Tag Archives: self care

The hurting counselor

By Gregory K. Moffatt August 13, 2018

It was like someone was sitting on my chest. From the moment I awoke each day, I could barely breathe, and throughout the day, I teetered on the verge of tears. My wife and I had separated, and I thought my 20-year marriage was about to end. My heart was in shreds and, especially because I am a counselor, I was humiliated that I was failing in my marriage. I felt like a fraud in front of my students, and as I struggled through lectures, the words and ideas that left my lips — the ones that normally were energizing to me — now seemed hollow and pointless.

I also struggled to get through my clinical appointments. As one married couple talked about their own pains, resentments and disappointments, I felt so incompetent that it was all I could do not to send them out the door. My worldview — everything I thought I believed in — had been shattered.

And, of course, I also had to face my children, explain things to my extended family and tell my close friends about my troubles. One of the most painful things ever said to me was delivered by one of those people at the time, like a spear thrust into my chest: “You might be a good counselor, but you sure don’t know how to practice it at home.”

It was an impulsive statement not intended to wound me, but those words sealed my burgeoning perception that not only had my marriage failed, but the successful person I thought I had become was merely an illusion. Many times I had talked to others about how failing didn’t make them a failure, but I couldn’t apply those words to myself. I believed I was indeed a failure. Nothing had prepared me for the crippling effects of such a personal crisis on my professional sense of competence, my worldview and my sense of self.

Those days are long behind me now, but the devastating feeling of that painful period was brought back to me recently as I worked with a colleague in the midst of a similar experience. Even now, after many years of healing, that wound is still tender in my heart, and as my colleague talked to me, tears pooling in his eyes, I knew there was little I could say to ease his pain. I recognized that fractured sense of competence in his face. It was the same one that looked back at me from the mirror all those years ago.

Children or no children, short marriage or long, amicable divorce or contentious, splitting up is always painful. I loved my family, and I was willing to do anything to salvage my marriage. In retrospect, that difficult time was one of the best things that could have happened to me. It helped me become a better person, and it helped my wife and me to heal some very deep hurts and disappointments and to begin nurturing a much healthier and happier relationship — one that thrives like wildflowers today. But that experience also taught me that the pain of personal crisis, whatever the cause, can be debilitating to a counselor.

A hard fall

As a professor, writer and clinician, I had always prided myself on practicing the things I taught. Looking back on those years, maybe I succeeded much of the time, but I failed more than I realized. I suppose counselors require a sense of competence, maybe even bordering on arrogance, to take the risks we take each day. After all, we are diagnosing and treating based on a professional judgment call, and if we didn’t have confidence in our abilities, we probably wouldn’t be very good at what we do. We might otherwise stand on the riverbank, foundering in indecision, never daring to venture across.

But that confidence and self-assurance may also blind us and make our fall much harder. As is also true for politicians and religious leaders, people expect more of counselors than perhaps they should. We are, after all, human. But a personal crisis, regardless of whether it is one of our own making, is not just our own. Our pain, embarrassment and shame are inevitably known to many and reflect, however unfairly, on our professionalism. That adds to the weight of our sorrows.

The self-care paradox

There is no shortage of books and articles on self-care for therapists. A quick search in an academic database yielded almost 1,000 articles on the topic. We talk a lot about self-care in our field, but I know that I didn’t practice it well. I suspect I am not alone — and this isn’t a new problem.

My professors and internship supervisors talked about the importance of self-care when I was a graduate student in the 1980s. In 2000, Theresa O’Halloran and Jeremy Linton noted that “wellness is a concept that we as counselors often focus on more readily for our clients than ourselves.” Then, almost 20 years after that, Denis’ A. Thomas and Melanie H. Morris (2017) wrote, “Although most counselors have knowledge about self-care and convey the importance to others, the same knowledge may not translate into self-care action — often when it is needed most.” Apparently, as a group, we practitioners haven’t learned much about the application of self-care in our own lives over the past few decades.

This is such a bizarre paradox. Counselors, of all people, should know better. We are trained to take care of ourselves, and we emphasize the importance of self-care to our clients. Yet my self-confidence in those days caused me to naively believe that crisis wouldn’t knock on my door. I think in some ways, when counselors talk about self-care, it is more of an academic conversation than a real one. It may be something like the fact that we all know we are going to die someday, but it isn’t real to us until we stare it square in the face.

Divorce, death of a loved one, loss of a job and chronic mental health issues strike counselors’ homes and lives just as they do the rest of the population, and these issues are potentially just as damaging to us as they are to those who are not in the field of mental health.

I couldn’t have prevented the pain of my own crisis, but there are many things I could have done differently to prepare myself for it. My self-care habits back then were weak at best. I’d like to offer some suggestions that can help counselors navigate the sweeping effects of personal tragedy.

Find a counselor before you need one

Unfortunately for me, when the reality of my fractured marriage came calling, I didn’t already have a personal therapist. I had seen one in the past, but I hadn’t had an appointment with him in years, so long that I couldn’t even remember his name.

I should have known better. All of us learn in graduate school that we need to manage our own issues if we want to be effective therapists, and I had been through both individual and group counseling as a part of my graduate work. I thought I had done enough. I reasoned that I had worked through past issues and found a place for my own life’s traumas. Maybe I thought I had “arrived,” but I was kidding myself. Managing the past helped to some degree but not with maintaining my ongoing mental health. Consequently, I wasn’t growing either.

It is easy to rationalize that the cost of regular therapy — both in time and money — doesn’t make sense. We work hard as counselors, and for every hour we spend in our own therapy, we are also losing money because we aren’t seeing clients. But that is false economy. Even if we are managing life fairly well, it still helps to get a checkup. I get a physical every year even though I’m fine; I go to the dentist twice a year even though I don’t have cavities; and I go to the eye doctor each year even though my eyesight is OK. I should have applied the same philosophy to my mental health, getting a mental health checkup every few months at minimum.

