Tag Archives: stress & anxiety

Crisis counseling: A blend of safety and compassion

By Bethany Bray July 27, 2021

When crisis strikes, clients need a counselor who can listen and share their heartbreak without inserting themselves into the situation, says Amanda DiLorenzo-Garcia, an American Counseling Association member and mobile response coordinator for the Alachua County Crisis Center in Gainesville, Florida. She describes crisis counseling as a short-term intervention to an acute situation with a singular purpose: ensuring that the client is safe and feels seen and heard.

Clients need someone who is “willing to be there, be present and be uncomfortable,” she explains. “We can’t help to fix the situation; all we can do is help the client to withstand it, to survive it — and often that’s heartbreaking. It challenges our humanity. … We have to stretch ourselves to be able to hold space for the immense emotions of despair, grief, hopelessness and helplessness, and that can be really uncomfortable to do.”

Part of life

Crisis counseling is a specialty within the counseling profession, but it’s also a skill that all counselors need to master because crises will pop up in everyday life for clients in all settings. 

Thelma Duffey and Shane Haberstroh, in the ACA-published book Introduction to Crisis and Trauma Counseling, explain that crisis “is often an immediate, unpredictable event that occurs in people’s lives — such as receiving a threatening medical diagnosis, experiencing a miscarriage or undergoing a divorce — that can overwhelm the ways that they naturally cope.” 

Crisis can also occur when multiple stressors are present simultaneously in a client’s life and a seemingly small incident, such as losing their keys and getting locked out of the house, pushes them to “the end of their rope” and sends them into a tailspin, says Ruth Ouzts Moore, an associate professor in the Counselor Education Department at the Chicago School of Professional Psychology.

Shock, denial and disbelief are often the first emotions that clients experience in crisis situations, along with hopelessness and helplessness, says DiLorenzo-Garcia, who co-presented on “Breaking Through Barriers to Provide Effective Crisis Support” at ACA’s Virtual Conference Experience this past spring with Jessica L. Tinstman Jones and Amber Haley. A vast range of physical, mental, emotional and behavioral symptoms can indicate that a client is in crisis, she notes. (See list below.) 

Moore defines crisis as the presence of a “risk of foreseeable harm” in a client’s life, either immediately or in the short term. The client may not automatically disclose this risk factor in counseling, however. Instead, their presenting concern can often be a “Band-Aid” or something more benign, she says, and it’s up to the counselor to “peel away the layers” to assess for risk. This can especially be the case with children, who may be referred to counseling for behavioral issues or because they’re falling behind at school. Sometimes, a crisis — such as abuse at home — may be the root cause of these struggles, notes Moore, an ACA member who specializes in working with children and adolescents who have experienced crisis and trauma.

Ali Martinez is a licensed marriage and family therapist and director of the Alachua County Crisis Center (where DiLorenzo-Garcia also works). In addition to mobile crisis response and in-person counseling services, the center operates a local 24/7 crisis hotline and responds to calls from their area of Florida to the National Suicide Prevention Lifeline. Most of the more than 45,000 calls the agency answers each year are from people who are feeling utterly alone as they face something that feels threatening to them, Martinez says. This includes losses that involve the death of a loved one as well as relational, financial and other losses.

“Most [callers] are not suicidal but are in some level of pain — experiencing something big that hasn’t been fully expressed, and they’re seeking space to do that,” Martinez explains. “They either are truly alone in what they are facing or feel alone in what they’re facing. They’re desperate for some sense of connection. They often know we can’t fix what’s happening — and that’s not usually what they’re seeking. …The struggle with crisis, what creates the danger and the true pain around a crisis, is the sense of how it disconnects us from people. The chaos, lack of control and strong emotions can make us feel alone. On the hotline, so often it’s trying to manage that chaos and find validation and connection — that what they’re feeling is a normal response to an abnormal situation. People often need someone outside their own world to let them know that what they’re feeling is OK and give them permission to express it.”

Crisis is self-defined

People can express their feeling of being in crisis very differently, but one common way that it manifests is tunnel vision, according to Martinez. In counseling, practitioners may hear a client who is experiencing a crisis speak with a narrowed scope or train of thought, returning to a singular experience or feeling over and over again.

