Tag Archives: empathy

Canine companions

By Laurie Meyers May 4, 2018

Having kids and young adults train rescue dogs isn’t technically animal assisted therapy, but for the kids—and dogs—involved in the Teacher’s Pet program, the result has definitely been therapeutic.

The youth —with the help of professional animal trainers— use positive reward-based training to increase local rescue dogs’ chances of being adopted. In return, working with the dogs helps the students develop patience, empathy, perseverance and hope, says Amy Johnson, the creator and executive director of Teacher’s Pet, a Detroit-area non-profit program.

The idea for the program was born when Johnson, a former public school teacher, was working as a dog training instructor at the Michigan Humane Society. Johnson, an American Counseling Association member, wasn’t sure what the training would look like at first — she simply knew

Images courtesy of Teacher’s Pet. Identifying features of (human) participants have been blurred for confidentiality.

she wanted an intervention that would help both kids and dogs. Johnson contacted every group she could find in the United States and Canada that worked with both youth and dogs to learn more about how their programs worked. Her intent was to work with kids who — like their canine counterparts — were behaviorally challenged and often unwanted. So, not only did Johnson contact school counselors and psychologists for their input, she decided to become a professional counselor herself.

The end result was a program that is 10 weeks long and meets twice a week for two hours. Teacher’s Pet currently works with teens from an alternative high school and three detention facilities and young adults, aged 18-24 at a homeless shelter, says Johnson, a licensed professional counselor. At each facility (except for the homeless shelter), the training takes place on site. Participants from the homeless shelter are brought to an animal shelter to complete the program.

The program’s group facilitators are all professional trainers and they choose only dogs with good temperaments to participate, says Johnson, who is also the special projects coordinator and director of the online animal assisted therapy certificate program at Oakland University in southeast Michigan. Before the participants begin working with the dogs, the facilitators give them some safety training.

“We spend the first day going over body language and stress signals,” Johnson says. “They meet the dogs on day two, after one more hour of dog body language education.”

Other safety measures include limiting the number of dogs — five or six per class of 10 students — and keeping the dogs on long tethers placed 10 feet apart so that they can’t interact with each other, she says. There are also always at least four trainers in the room and the dogs are closely monitored. If a dog gets overexcited, is struggling to get off the tether or barking at another dog, a trainer will remove it from the room, Johnson says.

At the beginning of each session, the lead facilitator goes over the goals for the session, such as teaching the commands “sit,” “stay” or “down,” learning to walk on a leash or not jump for the food bowl. The individual trainers explain how to teach the commands and let the teens or young adults do the actual training as they supervise. The dogs are never forced to participate—if an individual dog is nervous or reluctant, the goal for the day is to establish trust and confidence, she says.

Johnson says that sometimes dogs that come off the streets have specific problems like trembling when people walk by. In that case, the students will sit with the dog until it becomes more comfortable and then start with small steps like going for a brief walk outside.

As participants are teaching the dogs new behavior, often their own behavior changes, she says.

In particular, a lot of the teens and young adults who participate have poor communication skills, Johnson says. For instance, some are so shy that they don’t project their voices and the dogs don’t respond to their commands. The participants have to learn to speak firmly and assertively, and to demonstrate a sense of command by standing up straight. One boy told Johnson that he decided to test the tone of voice and body language he used with the dogs on his peers to see what would happen. Imitating the behavior he used with the dogs gave the boy more confidence and he found it easier to interact with his peers, she says.

Johnson describes another boy who was very angry, had little patience and low impulse control. He had a soft heart and would choose dogs that were struggling, which told Johnson that he was projecting his anger.

“Inside he was like the dogs [scared],” she says. So the trainers paired the boy with a dog that was afraid of men. His job was to make the dog like him, Johnson explains. The boy had to be patient and sit with the dog. As the dog got calmer and more confident, the boy would gently encourage it to move closer and closer. By the end of the program, the dog was joyfully playing with boy.

Johnson says that the program facilitators coordinate with the participants’ counselors when possible, so that if they are struggling with particular problems — such as patience or impulse control — training sessions can include activities that help address those difficulties.

The teens and young adults also learn from each other. The first hour of each session is devoted to training and the second to journaling and “debriefing” — talking as a group about what worked and what didn’t.

Johnson believes that even just the oxytocin release that comes from spending time with the dogs is highly beneficial. The program participants are often deprived of loving human touch and the dogs will lick and hug and make them laugh — reducing their anger and anxiety.

As the program draws to end, saying goodbye isn’t easy, but that in itself can be a lesson learned, Johnson says. The students start to detach from the dogs a little bit, and they’ll talk about how that is a normal part of processing grief and loss, she says. The kids also write letters to potential adopters  touting the dogs’ accomplishments.

When the program is over, the teens and young adults say goodbye to the dogs and learn that they can say goodbye and not have it be the end of the world, says Johnson. The participants also get lots of pictures of themselves with the dogs and a certificate for the wall. Many former students have told Johnson that they keep a picture of themselves and the dog they trained on their dressers.

“I had a youth email me seven years later and ask me for another copy of his certificate because his was in a storage unit that was auctioned off,” she says.

Many graduates want to volunteer with Teacher’s Pet for adoption and other events, Johnson says. The organization also remains a resource for the students — they can get letters of recommendation or basic things like clothes for school or school supplies if needed.

Johnson says that Teacher’s Pet is also currently working with the American Society for the Prevention of Cruelty to Animals (ASPCA) on a longitudinal study to determine if the program produces behavioral changes in the kids, and if so, for how long.

 

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For more information about Teacher’s Pet, visit the website at teacherspetmi.org or email Amy Johnson at amy.johnson@teacherspetmi.org.

Related reading, on therapeutic power of the human-animal bond, from the Counseling Today archives: “The people whisperers

 

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

Letters to the editor:ct@counseling.org

 

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

 

Differentiation of self through the lens of mindfulness

By Kevin Foose and Maria Cicio February 7, 2018

A few years ago, while teaching a course in family therapy, a particularly bright and insightful student named Maria lingered after class one day and asked, “Isn’t differentiation of self similar to mindfulness?” I hadn’t quite thought of it like that before, but it certainly seemed plausible. “Let’s set aside some time to talk,” I suggested. With that single question began many months of conversations.

In 2015, a continuation of those hours of exploration transformed into an “anti-presentation” that was awarded “Best of Show” at the Louisiana Counseling Association Annual Conference. The examination continued the following spring at the American Counseling Association Conference & Expo in Montréal. In the end, it was inquiry rather than answers that animated our informal lyceum. Quest and question are born of a common root. And teaching is thin soup if only the student grows. The current work is an attempt to extend the spirit and tone of those many fruitful hours of meeting.

Attempting to define differentiation

Differentiation of self (DoS), since first being introduced by Murray Bowen in the early years of the family therapy movement, has remained a lofty, elusive and often misunderstood concept. As Bowen’s colleague, Michael Kerr, pointed out, differentiation contains so many unique conceptual facets that it defies simple definition.

Bowen himself, persistently mystified by the consistent misinterpretation of differentiation, noted late in his life in one of his more cantankerous moments that he wished he’d never “discovered” it in the first place. Anthropologist Gregory Bateson once said of Charles Darwin that he didn’t discover evolution, he made it up. The same may be said of DoS. Viewed through this lens, DoS becomes a story (the point of which is to communicate its creator’s intent) steeped in a deep faith in science and the relatively recent emergence of the Western nuclear family.

If we are to accept the premise that differentiation does indeed defy simple definition, or at the very least is so subtle and nuanced that it is open to numerous interpretations, the initial question that emerges is: What in the world are we actually talking about when we talk about differentiation?

Michael Cowen, one of my colleagues at Loyola University New Orleans, provides a useful foundation from which to launch this conceptual ship with his interpretation of differentiation as “the capacity to be aware of one’s own unique pattern of feeling, valuing and thinking, and to decide and act in ways that remain faithful to that awareness.” Cowen’s definition shifts the focus of differentiation away from some thing that one is or has or even does, toward a description of understanding and action. It is a process that, at its core, allows individuals to make distinctions between thoughts and feelings and to remain calm in highly emotional situations. It is the ability to be both a part of and apart from significant relationships, and it places a high premium on the ability to behave rationally. It is not, however, a call for a Spock-like hyper-rationality nor a ringing endorsement of the ruggedly individualistic American mythology.