So, there I was, in crisis and in need of a therapist, and I had absolutely no idea who to turn to. Plus, I had another serious dilemma that is common among counselors. Almost everyone I knew and trusted in the field couldn’t ethically see me as a client. They were friends, colleagues, former students or former supervisees. I’d consulted with them, taught them or socialized with them. Now I had to find a therapist in the midst of my crisis, and I was left with the phone book — something I always tell people to avoid.

If I had been maintaining an ongoing relationship with a therapist already, this part of my crisis management would have been simple. For that matter, it’s very likely that at least some of the crisis itself might have been avoided. I’ll never find myself in that place again.

Exercise, eat right and rest

Good mental health requires us to eat right, sleep right and get reasonable exercise. I call it “Moffatt’s Mantra,” something my students, interns, supervisees and clients undoubtedly get tired of hearing.

Even before my crisis, I slept poorly, sometimes getting only an hour or two of sleep a night. This went on for years, and just as I apparently had been doing with my personal life issues, I chose to ignore my sleep issues. Oddly, my sleep problems allowed me to be exceptionally productive. Getting to my office sometimes at 1:30 or 2 a.m., I wrote prolifically, publishing many books and articles as a result. But then, in the midst of crisis when I desperately needed rest, even the little sleep I ordinarily might have gotten evaporated. I was preoccupied with shame, regrets and hopes, and sleep was nearly impossible. I made an appointment with my prescriber and began taking regular sleep aids, which was critical to my healing. Almost immediately, a reasonable night’s rest helped my mood improve.

Likewise, in those days, I rarely ate breakfast and often skipped lunch, only to overeat at the meals I did have. Fortunately, I have never been one to eat junk food, but my Southern diet was full of fried foods, fats and carbs. When crisis hit, I couldn’t eat at all. My stomach was upset, and I had a hard time downing even a few bites. Over just a few weeks, I lost more than 20 pounds. Just as was true with my sleep patterns, crisis magnified my poor eating habits. A good friend forced me to eat, often sitting with me during meals — including some that he made himself — to ensure I was getting at least some nutrition.

Of the three areas that constitute Moffatt’s Mantra, exercise was the only one that came easy to me. I have always been good about getting some type of daily exercise — running, biking, swimming or even all three in one day. This is the only thing that helped me offset the fatty, fried-food diet that was my routine and prevented me from gaining unhealthy weight.

Exercise has myriad benefits. Aside from building endurance, muscle tone and a stronger heart, it also improves quality of sleep and mood in general. Research has demonstrated that attention to healthy, reasonable exercise can either lessen the demand for medication or remove its necessity altogether, even with serious issues such as chronic depression. Exercise produces morphine-like endorphins that help to balance our moods. Even moderate exercise just two or three days a week can help manage weight and increase metabolism. Seeing a thinner self in the mirror can also improve mood.

“I’m too busy to exercise” is a very weak excuse. I was very glad that I didn’t have to add exercise to my life during the crisis because I doubt I would have possessed the motivation to work out and try to get in shape.

Supervision

Most counselors engage in supervision until a license or related credential is achieved, but after that, they rarely pursue any form of formal supervision. I think that is a mistake. As a supervisor myself, I have to recognize when a supervisee’s personal life issues, whatever they may be, are interfering with clinical practice without crossing the line and functioning as my supervisee’s therapist.

It would have been wise to have a second set of eyes during my crisis to evaluate my competence and ability to work with the clients I continued to see. An ongoing relationship with a trusted mentor or supervisor not only helps make us better counselors, but our supervisors may also be able to recognize when we are off our game. We lack objectivity when it comes to our own lives — both professional and personal.

That well-known line, “Physician, heal thyself,” sounds good, but it is an unattainable goal. Looking back at my own history, I was totally blinded by limitations of maturity and knowledge as well as by my good intentions. It is only through the lens of time that I am able to see that now. There is no way I could have been fully aware back then. Retaining a mentor who could have helped identify when it was time for me to take a step back would have been advisable.

Don’t forget to play

Building a private practice takes time, and many counselors burn the candle at both ends, working late hours and weekends, and seeing 35 to 40 clients per week. Such a schedule is unsustainable without life balance.

There is a huge body of research cataloging the benefits of play. It used to be thought that play was a kid thing. That is absolutely false. Human beings — in fact, most mammals — are prewired to play. The need to play doesn’t end at some arbitrary age that we call adulthood.

In general, research demonstrates the health benefits of play when it offers enjoyment and when the participant suspends time and place in exchange for focusing on an entertaining goal, such as winning a board game, playing tag or shooting basketball. Adults who play are happier and manage stress better. Play boosts morale, improves our “marketability” with the opposite sex and reduces heart rate. A 2016 study in the American Journal of Play even demonstrated the need for play among astronauts and proposed that NASA formally develop a “playscape” for those in microgravity.

Golfing, biking, hiking, playing games with your children or putting together a jigsaw puzzle are only some of the varied activities that constitute play. My favorite play activity these days is camping, and I am in the woods at least one or two days a month throughout the year — rain or shine, hot or cold. The isolation and recreation of the mountains energizes me and recharges my batteries.

Know your limits

One of my strengths in life is that I have never once done anything simply for money. Money doesn’t own me, so nobody else does either. But it is an easy mistake to make, especially as an American, to keep striving for more — a bigger house, a larger counseling practice, more staff, one more speaking engagement, more clients and so on.

Even when your practice energizes you, there has to be something more in life than appointments. It seems so logical, however, to keep taking on new obligations, mistakenly believing that you are “building a practice” when, in fact, you are burning the bridge from both banks. Long-term goals require some sacrifice, of course, but the decision of what to do and what to cut should be based on something other than the bottom line of your bank account or an arbitrary conceptualization of success.

