Tag Archives: Self-care

Counselor addresses self-care, guilt in the wake of Orlando shooting

By Samuel Sanabria July 5, 2016

“When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’” — Fred Rogers

 

It was 9:53 a.m. on Sunday, June 12, when I received a text from my husband regarding the mass shooting at Pulse, an Orlando, Florida, nightclub catering mainly to lesbian, gay, bisexual and transgender (LGBT) individuals.

I was wrapping up the week at a sex education and counseling conference in San Juan, Puerto Rico, where I was sitting in our closing plenary session. It had been a week of personal empowerment. I had been absorbed by the many workshops on sexual inclusivity, especially regarding the LGBT community. I was surrounded by like-minded professionals who were advocating for change in our society’s attitudes toward sexual minorities. My evenings were spent enjoying time with my husband and 7-year-old daughter, who had come with me to Puerto Rico to enjoy the beach and pool at the conference hotel. It was a nice way to kick off the summer with my family.

As I sat in the final session, I looked down at the text and read the headline of the link my husband had sent me, “Orlando Shooting: 50 People Killed.” Reading further, I learned the shooting had taken place at Pulse, which is just a few miles from our home. I had enjoyed visiting the nightclub with my husband and friends on numerous occasions.

After reading the article again, my thoughts quickly turned to my immediate friends who might have been at Pulse when the shooting occurred. I began to worry. I could no longer focus on the session and stepped outside to begin texting friends to see if they were OK. Thankfully, my friends were safe, but they were as distraught as I was and were anxiously going through their own lists of friends. Social media was filled with news of the shooting. Some posts provided reassurances of loved ones’ safety. But, heart-wrenchingly, other posts were from people seeking information about family and friends who were still missing.

As we traveled back home the next day and as the names and faces of the victims were gradually released in the media, I was struck by how many young people of color were killed on what was “Latin Night” at the nightclub. As a gay Latino man who had visited Pulse, I felt a strong connection to the victims and their families. I didn’t talk much during our flight back to Orlando. I spent the time turned inward, trying to make sense of what had happened and thinking about what my city was going through. I was distressed by my roiling emotions and felt trapped by the logistics of travel. I couldn’t wait to do something to help the victims and their families.

After arriving home, I visited The Center, Orlando’s LGBT community center, to volunteer crisis counseling and Spanish translation services. The common area of The Center was a beehive of activity as volunteers welcomed visitors, organized donations, worked crisis phone lines and did their best to help people affected by the shooting. Local individuals, organizations and

Lucia Lassiter-Sanabria, the author's 7 year-old daughter, at a memorial site set up recently at the Dr. Phillips Center for the Performing Arts in downtown Orlando. "I had been talking to Lucia about the [Pulse] shooting and wanted to show the enormous amount of love and support that was given.  It was a tender moment watching her walk around and look at the pictures of the victims and reading some of the signs of love," says Sanabria.

Lucia Lassiter-Sanabria, the author’s 7 year-old daughter, at a memorial site set up recently at the Dr. Phillips Center for the Performing Arts in downtown Orlando. “I had been talking to Lucia about the [Pulse] shooting and wanted to show the enormous amount of love and support that was given. It was a tender moment watching her walk around, look at the pictures of the victims and read some of the signs of love,” says Sanabria.

businesses had donated food, water, services and gifts, while others were providing safe spaces for anyone who needed support. People from all over the country and the world were donating money to support the survivors and victims’ families. And, of course, professional counselors from around the state had stepped up to provide grief and crisis counseling.

Witnessing all of this activity and the many people who were traumatized or retraumatized by the news and stories of the shooting, I felt the magnitude of what this tragedy had done, not only to the victims at Pulse but to our entire community. It was at this point, standing there witnessing the outpouring of grief and anger, that I felt anxious, insignificant and powerless. I immediately felt an internal pressure to do as much as I could to help.

Throughout the week, I met with and provided support for survivors of the shooting; debriefed with my students in each of my summer classes; took my daughter and a couple of her friends to the LGBT center with sympathy cards I had helped them create; attended vigils; donated money; and locked arms with other LGBT activists and allies to block the well-known hate group, Westboro Baptist Church, from disrupting the funeral of one of the victims.

Despite this involvement, I still felt anxious, insignificant and powerless. These feelings stubbornly remained in the face of so much need. As my anxiety grew, I began losing sleep, had difficulty concentrating and was irritable. The worst part was my need to reenact, in my imagination, some of the stories I had heard on the news and from the survivors I had spoken with. These feelings were exacerbated by the litany of anti-gay and pro-gun political messages being expressed by the talking heads on various media outlets.

I realized I was experiencing burnout as a result of vicarious trauma and needed to make some immediate changes, starting with recognizing the importance of self-care.

 

Counselor self-care

Most counselors are familiar with the importance of self-care. Many of us spend hours each day listening to difficult stories, and for those who work in crisis care, these stories can be exceedingly tragic. Providing empathy for our clients is the hallmark of our profession, but it is also a main contributor to compassion fatigue. Counselors often become so involved in their work that they do not take adequate time to check in with how that work is affecting them physically and emotionally.

It is important that counselors remain alert to the warning signs of compassion fatigue. Physiological symptoms may include physical exhaustion, headaches, insomnia and increased susceptibility to illness. Emotional symptoms include anger, irritability, gradual disassociation, depression and difficulty concentrating. Ignoring these warning signs can lead to counselor impairment, which puts clients at risk for harm.

Red sky with rainbowIt is a counselor’s ethical and professional responsibility to work toward reducing compassion fatigue. This does not mean fighting against these feelings, but rather working through them, both before and after meeting with clients. Giving oneself permission to break for self-care can also help reduce compassion fatigue. This can be as simple as pausing for a deep breath and identifying one’s physical and emotional responses throughout the day. It can also be vital to create some mental space between oneself and the work, perhaps by spending quality time with family and close friends.

Taking these steps may be challenging for some, especially when working with a community impacted by a tragic event. Luckily, my close friend and colleague has a background in crisis work and, knowing the importance of self-care, reached out to me daily with reminders to take breaks and meditate on my physiological and emotional responses.

Once I recognized the symptoms of compassion fatigue within myself, I made sure to spend quality time with my family and to show appreciation for them. These were meaningful experiences that helped me re-center myself.

Also, at my friend’s suggestion, and for the first time in my professional life, I attended a support group for counselors. I appreciated being able to share how this tragedy had affected me in a room of supportive individuals who were going through the same experience. This group outlet was important and I noticed a reduction in my level of anxiety. However, there was still something that kept me from moving forward. It wasn’t until I heard another counselor share her experience with guilt for not doing enough that something clicked inside me.

 

Recognizing and addressing guilt

Another common experience among crisis counselors is the feeling of empathy guilt and survivor’s guilt.

Empathy guilt is a reaction to someone’s pain or distress that leads to the belief that one should try to work toward relieving those feelings. This can also lead to the feeling that one is not doing enough to help others relieve their pain. Survivor’s guilt can occur with someone who has survived a traumatic event or, in the case of counselors, works directly with victims impacted by a traumatic event. The symptoms of empathy guilt and survivor’s guilt include feeling regret, isolation, helplessness and, in serious cases, suicidal ideation.