For the sake of moving forward with consensus, nebulous as it may be, I (Kevin) am inclined to give Bowen the final say in the construction of a working definition of differentiation as “a way of thinking that translates into a way of being.” So the story goes.

If that description of differentiation is to be accepted, the question then becomes, how is one to cultivate such “a way of thinking?” And who might act as a reliable translator? This is the point at which the teaching of the Buddha, in general, and mindfulness, specifically, can offer a helpful perspective from which to view perceptions and human experience.

At first glance, Bowen and Buddha may seem to be a strange pairing. After all, Bowen’s search for understanding led him back to the tumult of his family of origin, whereas Buddha left home seeking transcendence and never returned. Logistically, Buddha’s eightfold path provides a different road map toward liberation and understanding than does Bowen’s eight interlocking theoretical concepts. But the wisdom gained beneath the Bodhi tree may not be as divergent from the family tree as one might think. When differentiation is examined through the prism of mindfulness, significant conceptual convergences begin to emerge. The potential implications for personal growth, insight and clinical practice merit a pause, perhaps a deep breath, and further contemplation.

Mindfulness

Mindfulness is essentially the act of being present. Anchored in continuous awareness of each emerging moment, it is the cultivation of a calm, dispassionate state in which experience can be examined with acceptance and nonjudgment. Mindfulness, not unlike DoS, is a process that provides the possibility of escaping the trappings of emotional reactivity.

In an excellent article examining mindfulness (“Mindfulness: A Proposed Operational Definition” in the September 2004 issue of Clinical Psychology: Science and Practice), a group of Canadian academics, led by Scott R. Bishop, pointed out that the insight that emerges through disciplined contemplative practice creates an open “space between one’s perception and response, ultimately making it possible to respond and interact more reflectively (as opposed to reflexively).” Rather than becoming tangled up in “ruminative, elaborative thought streams about one’s experience and its origins, implications and associations, mindfulness involves a direct experience of events in the mind and body,” wrote Bishop and his colleagues

In other words, we are able to stay tethered in the present, experiencing our life with courage and composure as it actually unfolds in our midst. In this awakened state, our mind is freed from anger, attachment to desire and misperception. Providing an alternative to being swept away in a flood of emotionality and elaborate misinterpretation, we are able to resist the urge to flee into ideations of the imagined future clouded by the residue of the past, or compulsively bend reality to meet idiosyncratic needs.

Mindfulness is the antidote to fear, confusion and anxiety. It is a practice and process that tethers us to the immediacy of our lives with the insight to see “relationships between thoughts, feelings and actions and to discern the meaning and causes of experience and behavior” (as described in “Mindfulness: A Proposed Operational Definition”). Essentially, mindfulness cultivates the ability to interact rather than react.

The greatest hurdle in defining a self or sustaining mindful attention is emotional reactivity. When emotions escalate beyond a critical threshold, a state of mind emerges in which rational thinking evaporates and agitation hijacks the cognitive process. It is impossible to differentiate in such an agitated state. We become prisoners to automatic emotional responses saturated in fear.

Buddha referred to this reactive state as “monkey mind,” in which fear becomes much like a loud, drunken monkey frantically screeching the alarm bells of danger in our brains. The ability to quickly regain composure and quiet the monkey mind is the cornerstone of both differentiation and mindfulness.

The quiet mind is fertile ground for exploring what Buddha called “store consciousness.” Long before Sigmund Freud proposed his theory of the unconscious (again, see Bateson above) or Bowen began his examination of psychobiological cognitive-emotional processes, Buddha was wandering about preaching the Dharma, teaching practices aimed at liberating people from misperception and attachment to mental formations that seemed to be just beyond the reach of everyday awareness.

Vietnamese Buddhist monk Thich Nhat Hanh writes in the introduction of Cultivating the Mind of Love: “In our store consciousness are buried all the seeds, representing everything we have ever done, experienced or perceived. When a seed is watered, it manifests in our mind consciousness. … The work of meditation is to cultivate the garden of our store consciousness.”

Getting back into harmony with our lives

Whatever we “attend” to will grow. And what we don’t attend to will tend to grow out of control without insight into content and coping strategies buried deep in our store consciousness. For multigenerational family systems theory, the seeds in the soil are the early experiences in the family of origin. Differentiation allows for a bit of psychic “weeding” to occur so that intimacy and integrity may grow.

Buddha, too, was attuned to the influence that family members have on one another. Perhaps more poetic, but no less prophetic, a Buddhist teaching examines the importance of the emotional climate of filial bonds, invoking the image of the garden again: “A family is a place where minds come in contact with one another. If these minds love one another, the home will be as beautiful as a flower garden. But if these minds get out of harmony with one another, it is like a storm that plays havoc with the garden.”

It is precisely in those moments when one finds oneself in the “I” of the storm where mindful intention allows the well-differentiated self to stay calm and sift through frenetic cognition that often causes impairment in our lives. The ability to sit in the midst of the tempest and remain present, self-aware and in close emotional contact with others is the essence of what Soto Zen monk Shunryu Suzuki calls “imperturbable composure.”

The well-differentiated self exhibits radical acceptance to what Jon Kabat-Zinn calls the “full catastrophe of living.” In this way, we remain open and curious to the actual events of our lives as they unfold, freeing ourselves from endless cycles of suffering and automatic reactivity. Whether we call this mindfulness or differentiation becomes an exercise in semantics.

Through work and practice, we become available to the full reality of our lives, with the insight and courage to quietly slip through the cracks of our conditioning and allow our ego-cramped consciousness to release its grip on our battered psyche. Quite simply, DoS and mindfulness bring us back into harmony with our lives.

For Buddha, the ultimate act of enlightenment is to wake up. The Dharma teaches that it is possible for any of us to awaken at any moment in our lives. Much like achieving a fully mindful present state, people often find embarking on the path of defining a self to be a daunting task.

Bowen was clear and consistent in his insistence that the fully differentiated self is a theoretical concept that is practically unattainable. It is a guiding light rather than prescription. However, with much work and practice, it is possible to increase one’s level of differentiation. Bowen pointed out that if we can “control the anxiety and the reactiveness to anxiety, the functional level will improve.” The task at hand becomes “getting beyond anger and blaming to a level of objectivity that is far more than an intellectual activity. … The overall goal is to be constantly in contact” with emotional issues involving ourselves and others.

A common thread

Although Bowen and Buddha’s conceptualization of the “self” superficially seems to be the point at which the Venn in the Zen between DoS and mindfulness begins to diverge, it is through interdependence that the deepest synthesis actually occurs. Whether one adopts a scientific or a spiritual perspective, the influence that each of us has upon the other is the thread that ties mindfulness and differentiation together.

Bowen was certain that the self exists. Buddha sent his disciples out into the world in search of the self and sat patiently waiting for the report back. Ralph Waldo Emerson, with his ever-present, transcendental wisdom, offered this: “All that is said of the wise man by Stoic or Oriental or modern essayist … describes his unattained but attainable self.”

Both Buddha’s and Bowen’s philosophical views were undergirded by a belief in the profound effect that each of us has upon one another. Bowen believed that successfully differentiating oneself within the system could have significant influence on all others in that system. He noted that if one is able to successfully define a solid sense of self and defend against requests from others to change back to old ways of being, then the entire system can catapult forward into higher levels of functioning.

The Dharma teaches that when one is awakened with compassion and wisdom, all are touched by the light. In Cultivating the Mind of Love, Hanh examines Buddha’s teachings, exploring the ways in which the Dharma opens each of us to the possibility of deeper understanding and more intimate connection. In his introduction, Hanh invites us to become fully present, and “the rain of the Dharma will water the deepest seeds of your store consciousness. If the seed of understanding is watered … the fruits of love and understanding will grow.”