Another reality is that in the midst of crisis, you can’t expect yourself to perform at the same level you would when your life is more normal. When I plunged into crisis, I cut back on as much as I could. I still had to teach my classes, and I continued to see the clients on my caseload I felt I could ethically handle. But I took no new clients, accepted no new speaking engagements, put all of my writing projects on hold and cleared my calendar, canceling a number of events I just didn’t feel strong enough to manage.

You will assume that this article doesn’t apply to you

There are varied perspectives on self-care, but I particularly like O’Halloran and Linton (2000), who propose focusing on wellness in six domains: social, emotional, cognitive, physical, spiritual and professional. Prior to my crisis, I had focused only on one or two of these, even though self-care is mandated by the ACA Code of Ethics. The suggestions I have offered about self-care are a start, but if history has taught me anything, I predict that most readers will say to themselves, “That was an important article. Glad it doesn’t apply to me.” And then 10 or 20 years from now, somebody else will be writing an article for counselors addressing the need for self-care. I would love to be proved wrong.

Just because we are counselors doesn’t make us immune to the ills of life any more than an oncologist is immune to the risks of cancer. In the 1990s, when Elisabeth Kübler-Ross experienced a series of serious health issues, she recanted her “stage theory” completely. A full-page article in my local paper described her health woes and her disparaging comments regarding her theory. I thought at the time her recanting of the theory was, ironically, demonstrative of the anger stage of that very theory. Before her death some years later, she said as much and reaffirmed her personal belief in her theory and life’s work. Despite our knowledge and experience, a crisis blinds us. Affect always trumps logic.

Taking good care of yourself is not only healthy for you, it will help you better serve your clients. Even chronic mental health issues such as depression do not preclude our competence. One of the most influential people in my professional life endured a lifelong battle with depression. I had known her a very long time before she confided that information to me. But she was an amazing mentor whose words and example influence me to this day. Likewise, one of the most naturally gifted interns I have ever had was a woman who suffered major depressive disorder, marriage issues and significant self-esteem issues throughout most of her life. But when she closed her door to begin therapy with her clients, she was amazing.

Both of these women were surprisingly strong, despite their personal life frailties. I am confident that they had learned to manage their challenges — not avoid them — and had developed self-care processes that allowed them to flourish in the counseling room.

It is with some embarrassment that I share my personal failures with you, but as always, this isn’t about me. Instead, I am hopeful that sharing my struggles can help you to avoid the mistakes I made. Pain will eventually find us all. I hope that, with better preparations than I made for myself, you can be prepared to weather the inevitable storms on your own horizons.

My friend has a very long road ahead of him. Recovering when your world lies in tatters around your feet is overwhelming. But he has me — a friend and a confidant. He has his therapist. And he has the physical and spiritual health to face this daily challenge. That is a great start.

 

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Gregory K. Moffatt is a professor of counseling and human services at Point University in Georgia. He is a licensed professional counselor and a certified professional counselor supervisor. Contact him at greg.moffatt@point.edu.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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Related reading, from the Counseling Today archives:

The battle against burnout

A counselor’s journey back from burnout

Wellness matters

Doing our own work: A parallel process

Behind the Book: Counselor Self-Care

 

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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.

Cole delivers message of care and empowerment in Saturday keynote

By Jonathan Rollins April 28, 2018

Johnnetta Betsch Cole couldn’t help but chuckling at the audacity (or, as she phrased it, the “chutzpah”) of the keynote message she was about to deliver to the thousands of counselors congregated Saturday morning at the ACA 2018 Conference & Expo in Atlanta.

With charismatic presence — and a knowing sense of humor — Cole announced to the assembled crowd, “I’m going to give some good counsel to a bunch of counselors.”

Cole followed up by saying that she wasn’t bringing new words of wisdom. Rather, she said, “You’re going to have affirmed what you already know but what you may not be acting on.”

Johnnetta Betsch Cole gives the keynote address at the ACA 2018 Conference & Expo in Atlanta on April 28. (Images by Paul Sakuma Photography)

An educator, anthropologist and humanitarian, Cole was the first African-American woman to serve as president of Spelman College and later served as president of Bennett College. Spelman, in Atlanta, and Bennett, in Greensboro, North Carolina, are two historically black colleges that are dedicated exclusively to educating black women. Cole was also the director of the Smithsonian’s National Museum of African Art. In introducing her to conference attendees, ACA President Gerard Lawson noted that Cole “has tangled with inequality in all its forms.”

Cole opened by welcoming the “sisters, brothers and siblings all” in the audience. In a nod to her training as an anthropologist, Cole said that she was purposely using “kinship terms” in her greeting. “I know that kinship is about much more than blood,” she said, explaining that it is really about how people are connected by their shared values and beliefs. Among the values she knows that counselors share, she said, is the belief that “every child deserves the right to soar to the heights of their possibilities” and the worth of the extraordinary diversity among all human beings.

Cole then proceeded to remind the counselors in the room of some truths they already know but may need to rededicate themselves to in their practice.

First, Cole said, “It is immensely important for you to truly know the folks you are working with — their struggles, their lives and their culture. … You cannot be an effective counselor unless you genuinely find a way to walk in their moccasins or roll in their wheelchair” or understand what it is like to be someone who is transitioning genders.

Second, she said, “To serve as an effective and compassionate counselor to others, you first need to really know yourselves.” This involves a significant amount of soul searching and engaging in personal therapy, Cole acknowledged, but it also requires “understanding and owning your unconscious biases.”

Every single human being possesses these unconscious biases, Cole said, and they affect how we view and evaluate others and ourselves. “We’ve got to be aware of our unconscious biases. Why?” asked Cole. “So we can mitigate against them.”