One of the best ways to work through guilt is to share the experience with others and to recognize that this is a common emotion that, if properly managed, can be used to further empathize with the experiences of our clients. During the counselor support group, I was able to share my feelings of guilt and begin the acceptance process. I realized that it was not necessary to fully rid myself of these feelings of guilt; instead, I could use them to gain better insight into my internal emotional processes.

I came to understand that there was no amount of hours I could volunteer, marches I could walk, sympathy cards I could help my daughter create or money I could donate that would change what had happened to the victims of the shooting. I realized that “never enough” was good enough. This realization became a central part of my self-forgiveness and healing.

 

Conclusion: Never enough is good enough

This tragedy has shattered lives. It will take years to understand why this happened, if we ever can. The greater Orlando community has been galvanized, and I can feel a sense of unity and compassion that is heartening.

Personally, I have come to grasp one of the most important lessons of being a counselor, advocate, ally and humanitarian: Despite our best efforts and whatever time we put in, we will never achieve “enough.” Once I understood this, I felt a profound sense of peace and self-forgiveness. As I write this, the need for caring and supportive counselors in Orlando continues. Fortunately, I am able to volunteer service in a way that doesn’t deplete me or put those seeking my help at risk of harm.

It still breaks my heart to think about the bright lives taken from our community. As I sat with the other crisis workers in our support group, I realized that we had all been affected by this senseless tragedy and that we needed support just like everybody else. We laughed, cried and hugged each other; we respected our own emotional struggles; and we sat in silence to honor the lost lives. Most important, we helped strengthen one another so that we can go back out there and do work that will never be enough.

 

 

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Samuel Sanabria is a licensed mental health counselor in the state of Florida with more than 15 years of clinical experience. He is an associate professor in the graduate counseling program at Rollins College in Winter Park, Florida. Contact him at ssanabria@rollins.edu.

After Orlando: Helping others, helping ourselves

By Laura R. Shannonhouse June 22, 2016

In the wake of the recent shooting disaster in Orlando, we find ourselves faced with the difficult task of moving forward with purpose and hope, both as individuals and as a people.  While we may not have been directly touched by this event, or we may have been personally immune to such tragedies in our own past, disasters like this one may feel omnipresent and inescapable in today’s media rich culture. This is especially true now, since the nature of this photo-1463797987952-208b34e8e887particular event was incited by hate towards a specific group, the lesbian, gay, bisexual and transgender (LGBT) community, which has been under a perennial struggle for acceptance.

 

There are many ways to directly help the victims and their families, but from my perspective as a counselor educator who researches crisis, disasters and cultural issues, I would like to share three thoughts as to how all of us can intentionally focus on the future: helping others, helping ourselves and ensuring that them and me are instead us.

 

I am so heartened by the outpouring of love for those who were affected and the political resolve for doing what we can to ensure that such tragedies become far more rare. In terms of the literature on disaster response, I would say that we are in the “honeymoon” phase of disaster, characterized by community cohesion and shared resolve. Unfortunately, research shows that this period is only temporary, usually lasting a few weeks, and is followed by disillusionment. Eventually, survivors will realize that there are limits to the assistance available. Those that were injured or lost loved ones will have to go on with rebuilding their lives. The universal calls to action and justice may be met with the reality that institutions often change slowly, if at all. A painful reminder of this can be seen in the heartfelt essay from the mother of one of the Sandy Hook victims, “Orlando, I Am Sorry Our Tragedy Wasn’t Enough to Save Your Loved Ones” (written by Nelba Márquez-Greene, a licensed marriage and family therapist and mother of a child who died in the 2012 shooting at Sandy Hook Elementary school in Newtown, Connecticut). So, for my first thought, I challenge you to maintain your resolve and support through the impending disillusionment.

 

In the months and years to come, those affected will face anniversaries of the tragedy and trigger events such as missed birthdays. The strongest protection against disillusionment is resilience. If you are in the position to help a survivor or someone affected, challenge yourself to be a point of resilience for that person for as long as you can. That being said, resist the urge to parachute in, and if you feel compelled to respond to someone that you don’t personally know, be sure to do it as part of an organized response effort. Also remember to act within your own scope of care as a friend, counselor or human. For a good article on how to respond, I would suggest Jamie Aten’s recent piece in the Washington Post, “Tips for helping a loved one after a tragedy, from a Christian disaster expert.” And, if you are now calling for political change, don’t stop until that change is realized.

 

As a helping professional that has worked with trauma survivors and responders, I have seen many times how those not personally affected by crisis may yet still be touched. The literature is full of terms such as vicarious traumatization, secondary traumatic stress (STS), compassion fatigue and burnout. All of these constructs describe how bystanders and responders to disaster can themselves have real physical and emotional reactions. STS can result from witnessing (directly or indirectly) a traumatic event, whereas burnout results from repeated and prolonged exposure to stress. The media will be full of vivid descriptions of the event, and it’s likely [that] continuous coverage will keep us on alert. Daniel Antonius condensed much of the recent literature on this phenomenon after the 2015 San Bernardino shooting in his article, “How the media-related ‘contagion effect’ after terror attacks impacts our mental health.” Consequently, my second thought is to protect yourself from the vicarious traumatization that you may experience from our 24 hour news cycle and practice self-care.

 

If you are more closely connected to the Orlando event, either because of some prior life experience with trauma or because you closely identify with the targeted group, then I would urge you to be on guard for common stress reactions. The list of possible symptoms is long and includes changes in emotional, cognitive, behavioral, physical and spiritual domains. If several of those listed symptoms look like they apply to you, then do the following:

  • Unplug – turn off the TV and social media
  • Do what normally helps you feel better (e.g. exercise, listen to music, be creative or routine, spend time with friends, etc.). For a longer list, check out the Department of Health and Human Services’ self-help guide, “Dealing with the Effects of Trauma.”
  • Consider pursuing mental health care. As a licensed counselor and trainer of new counselors, I definitely believe in my profession’s power to help those that are struggling.  There is no shame in asking for help, and there are often low-cost resources available in your community.

 

Since this shooting was, effectively, a hate crime, my final thought is one regarding empathy: live the African concept of ubuntu, or “I am because we are.” The construct of empathy is core to professional counseling (for a three minute visual summary, consider watching Brené Brown on Empathy). In my counseling skills classes, we often talk about “getting in the well” and genuinely connecting with others. Those are good clinical skills, but for those of us that aren’t in Orlando and aren’t directly interacting with someone personally affected by the shooting, it isn’t possible to truly show our empathy. Instead, we can ensure that we hold empathy close as a personal virtue in how we relate to others, especially those different from ourselves in beliefs or worldview. In my travels to Southern Africa on research projects and clinical outreaches, I’ve found that the Bantu word ubuntu truly captures this internalized empathy. In the words of Archbishop Desmond Tutu, “My humanity is caught up, and inextricably bound up, in yours … A person is a person through other persons …  A person with ubuntu is open and available to others, affirming of others [and] does not feel threatened that others are able and good, for he or she has a proper self-assurance that comes from knowing that he or she belongs in a greater whole and is diminished when others are humiliated or diminished, when others are tortured or oppressed, or treated as if they were less than who they are.”

 

In the wake of the recent horrific events in Orlando, I pray that we may all show love for each other, take care of ourselves and remember that I am because we are.