Examining the teaching of interbeing and the delusion of separateness falsely constructed in the mind, Hanh concludes: “We must vow to practice for everyone, not just for ourselves. … Because of our ignorance and habit energies, we usually perceive things incorrectly. We are caught in our mental categories, especially our notions of self, person, living being and life span. We discriminate between self and nonself. … When we see things this way, our behavior will be based on wrong perceptions. Our mind is like a sword cutting reality into pieces, and then we act as though each piece of reality is independent from other pieces. If we look deeply, we will remove these barriers between our mental categories and see the one in the many and the many in the one, which is the true nature of interbeing. … Everything is touching everything else. … To bring relief to one person is to bring relief to everyone, including ourselves. This insight brings about the kinds of actions that are truly helpful.”

These are hopeful thoughts for troubled times. What is called for in this moment, if one is to view differentiation through the lens of mindfulness, is a “way of thinking that translates into a way of being in the world” that accurately perceives the deep connection that we have with the world surrounding us and the profound effect that each of us has upon one another. So the story goes.

Compassionate listening

Counseling is a reciprocal process of story and interpretation. As a conversational intervention, much attention has been given to the narrative telling of the tale — the “talk” in talk therapy. Often lost in the reciprocity is the transformative power of listening. As Hanh points out, when we listen to another deeply and compassionately, we help that person to suffer less. “One hour like that can bring transformation and healing,” he teaches.

If listening in this way does indeed, as we believe, lead to the alleviation of suffering, the question becomes, how does one engage in the process of compassionate listening?

The calm that accompanies the differentiated self, and a mindful stance tethered in the present, provide a helpful perspective from which to enter into another’s story. It allows one to avoid judgment without abandoning discernment and concern. This way of being allows the counselor to bear witness to the tumultuous content of clients’ troubled narratives without becoming overwhelmed. We can tolerate intense emotion without needing to flee for safety and care without getting carried away.

Deep listening contains the seeds of empathy. The calm that accompanies a well-differentiated presence opens up the space to create the distance necessary to examine problem-saturated narratives. The practice of active listening artfully folds the story continuously back upon itself, returning the client to present-moment awareness. The acceptance that accompanies awareness invites the client to slow down, resist the impulse to avoid the suffering and instead examine the story with compassion. The wisdom to accept that which is beyond our control paradoxically generates the flexibility necessary for transformation to occur.

Pragmatically speaking, compassionate listening is rooted in language. To listen in this manner, it is essential to remain firmly planted in the present, gathering content without getting lost in the labyrinth of past suffering or anxious projections of the future. When listening to stories of suffering, it can be easy to lose sight of the fact that the actual experience is the retelling of the tale here and now, not what occurred there and then. It is imperative to honor our clients’ suffering while also uncovering their strength.

The task is to attend to the content of the client’s story while staying deeply connected to the person. Listening in this way allows us to wonder what the client is trying to communicate about his or her struggle through the story. What meaning is seeking to be understood? What are the relational and emotional elements recurring in the client’s words? Compassionate listening is the conduit into the deepest sense of clients’ experiences. It asks, how can we be present to the struggle and help our clients confront the frustrating and most frightening moments of their lives?

At its core, compassionate listening holds the therapeutic space. It widens the client’s interpretation just a bit. It uses the client’s language, symbols and metaphors. It sees as well as hears, deconstructing the story, searching the margins for what has been edited out, pulling the thread of seemingly disjointed pieces and reflecting it back in recognizable form. This way of listening is ultimately a path toward healing that allows for safe passage through suffering. As American Buddhist nun Pema Chödrön points out, mindfulness allows us to choose an alternative course for our lives. A process such as DoS requires us to first notice the true nature of our experience, then disrupt our habitual patterns and do things differently and, finally, practice again and again, one moment at a time.

A client suffers and a change is necessary. The struggle often comes with not knowing how to manifest a healthy change. The client has likely been avoiding, wrestling with and running away from anxiety for years, creating deeply ingrained habits. In the space created by deep listening, the client can experience something different. Clients may be able to look at their anxiety for the first time with compassion and understanding. The paradox is that once they are able to sit with their struggle instead of avoiding it, anxiety loosens its grip on their lives.

DoS, viewed through the lens of mindfulness, creates the clarity and compassion for transformation to occur. Mindfulness aids in the process by creating awareness of our mind-body interaction so that we can become more skillful in our interpersonal, and intrapersonal, relationship(s).

Just as the counseling process makes space for emotions, thoughts, ideas and stories in session, mindfulness creates a similar space for our internal experience to occur. This is the “deep listening” to our own process. Mindful awareness allows for attunement, not only with our clients but with ourselves. It creates systemic and intrapsychic awareness to the ways that we get hooked into metanarratives and mental confines. Emotions no longer run amok, and we are available to be in relationship with others. As clinicians, we must first listen deeply to the mystery and history of our own stories before making contact with someone else’s.

The Beat Zen of Richard Brautigan leads us to a quiet place to begin in his poem “Karma Repair Kit: Items 1-4”:

1. Get enough food to eat,/ and eat it.

2. Find a place to sleep where it is quiet,/ and sleep there.

3. Reduce intellectual and emotional noise/ until you arrive at the silence of yourself,/ and listen to it.

4. ???

 

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

Kevin Foose is an assistant professor in the Department of Counseling at Loyola University New Orleans. He maintains a private practice that focuses on couples and adult individuals. Contact him at kjfoose@loyno.edu.

Maria Cicio is a graduate of the Loyola University New Orleans master’s in counseling program, class of 2015. A licensed professional counselor, she is currently working in community mental health in rural Oklahoma.

Letters to the editor: ct@counseling.org

 

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

Building better counselors

By John Sommers-Flanagan and Kindle Lewis November 6, 2017

In the opening chapter of the sixth edition of Counseling and Psychotherapy: Theories and Interventions (published by the American Counseling Association), David Capuzzi, Mark Stauffer and Douglas Gross make the case that the helping relationship is central to all effective counseling. Not many counselors would argue with this idea. Nevertheless, many counseling practitioners still feel pressure to implement empirically supported or evidence-based mental health treatments. Consider this case:

Darrell is a 50-year-old Native American. He identifies as a male heterosexual. In his first counseling session, he talks about feeling “bad and sad” for the past six months and meets diagnostic criteria for a depressive disorder. Darrell’s counselor, Sharice, is trained in a manualized, empirically supported cognitive-behavioral model for treating depression. However, as a professional counselor, she values collaborative counseling relationships over manualized approaches. She especially emphasizes relational connections during initial sessions with clients who are culturally different from her.

The question is, how can Sharice be relationally oriented and still practice evidence-based counseling? The answer: She can use evidence-based relationship factors early and throughout the counseling process.

Evidence-based relationship factors

Back in 1957, Carl Rogers wrote that “a certain type of relationship between psychotherapist and client” was “necessary and sufficient” to produce positive change. In contrast, if you immerse yourself in contemporary research on counseling and psychotherapy, you might conclude that relationship factors in counseling are passé and that, instead, cutting-edge (and ethical) practitioners must use empirically supported treatments. But you would be wrong.

Most reasonable people recognize that both relationship factors and techniques contribute to positive outcomes. However, it is also true that relationship factors in and of themselves have strong empirical support. More than 60 years of scientific evidence supports Rogerian core conditions of congruence, unconditional positive regard and empathic understanding. In fact, counseling relationship factors are just as scientifically potent (and maybe more so) as so-called empirically supported treatments.

Newer terminology for acknowledging the research base for therapeutic relationships has been coming for about 15 years. In 2001, a task force from Division 29 (Society for the Advancement of Psychotherapy) of the American Psychological Association coined the phrase “empirically supported therapy relationships.” The task force’s purpose was to place therapeutic relationships on equal footing with empirically supported treatments. Despite those efforts, many (and perhaps most) psychologists value technical procedures (for example, cognitive behavior therapy) over relational factors. In contrast, because of counseling’s emphasis on therapeutic relationships, in some ways, empirically supported therapy relationships are much more relevant to professional counselors.

In this article, we use the broader phrasing of “evidence-based relationship factors” (EBRFs) to represent ways in which professional counselors can integrate research-based relationship knowledge into counseling practice. But what is an EBRF, and how can counseling practitioners implement them in ways that are more specific than simply saying, “I value the therapeutic relationship?”