Third, as counselors work with students and clients from marginalized groups in society, Cole said, it is extremely important to help these individuals “acknowledge, own and execute their power … to become champions for themselves and for their community, their nation and the world.”

Cole recalled a middle school teacher who helped her to realize and claim this power in her own life. Cole was attending a private school where almost all of the teachers were white, including this particular Latin teacher, Miss Morris, whom Cole remembers as having “tightly permed hair with too much blue rinse in it.”

At this particular age, Cole said, she was beginning to “feel my power,” and she decided to direct it against Latin itself, organizing “her girls” to disrupt the beginning of class with a rhyme about how the rigors of Latin was killing them. After two days of this, Miss Morris stopped the girls and told them that they weren’t there to learn Latin. Using the language of the day, she told them, “You’re in this class to learn that, as negro girls, you can learn anything.”

“That is a message that we should give to every child,” Cole said.

That message should also stir up something in us to claim and use our own power to effect change in our own lives and communities, Cole said, adding that there is no shortage of issues in our society needing nonviolent action on the part of people.

When encouraging people to tap into their power, Cole likes to reference an African proverb: “If you think you’re too small to make a difference in the world, you’ve never spent the night in a closed room with a mosquito.”

In closing, Cole gave the counselors one last reminder: “Each of you is in the business of teaching your clients and students how to take better care of themselves. But in addition, dear counselors, you’ve got to take good care of yourselves.”

Cole then asked for the house lights in the ballroom to be brought up and requested each of the counselors who were able to stand. She told them to get in a comfortable stance, to bring their right arm across their body and then their left – and then to give themselves a big hug.

“I’m asking you to do better at loving and empowering yourselves,” Cole said to the attendees. She then asked them to take that message of care and empowerment to their students and clients so that they, in turn, could work to improve their communities, put a message of love and respect into action, and pursue social justice throughout society.

Cole may have been preaching to the choir, but her message unquestionably rang clear and true.

 

 

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Jonathan Rollins is the editor-in-chief of Counseling Today. Contact him at jrollins@counseling.org.

 

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The ACA 2018 Conference & Expo in Atlanta began with an ACA Governing Council meeting mid-week; festivities stretch through the weekend.

Find out more, including information on live streaming, at counseling.org/conference

 

See more photos from conference on the ACA Flickr: bit.ly/1MOAysM

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Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

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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.

Informed by trauma

By Laurie Meyers September 22, 2017

In 1995, the Centers for Disease Control and Prevention and Kaiser Permanente began what would become a landmark study on the health effects of adverse childhood experiences. Over the course of two years, researchers collected detailed medical information from 17,000 patients at Kaiser’s Health Appraisal Clinic in San Diego. In addition to personal and family medical history, participants were asked about childhood experiences of abuse, neglect and family dysfunction, such as emotional and physical neglect, sexual and physical abuse, exposure to violence in the household and household members who had substance abuse problems or had been in prison.

Researchers found that the presence of these negative experiences in childhood was predictive of lifelong problems with health and well-being. The more negative experiences a participant had, the more likely — and numerous — these problems became. Another disquieting finding was that adverse childhood experiences were incredibly common. Almost two-thirds of participants had endured at least one adverse childhood experience, and more than 1 in 5 respondents had endured three or more such experiences.

In the decades that followed, this discovery of the prevalence and devastating effects of trauma spurred the development of practices such as trauma-informed counseling, which stresses the importance of recognizing and treating trauma and, most importantly, preventing additional trauma.

Drawing on basic counseling skills

According to the U.S. Substance Abuse and Mental Health Services Administration, programs, organizations or systems that are trauma informed:

  • Realize the widespread impact of trauma and understand potential paths for recovery
  • Recognize the signs and symptoms of trauma in clients, families, staff members and others involved with the system
  • Respond by fully integrating knowledge about trauma into policies, procedures and practices
  • Seek to actively resist retraumatization

In many ways, trauma-informed care involves using skills that every counselor should already possess. “Remain empathic, open, nonjudgmental and steady. Steadiness is particularly important,” says American Counseling Association member Cynthia Miller, a licensed professional counselor (LPC) in Charlottesville, Virginia, whose practice specializes in trauma. “You don’t want to overreact to things a client tells you. But you don’t want to underreact either. Screen for trauma at intake. Don’t just ask a client if they’ve ever been abused or neglected. Many clients won’t define themselves as victims of abuse or neglect, and if you ask it that way, you’ll miss it. Ask behaviorally instead.”

Miller suggests using questions such as, “Has anyone ever hit, punched, slapped or kicked you? Has anyone ever put you down, called you names or made you feel worthless? Has anyone ever touched you without your permission? Have you ever witnessed a violent or upsetting event that really troubled you?”

“If a client responds with a ‘yes’ to any of those questions, ask them if they’d like to share more about it now,” Miller continues. “Help them feel in control of what they disclose and when and how much. Don’t make the mistake of thinking you need all the details and then push to get them. You can retraumatize someone that way. Instead, ask them how they think the experience impacted them and if they think it is related in any way to their current struggles.

“At the opposite end, if they respond to everything with ‘no,’ don’t assume a trauma never happened. It may very well be that they’re just not telling you about it right now because they don’t yet feel comfortable. Stay open to the possibility and rescreen as appropriate.”

When specific questions about trauma don’t elicit answers, ACA member Rebecca Pender Baum, a licensed professional clinical counselor in Kentucky who has worked with survivors of sexual assault and interpersonal violence, often asks clients if there is anything they haven’t already told her that they think she needs to know. She has found that this approach often helps clients express concerns that they have been holding back.

