The authors’ conclusions highlight the need to train all mental health providers in violence assessment. The use of evidence-based criteria — rather than a diagnosis of mental illness — to prohibit firearm access requires a change in current policies and procedures. Saying “enough!” in the face of gun violence is neither a partisan statement nor an opposition to the Second Amendment. It’s a call for an end to the death and trauma. Gun violence permeates our society in multiple ways — not just in mass shootings but also through gun-related crime and suicide. Complex issues surround this violence, but there are definite steps we as a society can take such as reexamining gun control policy, demanding further research on predicting violent behavior, addressing insufficient access to mental health care and reducing the stigma attached to seeking care.

As counselors, we are trained to be value-neutral. We support the goals of our clients even when they directly oppose our own beliefs. We offer a non-judgmental presence. Regarding mental health care accessibility and gun violence, we need to dare to have an opinion. We need to know the platforms of our representatives and have their office number on speed dial. We need to use the strength of our collective voices and demand change.

Conclusion

Annapolis, Maryland, USA downtown view over Main Street with the State House.In the wake of the attack, I heard my community’s resounding cry of solidarity with all the victims of gun violence. Naptown Strong! We love you, Annapolis! And just like every other school, church, concert, movie theater and community affected by gun violence, we are striving to put the pieces back together from a horror that will forever inform our narrative. Enough is enough! Prayers and thoughts must be followed with action!

Annapolis and the Capital Gazette will not be defeated by violence. In the immediate aftermath of the shooting, the staff at the Gazette refused to be silenced. “I can tell you this: We are putting out at damn paper tomorrow,” tweeted reporter Chase Cook. And they did. Let us all be inspired by the courage and the conviction of these journalists.

 

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Resources from ACA relating to gun violence and trauma for, both counselors and consumers: counseling.org/knowledge-center/gun-violence-trauma-resources

 

 

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Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is director and assistant professor for Alliant International University California School of Professional Psychology’s online MA in Clinical Counseling.  Her research interests include examining sexuality and spirituality in young women with advanced breast cancer; nature-informed therapy: and geek therapy. She may be contacted at cyfisherphd@gmail.com.

 

 

 

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

 

Counseling Connoisseur: Thanatechnology – Grief and loss in a digital world

By Cheryl Fisher June 8, 2018

Thanatechnology: Any kind of technology that can be used to deal with death, dying, grief, loss and illness.

 

Kelly (an alias), an eighth-grader, sits with her friends in the school auditorium as her principal calls out the names of each of her classmates who were killed in the recent shooting. To honor the lives of these young people, the school is hosting a remembrance ceremony. As tears run down her face, Kelly huddles close to her schoolmates and clicks away on her phone posting messages on several social network sites and a memorial site that she and her friends created. A text message pops up from a boy she met on one of the sites. He is a survivor of a school shooting that happened a couple of years ago — he understands.

Tony’s (alias) phone vibrates, rousing him from his slumber. He looks at the clock – it’s 2 a.m. He has to be up for school in just a few hours. He squints, trying to read the alert on his phone. Another teenager has died from drug overdose. He heaves a mournful sigh and turns on the bedside lamp. His phone begins to blow up with social media posts. The deceased didn’t attend his school but is related to his girlfriend’s best friend. Tony attempts to return to sleep, but he keeps thinking about the teenager [and] wondering why it happened.

Without a doubt, the youth of today are often exposed to significant and traumatic losses. Traditionally, we have marked death with rituals such as funerals and memorials and grieved with the support of counseling, faith communities and neighbors. In more recent years, technology has provided additional ways to remember and mourn, such as creating online memorials, seeking distant or virtual grief counseling and connecting with family, friends and even strangers without geographical limitations. It erases time and distance and allows for virtual experiences and expressions that promote a narrative that lives forever.