EBRFs include the three Rogerian core conditions and other purposefully formed and implemented relational dimensions. Below, we provide concrete examples of 12 EBRFs that are empirically linked to positive counseling and psychotherapy outcomes. For each EBRF, we use the case of Sharice and Darrell to illustrate how Sharice can work relationally with Darrell and still engage in evidence-based practice.

Evidence-based attitudes and behaviors

Rogerian core conditions of congruence, unconditional positive regard and empathic understanding are foundational EBRFs. Although Rogers described them as attitudes, they also have behavioral dimensions. Additionally, counselors bring other relational factors into the room, such as role induction, cultural humility and scientific mindedness. Together, these EBRFs create a welcoming, safe and transparent environment that fosters therapeutic relationship development. Simultaneously, counselors are responsible for managing their countertransference throughout the relationship development process.

Congruence

Congruence implies counselor self-awareness and involves holding an attitude that values authenticity. Clients typically experience counselor congruence as the unfolding of a genuine relationship with their counselor. Genuineness involves counselors striving to be mindfully open and honest in their interactions with clients. This usually, but not always, involves self-disclosure, immediacy and offering feedback.

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Sharice displays congruence in several ways. First, she presents Darrell with an informed consent document that is written in her unique voice and that includes information on how she works with clients in counseling. She also greets Darrell with clear interest in learning more about who he is and what he wants. To focus on him, she might sit and emotionally center herself before going to meet him in the waiting room.

During the session, when Darrell talks about details of his professional work, Sharice openly expresses curiosity, “Oh, you know, I’m not sure what you mean by that. Could you tell me more so I can better understand what you’re experiencing in the workplace?” After Darrell shares details, she says, “Thank you. That helped me understand what you’re up against
at work.”

Role induction

Role induction is the process through which counselors educate clients about their role in counseling. Role induction is necessary because clients do not naturally know what they should talk about and because they may have inaccurate expectations about what counseling involves. When it goes well, role induction is interactive, and counselors simultaneously exhibit Rogerian core conditions (“I hope you’ll always feel free to ask me anything you want about counseling and how we’re working together”). Role induction begins with the written informed consent form.

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Sharice includes in her informed consent document what her clients can expect in counseling. She also explores these topics with Darrell in their first session.

Sharice: I’d like to share a bit with you about what we’ll be doing in this first session. To start, I want to hear about what’s been happening in your life that brings you to counseling now. As you talk, I’ll ask a few questions and try to get to know you and your situation better. We’ll talk about what’s happening now in your life and, if it’s relevant, we’ll talk some about your past. Then, toward the end of our session, I’ll share with you some ideas on how we can work together, and we’ll start to make a counseling plan together. Please ask me questions whenever you like.

Unconditional positive regard

Unconditional positive regard involves the warm acceptance of clients. Rogers himself noted that unconditional positive regard was an “unfortunate” term because no counselor can constantly experience unconditional positive regard for clients. However, to the extent that it can be accomplished, unconditional positive regard involves acceptance of the client’s self-reported experiences, attitudes, beliefs and emotions. Unconditional positive regard allows clients to feel the safety and trust needed to explore their self-doubts, insecurities and weaknesses.

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Throughout their time together, Sharice shows Darrell unconditional positive regard by listening to his experiences, attitudes, beliefs and emotions without showing judgment. She’s open to whatever he brings into the session and encourages him when they encounter subjects he finds difficult to explore. She not only listens nondirectively but also asks questions such as, “What’s your best explanation for why you’re feeling down now?” and “What are you thinking right now?” These questions show acceptance by supporting and exploring Darrell’s self-evaluation rather than focusing on Sharice’s judgments.

Empathic understanding

Empathy is one of the strongest predictors of positive counseling outcomes. However, there is one interesting caveat. It doesn’t matter if counselors view themselves as empathic; what matters is for clients to view their counselors as empathic.

Although measuring empathic responding is challenging, there is consensus that using reflections of feeling and engaging in limited self-disclosure are effective strategies. Also, there is evidence from neuroscience research that resonating with or feeling some of what clients are feeling is part of an empathic response.

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When responding to Darrell, Sharice uses her facial expressions, posture, voice tone and verbal reflections in an effort to comprehend Darrell’s unique thoughts, feelings and impulses. She expresses empathy as he talks about work stress.

Darrell: I feel pressure coming at me from everywhere. Deadlines that need to be met, clients to make happy, bills that need to be paid, and I need to maintain this image in the community, you know?

Sharice: That sounds stressful. You have people counting on you, and it feels overwhelming.

Following an initial reflection of feeling, Sharice uses what Rogers referred to as “walking within” to emotionally connect on a deeper level.

Darrell: It’s starting to get to me in ways stress hasn’t before. Like, I can’t sleep, it’s harder to focus, and I feel like I’m going to burn out soon.

Sharice: It’s like you’re saying, “I don’t know how much more of this I can take, and I don’t know what to do.” Do I have that right?

Later, Sharice uses a reflective self-disclosure (which combines congruence with empathic understanding) in an effort to deepen her empathic resonance.

Sharice: As I listen to you, Darrell, and as I try to put myself in your shoes, I feel physically anxious. It’s almost like this pressure and pace make me feel out of breath. Is that some of what it feels like for you?

Just like Carl Rogers would do, Sharice intermittently checks in with Darrell on the accuracy of her reflections (“Do I have that right?”). Additionally, if Darrell indicates that Sharice is not hearing him accurately, she uses paraphrasing to refine her reflection and sometimes apologizes while correcting herself.

Cultural humility

Cultural humility is an overarching multicultural orientation or perspective that includes three dimensions:

1) An other-orientation instead of a self-orientation

2) Respect for client values and ways of being

3) An attitude of equality, not superiority

Like the Rogerian core conditions, cultural humility is an attitude that counselors adopt before entering the counseling office, but there are also behavioral manifestations of cultural humility.

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In their first session, Sharice creates a space for Darrell to speak about what his culture means to him. She notes that even though they come from different cultures, understanding his culture is important to her.

Sharice: Thank you for filling out the intake form, Darrell. I know it can be daunting with all the personal information we ask for. I see that you are Native American. I’m a mix of German and Swiss and grew up outside of Denver. What this means to me is that I’ll be trying my best to understand your life experiences. If at any point you think I’m not getting your perspective, I hope you’ll tell me. Sound OK? (Darrell nods.) Thanks. Also, whenever you’d like, I’d be interested in hearing more about your culture and how it informs your way of being in the world.

Scientific mindedness

Scientific mindedness is a concept and skill originally described by Stanley Sue. It refers to the process of counselors forming and testing hypotheses about clients rather than coming to premature, and potentially faulty, conclusions.

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As Sharice gets to know Darrell and the issues that brought him to her office, she uses scientific mindedness to hypothesize how culture may (or may not) be a salient factor in his experience of stress in the workplace. When he talks about “immense pressures” that he puts on himself, she’s reminded of how some individuals from minority groups can feel added stress because they view themselves as representing their entire minority community. Sharice keeps this hypothesis in the back of her mind and, eventually, when the time seems right, uses a reflective listening response to test her hypothesis.

Sharice: When you talk about the pressure you put on yourself to perform, it sounds like you’re performing not only for yourself but also for others.

Darrell: Absolutely. I can’t help but worry because my family depends on me to generate income. (Somewhat to Sharice’s surprise, Darrell doesn’t identify his tribe or the reservation community as an additional source of pressure to perform, so she explores the issue more directly.)

Sharice: I’ve read and heard from some of my other Native American clients and students that it’s possible to feel added stress because they might view themselves as representing their tribe or other Native American people. Is that true for you?

Darrell: I always tell myself that that’s not an issue for me. But if I’m totally honest with myself and with you, I’d have to say that being an Indian man in an intense business environment makes for more stress. In some ways, I think it has less to do with representing my people and more to do with how I think my colleagues — and even my friends at work — somehow expect me to be less competent. I don’t know exactly what they think of me, but I feel I need to work twice as hard to earn and keep their respect. (After listening to Darrell’s disclosure, Sharice updates her hypothesis about how race and culture might be adding to his stress at work.)