Clients in crisis may feel like they’re drowning in emotions and that the issue that sent them into crisis is all-encompassing. Counselors may get the sense that their words are not getting through to the client because the client’s anger or despair is “filling the room,” Martinez says. Attending to the pain a client experiences during a crisis forces counselors to slow down their approach.

If counselors are “trying to get [the client] to look at the long term or take a bigger perspective and they can’t seem to do that and they keep coming back to that one painful thing, then we must change our approach and realize that this is the most important thing for them right now — and we have to listen for that,” Martinez says.

Above all, counselors must remember that “a crisis is defined by the person in it,” Martinez stresses. “For them, if it’s a crisis, it’s a crisis, and we have to honor that. Be aware that in that moment, we might have a much broader perspective on the possibilities [in the client’s life] and we might have good ideas about what could happen, but they may not be ready to hear it.” One of the most powerful things a counselor can say to a client in crisis is “tell me what this means to you,” she adds.

Martinez gives an example of a 12-year-old adolescent who is devastated after their first romantic relationship ends in heartbreak. As an adult, it would be easy for a counselor to tell the preteen client that this is the first of many heartbreaks life will bring. However, the client won’t be ready to focus on larger lessons about relationships and self until the counselor has helped them attend to their initial pain and despair over the breakup.

“For them, this is everything — feeling rejection and shame, sadness and despair. It doesn’t make it any less of a crisis experience for them,” Martinez says. “We [counselors] have to go in understanding it from their thinking.”

Josh Larson, a licensed professional counselor (LPC) in private practice in Denver, agrees that crisis must be self-defined by the client. He previously worked as a crisis clinician and operations and quality assurance specialist at Rocky Mountain Crisis Partners, a nonprofit organization that answers calls around the clock for several crisis hotlines, including the National Suicide Prevention Lifeline.

“We would always assure the caller that what they feel is a crisis, is a crisis. For one person, it could be that their cat got outside and they haven’t seen [the cat] for two hours and they’re feeling suicidal. For someone else, it’s something much bigger or more layered,” says Larson, an ACA member. “As a practitioner, even if what the client is telling us wouldn’t be a crisis for us, if they identify it as a crisis, then we need to treat it as such.”

Freedom to speak authentically

There is no shortage of crisis counseling models and assessment tools in the professional literature for practitioners to draw from in their work with clients. The counselors interviewed for this article did not recommend any one particular model or framework over another. They instead encouraged practitioners to research and select the counseling approach that works best for their style and client population.

No matter the model — or even if no model is used at all — a competent crisis counselor should shape a session into an arc that begins with rapport building and ends with connecting the person with resources. This last step ensures that the client has a safety plan (if needed) and is aware of options for follow-up care, such as local counseling services, walk-in crisis clinics and emergency hotline numbers. In the middle of this arc, at the core and heart of the therapeutic interaction, counselors create a nonjudgmental and empathetic space for the client to talk about their situation and share their burden.

The client does most of the talking in crisis counseling sessions, with the majority of the time spent simply “letting them tell their story,” DiLorenzo-Garcia explains.

Given that some clients may experience suicidal ideation during a crisis, an important part of this work is becoming well-versed in suicide assessment. DiLorenzo-Garcia and the other counselors interviewed for this article recommend that practitioners weave questions about a client’s safety, including those focused on suicide assessment benchmarks and protective factors, throughout the conversation.

In some situations, crisis counseling can offer clients the much-needed freedom to make strong statements without feeling judged or censored, Moore notes. This includes the freedom to talk about feelings such as anger or thoughts of harming oneself that can have shame or stigma attached to them.

This was the case for a 15-year-old client Moore once counseled who had turned to drinking, taking drugs and other risky behaviors to deal with turmoil at home, including feeling powerless when his father was abusive toward his mother. In session, the teen, referring back to an invective his father had directed at him, asserted, “I want to be an asshole.” Moore didn’t flinch at the client’s use of profanity. Instead, she responded, “You’re not an asshole.” When she repeated her statement, the teen began to cry, releasing emotions that had been pent-up. 