 

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If you are in need of immediate crisis counseling, contact the Substance Abuse and Mental Health Services Administration (SAMHSA)’s Disaster Distress Helpline: Call 1-800-985-5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor.

 

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Laura R. Shannonhouse

Laura R. Shannonhouse

Laura R. Shannonhouse is a licensed professional counselor (LPC), American Counseling Association member and assistant professor in the Department of Counseling and Psychological Services at Georgia State University in Atlanta. Contact her at lshannonhouse@gsu.edu

 

The serious leisure perspective in mental health counseling

By Rodney B. Dieser, Jacob Christenson and Darcie Davis-Gage June 1, 2016

In his book The Gift of Therapy, Irvin Yalom explains the vital role of learning about a client’s “leisure-time activities,” “hobbies” and “recreation habits,” yet he never defines what leisure is and how it is connected to mental health or mental health counseling. Many other well-known mental health theorists have duplicated this same pattern of highlighting the relationship Branding-Images_Artistbetween leisure and mental health/mental health counseling but not explaining leisure with much precision, depth or breadth.

Historically, Sigmund Freud’s pleasure principle, Erich Fromm’s humanistic psychoanalysis framework, Eric Berne’s transactional analysis structuring of time and social activities and William Glasser’s genetically encoded need for “fun” within control/reality counseling theory have provided a superficial overview of leisure. More recently, Allen Ivey and his colleagues have mentioned the importance of leisure within their framework of developmental counseling and therapy but have never explained or defined leisure. Likewise, Russ Harris and Judith Beck follow this pattern of mentioning, but not explaining, leisure related to acceptance and commitment therapy and behavioral activation within cognitive behavior therapy, respectfully.

So, what is leisure, and how can it be utilized during mental health counseling?

SLP and the optimal leisure lifestyle

Approximately 13 differing theories of leisure exist. The serious leisure perspective (SLP) is one of the more credible theories, with hundreds of studies from more than 30 years of research from diverse researchers throughout the world supporting its theoretical and practical basis.

Robert Stebbins developed SLP in 1982 when he authored a conceptual paper in the Pacific Sociological Review. Since then, he has written 34 books related to SLP, along with hundreds of research articles. Today, as Stebbins has outlined in his more recent books, SLP comprises three main forms of leisure: serious leisure, casual leisure and project-based leisure. (The information about SLP that follows in this section is taken from Stebbins’ most recent book, The Serious Leisure Perspective: An Introduction, which he co-authored with Sam Elkington in 2014, and Serious Leisure: A Perspective for Our Time, which Stebbins wrote in 2007.)

The pursuit and balance of serious leisure, casual leisure and project-based leisure can lead to what Stebbins terms an “optimal leisure lifestyle.” He defines this as the deeply rewarding pursuit during free time of at least one serious leisure activity, supplemented by casual and project-based leisure.

Serious leisure

Serious leisure is defined as the systematic pursuit of an amateur, hobbyist or volunteer activity participants find so substantial, interesting and fulfilling that they launch themselves on a leisure career centered on acquiring and expressing special skills, knowledge and experience. The quintessential element is the development of special skills, knowledge and experience — which can take months or even years to develop. For example, it can take years to develop the skills needed to play a musical instrument well enough to become a member of a community orchestra or to track a bird by sound in a birding club.

Serious leisure can be divided into three types: amateur, hobbyist and career volunteer. Amateurs are found in the worlds of art, science, sport and entertainment, where they are inevitably linked in many ways to a professional counterpart, such as tournament bass anglers or members of an amateur community theater. Hobbyists lack the professional ego of amateurs but maintain small publics with similar interests. An example of serious leisure hobbyists are members of small stamp, coin or comic book collection organizations in which local collectors can buy and sell items and have conversations about their shared interest.

Career volunteering, the third type of serious leisure, is exemplified by a person who uses specialized skills, knowledge or experiences as an uncoerced means of helping that is not aimed at material gain. An example is a retired plumber who likes to volunteer his or her skills to help build homes for Habitat for Humanity, or a retired accountant who volunteers his or her specialized skills for a Boys & Girls Club.

Serious leisure provides many human wellness benefits such as personal fulfillment (meaning-making in life), personal enrichment (self-actualization), regeneration of oneself, financial return, self-expression and creativity, social attraction and the development of friendships, and group and personal accomplishments.

Casual and project-based leisure

Casual leisure is defined as immediate, intrinsically rewarding, relatively short-lived activities that require little or no specialized training to enjoy. The quintessential element of casual leisure is hedonism or pleasure.

Casual leisure can include relaxation (e.g., napping in a hammock), passive entertainment (e.g., watching television) or sociable conversation (e.g., chatting outside an ice cream parlor). Beneficial outcomes derived from casual leisure include development of interpersonal relationships, regeneration in life, serendipitous discovery/creativity, edutainment and general well-being (e.g., distraction from stressors).

Project-based leisure is defined as a short-term, reasonably complicated, one-shot or occasional (though infrequent) creative undertaking carried out in a person’s free time. It lies between serious and casual leisure because it requires considerable planning, effort and, sometimes, specialized skills like serious leisure, yet it is not intended to develop into serious leisure or become a long-term sustainable leisure activity. Examples include establishing a family reunion or getting involved in fundraising efforts toward a social cause, such as Mental Illness Awareness Week, in a local community.

Integrating leisure into the counseling process

With an understating of SLP, counselors can easily integrate discussion of leisure into the counseling process. As part of the intake process, counselors can have clients complete a leisure measure and inquire about their history of leisure and current level of activity. Gathering this information can inform counselors about how active clients are physically, socially and psychologically.

An optimal leisure lifestyle has been linked to one’s overall wellness, life satisfaction and ability to cope with emotional distress. According to a study published in Counselling and Psychotherapy Research by Elizabeth Marley in 2011 regarding self-help strategies to reduce emotional distress, mental health is improved by leisure, which can include such serious and casual activities as playing cricket, shopping, gardening, dancing, socializing and even driving a car.

With this in mind, clients may also benefit from integrating leisure activities into their counseling treatment. As indicated above, counselors can assess clients’ interest in various leisure activities by using formal assessment tools such as career, leisure and interest inventories. In addition, assessment tools from the areas of leisure services and therapeutic recreation, such as the Serious Leisure Inventory and Measure or the Leisure Motivation Scale, can be helpful. On the basis of these types of assessments and a client’s leisure history, counselors can encourage a discussion about how clients can engage in serious, casual or project-based leisure and which type of leisure would be most beneficial to add to their treatment.

Following the intake process, counselors can integrate goals regarding leisure into the treatment plan. Counselors can use active listening skills to find an avenue to introduce the idea that leisure can serve as an adjunct to other counseling activities. As the counselor listens to the client’s story, he or she will gain insight into those areas of the client’s life that may be amenable to such an approach. For example, clients will often mention how they spend their free time or what activities they enjoy. Such revelations occur naturally in sessions and provide a trailhead for counselors to follow to provide psychoeducation about the importance of leisure in overall well-being.

Once the concept has been taught and understood, counselors might reserve the first few minutes of each session to review what clients have done since the last session to engage in some form of leisure. Alternatively, the last few minutes of each session could be used to brainstorm possibilities for leisure and make assignments.