Sharice: So, it’s not so much that you feel like a representative for your people. It’s more that you’re thinking and feeling that you should do double the work to prove yourself to your colleagues. I can imagine how feeling discounted compounds the everyday workplace stress you feel.

Managing countertransference

Countertransference is unavoidable. Countertransference includes the counselor’s emotional reactions to any or all clinically relevant client material (transference, client personality, content presented by the client, client appearance and so on). These reactions may be related to the counselor’s unresolved personal conflicts or the client’s interpersonal behaviors. Countertransference can be a hindrance or a potential benefit to the therapeutic process; it can distort your perceptions of your client, but it can also inform your relationship with the client.

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During their work, Sharice notices that she gets impatient with Darrell’s pace of speech and finds herself feeling annoyed with him. She brings this to her consultation group to understand why this is happening and how it is affecting her work with Darrell. Talking about it with her supportive group helps her deal with her emotional reactions more effectively and build understanding for why she is experiencing frustration and how to adjust so she can provide the best service possible to Darrell.

The evidence-based therapeutic alliance

The therapeutic alliance was a psychoanalytic construct until Edward Bordin described it in pantheoretical terms. Alliance factors include three dimensions:

1) The emotional bond

2) Mutual goals

3) Collaborative tasks in counseling

Additionally, progress monitoring and rupture and repair can be viewed as EBRFs related to the alliance.

The emotional bond

Although it can be difficult to measure an emotional bond, in the counseling context it is usually defined as clients showing a positive affective response toward their counselors. In many ways, the counselor-client emotional bond is a natural byproduct of the Rogerian core conditions and of the work that counselors and clients do together. However, counselors lead in this process by greeting clients with a positive affect and consistently showing interest in what clients talk about.

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When Darrell arrives at Sharice’s office, she is visibly happy to see him. In addition, she expresses her interest in working with him and her belief that he possesses the ability to overcome the issues with which he is struggling.

After a few sessions, Darrell begins to show trust in Sharice. He no longer looks anxious to be in her office, his speech is less guarded and he smiles more during their interactions. He mentions that although counseling is difficult at times, he appreciates having time every week with Sharice to talk about his life and sort out what is troubling him. He has become emotionally bonded to Sharice and looks forward to counseling sessions.

Mutual goals

In the first few sessions, counselors and clients explicitly discuss clients’ personal problems and corresponding counseling goals. Eventually, and sometimes even in the first session, clients and counselors agree on which goal or goals to focus on in counseling.

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Sharice (after discussing Darrell’s presenting problems and possible solutions): Darrell, we’ve identified several goals that we can work on together: stress management, managing the negative or critical thoughts you have about your work performance and getting better sleep. Which of these would you like to focus on first?

Collaboration on tasks linked to goals

After working with clients to decide on counseling goals, counselors introduce tasks or activities in session (or as homework) that are meaningfully related to the agreed-upon goals. These collaborative tasks often constitute the “technical” part of counseling.

When applying techniques, relationally oriented counselors:

  • Are careful to listen closely to what clients have already tried
  • Use reflective listening to gain a mutual understanding of what has worked worse or better
  • Jointly brainstorm new options with clients
  • Ask permission to try out technical procedures
  • Jointly monitor client reactions to new strategies

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Sharice: We’ve been talking about everything you’ve tried to help yourself sleep better. It sounds like you’ve been working on this for years. How about we rank which strategies have worked better for you and which have worked worse?

Darrell: Sure. (Sharice and Darrell work on Darrell’s rankings.)

Sharice: One of the things I’ve noticed that seems to work better for you is
when you’re able to distract yourself from your thoughts about work. Does that sound right?

Darrell: Absolutely. It’s so hard for me to get my brain to stop problem-solving.

Sharice: One thing I’d add to your list of possible strategies is mindfulness meditation. It can be a powerful technique to deal with racing thoughts. What’s your reaction to that idea?

Progress monitoring

After counseling goals are established and collaborative tasks identified, counselors and clients work together to evaluate counseling progress. There’s a robust body of research attesting to the positive effects of progress monitoring.

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Sharice consistently checks in with Darrell in two ways. First, she uses the Session Rating Scale after each session to gauge her therapy alliance with Darrell. Second, she directly asks Darrell about his reactions to the counseling strategies they are working on together.

As a part of her progress monitoring efforts, Sharice asks Darrell to keep a log of his mindfulness meditation activities, along with his sleep quality and quantity. Each week, they discuss what went well and what was challenging. She offers empathy and makes adjustments to his homework as needed.

Rupture and repair

Rupture is defined as tension or a breakdown in the counselor-client collaborative relationship. Repair involves counselors making statements and taking actions to restore the therapeutic relationship. Rupture can happen at any time during counseling. Usually it involves clients withdrawing or showing irritation.

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After a few weeks of logging his mindfulness meditation, Darrell appears agitated. When Sharice asks about the log, Darrell says, “This is a waste of time, and I don’t know why you thought it was going to help. I’m done with this stupid meditation.”

Sharice responds empathically and then explores with Darrell the source of his frustration. She discusses how embracing a passive attitude during meditation can be extremely difficult, especially because of the pressured and problem-solving orientation he has at work. She apologizes for pushing the idea of mindfulness meditation.

Darrell’s response is paradoxical. He spontaneously shares how important it is for him to find time to get out of his hard-driving mentality. Sharice then tweaks the mindfulness approach they have been using. The new emphasis moves away from formal logging and embraces small moments of progress.

The relationally focused, scientifically based counselor

Beginning with Rogers and moving forward into the 21st century, counseling practitioners have embraced the therapeutic relationship as central to positive counseling outcomes. However, at times, allegiance to and emphasis on the counseling relationship has been viewed as anti-science. The good news is that, now, more than ever, we have growing empirical evidence to support the efficacy and effectiveness of a relational emphasis in counseling. In this article, we reviewed and illustrated specific ways in which you can emphasize the therapeutic relationship and be evidence-based. This is welcome progress for the counseling profession in general and counseling practitioners in particular.

 

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

John Sommers-Flanagan is a professor in the Department of Counselor Education at the University of Montana. He has co-authored many books, including Tough Kids, Cool Counseling (published by the American Counseling Association) and Counseling and Psychotherapy Theories in Context and Practice (published by Wiley). Contact him at john.sf@mso.umt.edu or through his blog at johnsommersflanagan.com.

Kindle Lewis is a doctoral student in counselor education and supervision at the University of Montana. She is a national certified counselor, holds a license in school counseling and has 10 years of experience working with youth in education and counseling settings both locally and internationally. Her areas of focus are youth and school counseling, community building and holistic wellness. Contact her at kindle1.lewis@umconnect.umt.edu.

Letters to the editor: ct@counseling.org

 

 

 

 

 

 

 

 

 

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

Creative and novel approaches to empathy

By Ed Neukrug February 2, 2017

Near the end of Carl Rogers’ life, he wrote a scathing article noting that his conceptualization of empathy had little to do with the popularized notion of empathy that had become known as “reflection of feelings.” He may have been particularly angry because there were some apocryphal stories circulating about Rogers’ work with clients. One of them goes something like this:

Rogers is seeing a client in his office on the 10th floor of a building. The client tells Rogers that he is really depressed, and Rogers says, “Sounds like you’re really depressed.” The client goes on to say that he is thinking of killing himself, and Rogers responds, “You’re so depressed that you’re even thinking you might take your life.” This “reflection” goes on and on for quite a while until the client eventually declares, “I’m so depressed I’m thinking I might jump out of that window.” Rogers again reflects back, almost verbatim, what the client just said, at which point the client goes over to the window, opens it and says, “I’m so depressed, I’m going to jump out of this window.” Rogers says, “You’re so depressed you might jump out of that window.” Exasperated, the client stands on the ledge, and the last thing out of his mouth as he jumps is, “Ahhhhhh!” Rogers, left in the office alone, repeats, “Ahhhhhh.”

You can understand why Carl Rogers, the person who popularized empathy in the 20th century, was pretty upset by this distorted image of his work. In fact, his actual definition of empathy was much more nuanced than “reflection of feelings.” Rogers suggested that empathy is the ability to understand another person’s experience in the world, as if you were that person, without ever losing the “as if” sense. He also noted that empathy entails letting the person know that you understand his or her experience. However, he never suggested that one should rely solely on reflection of feelings to show this understanding. In fact, he implied there were many ways to show your clients that you have understood them.