Jane Webber, an ACA member and LPC in New Jersey who has written extensively about trauma and disaster, often mixes less threatening questions in with questions related to trauma. For example, in the midst of gathering basic background on family history, she will ask clients about events such as accidents or a history of falling. She then works up to questions about physical and sexual abuse. Webber emphasizes the importance of counselors using the same calm, steady tone of voice for all questions to prevent distressing the client.

Webber also finds it useful to tell her clients, particularly those on the younger end of the spectrum, that they can answer her questions via text during the session. She says that sometimes clients are more open to texting about things that they might struggle to express verbally.

Webber urges counselors to be intuitive with clients and look for signs of unexpressed trauma such as sweaty palms, restless movement in sessions and failure to make eye contact.

Miller says that she stays alert “for what I think of as disordered self-soothing,” which may include “substance use, self-injury or aggression. Individually, any one of them can be a clinical indicator. As a triad, they’re almost certainly covering up an untreated trauma.”

A different focus

At first, it may seem strange to treat every client as if he or she is a trauma survivor. However, clinicians who use trauma-informed counseling say that the practice is also about changing the overall focus of counseling by moving away from the “problem” approach. That approach demands, “What’s wrong with you? What did you do wrong? What’s making you act that way?” says Webber, a lecturer in the counselor education department at Kean University’s East Campus in Hillside, New Jersey. “[Trauma-informed counseling] is a paradigm shift from what is wrong with the client to what happened to the client.”

Julaine Field, an ACA member and LPC from Colorado Springs who works with traumatized children, agrees with Webber. Field explains that rather than focusing on changing a client’s thoughts or behaviors, trauma-informed care seeks to understand how people react and adapt to experiences.

A trauma-informed counselor helps clients understand where their behavior is coming from by explaining trauma’s effects on the brain and emotional regulation, says Field, a counseling professor and coordinator of the clinical mental health track in the Department of Counseling and Human Services at the University of Colorado Colorado Springs. “[Counselors] can also help [clients] understand the real importance of basic self-care, deep breathing, good eating, exercise and that a focus on wellness on a daily basis is the best way to fight the trauma impact and arousal,” says Field, who has also counseled veterans and survivors of interpersonal violence.

A recurrent — and perhaps predominant — theme when talking about trauma-informed counseling is safety. Making the client feel safe and welcome is paramount, say trauma experts. That sense of safety starts with the environment. Counselors should make sure their offices appear warm and inviting, considering everything from comfortable seating to appropriate lighting (neither too harsh nor too dim), says Pender Baum, an assistant professor of counselor education and practicum internship coordinator at Murray State University in Kentucky.

Clients should also feel that they have some control over the counseling process. “Even if you don’t know if a client has been through trauma, you can do things as a clinician that communicate to clients that they are safe and in control of what happens in the consulting room,” says Miller, an assistant professor of counseling at South University in Richmond, Virginia, who has also worked with incarcerated women.

“Let them determine where they want to sit. Ask if they are comfortable. Give them permission to decline to answer any question they are uncomfortable with and to take breaks at any time during the intake if they start to feel uncomfortable,” she suggests. “Pay attention to body language, tone of voice and other cues of emotional distress, and respond to them. Be willing to pause during a session and encourage clients to take a breath, ground themselves or stretch.”

Establishing safety

Both Miller and Webber stress that uncovering trauma is not an automatic green light for counselors and clients to start dissecting the past.

“Establishing safety is the most important and, often, the longest stage of treatment,” Miller says. “Don’t jump immediately into reprocessing, and don’t assume that everyone needs to reprocess. And remember that if you take away someone’s primary coping skill — however maladaptive it may be — you’re leaving them with nothing to soothe themselves when their emotions run high unless you teach them more productive skills.”

Webber spends substantial time helping clients build coping skills. She says that deep breathing is the fastest, easiest and most effective way to regulate emotion, but she cautions that there is no one-size-fits-all approach to this technique. Some people like to use counting — breathing in for three or four beats, holding the breath for another three or four beats, and then slowly breathing out, perhaps for six to eight beats.

However, some clients find it stressful to focus on counting, Webber says. In those cases, the counselor and client should just focus on breathing in and breathing out. She directs clients to inhale slowly and to exhale twice as slowly, noting that the slow exhale is what calms the nervous system and helps decrease a person’s level of physical agitation.

Another factor in breathing “style” is environment. Some people need to look at something specific such as a wall to focus on their deep breathing, whereas others prefer to close their eyes, Webber says. Counselors and clients should experiment with what works best. It can also be difficult to visualize what breathing from the diaphragm means, so counselors should practice their breathing in front of a mirror so they can better demonstrate it to clients, Webber advises. Because it is hard for people to learn when they feel overwhelmed, she also emphasizes the importance of teaching deep breathing and other grounding techniques to clients when they are calm.

Another grounding technique that Webber uses is anchoring in a safe place. Before asking a client to visualize a safe place, however, she says it is important for the counselor to know whether the client has experienced sexual or physical trauma. In those cases, “safety” for the client might mean hiding behind a locked door, which doesn’t provide a healthy, calm image.

“They may not have a happy place,” Webber says. “We might have to create a brand-new place [to visualize], such as a place with no people.” Counselors can help clients visualize their safe places by asking what environments are most comfortable for them.

Webber also uses tapping as a grounding technique. Tapping is a form of bilateral stimulation that helps clients desensitize feelings of trauma and stress. Webber leads clients through deep breathing and asks them to imagine something that is agitating but not overwhelmingly traumatic. Then, she instructs them to use their hands to tap their shoulders repeatedly, alternating between left and right. After about 40 taps, she asks clients to stop and smile.

Clients can also use tapping in public if they are feeling agitated or overwhelmed. Simple and inconspicuous techniques include tapping a foot on the ground three times, lifting a heel in and out of a shoe, or simply looking left and then right repeatedly, Webber says.