It is important to remember that the development of a serious leisure pursuit often takes time and requires patience. Clients should be encouraged to be deliberate in their approach, resisting the temptation to rush the process. They may need to try a number of different activities before finding something that will have the desired effect.

Throughout this process, the client’s views should be given preference when it comes to deciding on which activities to focus. When a particular activity is difficult or the client experiences setbacks and failures, the counselor should encourage the client to exercise self-compassion and nonjudgmental self-evaluation.

Two case examples

“David,” a former client of one of this article’s authors, struggled with debilitating anxiety and felt hopeless after being discharged from an inpatient unit. During the course of therapy, the counselor noticed that David talked frequently about wanting to help others who struggle with mental health issues. David and the counselor collaborated on a plan to provide him with opportunities to volunteer — as leisure — at a local community mental health center.

David frequently had days in which he failed to show up for his shift, but he was able to recommit after exercising self-compassion. He was eventually able to become more consistent and began to increase his capacity to offer support to individuals at the center by becoming involved in various programs. David later chose to further develop his interest in helping others by studying to become a counselor himself.

“Sally,” also a former client of one of this article’s authors, was able to develop an optimal leisure lifestyle related to her involvement in quilting. As previously mentioned, an optimal leisure lifestyle is possible when the SLP subtypes are pursued and balanced. This occurred to Sally, who became a well-known quilter, when her husband was out of the country for an extended period of time.

As a consequence of being left alone with a struggling young family, Sally found herself slipping into deep depression and anxiety. She had previously been involved in crafting as a casual pursuit, and when she brought this up in session, the counselor recognized this as an opportunity to introduce leisure as a part of the process. This casual pursuit was identified as an exception to the lack of energy and withdrawal Sally was showing as her depression deepened. The counselor provided some information about the importance of these types of leisure activities to overall well-being, and Sally agreed that she would benefit from becoming more involved in quilting.

As she got more involved, Sally started a blog so that she would have a venue for displaying her work and to show her husband what she had been able to accomplish. Growth in the readership of her blog led to recognition throughout the quilting community and provided Sally with opportunities to associate with others who held similar interests. Quilting also provided Sally an avenue for building her sense of self-worth, and she began to emerge from the darkness of depression.

Although Sally’s development of a serious leisure pursuit had produced valuable fruit, it was at this point she realized that her relationship with her children could suffer because of the amount of time she was quilting. So, with the help of the counselor, she decided to balance her pursuit of quilting with family-centered casual leisure. She began spending more time developing her relationship with her children and attending to their developmental needs. As a result, her relationship with her children was strengthened even as she continued to grow and develop as a quilter.

Today, Sally is a sought-after speaker and instructor by quilt guilds throughout the nation. She offers an inspiring perspective on the changes that have been brought about in her life through her leisure pursuits. In this case, a hobby was incorporated into Sally’s change process and has since been developed into an example of an optimal leisure lifestyle.

Conclusion

Although various mental health theorists have mentioned the importance of leisure, little has been written about it in an in-depth manner related specifically to mental health counseling. SLP is a mature theory of leisure with hundreds of studies supporting its theoretical and practical basis. We have presented two case studies to explain how SLP can be used in the counseling process to help clients manage life challenges and mental health struggles.

To learn more about SLP, counselors can visit seriousleisure.net. In addition, the authors of this article wrote a more research-based and theoretically explained article on integrating SLP into mental health counseling in the first issue of the 2015 Counselling Psychology Quarterly (volume 28, pages 97–111).

 

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Rodney B. Dieser is a professor in the School of Health, Physical Education and Leisure Services at the University of Northern Iowa. He is a certified therapeutic recreation specialist, national certified counselor and temporary licensed mental health counselor in Iowa. He practices as a therapist 10-15 hours per week. Contact him at rodney.dieser@uni.edu.

Jacob Christenson is an assistant professor in the marriage and family therapy program at Mount Mercy University (Iowa) and serves as the clinical director for the Olson Marriage and Family Therapy Clinic in Cedar Rapids. He has practiced as a therapist for more than 10 years and specializes in working with adolescents who are treatment resistant and those suffering from severe mental illness. Contact him at jchristenson@mtmercy.edu.

Darcie Davis-Gage is an associate professor in the clinical mental health counseling program at the University of Northern Iowa. She has more than 10 years of various counseling experiences, including working in private practice. Contact her at darcie.davis-gage@uni.edu.

Letters to the editor: ct@counseling.org

Self-care in the world of empirically supported treatments

By Dolores “Lori” Puterbaugh May 28, 2015

One of the many profound changes within the counseling profession for mental health counselors has been a gradual shift from psychodynamic and person-centered therapies to an emphasis on the medical model. The full history of this shift is an interesting one, featuring as much sociopolitical Checklist-face_smallinfluence as scientific influence, but that is beyond the scope of this article. The end result of this shift is a focus on diagnosing and matching treatment interventions to the diagnostic criteria. Those who were focused on efficacy and efficiency in the early stages might never have imagined the unintended consequences of their best intentions.

Today, our graduate students are preparing to work in a world in which diagnosing according to the latest established criteria and then matching the appropriate brief, empirically supported interventions to those diagnoses are paramount. For students and new professionals, this reductionist approach might make it seem as if mental health treatment is a very straightforward process of applying Technique A to Problem B.

Medicalized mental health frames diagnostic criteria as signs of illness to be wiped out rather than indicators of pain to be uncovered, addressed and integrated. Symptoms are problems in themselves rather than signs of problems of being. This mechanization of mental health care can have strange effects on counselors. One in particular — the focus of this discussion — is the stultifying effect that reductionism can have on self-care.

Self-care is a standard topic in introductory graduate counseling courses, practicum courses, internship supervision sessions, professional trainings and the professional literature. Nearly every week, I receive invitations to participate in a survey on self-care for dissertation research and receive several offers of continuing education courses on the same topic. Ubiquitous a topic as self-care may be, the definition seems to be so broad that, as with a client’s complaint of depression, no two people can be sure that they really understand what the other is subsuming when the murky phrase “self-care” is introduced.

In recent research focused on grief counseling, not yet published, I surveyed counselors ranging from new professionals (less than five years of postgrad experience) to the seasoned (20 years of experience or more). The sample size was quite small, minimizing the generalizability of the findings. Still, one aspect in particular piqued my curiosity: the tendency among less experienced practitioners to confound recreation with self-care. Although recreation is part of self-care, it is not synonymous with the full range of internal and external attention that constitutes all of self-care.

Another pattern in the research was the assertion, most common among newer professionals in my small pool of respondents, that the right intervention (in this case, within grief counseling) would come naturally and they would know what to do or say in session without concern. More experienced therapists were far less likely to subscribe to this option because they shared an awareness that within (grief) counseling there is no single “right” answer that will naturally come to the foreground. In short, the less experienced counselors were more likely to oversimplify self-care and to have a great deal of confidence that they would simply know what to do when faced with client issues in grief counseling. More experienced counselors were more likely to cite a variety of self-care strategies and to be less confident that the correct intervention would simply rise to the surface during counseling.