Digital Presence and Youth

In Dying, Death, and Grief in an Online Universe, researchers Kathleen R. Gilbert and Michael Massimi observe that digital technology can “bring people together for social support, provide information, and offer a venue for conducting grief work such as telling stories or building digital memorials.”

In another section of the book, researcher Carla Sofka writes that young people are even more likely to seek grief support online. Sofka explains that the internet, social media and other digital platforms are where younger generations are most comfortable because they provide opportunities for social interaction; a sense of independence and privacy; the ability to express and form their own identity; a sense of community that includes those that are marginalized; and instant alerts and communication. All of these elements allow youth to seek and find like-minded communities that can provide immediate support and strategies for coping with myriad life issues — including death and dying, and grief and loss.

 

Social Interaction

Online bereavement forums and chat rooms provide a sense of social connection with users. Sites such as Caring Bridge allow multiple users to maintain a virtual journal offering information and capturing narratives that are accessible to members. Tumblr, Facebook and Instagram create spaces where youth can just “hang out.” Video calling technology such as FaceTime and Skype bridge the distance between users and promote interaction and communication. Additionally, grief counseling may be offered via video, phone, chat or email formats.

Independence and Sense of Privacy

Teens turn to technology to carve out a private space for self-expression. However, research indicates that internet use often provides the illusion of anonymity, which may encourage a false sense of privacy. The struggle for privacy is nothing new: The tension between privacy and personal expression has existed between teens and parents for decades. In It’s Complicated: The Social Lives of Networked Teens, danah boyd*, principal researcher at Microsoft Research notes that social media introduced a new dimension to this age-old power struggle. Instead of worrying about what teens wear outside, parents are concerned about what pictures teens are posting about what they wear outside.

[*boyd prefers to spell her name with lowercase letters.]

“Although teens grapple with managing their identity and navigating youth-centric communities while simultaneously maintaining spaces for intimacy, they do so under the spotlight of a media ecosystem designed to publicize every teen fad, moral panic, and new hyped technology,” writes boyd.

Yet, online spaces allow for exploration of feelings and thoughts, examination of death anxiety, and expression of grief and loss. For example, a 14 year- old client crafted an entire mix of music and prose around the complicated emotions she experienced related to the death of her estranged father who had abused her as a little girl. Using an alias, she posted the eulogy online and watched as strangers connected with her, validating her feelings and experience.

Expression and Influence of Identity Formation

The internet provides creative space for expressing grief and honoring loved ones. Sites such as KIDSAID.com, offer children the opportunity to connect, interact and creatively express their grief. In addition to expressive sites and online memorial services such as Legacy, Remembered.com and Your Tribute provide an unfettered opportunity to honor loss, especially for those who are marginalized or disenfranchised. The use of letters, photos and sound provide rich and detailed memorials that allow users to express their grief, absorb their loss and ultimately move forward.

Sense of Community

Blogs provide a venue to capture experiences and to cultivate topic-based virtual communities. Boyd suggests that these constructed networks serve as a public place to interact with real and imagined communities, thus satisfying a desire to be part of a broader world.

Instant Alerts

Online communication is often in real time. Twitter, Snapchat and a variety of other digital sites offer instant notifications and ongoing engagement. Technology allows users to gather multiple streams of almost instantaneous information from afar. For example, recently I was at a social gathering where a young woman, glued to her phone, was continuously texting. At one point I interjected, “Is everything alright?” She looked up and shook her head. “No, I have a friend who was just in a car accident and the medics are transporting her to shock trauma. Her parents are on their way to the hospital — but no one thinks she’s going to make it.”

The accident occurred in another state, yet this young woman was experiencing the event minute by minute via her phone messaging.

There are numerous attractive features to thanatechnology. Information is persistent and endures. There is a sense of immortality and legacy when a person’s comments, photos and work is posted in cyberspace. It is visible to infinite numbers of individuals. It is spreadable, and with one repost or share, hundreds more are invited into our experience. It is searchable. Just yesterday someone emailed me after reading my article on pet loss and grief. She had been Googling information about pet loss and my article popped up. I was able to provide her with additional support resources.