Even in the midst of teaching clients coping skills and grounding techniques, their safety is never far from Webber’s mind. To avoid retraumatizing clients, she monitors their level of distress in each session, giving them a scale on which 1 represents complete calm and 10 represents overwhelming agitation. Webber begins and ends sessions with the scale. She also pauses and does a quick check within the session if the client shows signs of agitation or arousal. If the client’s distress level is too high, Webber stops and does some grounding and deep breathing with the client.

All of the professionals interviewed for this article stressed the importance of counselors receiving supervision or working in tandem with a trauma specialist if needed. “When you start to feel in over your head, you’re probably in over your head,” Miller says. “That’s a good time to get supervision or to consult with someone who has more training and experience than you.”

However, there are basic principles of trauma-informed counseling that all counselors should know, Field says. These include:

  • Psychological first aid
  • Mindfulness techniques
  • Breathing techniques
  • Grounding strategies
  • Relaxation methods

“Psychoeducation about the brain and the impact of trauma on the brain is something that all practitioners can do,” adds Field, noting that simply normalizing the effects of trauma can be enormously helpful for many clients.

Helping the helper

Another tenet of trauma-informed counseling is self-care. Immersing themselves in others’ problems and pain can take a toll on counselors, and counselors who regularly engage in trauma work face an increased risk of vicarious or secondary traumatization. According to the second edition of the APA Dictionary of Psychology, burnout can be “particularly acute in therapists or counselors doing trauma work, who feel overwhelmed by the cumulative secondary trauma of witnessing the effects.”

To continue to treat clients affected by trauma with compassion, counselors must extend some of that same consideration toward themselves. A practice of good self-care can help trauma-informed counselors to safeguard their own mental and physical health.

That is a lesson Jessica Smith, an LPC with a private practice in the Denver area, learned early in her career. “My work used to define me,” says Smith, an ACA member who specializes in addictions and trauma. “If I did a pie chart of where I found meaning in my life, three-quarters of it would have been my work as a counselor when I first started out on this professional journey, but through my burnout and recovery, I’ve learned that I am so much more than this work. I care about my clients deeply, but I also love and care about myself deeply too.

“I used to view self-care as a burden — just one more thing to do. But now I see it as an opportunity to show up more fully in my life and the lives of those around me, including my clients.”

Smith now makes self-care a regular part of her day. “I start my day with meditation, journaling and movement in the form of walking, yoga or another form of exercise. I infuse self-care throughout my day through meals, writing, music, mantras, and connections and conversations with other colleagues. I have a mantra that I say before each session, which is, ‘Help me to be a conduit or reed to transmit … messages to this person in a way that they are able to receive them. Help me to remember that I cannot fix, change or save this person and that I am only one small part of their healing journey on this earth. Give me love, give me hope and give me light.’”

The creative interventions that Smith does with clients — including movement, art, visualizations, writing and breathwork — also serve as a kind of pressure valve, she says. “I’m constantly checking in with my body during sessions, especially when I’m working with [clients who have experienced] trauma, to notice, breathe into and release any areas of tightness and tension.” Smith finds that her body reflects the tension in clients’ bodies. “[I] check in with them about their sensations, then disclose mine as well in order to help model healthy body awareness and connection.”

At the end of the day, Smith clears the office by burning sage and consciously making a decision to let go of any residual trauma or distress. When she gets home, she physically “shakes off” the day before going into the house.

“I end each day with a meditation and gratitude practice where I write down three things I am thankful for that day,” Smith says. “I stretch and do heart-opening yoga poses, then go to sleep.”

Counselors need to have self-care strategies that allow them to gain distance from their work and give them the ability to check out mentally and physically from the responsibilities of being a counselor, Pender Baum says. She has learned to literally put self-care on her calendar.

“I live by my calendar, so if it is on there, it becomes just like another required staff meeting or counseling session,” she says. “It’s not negotiable. Admittedly, I can still struggle with this one at times, [but] it’s important not to let work get in the way of your me time. Get that self-care in whenever you can. It might be closing the door for five minutes and doing some deep breathing or taking a walk around the building. Something to break up the day and get you away from your office.”

It’s also important to engage in activities that don’t have a timeline or deadline and, most importantly, that are fun, Pender Baum says. “I like to kayak, watch movies with my husband [and] read to my daughter. Others might like going for a run, reading their own book [or] soaking in a bubble bath.”

Another self-care strategy that Pender Baum emphasizes for counselors is to avoid isolation. “Developing connections sometimes can involve seeking out professional development opportunities. This helps to keep you connected to the profession, learn new skills and be around other professional counselors without hearing the traumatizing stories from clients.

“For example, just this summer, my mother — a fellow counselor educator and counselor — and I attended a training on finding meaning with mandalas. We not only learned a fantastic clinical skill, but it was very therapeutic [for us] at the same time.”

Pender Baum also stresses the importance of peer support and supervision. “It’s … important to debrief after particularly difficult cases,” she says. “Have that peer support group, supervisor [or] consultant on hand that you can engage with. Have a mentor or be a mentor to someone.”

Smith participates in two therapist support groups that meet once a month. “Since I’m in private practice, isolation can be a risk, so I do these groups as well as go to lunch or coffee with at least one friend or colleague in the field each week,” she says. “I take time off each month and no longer feel guilty about doing so as I did early on in my career. I try to do a training or workshop quarterly for self-care, connection and to nurture my inner student.”

Pender Baum says counselors need to know themselves. “Give yourself permission to experience the emotions, but also set clear boundaries,” she says. “Know your limits, avoid overtime, commit to a schedule, and recognize and change negative coping skills.”

All counselors should also be aware of the signs and symptoms of vicarious trauma, Pender Baum stresses.