I suspect the disparate attitudes between cohorts rests in part on the increasing emphasis on empirically supported interventions and psychiatry’s ongoing reductionist approach to the richness of human experience. We do very well in ensuring that our students know the diagnostic criteria and the most recent research-supported, efficacious interventions that match those criteria. However, we are into perhaps a second generation of counselors who are proceeding with protocols developed by others who are blind to the section of the Johari window that comprises all that is unknown.

Taking a shallower approach

A mere two counselor generations ago, our education and training were solidly grounded in psychodynamic theories, with a tremendous emphasis on self-awareness, therapy for therapists and a profound respect for the depth and breadth of the field of therapy. The power of the relationship was emphasized, and this has not lost its importance, as evidenced by the keynote session presented by Jeffrey Kottler and Richard Balkin at the 2015 ACA Conference & Expo in Orlando, Florida. The developers of what comprise the brief therapies were well-grounded in psychodynamic theory.

Subsequent generations of counselors more often give a drive-by nod to theories that involve the unconscious aspects of experience. They can easily be misled to believe that the readily accessed cognitions are all there are to the client’s misconceptions. Unaware of how a leader such as Donald Meichenbaum’s deep knowledge of psychodynamics colors his current research and work with posttraumatic stress disorder, the new practitioner is prone to merely parroting technique. Meichenbaum, or a therapist with a similar depth and breadth of knowledge, will hear subtle cues about the client’s stability, insecurities, capacity for abstract thought and ability to tolerate frustration or ambiguity and then make nuanced adjustments to interventions on the basis of these minute variations in individual functioning. Meanwhile, a counselor whose education has been aimed at providing empirically based interventions for specific diagnoses is tightly gripping the hammer of cognitive-based therapies, in which every problem is a simple case of irrational belief or cognitive distortion to be thumped into a more logical shape.

Is there a risk that a superficial approach in one area will ineluctably contaminate others? Will the new counselor, ill-prepared to wade into the depths of the client and holding an empirically defended disregard for the importance of those depths, mirror this with a lack of insight into the depth of the self?

Many graduate students and new practitioners have taken advantage of personal therapy and other opportunities for reflection and growth. However, when I review a taped session with a counselor-in-training and my question “What was/is going on for you right now in the session?” is met with a blank stare or a recitation of the relationship between the intervention and the client’s issue, I suspect that insight into the internal experience of the counselor was a chapter only skimmed during formation.  Likewise, countertransference was reduced to a mere vocabulary word or reflexively described as a source of ethical violations. It is rarely considered a source of useful insight when handled properly and brought to supervision, consultation or the counselor’s own therapy session.

When I encounter insufficiency in attending to internal experiences (in counselors and in clients), that insufficiency often co-occurs in the realm of self-care. How, then, do we bridge the gap for students, interns and new practitioners who are attempting to meet the self-care needs of a counselor’s heart, mind and soul through lighthearted socializing or with a stroll in the park?

A superficial model of self-care

The awareness of a need is required before any meaningful attempt to meet that need will be taken. The counselor who has decided that emotions regarding clients are “wrong” because they signify “countertransference,” and subsequently attempts to ignore or suppress those responses to the client, is at risk for the very problems that countertransference can spur. Similarly, self-care requires quiet times for reflection, but a counselor who has absorbed the societal bias against introverted behavior may mislabel these quiet times as “isolating.” Busy students and practitioners — like so many of our clients — can no doubt find multiple reasons, from lack of time to lack of finances, to postpone individual therapy, spiritual guidance and peer supervision.

Yet lack of reflection feeds into a deeper ocean of lack of insight. Meanwhile, self-care, dumbed down to socializing and recreational pursuits, skips lightly over the surface, not sinking into the opportunity for deep reflection and its rewards, including insight into self and others. Self-care gets reduced to time spent relaxing with television or friends or, more rarely, exercising or playing outdoors. These are aspects of self-care, but they elude the essence and responsibility we have for a well-rounded and consistent habit of true self-care.

Our professional literature and conferences are rich with articles and experiential trainings on the importance of deep, well-rounded self-care that addresses the whole person: body, mind and spirit. One suspects that, overstretched and desperately in need of self-care, a great many counseling graduate students, interns and professionals are failing to give more than a cursory glance at these offerings because life is overwhelming. Using a superficial model of self-care, they throw interventions at themselves the same way we are trained to toss interventions at client complaints. As with the empirically supported interventions of therapy, many self-care interventions are focused on the immediate, conscious needs — for example, I need to unwind/blow off steam/throw my head back and laugh until my sides ache. These are indeed real aspects of self-care, but they are not sufficient on their own.

I suggest, then, that frequently shallow practices of self-care and the potential problems of relying on menu-driven, empirically supported interventions are not random parallel processes. They are one regrettable, predictable outcome of an efficiency-focused, reductionist approach to mental health that is not reflective of mental health counseling as a profession. Counselors are historically holistic, incorporating relationships, client strengths and insight into development with an understanding of pathology and treatment.

The current reductionist approach has been imposed on us by larger forces: third-party payers and the American Psychiatric Association. Meanwhile, our accreditation boards continue to emphasize proper formation, and mental health counseling graduate programs always feature foundational courses that include self-care. We must frequently revisit what is meant by self-care, as well as the implications of the various aspects of self-care for personal and professional functioning.

Client care and self-care ought to be rooted in a deep understanding of the human experience and a profound respect and reverence for the unknowable in each of us. A comprehensive self-care practice feeds our deep need to reflect, make meaning from the events of our lives and develop deep connections with others. Information on self-care and its many vital facets is readily available; we must ensure that the next generations of counselors integrate holistic care of the self into the fabric of their beings and the texture of their lives.

 

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A whole-person approach to self-care

The ways in which we meet our self-care needs will vary. The unique preferences, temperament and style of each counselor require a nuanced approach to self-care. Whatever your style, good self-care will encompass the following elements.

Physical: Strive for good nutrition, regular medical care, adequate sleep and appropriate exercise on a regular basis. Choose a few activities that suit your physical condition and temperament. For example, an extrovert might not enjoy long solo runs, whereas an introvert may relish the alone time for reflection and time in nature. Frequency: Daily practices.

Psychological: Have colleagues with whom you can meet and debrief on a regular basis. Consult with others. Have a therapist or supervisor to help you process the issues raised by your work with clients. Frequency: Weekly, meaningful interaction with colleagues or supervisors.

Social: Meet your social needs in the ways that suit your personality. Failure to meet your social needs outside of therapy will leave you vulnerable to meeting your needs in the therapy room. Frequency: Know your personality and adjust accordingly. Extroverts will need more contact to feel refreshed, whereas introverts will need more quiet after a day of interaction.

Emotional: Have a few people with whom you can be emotionally honest and feel the safety of mutual support. Frequency: Daily contact of some kind with a member of your inner circle.

Creativity: Seek a regular outlet for creativity that is wholly separate from the creativity required in the therapy room. Thinking outside the box in one area will enhance your creativity in the professional area, and investing energy into this kind of play is a way to refuel your spirit. From gardening, woodwork and music to haiku, drawing and cake decorating, the options are endless. Frequency: At minimum, a session of at least a couple of hours once per week.

Intellectual: Years ago, an instructor advised me to expect to spend 10 percent of my professional time reading and learning for the rest of my career. Make a habit of trying to learn something new about the profession every week. Frequency: Ten percent of the time you spend working, which includes reading, watching truly educational video presentations and earning continuing education units.