While there are many helpful aspects of using technology for grief support, there are some serious causes for pause. Are the online interactions healthy? Who is actually participating in the network communities? Are youth oversharing personal information while in a vulnerable state? How pervasive are social divisions and are they perpetuated in the participating forums?

Clinicians, parents and educators must be digitally literate and provide opportunities for genuine face to face connection while acknowledging the cyberworld of teens. Using technology during this very vulnerable time can provide tremendous support and healing, but it may pose risks. Counselors have the responsibility to help youth develop the skills to navigate technology in a way that creates a safe environment for their grief experience and promotes bereavement support.

 

 

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Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is director and assistant professor for Alliant International University California School of Professional Psychology’s online MA in Clinical Counseling.  Her research interests include examining sexuality and spirituality in young women with advanced breast cancer; nature-informed therapy: and geek therapy. She may be contacted at cyfisherphd@gmail.com.

 

 

 

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

The Counseling Connoisseur: The contour of hope in trauma

By Cheryl Fisher March 30, 2018

“Nothing is hopeless; we must hope for everything.”― Euripides

 

Recently I was invited to provide an afternoon keynote at a conference examining community trauma and human violence. The morning keynote speaker, Reverend Matt Crebbin, gave a compelling presentation about his congregation’s role in helping Newtown, Connecticut rise from the violence that devastated Sandy Hook Elementary School and the surrounding community on December 14, 2012. In his speech, Crebbin discussed the reality of the pain and suffering resulting from the fatal shooting of 20 elementary school-aged children* and noted that the scars would forever run deep as Newtown attempts to create a “new normal.” The keynote ended with his personal call to advocacy aimed at ending the cycle of gun violence. The conference was held just two weeks after the Parkland High School shooting.

(*The Dec. 14, 2012, shooting at Sandy Hook Elementary School left six adults and 20 children dead, as well as the 20-year-old shooter, who took his own life. His mother was killed earlier that day in her Newtown home.)

Later that day, I presented a summary of vicarious and secondary trauma, moral distress and introduced a nature-informed resiliency model of care for caregivers. How do we, as counselors, take care of ourselves amid such tragedy and pain? How do we hold the space for devastation and not become prey to its effects? How can we use this space for healing?

Although the session was well-received, I found my words lacking substance and weight — a thin veneer of comfort in the face of the morning’s recounting of despair. There are no answers that can return these children to their families; no words that can mend the broken hearts or rebuild the shattered dreams of these communities. I wondered, if, as a grieving counselor-client once proclaimed to me, we are all frauds.

The conference ended with a panel discussion I took part in. As I perched in my seat next to Rev. Crebbin, microphone in hand, the moderator asked me, “What about hope?” I sat baffled for a moment as I searched for a few bits of wisdom to impart. After all, I imbue my graduate students with the title of Ambassadors of Hope because we hold the space for hope to ignite within our clients. I muttered a few brief, albeit flimsy, answers and concluded. However, the question lingered long after the panel had ended: “What about hope?”

Hope

Hope theory, developed by the researcher, author and psychologist Charles R. Snyder and colleagues, describes hope as a process characterized by the determination to reach one’s goals and the ability to make plans to meet those goals. Erik Erikson defined hope as “both the earliest and the most indispensable virtue inherent in the state of being alive.” There are agency and action in the experience of hope. The research is undeniable — experiencing hope is associated with life satisfaction and positive aspects of well-being. Conversely, an absence of hope is related to depression, anxiety and an overall sense of despair.

Therefore, how do we help clients access hope? Pamela McCarroll, in her book The End of Hope-The Beginning: Narratives of Hope in the Face of Death and Trauma describes five experiences of hope in an attempt to capture some of its complexity “in the face of endings, in the face of death and trauma, in the face of the unalterable and unwanted crises in life.”  McCarroll asserts that hope and despair are not binary, but a continuum mediated by time where “hope represents a future filled with possibilities.”