“Vicarious trauma can change one’s spirituality, and this can impact the way we see the world and how we make sense out of it,” she says. “Some counselors experience difficulty talking about their feelings, anger or irritation, an increased startle response and difficulty sleeping. Others might experience over- or undereating, an ever-present worry that they are not doing enough for their clients [or] possibly even dreaming about clients’ traumatic experiences. Still others might feel trapped in their jobs, lose interest in things they typically enjoy and even [experience] a loss of satisfaction and accomplishment. Some experience intrusive thoughts related to client stories and feeling hopeless.” These are all signs that counselors need to step back and focus on self-care, she says.

Other symptoms include:

  • Chronic lateness or absence from work
  • Low motivation and an increase in errors at work
  • Overworking
  • Avoidance of responsibilities
  • Conflict at work and in personal relationships
  • Low self-image

Pender Baum also urges practitioners to listen to their peers, family members, friends and loved ones if they say they are noticing a change in them. Counselors may be unaware that they are showing signs of burnout, and feedback from others can be helpful in preventing a crash from overwork and stress.

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

  • “Coming to grips with childhood adversity” by Oliver J. Morgan
  • “The toll of childhood trauma” by Laurie Meyers
  • “Traumatology: A widespread and growing need” by Bethany Bray
  • “The transformative power of trauma” by Jonathan Rollins
  • “A counselor’s journey back from burnout” by Jessica Smith
  • “Stumbling blocks to counselor self-care” by Laurie Meyers

Books (counseling.org/publications/bookstore)

  • Terrorism, Trauma and Tragedies: A Counselor’s Guide to Preparing and Responding, third edition, edited by Jane Webber & J. Barry Mascari (fourth edition being published in 2018)

Webinars (aca.digitellinc.com/aca)

  • “ABCs of trauma” with A. Stephen Lenz
  • “Children and trauma” with Kimberly N. Frazier
  • “Counseling students who have experienced trauma: Practical recommendations at the elementary, secondary and college levels” with Richard Joseph Behun
  • “Traumatic stress and marginalized groups” with Cirecie A. West-Olatunji

ACA interest networks

 

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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.

Nonprofit News: Self-care for caregivers

By “Doc Warren” Corson III March 20, 2017

The field of counseling is one that offers great rewards. We get to see people go from their worst to their best. We get to be a part of the change that our clients are seeking.

Even so, the hours and hours we spend listening to the pain of others can take its toll. That raises an important question: While you invest so much in “saving” others, are you neglecting yourself? If so, you, like many of us in this profession, could be in danger of compassion fatigue or burnout.

 

Understanding compassion fatigue and burnout

Working as a counselor can weigh on you. You may find that you are having more difficulty being empathic in situations in which it once came naturally to you.

And although this compassion fatigue may start at your job, it can bleed over into your most intimate relationships. You may even find yourself feeling that you cannot possibly give anything else emotionally to others.

Among the signs of compassion fatigue are:

  • Excessive blaming
  • Bottled-up emotions
  • Isolating from others
  • Substance abuse
  • Compulsive behaviors
  • Poor self-care
  • Legal problems
  • Apathy
  • Feeling mentally and physically tired
  • Feeling preoccupied
  • Living in denial about problems
  • Difficulty concentrating

Burnout is closely related to compassion fatigue, but in extreme cases it can have more serious impacts on a person’s physical and mental health. Some of the signs of burnout include:

  • Chronic fatigue
  • A quick trigger to feel angry or suspicious
  • Susceptibility to illness
  • Forgetfulness
  • Insomnia
  • Loss of appetite
  • Anxiety
  • Depression

Burnout does not just happen overnight. Instead, there are stages and patterns that can help you to identify the issues and assist you in addressing them. Although having a great deal of enthusiasm for a project is considered positive and can often lead to a wealth of progress, look for signs of stagnation, frustration or apathy that may follow. Each is a sign of trouble.

Stages of burnout:

  • Enthusiasm
  • Stagnation
  • Frustration
  • Apathy

 

Prevention

Prevention is vital if one wants to keep working at optimum levels. Look at the list of practical ways to find balance, recharge and stay focused. Be prepared to think outside of “normal therapist behaviors” and identify those things that help you remain focused and energetic. Consider hobbies and activities that you once enjoyed but perhaps stepped away from because of graduate studies or other life-related obstacles. Embrace what you once enjoyed, especially those things that are far removed from the helping professions.

As for me, I re-embraced classic car restoration and time spent in nature, while adding classic farm tractor collecting (among other hobbies). So, go see that play or musical, get your hands dirty, listen to loud music or take part in other events. You cannot stay “on” all the time and still be effective as a counselor.

Here are some tips on prevention of compassion fatigue and burnout for helping professionals:

  • Get educated on signs and symptoms of compassion fatigue and burnout
  • Practice self-care
  • Set emotional boundaries
  • Engage in outside hobbies
  • Cultivate healthy friendships outside of work
  • Keep a journal
  • Boost your resiliency
  • Use positive coping strategies
  • Identify workplace strategies
  • Seek personal therapy

We are involved in one of the most emotionally draining professions that exist. You are here because you want to help people make a change and sustain that change. So give yourself the ongoing maintenance that your body and mind require. Find the answer that works best for you and follow through. We have too many people depending on us. We owe it to them, but, most importantly, we owe it to ourselves. Let’s do this.

 

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Dr. Warren Corson III

“Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, and clinical and executive director of Community Counseling Centers of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). Contact him at docwarren@docwarren.org. Additional resources related to nonprofit design, documentation and related information can be found at docwarren.org/supervisionservices/resourcesforclinicians.html.

 

 

 

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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: Break away: Five vacation hacks for the responsible counselor

By Cheryl Fisher September 5, 2016

The alarm was relentless, even with several taps on the snooze button. I finally surrendered to the morning and rolled out of bed, practically tumbling over my 65-pound goldendoodle, Max, who was snoring below my feet.