Spiritual: Nurture this aspect of yourself through whatever discipline is appropriate, whether it is the observation of an established religion or spending adequate time for reflection, meditation and quiet separateness from the busyness of life. Frequency: Daily.

Sound like a lot? We ask this of our clients; perhaps asking less of ourselves is not asking enough.

Imagine yourself well-fed, well-exercised and well-rested. You are regularly surrounded by supportive and insightful colleagues and have a safe place in which to explore your thoughts, feelings and memories as affected by counseling clients. You enjoy regular, meaningful contact with the people you love. You find your creativity blossoming in ways you may not have enjoyed since childhood — or certainly not since graduate school — and your counseling skills seem rejuvenated. At the same time, a regular stream of new ideas and research informs your work and challenges you to stretch your portfolio of techniques. With all this constant growth and change, the quiet time you spend in reflection, meditation, prayer or journaling becomes all the more precious as a way to integrate the totality of your life.

This is the self-care we want for our clients, our loved ones, our students, our colleagues and, yes, for ourselves.

 

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Dolores “Lori” Puterbaugh is a licensed mental health counselor and licensed marriage and family therapist who has been in private practice since 1999. She is an approved supervisor for registered mental health counseling and marriage and family therapy interns in Florida and teaches undergraduate and graduate courses in counseling and psychology. Contact her at puterbaugh@mindspring.com or visit her website at drloriputerbaugh.com.

Letters to the editor: ct@counseling.org

Stumbling blocks to counselor self-care

By Laurie Meyers February 23, 2015

As a counselor, which of the following elements are absolutely essential for you to do your job well?

a) Thorough grounding in counseling methods and techniques

b) A strong sense of empathy and compassion

c) Adequate sleep

d) Regular vacations or breaks

e) All of the above

The correct answer is e) All of the above. You probably knew that already. But do you also think that answers A and B far outweigh the importance of C and D? If so, you may not be tending to your own wellness the way that you should. All counselors need to regularly engage in a healthy self-care routine to help mitigate the very real risk of burnout.

Many people struggle to attain a healthy work-life balance. Counselors often work with clients toward achieving that balance by helping them understand the concept of self-care and how to nourish wellness. But sometimes counselors get so busy and focused on helping others that they neglect to monitor their own wellness. Counselors may also operate under the assumption that their training and emotional insight somehow inoculate them against burnout — or at least help to prevent it. That Branding-Box-stumbling-blocksis a fallacy. Counseling, like other helping professions such as medicine, nursing, psychology, social work and teaching, has a high burnout rate. Individuals in each of these professions are at greater risk for burnout because of the empathic and close relationships they must form to do their jobs.

“It’s important for people — for counselors in particular — to realize that this is hard work,” says Gerard Lawson, an American Counseling Association member and associate professor of education at Virginia Tech. Though counseling work is not typically physically demanding, emotionally it can take a toll, he says.

Research has shown that the strength of the therapeutic relationship between the counselor and the client is the most important predictor of successful outcomes. But forming, maintaining and operating within that bond are not easy tasks, notes Lawson, a licensed professional counselor (LPC) who studies counselor wellness and burnout. Due to the nature of counseling work, this bond is often forged with people who are struggling or in pain. Confronting those emotions day in and day out can take a toll over time, sometimes leading to vicarious trauma, Lawson explains.

“We are seeing some of the hardest things,” says ACA member Elizabeth Venart, an LPC and director of The Resiliency Center of Greater Philadelphia, where she practices and also provides trauma and resilience training to other mental health professionals. “We often meet people at the worst times in their lives.” In addition, the essential professional component of empathy is the “conduit” through which other people’s experiences can profoundly affect counselors, she says.

On top of that, it’s hard not to want to “fix” every client, says Charles Crews, an ACA member and associate professor in the Texas Tech University College of Education. Although it sounds cliché, many times counselors really do care too much, he notes. “They want to help every single person who comes in,” he says.

Although counselors should want to help every client, when a client isn’t progressing, it can be easy to become disenchanted or hardened, says Crews, whose doctoral dissertation focused on counselor burnout. Less experienced counselors may also start to battle discouragement, doubting themselves and their skills, he adds.

Jennifer Sharp, an ACA member and assistant professor at Northern Kentucky University, says that many of her students come in wanting to change the world. “They don’t understand the barriers,” she says. “We come in [to the profession], and we don’t have realistic expectations.”

ACA member Jonathan Ohrt, an assistant professor in the counselor education program at the University of South Carolina, agrees. He says that counselors-in-training need to give serious consideration to what their professional lives might look like, taking into account their individual work styles, interests and values. Understanding the potential challenges of the work environment for counselors is also particularly important because factors such as inappropriately heavy caseloads, inadequate supervision and poor peer support have a significant influence on burnout rates, say Ohrt and Sharp.

“We don’t necessarily think about what specializations we might be best at,” Ohrt says. He adds that students should ask themselves, “What is my job satisfaction if I work in this setting? Will I be happy? Will I be able to work with addiction? Am I going to be comfortable working in school settings where teachers, the principal and parents are all pulling me in different directions?”

Ohrt says graduate students should also ask themselves the ultimate question: “Do I want to be a counselor?”

Signs of burnout

Having realistic career expectations might help newer counselors to prepare for some of the job’s stresses, but even established counselors need to understand the signs of impending burnout and the steps they can take to avoid it.

According to Lawson, who served as chair of the ACA Task Force on Counselor Wellness and Impairment several years ago, research shows that burnout has three stages.

Emotional exhaustion: Every counselor experiences a bit of exhaustion at one time or another. But when practitioners feel drained as soon as they step through the office door, even with plenty of sleep and after time away to get recharged, that’s generally a sign of emotional exhaustion, Lawson says.

“Sometimes in session, you can see counselors might steer away from a topic that they know is going to be difficult to talk about because they just can’t do it,” he says. “They don’t have anything left there to give to this client, and that’s not good for the client.”

Depersonalization: At this stage of burnout, counselors start viewing clients not as people but as cases. “Sometimes it slips into our language,” Lawson notes. “You’ll hear counselors talk about ‘I have another borderline this afternoon.’”

Lawson acknowledges that this may occasionally be nothing more than a kind of shorthand in the counselor’s language. But usually, he says, it’s more serious, indicating that the counselor is no longer connecting with clients as people and instead reducing them to their problems.

Reduced feelings of accomplishment: At this stage of burnout, a counselor feels that whatever he or she does won’t make a difference. The counselor has, in effect, “checked out,” Lawson says.

Other signs that a counselor is burning out can include a decreased level of involvement with family and friends, a failure to engage in normal social activities and increased instances of tardiness or absenteeism. Sharp says that counselors in a downward burnout “spiral” may also display the inability to handle crises and a noticeable increase in negativism, cynicism and defensiveness.

Burning bright, not out

“I don’t know that there’s a specific antidote to how I keep [burnout] from happening to me, which is why we focus so much on wellness when things are going OK,” Lawson says.

An emphasis on wellness helps counselors to build up their emotional resources so they will be better able to handle bumps in the road when they occur, Lawson emphasizes. Counselors can do a number of things to engage in self-care. Maintaining professional boundaries, seeking supervision and support from colleagues, drawing a clear line between home and office, participating consistently in activities and hobbies, and taking regular vacations are all important parts of the wellness picture.