The five levels of responding

During the 1960s and 1970s, microcounseling skills were popularized. Although these preprogrammed methods of teaching basic counseling skills were pretty effective, they reinforced the notion that counselors should mostly reflect back feelings and content to be empathic. Models developed by such well-known authors as Gerard Egan, Allen Ivey and Robert Carkhuff flourished at this time, and their work, and similar work by others, continues to dominate the ways that counselor trainees learn basic counseling skills.

The downside of these models was that many counselors grew to believe, and continue to believe, that empathy and reflection of feelings are pretty much synonymous. The upside was that counselors could learn this one form of empathic responding pretty quickly. Because empathy has been shown to be related to positive client outcomes, and because students can learn how to be empathic (or at least good at demonstrating this one type of empathy) in a relatively short amount of time, counselor educators have been generally satisfied to continue using these approaches.

All of the microcounseling skills models were pretty similar, but I was always partial to Carkhuff’s model because he suggested there were five levels of responding. Level 1 is when the counselor is simply horrible, reflects little if any of the feelings and content, and may even be critical of the client. Level 2 is when the counselor misses the mark by using a feeling that is not quite on target (e.g., saying “You feel upset” when “You feel depressed” would be more accurate) or uses content that does not quite capture the meaning of what the client said. Level 3 is when the counselor is on target, reflecting back feelings and content that capture exactly what the client was saying.

Level 4 is when the counselor “subceives” feelings just below what the client was outwardly expressing and accurately reflects those feelings back to the client. For example, “So, I’m sensing that in addition to your anger, you feel pretty hurt …”

Level 4 responses can also demonstrate complex and critical thinking that helps the client gain awareness about his or her life: “It seems like every time you get close to someone, you get scared — similar to how you felt when you were rejected by your parents.” These responses reflect understanding, not a “guess” or an interpretation.

Another Level 4 response is when the counselor reflects back a dilemma that the client may be experiencing but is not seeing directly. For instance, “So on one hand, I hear your deep attraction to this person in your office, but on the other hand, I also hear your ongoing love for your spouse.”

Level 4 responses are like icing on the cake — bringing more depth and clarity to the client’s experience — but they are not essential. In fact, I usually tell beginning counselors to shoot for Level 3 responses, and if a Level 4 response happens to pop into their consciousness, then go for it.

Level 5 responses occur when the counselor is “with” the client in his or her deepest moments of pain and demonstrates this in some way with the client. These are relatively rare responses, usually made in long-term counseling relationships, so I won’t go into depth about them in this article.

Because microcounseling skills models train students effectively and quickly at making basic empathic responses, they have become the gold standard in the field. However, they lack the nuance and complexity that can be offered by creative and novel empathic responses. Rogers alluded to this complexity and creativity when he said, “Gradually my understanding of empathy extended to an intuitive capacity for empathy, where I would find something rising in myself that wanted to be said. It might be bizarre. It might be out of context. But I found that if I voiced it, it often rang a real bell with the person and opened up all kinds of areas that had been dimly sensed by the client but not really experienced.”

Ten creative and novel empathic responses

Enamored of this definition of empathy from Rogers, and personally being a little burned out by the reflection of feelings formula, I began to look at other ways to operationalize empathy. I eventually came up with 10 empathic responses that I call creative and novel empathy.

1) Reflecting nonverbal behaviors: The most basic of the advanced responses, most counselors likely have already made such empathic rejoinders simply by acknowledging a client’s nonverbal behaviors. The following is a brief example of such a response:

Client: I’m not even sure where to begin today. So much has been going on.

Counselor: Well, just looking at your nonverbal behaviors, I can see that you have probably gone through a lot this past week. Your slouching body just looks depressed, and I can see you’re on the verge of tears.

Such basic but important responses acknowledge, through reflection of body language, what the client is saying and cuts through the verbal jargon about the client’s feeling state.

2) Reflecting deeper feelings: This type of advanced empathic response is similar to Carkhuff’s understanding of a Level 4 response, when the counselor is subceiving feelings beyond what the client is outwardly saying. It is important to note that these are not interpretive responses in which the counselor is hypothesizing about what the client is feeling. These responses are when the counselor actually experiences a feeling of which the client is unaware that resides just below the surface. For example:

Client: I’m at my wits’ end. I’m so frustrated with my spouse. No matter what I do, nothing seems to work. I keep offering new ways to try and work things out, but he doesn’t seem to care. I feel like throwing something at him.

Counselor: Your frustration really shows. You’ve tried so many different things, yet nothing seems to work. But most of all, I think I hear the sadness in your voice — sadness about the lack of connection that you feel with your husband.

In the example, look at how the counselor first reflects the frustration the client is clearly feeling, but then moves on to reflect sadness. Not outwardly stated by the client, this sadness was subceived by the counselor. If the counselor is on target, the client will respond accordingly.

3) Pointing out conflictual feelings and thoughts: Also an outgrowth from the Carkhuff model, this response enlightens the client’s understanding of self by pointing out different and conflicting parts of self with which the client is struggling. These contradictory parts of self are often responsible for a client feeling stuck in life. It is only through awareness of these conflicting parts of self that one can make smart choices about how to move forward in life. For instance:

Client: You know, I love my wife so much that the thought of being without her is incredibly painful. She is my rock and makes my life so much easier.

Ten minutes later

Client: I went out to lunch with my co-worker the other day, and I know she was flirting with me. When I’m around her, I feel lifted out of my depression. I so wish that I had someone like her in my life, and I’m even thinking I could have an affair with her.

Counselor: I’m hearing two parts of you. One that feels as if your spouse is your bedrock — a person who keeps you grounded — and another that wishes there were more excitement and vibrancy in your life.

All of us have feelings and thoughts that conflict with one another, and counselors can highlight these conflicts. Once these dilemmas are faced squarely, they can be understood more fully. Otherwise, individuals go through life bouncing from one conflicting thought or feeling to another, and they have a difficult time making sense of it all. Imagine what the conversation might be like if the client in the example talked about his or her conflicting feelings.

4) Using visual imagery: Using visual imagery reaches a client through different neural pathways than does traditional talk therapy. For instance, imagine working with a client who has been so bullied by friends and family that the client has considered suicide. As you sit with your client, an image floats into your consciousness that you share with your client.

Counselor: You know, as you’re telling me about your situation, I imagine you lying on the ground, surrounded by friends and family as they hover over you and barrage you with negative statements. You feel like you can’t move. You’re looking for an escape route, but none comes to mind.

Powerful images such as this show the client that you understand the gravity of his or her situation. They also help the client understand the intensity of the situation in a new and dramatic manner, potentially leading to the client generating ways of freeing himself or herself from the situation.

Another visual image was used with me. I was depressed and kept trying different change strategies, but nothing seemed to work. My therapist looked at me and said, “Sounds like you’re rearranging chairs on the Titanic.” On the surface this may seem like a pretty dismal state of affairs, but at least in my situation, it gave me hope. I knew that I had to get off this ship. And, indeed, it led me to make significant changes in my life.

5) Using analogies: Like visual images, analogies reach clients through different neural pathways than those used with basic reflections. Analogies use a logical analysis to compare a person’s situation to another situation that has a similar theme but different content. This allows the client to see the situation from a slightly removed and alternative position — a perspective that is sometimes more palatable for the client. For instance:

Client: I work in this huge office, and every day I go in and sit in my cubicle. There are literally dozens of people around me, and yet I feel like I’m alone. It’s almost more depressing than actually being by myself — all of these people around me and no one acknowledging, talking with or interacting with me. Sometimes I get so low, I just want to kill myself right there in my cubicle, but no one would probably even notice.

Counselor: It’s kind of like you’re an ant in an ant colony. All the ants are busy, busy, busy, and they don’t see you, hear you or touch you. You could just disappear, right there, and none of the rest of the colony would know you’re gone.

In the example, the counselor builds an image that can be related to the client’s situation but is clearly different visually. This allows the counselor to use different words than the client has used and also allows different channels of understanding.