With one eye open, I made my way to the shower and blasted the scalding droplets over my sleepy body, allowing the water to wash away the slumber. Eventually, I resurrected to a new day.

Walking to my bedroom, I threw on the work attire I had set out the evening prior and towel dried my hair, desperately trying to hide the impending gray that was peeking through faded highlights. I painted on my face, twisted up my hair and headed to the kitchen, where I grabbed my oatmeal packet and a glass of juice.

Perusing my day planner (yes, I still use the old-school paper kind), I reflected on the day ahead. It would include seeing eight clients, submitting end-of-the-month claims, contacting an insurance company regarding a denial, returning phone calls from prospective clients and scheduling my own dental appointment. Glancing over the client list, I noted that my last two appointments were with couples that were still refining their communication from competitive yelling matches to accusatory squabbling.

Sigh. By this point, I felt horribly exhausted — and it was only 6:30 a.m.!

I texted my husband, “I am working till 8 tonight. Love you.”

“I love you too!” I heard from the other room. He was still home?

I walked into the other room, kissed the dogs and rubbed my husband behind the ears. Perhaps coincidentally, I suddenly realized it was time for a vacation.

 

Take a break

As counselors, we spend hours listening with great attentiveness to the pain and suffering of others. I see approximately 25 clients per week. That is 25 hours of meetings with individuals who are hurting and hoping to discover an elixir to their pain in our therapeutic work together. It is, by far, the most rewarding (and exhausting) vocation I have had the privilege of engaging in.

With that privilege comes great responsibility, which includes accessibility. Technology allows clients to seek immediate connection to their counselors via text, instant messaging and email. Counselors are now (theoretically) accessible 24/7.

I remember receiving a text message from a client at 11:30 p.m. I am normally snoring at that time, but this particular night, I was up reading a book when the message buzzed through. The client was texting me her suicide note.

Of course I acted on it by calling the police on my landline and hanging on the business phone with the client until she was found and taken to the hospital. But the magnitude of responsibility around receiving that message haunted me for days. What if I had been asleep when it came through?

The point is that we do “people work” that often involves crisis intervention related to life-and-death issues. Our jobs, while incredibly rewarding, are stressful, so we need to take breaks to retain some form of homeostasis in our lives.

 

Strike a balance

Unlike many other career paths, counselors must navigate the needs of their clients when planning vacations. There are ethical and legal issues to consider when taking a hiatus from a clinical practice. Standard A.12. of the ACA Code of Ethics mandates that counselors do not abandon or neglect clients and instead make “appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacations, illness, and following termination.”

Furthermore, counselors may be held legally liable should something happen to a client in the counselor’s absence if no backup care was provided. Therefore, there must be a balance between self-care and client care.

 

Tips for a smooth (and responsible) getaway

Here are five quick tips for planning that much-deserved vacation while still attending to your practice.

1) Alert your clients of your pending absence in advance and discuss backup plans with them. My daughter (who lives out of state) requested that I spend a month with her following the birth of my grandson. Although I longed to spend as much time as possible with them, I also was concerned about the needs of my clients. I discussed this with my daughter (and son-in-law), and we decided on a three-week visit instead (to be evaluated and changed as needed). I then began informing my clients about my pending absence several months prior to the delivery. Together we discussed strategies for coping and created scenarios for possible relapse that allowed for preventative measures. Finally, we discussed using a backup counselor for added support.

2) Arrange for a backup counselor. I have made arrangements with several of my colleagues to trade off services when vacations arise. Although my clients have never activated this backup system, I have found that it is a great comfort to them to have it in place.

3) Set a clear away message on your phone and email settings that provide the telephone numbers for the Warm Line, Hot Line and emergency backup counselor. Not all clients will require a session with a backup counselor, but a brief interlude with a Warm Line professional can alleviate their nervous jitters in your absence.

4) Unplug. This is probably one of the most challenging aspects of going on vacation as a counselor today. In the olden days — you know, in the age of landlines — clients left messages that were addressed when the counselor returned to the office. But technology provides the impression of total accessibility, even when you are on vacation. For example, while I was in Scotland, I had a client continually attempt to email and call me. Despite my months of preparation with her and my detailed away message that provided phone numbers for additional support, she was relentless in her pursuit. Finally, I returned her call, directed her to a support in my absence and turned off my phone.

5) Contact the ACA Risk Management Helpline for additional guidance. Invariably, there are going to be times when you must leave unexpectedly and are not able to provide your clients with weeks of preparation. The Risk Management Helpline, sponsored by the American Counseling Association, can provide guidance to ACA members concerning standards of practice that will best support the safety and well-being of your clients … and the enjoyment of your much-needed and deserved downtime. See counseling.org/knowledge-center/ethics for more information.

 

Conclusion

As counselors, it is imperative that we take time for vacation, unplug from our clients and reconnect with ourselves, our family members and friends, and that which is sacred in our lives. In doing so, we not only replenish our own reserves (which allows us to remain available to our clients over the long term), but also provide our clients and colleagues with a model of good self-care.

On that note, I think I will pack up my Jeep and head to the beach for a few days of sun, sand and solitude!

Till next month …

 

Surf fishing before sunrise in the Outer Banks, North Carolina

Outer Banks, North Carolina/Photo via unspash.com

 

 

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Cheryl Fisher

Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland, and a visiting full-time faculty member in the Pastoral Counseling Department at Loyola University Maryland. Her current research examines sexuality and spirituality in young women with advanced breast cancer. She is currently working on a book titled Homegrown Psychotherapy: Scientifically-Based Organic Practices, of which this article is an excerpt. Contact her at cy.fisher@verizon.net.

 

 

 

 

 

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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.
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