Perhaps nothing is more important to maintaining counselor wellness than refusing to navigate professional issues in isolation. That is why it is so critical that practitioners actively seek out peer support and ongoing supervision, Lawson says.

“Burnout is a long-term process, a long-term degradation,” he says. “But compassion fatigue, vicarious trauma, those things can happen very quickly. Good clinical supervision is top of the list [of preventive measures] — having someone you can debrief with, someone to help you shoulder the burden. And for people who aren’t in supervision, [having] a colleague or a peer [whom] you can turn to and consult with or debrief with, even if it’s not a formal supervision-type relationship.”

Lawson emphasizes that the supervision should be clinical in nature. “I think in our world, supervision has become a product of being sure that all the boxes are checked and all the t’s are crossed and all the i’s are dotted,” he says. “And that’s important to get reimbursed for the work we do and to be sure that we’re complying with all the expectations. But good clinical supervision is different from that, and that’s where a supervisor is able to ask, ‘What’s happening in the work you’re doing for this client?’ and ‘How are you doing working with this client?’”

If a direct supervisory relationship isn’t possible, counselors should look at the alternative resources available to them, Sharp says. “For example, in school counseling there are not a lot of opportunities for supervision. But one of the things I would do is talk to a more senior school counselor and set up a time twice a month to talk,” she explains. Sharp adds that if a counselor doesn’t have any colleagues within the same school, he or she could look to other schools within the district to find a senior-level counselor.

If counselors don’t have supervisory resources, they should turn to a colleague or peer, Lawson says. Ultimately, what matters is that counselors have someone they can check in with to gain perspective or just to talk to about how certain clients are affecting them.

Venart leads a regular supervision group for counselors who are working to obtain their licensure. Through the years, several group participants have decided to continue meeting together for peer supervision even after completing their licensure hours. Venart stresses the importance of educating new counselors to view supervision as an ongoing, careerlong necessity. She suggests that counselors look for colleagues to connect with in their current workplaces, from former jobs or past professional trainings, or perhaps among the people they met in their graduate programs.

While working on his dissertation, Crews found that if counselors felt they were part of team — even one of their own making — it seemed to have a beneficial effect on their job satisfaction and degree of wellness.

Lawson concurs. His research has concluded that participating in professional organizations plays an important role in peer support, and counselors who are part of such organizations are generally more “well.”

Accepting limits

In addition to offering encouragement, supportive peer groups can help counselors to recognize and accept their boundaries and limitations. This is important because one of the difficult realizations about being a counselor is that it’s not possible to help everybody, Lawson says.

“I think part of the struggle for counselors is when they meet somebody and they want desperately to help them solve their problem,” he says. “Sometimes we counsel people who have problems that are not really solvable.”

He explains further: “I am thinking specifically about things like domestic violence or intimate partner violence. I may meet with someone who is experiencing intimate partner violence … and they’re going to go home to the same violent situation because it’s unsafe for them to leave. [When under no legal mandate to report] I have to sit with that week in and week out knowing that I can’t solve that problem. So I need to have good boundaries about what I can do and what I can’t do. … For me to become more and more invested in them doesn’t help them more. It just means that it takes a greater toll on me.”

When the need is so great, it is easy for counselors to convince themselves that just a little more time or effort, either in the office or outside of it, will solve all the client’s problems, observes Crews. “I work with traumatized kids, and it is really hard not to want to get more involved in their lives,” he says.

However, in his practice and in his role coordinating the school counselor program at Texas Tech, Crews has learned that no counselor can control what happens in a child’s life outside of the counseling office. “Often, school counselors are dealing with parents who do not understand what is going on with their child. You do all this work with [the child] from 8 to 4,” he says, “but then they go home.”

Addiction counseling is another area that requires counselors to have a firm grasp of what they can and cannot do, Crews notes. “Counselors get tired out. They [feel like they] keep banging their heads against the wall because their clients relapse, but that is the nature of addiction,” he says. That doesn’t mean that clients struggling with addiction can’t be helped, but relapse is often part of the process, and counselors need to be able to make peace with that, Crews says.

Counselors also need to recognize when they have reached their limits. “I think one of the things that is really difficult for counselors is to say that ‘I can’t take on another individual who is experiencing such trauma or immediate risk, and there are a lot of good folks out there who can do that work,’” Lawson says. He emphasizes that it is crucial for counselors to realize these limitations before a potential client becomes an ongoing client, however. Disrupting the therapeutic alliance after it has developed can be damaging for the client.

Other times the solution might involve some creative scheduling rather than putting a moratorium on certain types of clients. “I had a period of time when I had many depressed adolescents on my roster in my practice,” recounts ACA member Stacey Chadwick Brown, a licensed mental health counselor with a private practice in Fort Myers, Florida. “Then I noticed that when I had six depressed teenagers in a row on one day, I got depressed.”

Brown didn’t want to turn any of the adolescents away, but she knew she needed to make some adjustments to safeguard her own mental health. After giving the situation some thought, she realized she just needed to spread the clients’ sessions throughout the week rather than scheduling them all on one day.

Sometimes, tweaking schedules can help counselors who are feeling overwhelmed. But other times, caseloads are simply too heavy, and that can be detrimental to both practitioners and their clients, Lawson says. “You have to have pretty good judgment and be able to say, ‘I’m already working 60 hours a week. I’m probably not the best person to take on this next client.’”

In certain environments such as large practices, clinics or agencies, counselors may not have total control over the number of cases they are handling, notes Sharp, a national certified counselor and former school counselor. However, with some planning, counselors may still be able to set some boundaries, she says.

“Counselors need to be careful about what boundaries they can set without putting their jobs at risk,” she cautions. “[But] there are small adjustments you can do to make things more manageable, such as not scheduling things after 6 p.m. or not working 10-hour days.”

Work and life in harmony

Another boundary proves exceedingly difficult for many counselors: leaving work at work and embracing some true downtime.

It took Brown a while to learn how to separate her work from her personal life. “When I was younger, my worldview was different. I thought I could do anything,” she recounts ruefully. “Once I had my first baby, I guess I was just exhausted — and still working. I think that’s when things changed for me. That’s when I realized I had to compartmentalize more.”

Whereas Brown had previously responded to clients in the middle of the night, she decided to stop putting herself “on call.” Instead, she made sure her clients had resources for off-hours crises and informed them she would check in with them the next morning. Brown also stepped up her self-care by making sure she got enough sleep, eating well, getting exercise and taking extra walks in between counseling sessions with clients.

But there was another instance when Brown felt the need to step away from her work for a week to regroup. It occurred when the mother of one of her clients died in an accident that was both extremely traumatic and very public. Brown didn’t know the woman’s mother directly, but the combination of her tangential connection to the woman and the tragic circumstances behind her death made Brown feel that she was experiencing secondary trauma.

Part of that had to do with the shocking and public nature of the story. “It was in the news everywhere, and everyone was talking about it, but I couldn’t say anything,” Brown recounts. She realized that she needed to take a step back and reground herself professionally, which included increasing her focus on self-care. Among other steps, she met and talked things through with colleagues whom she regularly turns to for support.