6) Using metaphors: As with the use of visual images and analogies, metaphors also allow clients to receive information in a different form than the typical reflections used in traditional talk therapy. In this case, however, the counselor uses a figure of speech that is symbolic or representative of the client’s situation.

Client: Things have been going so well for me. Since I’ve been coming here, I just feel like everything has changed. I’m happier, I’m more in touch with myself and, best of all, I have met all these new people and have had all these new experiences. I am just flying.

Counselor: You certainly found the light and now seem to have an infinite spectrum of possibilities.

Here we see the counselor using a figure of speech (rather than a logical comparison as in analogies) to make a comparison between the client’s situation and the counselor’s response. This allows the counselor to reflect back a meaningful understanding of the client’s situation without having to use the client’s same words. It also reaches the client at a deeper level.

Here is another use of metaphor:

Client: I have been so busy lately that I can hardly keep track of what I’m doing. It’s a great relief in some ways because I don’t think about my problems and I kind of feel refreshed — like nothing is sticking to me. I mean, the usual problems I deal with don’t seem to take hold. I kind of like it.

Counselor: That makes me think about that old saying, “A rolling stone gathers no moss.”

Again we see a figure of speech being used to make a comparison between the client’s situation and the counselor’s response. This particular response is short and to the point and allows the client simply to think about what is going on in his or her life.

7) Using targeted self-disclosure: Revealing an aspect of self that parallels what the client is experiencing can be an important way to demonstrate understanding. In addition, clients will sometimes assume that if their counselor was able to overcome a struggle similar to theirs, then they can also be successful. One type of self-disclosure includes the counselor revealing feelings in the moment. Often called immediacy, this response demonstrates understanding of the client’s feelings and also models how the client can share his or her innermost thoughts and feelings with someone close.

Client: I’m at my wits’ end. I’m as depressed as ever. I keep trying to change my life, but nothing works. I try communicating better, I change my job, I change my looks … I even take antidepressants, but nothing helps.

Counselor: As you talk, I feel sad and anxious. Sad, because I can tell how hard this is for you, and anxious, because I feel the frustration of nothing working.

Content self-disclosure, on the other hand, reveals an event about a counselor’s life that mimics the client’s experience. This type of response shows the client that you understand him or her and that such struggles can be overcome.

Client: I’m at my wits’ end. I’m as depressed as ever. I keep trying to change my life, but nothing works. I try communicating better, I change my job, I change my looks … I even take antidepressants, but nothing helps.

Counselor: You know, there was a time in my life when I really struggled. I remember how difficult it was for me to get through that time.

Here, the revelation about the counselor’s life demonstrates that the counselor understands the client’s struggles. Notice the nonspecifics of this response. The counselor clearly does not want to reveal too much about his or her life. Targeted self-disclosure should be done carefully and used only to show a client that he or she is being heard, not because the counselor gets something out of self-disclosing. I often say that if it feels good to self-disclose, then you are probably doing so for your own benefit.

8) Reflecting media: Sometimes a client’s situation might remind the counselor of a particular movie, book or popular story. To show the client that the counselor recognizes his or her situation, the counselor references the media. For example:

Client: I had everything. I just bought a new home, was about to go into business for myself and simply had a wonderful life. Then the tornado took it all away.

Counselor: What you have gone through reminds me of the book The Old Man and the Sea. After catching the fish of his life that will lift the man out of poverty, he ties it to his boat, but sharks attack it, and the man’s treasure is lost.

Here’s another example:

Client: I’m going to avenge my brother’s attackers. I will do whatever I can to make sure they are caught and brought to justice.

Counselor: You remind me of Luke Skywalker, ready to take on injustice.

These responses can sometimes lead to more involved discussions about the characters, and analogies can then be made to the client’s life. For instance, The Old Man and the Sea ends with the defeated and worn-out fisherman saying that he promises to fish again with a young boy who has taken him on as a father figure. This story can provide hope to the client who has lost everything in the tornado.

9) Reflecting tactile responses: Using the counselor’s own physical reactions to the client’s disclosures can also demonstrate empathy. Here, the counselor closely monitors his or her bodily sensations and reflects those to the client in an attempt to mirror the client’s own experience.

Client: Anytime I’m around my partner, he harasses me with negative statements. I try my best to be what he wants me to be but just can’t live up to his expectations. Even when I think I’m doing what he wants me to do, it’s not good enough. I’m lost.

Counselor: When you just told me what you’re going through, I felt a gripping bite in my jaw and my stomach twist and turn. I imagine this is how you must be feeling.

Acknowledging a client’s physical state can assure the client that you understand the gravity of the situation. However, such responses are not limited to sad or negative emotions.

Client: I went into work today and, out of the blue, my boss came up to me, told me what a great job I was doing and said she was recommending me for a raise. I was elated!

Counselor: I just felt this chill go through my body when you told me about your experience with your boss. I know how difficult your work situation has been, and your boss’s feedback must have been an incredible high.

10) Using discursive responses: Based in narrative therapy, discursive empathy assumes that part of the client’s experience is based on older, historical and, possibly, cultural narratives. Clearly, one has to possess knowledge of the client’s old narratives, historical roots and cultural experiences.

For example, when conducting a workshop on empathy, I role-played a real situation in my life about having had cancer. I noted that I wished I had been “stronger” when facing my potential death. Asking for workshop participants to respond empathically to me, one said something akin to this: “The pain you felt in facing death seems like it may be related to a broader, more historical event in your life.”

Being Jewish, I immediately thought of the Holocaust and the kinds of messages I received growing up. I realized that “death” was something that was pervasive in my life as a child, and it continued to have an impact on me as an adult. I began to sob, realizing that my death was more than the death of my “self” — it also included the death of a people. It turns out that the person who made the response was the child of Holocaust survivors and saw in me some themes she had experienced. It was quite a powerful response.

Here is another example of discursive empathy:

Client: You know, I feel like wherever I go, I’m treated as a second-class citizen and I don’t get the same opportunities that Whites get.

Counselor: I wonder if I’m hearing how pervasive racism has been in your life as you were growing up — and even today — and how it has impacted your view of the world in such an important way.

Of all the responses I have introduced in this article, discursive empathy has the most potential for abuse because it makes assumptions about a client’s past. Thus, it should be used only if the counselor has a good feel for and understanding of the client’s historical themes.

Final thoughts

Creative and novel empathic responses can bring new energy to sessions as they help clients understand their situations through new modalities and in different ways. However, I always caution that these responses should be made spontaneously, as opposed to trying to manufacture them in the moment. My experience has been that when one becomes expert at basic empathy (e.g., Level 3 empathy on the Carkhuff scale) and has some understanding of creative and novel approaches, then these advanced responses will become a natural part of the counselor’s repertoire.

For those readers who regularly use such responses, you know how fulfilling they can be, both to the client and the counselor. For those who are new to such responses, it is akin to having an “aha” experience. When you offer these empathic responses, you know that you have given your clients a new way to look at their experiences and have likely broadened their depth of knowledge about self.

 

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

Ed Neukrug is professor of counseling at Old Dominion University. A well-known author of 10 books in counseling and human services, he has worked in a variety of settings, including agencies, schools and private practice, and has been active in numerous professional associations over the years. He maintains a variety of open access websites, including one in which visitors can assess their theoretical orientations, another that features oral stories about famous therapists and a third that features animations of famous therapists discussing their theories (see odu.edu/~eneukrug). Contact him at eneukrug@odu.edu.

Letters to the editor: ct@counseling.org

 

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

Why you should incorporate volunteering into your training: A student’s perspective

By Eleanor Rector October 17, 2016

You’re about to start a graduate counseling program. You’ve likely traveled to a new place, so you’re trying to adjust and find a new go-to burger joint. You have your priorities straight.

The last thing you want to do is research places to start volunteering. Besides, you’re already training for a career in which the focal point is helping people. Do you really need to go out of your way to do more? Sure, volunteering sounds good, and you would like to do it, but you’ve worked so hard to get here, and you don’t really have the drive to begin something that won’t further your career.