According to McCarroll, these are the five ways in which we express hope:

  • Fight: Hope as fight capitalizes on the tension between giving up and moving forward. Hope is cultivated as one discerns a path to forge in battle. As counselors, we can help clients identify what is worth fighting for, such as “that which feeds life, love, connectedness, gratitude, meaning and transcendent possibility.”
  • Meaning: Hope as meaning is manifested in the ways that we honor the lives of our loved ones. Recently I was invited to be the presenter on the topic of children’s grief and spirituality at a lecture series. The series was named after a college freshman who had been killed in a car accident tragically. Her parents created this lecture series to honor the life of their daughter, a talented athlete and dedicated student.
  • Survival: Hope as survival is complex. The survivor often feels stuck between the past and the present. Care requires concern for safety, remembrance of events and mourning losses, reconnection to self, others and something sacred, and ultimately channeling trauma to a greater good. Hope as survival is lived through the recovery process of survivors. Just today a client disclosed [to me] that as a survivor of a sexual assault, she speaks out to other women in the hope of helping to empower others.
  • Lament: Hope as lament can be understood in the cries of the families who mourn the tragic loss of loved ones from violence. Lamenting demonstrates the meaningfulness of relationship and the pain of endings. To lament is to love; to love is to hope. According to McCarroll, “hope murmurs in the expression of ruptured love” and “sometimes it is the only language of hope available.” This is a language that seeks to be heard and shared. The funeral or memorial is a space where lamenting is welcomed and shared.
  • Surrender: Hope as surrender invites letting go and letting as is translate to living moment-by-moment. McCarroll suggests that “surrender feeds hope by engaging a posture of trust and receptivity-rather than defeat.” It embraces that which cannot be changed and allows space for forgiveness to enter.

 

Hope may present as an act of advocacy (fight), or the development of a lecture series (meaning), or community efforts for trauma recovery (survival), or memorials (lament) or rituals for release (surrender).

We, as counselors, hold the space for pain and suffering to reside while we attempt to help our clients make sense of their broken worlds. In order to be an anchor, we must spend some time with our own meaning-making philosophy or theology. How do we understand the suffering of the world? Maybe our understanding is simply that we don’t understand. We don’t have the answers. McCarroll proposes that many have lost hope amid such suffering and tragedies.

Further, we need to craft a common story with a shared vision that allows for differences and complexity and affords a unified message of hope. Maybe we need to be more than Ambassadors of Hope. Maybe, as suggested by the character Mrs.Which in Madeleine L’Engle’s, A Wrinkle in Time, we must dare to be warriors. Warriors of hope.

 

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Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is an assistant professor and program coordinator for the Alliant International University- California School of Professional Psychology online clinical counseling program. Her research interests include spirituality and meaning-construction; nature-informed therapy; and geek therapy. She will be presenting “Superhero Therapy 101” and “Homegrown Psychotherapy: Nature-Enhanced Counseling” at the Association for Creativity in Counseling conference in September. Contact her at cyfisherphd@gmail.com.

 

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

The Counseling Connoisseur: Compassion and self-care during flu season

By Cheryl Fisher February 16, 2018

“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.” ― Audre Lorde

 

The familiar buzz from my bedside wakes me. Squinting, I pick up my cell phone, and I see that a client is notifying me of her current malady. She describes, in detail, her symptoms which include a fever, digestive discontent and upper respiratory discomfort. “But I plan on coming to my appointment tomorrow, Dr. Fisher,” she writes. I bolt up from the comfort of my bed, now fully awake at the thought of this client infecting my office, and reply as therapeutically as I can at 2 a.m., “Oh my goodness, no. Please stay home, drink lots of liquids and get your rest. We can reschedule for next week.” Whew! Crisis averted. Dodged that one! I roll over and resume my sleep, albeit a bit less restful.