“Usually what we do as counselors is say, ‘I’ll take on this client, this committee or this task, and I know I have to give something up to have time to do it,’” says Lawson. “And the stuff that we give up is the stuff that’s good for us — like sleeping and time with friends and vacations and all of those things that we know are good for us.”

“I think counselors are notorious for not taking time off, and we have convinced ourselves that we are indispensable in the lives of our clients,” he continues. “As a result of that, we don’t take a week or two weeks off to go recharge our own batteries, and the results can be pretty dire.”

Lawson acknowledges that leaving work behind can be difficult but says counselors can take some intentional small steps to do just that. “I think it’s really important for folks to have rituals for how they take care of themselves,” he says. “Part of that is how do they leave work at work and not take it home with them? So, even with my students, I recommend that when they get home from their internships or when they get home from their work, the first thing you do when you come through the door is change clothes so that you can literally shed the day. I hate to say it this way, but [it’s] so you don’t take the ‘residue’ of work home with you. You put on comfortable clothes — clothes that you’re going to want to spend time with your family in.”

Lawson also knows many counselors who maintain rituals for “closing time” at the office as part of their self-care routines. “Some people have plants in their office, and the last thing they do in the evening is water the plants and tend to them,” he says. “It is sort of a very grounding thing for them. It’s a nurturing thing, but it’s also a closing sort of ceremony for them at the end of their day.”

Other counselors like to leave a clean desk, clearing papers and charts and putting away files. “Then, when you lock that file cabinet, it’s sort of a symbolic ‘I’m putting that stuff aside so that I can move on and go home without it,’” Lawson says.

Lawson asserts that when counselors incorporate a deliberate process of leaving the day behind, they’re less likely to take work home with them too often.

Lawson has a personal story that he keeps in mind: “My grandfather was a police officer back in the days when they didn’t have radios, so they had call boxes around town,” he recounts. “The police officers would carry around these call box keys, and when [my grandfather] got home, he would hang up that key and would be done for the day.”

Crews’ wife teaches theater, where a common directive is, “Leave your issues offstage.” Crews has altered that advice and adopted it as his mantra: Leave it at the door.

“I had an actual floor mat that said, ‘Leave it at the door,’” Crews recounts. “It was a very physical thing. If I wiped my feet, I could leave it there and go on.”

Venart suggests that counselors try “writing and ripping” to help them close the day and leave their work at work. She thinks that the practice of writing about whatever was stressful that day and then ripping up the pages and throwing them away offers a symbolic ritual to help release whatever stress has accumulated. Venart also recommends visualization. For example, counselors might imagine a strong container in which they can transfer the stressful events and emotions from the day. Counselors can then “seal” the container, lock it and put it away somewhere safe.

Leaving room for play

The ability to leave work behind, both physically and mentally, is essential to counselor wellness, and one element that goes hand in hand with that goal is making time to engage in activities that are personally enjoyable, Lawson says.

Some counselors find physical activities to be most helpful, while others enjoy tackling pursuits that sharpen the mind without being related to work.

Lawson likes to take a break from textbooks and other professional publications and read purely for pleasure, while Crews prefers playing video games and going out and being social.

Brown embraces her creativity. “I’m a crafter and a painter. That is really my therapy, my Zen,” she says. “When I am doing artwork, I am fully present.”

Venart is a proponent of grounding work, such as connecting with the body through deep breathing, posture and movement. She’s also a certified “laughter yoga” instructor. (“It’s an actual thing!” she exclaims.) The practice incorporates playful group exercises, laughter and deep yoga breathing. “Research has found that whether you are actually laughing or faking laughter, the [physiological] result is the same,” Venart explains.

Sharp advises counselors to embrace whatever brings them joy, community and a sense of belonging because those elements go a long way toward achieving wellness. “Develop a life outside work that is fulfilling,” she says, “because that can be a buffer and carry you through when work is not a source of fulfillment.”

Small town, big fishbowl

Practicing in a rural or small community poses a particular set of challenges to a counselor’s wellness, say Deborah Drew and Mikal Crawford, both of whom practice in, live in and have studied small rural communities. In these communities, counselors are isolated, yet never alone — and that’s not always a good thing.

“You’re living in a fishbowl,” says Crawford, who has previously presented with Drew on the ethics of self-care in small or rural communities at the ACA Conference. “When you’re living in the same community where you work, your personal life is exposed on a regular basis.”

It is difficult for counselors in rural or small communities to completely set aside work. Seeing clients at the gym, in the grocery store, on community committees, in clubs or at church is a regular occurrence, Crawford notes.

“It’s like, where do I go to let my hair down?” Drew exclaims, voicing a common lament.

Some practitioners cope with this fishbowl effect by finding social outlets in another community or by doing small things such as going to the grocery store or the doctor’s office somewhere else.

But the reality is that it is hard for counselors to truly relax when they’re constantly navigating such tricky boundaries, Drew and Crawford say.

“There is no such thing as avoiding dual relationships in rural areas,” Drew says, adding that they can pop up when a counselor least expects them. For example, Crawford says, imagine bringing on a new client, beginning to work with that client, then taking your car to the repair shop and finding out that the client is your mechanic.

The dual relationship could happen even closer to home. For example, the sole school counselor might have a child or relative who is also a student at the school, Drew says.

Sometimes, counselors in small or rural communities even discover that they are counseling two clients who are related to each other, Drew says. This circumstance is especially tricky because if the counselor discloses the link to the clients, the counselor could be breaking confidentiality. On the other hand, client A may disclose information in session about client B that client B hasn’t chosen to share with the counselor. At some point, the counselor will need to decide how — or whether — to manage seeing both clients. In some cases, it might be best to refer one or both clients, Drew says.

In these communities, seemingly everyone is connected by fewer than six degrees of separation, yet counselors often lack professional connections of their own, Drew and Crawford say. Counselors may have few colleagues to consult with and even fewer specialists to refer to. Practitioners in these communities have to learn to be generalists so they can handle a variety of needs, Drew explains. Counselors who are practicing or wish to practice in a rural area or small community need to ask themselves if they can learn to be OK with such challenges, Drew advises.

But for their own wellness, counselors in these environments still need to have people they can talk to about living and working in rural areas and who can help them work through the challenges, Drew says. She and Crawford recommend that these counselors seek out other mental health professionals, even if it involves driving a substantial distance. For example, Crawford cites a group of women practitioners that she talked to while doing research. They all lived and practiced in rural Vermont and New Hampshire and formed a support group that met monthly in a centralized location.

Professional organizations are also an important source of support, Drew and Crawford say, noting that in Maine, the rural practitioners are often the most active members in the state counseling association.

But they stress that counselors practicing in these comparatively isolated areas need additional support from colleagues and support networks to properly care for themselves and their clients. These counselors also need to be particularly intentional about practicing self-care by regularly engaging in activities that they enjoy.

At the same time, Drew and Crawford think that most counselors-in-training don’t truly understand how different it can be to practice in a small or rural area. Thus, they aren’t adequately prepared for the challenges — both personal and professional — that they will face.

“I think there is not enough training in the counseling profession that is specifically for rural areas,” Crawford says. “I think we need to focus on that. How can I not just survive in a rural area but thrive?”

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To contact the individuals interviewed for this article, email:

 

 

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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