I have been there. You’re talking to a professional promise-maker here. I’ve organized groups to bring food and hygiene products to homeless individuals, but I’ve also made a thousand promises to myself or to other groups with good missions to volunteer, and when the time came, there was always a great excuse not to follow through. Maybe my cat was being extra cute, or my murder mystery suddenly took an interesting turn.

Whatever the excuse is, it seems important at the time. Besides, I tell myself, if I’m not there to help, someone else will take my place. And sometimes the amount of hurt in the world feels like photo-1469398718052-b9d13df0d7c9too much for me to bear. And I wonder, even if I am there to help, will it really make any difference?

Fortunately, I attend a university that removes the hard part from the equation. At Adler University, volunteering in your first year is a mandatory part of every program. Students fill out a form about their experiences, strengths and interests. Then, in a process I have been promised is not random, they are assigned volunteer positions in underserved communities.

Some individuals are placed in nonprofit organizations they find interesting; others remain confused about their placement throughout the experience. I have watched one particular thing happen across the board, however. Those individuals who complete their volunteer hours with as little effort as possible don’t really gain much from the experience. On the other hand, those who complete their placements by really getting involved and being passionate about serving the underserved ultimately grow immensely.

This experience is so pedestrian that a saying developed around it: “You get out of it what you put into it.” However, clinicians, and especially those of us studying to become clinicians, may not understand how vital this volunteer experience is to our clinical practice. If we are to be guided by the ethical principle of beneficence, then we must do more than simply our jobs to help our communities and the individuals within them.

We must find ways to integrate our pledge to help the community into our everyday lives. Otherwise, we are following only the principle of nonmalfeasance. That is an essential principle, but simply doing no harm is not enough. Doing actual good reaches much further.

Yes, we are “doing good” when we are effective and ethical practitioners. But at the same time, we are simply doing our job well. To fulfill the principle of beneficence, we must go beyond the minimum of being effective clinicians and do good that effects change outside of our own personal spheres. Involving ourselves in our communities, in whatever way one chooses, will also benefit our practices immensely and allow us to be much more effective clinicians.

 

Acknowledging privilege

This, of course, requires a brief discussion on privilege. Luckily, the program at my university that organizes this volunteer placement to underserved populations also provides training sessions that help students understand the oppressive systems at work in the world, specifically inside the United States, and confront the privilege that we all possess.

This is incredibly helpful because acknowledging our own privilege is uncomfortable for many of us. All of us have faced struggles in one form or another throughout our lives. Some of us may not feel that we possess privilege in many respects. And this may be true, because privilege comes in multitudinous forms. But no matter the lack of Master Statuses we may possess, being able to afford (or even have the good standing to take out loans) to go to graduate school and become a counselor is a privilege in its own right.

Many people are afraid of acknowledging their privilege because they think that having privilege is a shameful thing. That’s a logical, although untrue, line of thought. There is often unnecessary guilt inherent in being born with privilege because we live in a world that works to keep the privileged on top while oppressing the underserved.

I am a Caucasian woman. So, even though I am a woman, I still carry the Master Status of “whiteness.” No matter what I’ve experienced or how difficult life may have been, I still carry that one Master Status. I can do my best to understand the experiences of other individuals and empathize with them. But there has to be a point at which each of us acknowledges that some individuals have had experiences we simply cannot understand.

This isn’t something to be ashamed of because no one can control the circumstances into which she or he was born. However, it is our responsibility to confront these circumstances and subsequent biases head-on if we are going to be socially conscious clinicians who are dedicated to following ethical principles. Furthermore, those of us with privilege have a responsibility to help those without privilege and without a voice.

I think the writer Toni Morrison expressed this sentiment particularly effectively: “I tell my students, when you get these jobs that you have been so brilliantly trained for, just remember that your real job is that if you are free, you need to free somebody else. If you have some power, then your job is to empower somebody else. This is not just a grab-bag candy game.”

 

Giving empathy another dimension

Acknowledging our privilege is important for many aspects of our work and a vital component of volunteerism. For starters, it helps us form empathy.

Although most (hopefully all) clinicians and clinicians-in-training possess some amount of empathy, acknowledging privilege gives our empathy another dimension. For instance, when working with homeless individuals as a teenager, I clearly had empathy for the population. Especially during the Great Recession, I understood that circumstances beyond these individuals’ control had led them to this place of desperation.

But this empathy needs to be multidimensional. Acknowledging one’s own privilege, and therefore the societal systems of oppression at play, allows one’s empathy to extend not only to the individual directly before you, but also to a whole group of individuals who have been affected by these systems. Now instead of feeling empathy only because of a particular individual’s immediate circumstances, I’m able to understand that clients’ lives have often been controlled by societal systems that existed long before these people came to be. These systems were created to oppress classes of individuals, leaving upward mobility out of the question for many and, too often, making simple survival an enormous feat.

 

Understanding community

In addition to growing our empathy, acknowledging our privilege is an essential part of understanding our own communities. Because we all experience privilege, we simply remain unaware of certain parts of our communities. These sections of our communities don’t concern us, so we often don’t bother to get involved in them.

This isn’t a lack of empathy. Rather, it is simply a lack of knowledge. Acknowledging our privilege means opening ourselves up to learning about the underserved of our communities and the problems that plague those with less privilege than us. Because we are clinicians, learning often sparks passion in us, and when we become passionate about changing an issue and providing voice to the voiceless, we can be unstoppable.

This deeper understanding of my community took place for me at my volunteer site, where I took notes at a monthly meeting for the Harm Reduction Coalition, which aims to provide prophylactic availability in prisons to stop HIV transmissions both inside and outside of prison. By being in a meeting of this kind, I ended up learning far more about the correctional system than prophylactic availability. Simply by being involved, I was able to meet so many individuals whose lives had been touched by the general lack of health care within prisons. In the process, I was forced to let go of my preconceptions.

I logically had assumed that when individuals in prison became sick, they were provided with the health care to which they have a right. That is until I met a woman whose husband had been diagnosed with cancer in prison but was refused knowledge of his diagnosis and treatment. His family only learned that he had cancer when he died behind bars in the arms of his friends and an autopsy revealed the truth. I met another man who had been so deprived of sensory stimulation that he had to relearn how to talk, read, write and interact with individuals upon being released from prison. I heard horror stories of treatment being denied again and again and again so that the cost wouldn’t cut into the profits of privatized correctional healthPeople Hands Holding Colorful Word Volunteer care corporations. When you are in prison, you are still supposed to have certain rights. But when those rights are violated, you are voiceless and powerless.

When I started volunteering, I thought I understood the population I was working with and the system by which they are controlled. But when you have the privilege to not automatically be aware of these systems, you find that they are far more intricate than you ever could have imagined. Often, simply learning about the populations who live within these systems and cannot escape makes it impossible to not want to be involved.

As clinicians, we need to understand that we have preconceived beliefs that are inaccurate about many parts of our society. And the reality is, we are going to have clients who are part of these populations or have been touched by these systems. To be truly responsible clinicians, we need to confront these preconceptions head-on by involving ourselves with populations with which we would not generally come into contact.

I still struggle with the idea that what I do doesn’t really make a difference — that the oppressive systems at work are so big and so concrete that anything I do can only make a dent. That’s true in a way. After all, I’m only one person. There’s only so much I can do. But I can help educate others so that they too can begin to make chinks in the armor around this system. And they can educate the people around them about the reality of the world in which we live. At the end of the day, no matter how small the things I’ve accomplished are, they’re still there. And they still make a difference.

Don’t be afraid to admit that your preconceptions are wrong. Instead be afraid of keeping those preconceptions rather than confronting them. Identify an area of society that sparks your interest and passion, and find ways to get involved. Only through accepting your privilege and confronting your biases and beliefs can you deepen your understanding of society and strengthen your abilities as a clinician.

So force yourself to get off the couch. Find a nonprofit that works in an area that interests you. Schedule a time to volunteer, and then follow through. You won’t regret it.

 

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Eleanor Rector is a second year master’s counseling student specializing in forensic psychology at Adler University in Chicago. Originally from South Florida, she studied poetry and psychology at the University of Miami. She hopes to continue her education by pursuing a Ph.D. in applied neuropsychology. Contact her at erector@my.adler.edu.

 

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