A few hours later, I am (again) awakened by my phone. It is another client who has been up all night vomiting. She will not be in today. Thank goodness! Again, I write a compassionate and caring response wishing her a speedy recovery. I roll over and surrender to an extra hour of sleep.

My alarm sounds and I roll out of bed and prepare for my very full day — minus the two clients who are ill.

My phone rings. It’s a client who was driving to the office and had to stop because she doubled over in intestinal distress. Another client ill! No worries —

I have paperwork to do. I settle in front of my computer, and I notice an email — another client is sick and won’t be making her appointment.

I begin making calls from my cancellation list as I wait for my next client. I am able to fill most of the open spaces. I note the time — my next client should have arrived. I open my office door and walk to the waiting area, where my next client sits, complete with glazed and droopy eyes and a red runny nose. With a deep cough, he stands and extends his hand, which is stuffed with tissues.

It’s flu season!

As counselors, we sit with people who are in emotional and psychological pain and discomfort. We provide them with a compassionate and welcoming space to express their pain with the hope of lightening the load and identifying strategies for care. Our physical wellness informs our mental comfort and we certainly want to be available for our clients. I would like to think of myself as a compassionate person. I know my clients certainly hold me to this standard. However, how do we offer compassion and promote self-care?

Here are a few tips to get you and your clients through this cold and flu season:

  1. Wash your hands frequently: The U.S. Centers for Disease Control and Prevention (CDC) recommends thoroughly washing hands frequently throughout the day. If soap and water are not accessible, keep a bottle of alcohol-based hand sanitizer in your office and waiting area.
  2. Offer tissues: As counselors, we understand the comfort in a box of tissues. Be certain to have several boxes on hand for clients. Do not forget to also have multiple trash receptacles available.
  3. Keep fluids on hand: I offer my clients filtered water, coffee, hot chocolate, or tea. I like to keep a variety of teas including echinacea, peppermint, ginger and chamomile for their various soothing qualities. I also have local honey on hand.
  4. Assemble a care kit: Keep a care kit of lip balm (for yourself), lotion and hard candies. I keep separate hand lotion for clients by the sinks in my kitchenette and in the bathroom. I have a bowl of Key lime-flavored hard candy in my office and waiting areas. This extra effort can offer great comfort during the cold season.
  5. Disinfect your office: I spray my office at the beginning and end of my day with a natural disinfectant spray to eliminate possible contaminants. It cleanses the air and makes the office smell great.
  6. Use sanitary wipes to clean surfaces: I keep a container of sanitary wipes on hand to wipe down my phone, desktop, computer and the arms and backs of furniture. Body oils (and germs) can build up and remain on furniture.
  7. Clarify your cancellation policy: I inform my clients during the intake that I will waive the late cancellation fee for illness. I prefer that they stay home and rest rather than come into the office — for everyone’s sake.
  8. Consider offering teletherapy: I became a distance certified counselor (DCC) many years ago and provide phone and web-based counseling sessions under a variety of circumstances. Many of my clients opt for teletherapy when the weather is poor while caring for a sick relative, or when they are not feeling well but want the support of therapy. Counselors need not be certified to offer teletherapy, but I highly recommend it. Some insurance companies offer reimbursement for distance counseling, so check with your provider.

 

This time of year offers multiple challenges including colds and flu. As counselors, we can provide our clients with psychoeducation around the importance of self-care, rest, nutrition, exercise and fresh air. We can model good care by engaging in a healthy lifestyle. And, when we do succumb to the flu, we can demonstrate care by taking the time off to get the rest we need. We can offer compassion while promoting self-care.

 

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Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is affiliate faculty at Loyola and Fordham Universities. Her research interests include examining sexuality and spirituality in young women with advanced breast cancer; nature-informed therapy; and geek therapy. She may be contacted at cyfisherphd@gmail.com.

 

 

 

 

 

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