“He had a deep, deep level of anger, resentment and betrayal that we needed to talk through. He found freedom in being able to say those things in a safe environment,” Moore recalls. “It was freeing that he could speak so strongly and hear his counselor repeat it back.”

Many of the crisis calls DiLorenzo-Garcia’s team responds to are in the public schools. Sometimes they respond because a student has called the county hotline themselves, but most often it’s because a school staff member (a school counselor, principal, school resource officer or administrator) has called to request their help.

In such cases, DiLorenzo-Garcia often begins a one-on-one session with a student by explaining the context of why the school asked her to come and speak with them. She assures the student that they are not in trouble and that she’s there because people are concerned about them. For example, she may say, “This is what I’ve heard from your school counselor, but I’m curious what your perspective is. What’s going on for you?” 

“That’s the door opener. I reassure them, ‘I don’t want to make any assumptions about you. Your experience is your own, and I want to understand,’” says DiLorenzo-Garcia, a postdoctoral scholar at the University of Central Florida whose dissertation was on the loss and growth experience of mass shooting survivors and their families.

If the client’s experience includes thoughts of suicide, allowing them to talk through how they truly feel can help both the client and counselor realize how serious those thoughts are, DiLorenzo-Garcia adds. Sometimes a client has thoughts of suicide but doesn’t want to die, which can be accompanied by feelings of shame or isolation. If a client has a concrete plan to end their life, talking that through can help determine whether or how soon the client might act on that plan — and the necessity for follow-up care.

Assessing client needs

Larson notes that a majority of the callers during his time at Rocky Mountain Crisis Partners were not suicidal. However, some callers would say at the start of the call that they were not suicidal, but as the conversation went on and they began to unpack the depth of their emotions, it would become clear they were in fact experiencing suicidal ideation, he says.

This aspect of crisis counseling is why it’s imperative for counselors to be familiar with and proficient in suicide assessment. A counselor should be able to assess for preparatory behaviors, substance use problems, a client’s internal and external coping mechanisms, and other benchmarks to determine next steps, including safety planning or follow-up counseling, DiLorenzo-Garcia says.

Moore says it is important to be knowledgeable about assessing for not only suicidal ideation but also homicidal ideation when clients are in crisis. She acknowledges that asking questions about homicidal intent can be uncomfortable for practitioners. However, counselors must keep in mind that when in crisis, clients could have thoughts about harming others as well as themselves, she says.

“Be comfortable asking those difficult questions: ‘Are you having thoughts of killing yourself or harming anyone else?’ Don’t sugarcoat it,” says Moore, who presented the session “One Size Doesn’t Fit All: Creative Strategies for Counseling Diverse Families in Crisis” at ACA’s Virtual Conference Experience.

Larson points out that, along with active listening, validation of a client’s concerns and assurance of safety, de-escalation is a large part of crisis counseling. This can include mini versions of deep breathing and other grounding skills that clinicians might use in long-term counseling sessions with clients.

It can be helpful to match the person’s affect level, Larson says. For example, a counselor shouldn’t respond to a person who is hysterical with a flat, monotone voice. Instead, mirror them with a tone that is slightly calmer to gradually de-escalate the situation, he advises. Similarly, a crisis counselor shouldn’t respond to a client who is monotone or expressionless with a bright, bubbly demeanor. Instead, mirror their tone at a slightly more expressive level to gradually lift their affect, he says.

In crisis counseling, de-escalation and being presented with the opportunity to talk through what they are feeling will be enough for some clients, Larson continues. Others will be looking for help with problem-solving, such as conflict resolution or next steps to take after receiving a crushing health diagnosis. But Larson finds that clients in crisis are usually looking for one or the other, not both. Therefore, he advises counselors to be upfront and ask those in crisis, “What do you need? Do you want someone to listen or [someone to] help you problem-solve?” 

“If you offer solutions to someone who is not wanting them, it can escalate them further into crisis,” Larson adds. Instead, he may tell clients, “I’m listening, and I’m willing to offer solutions if that’s what you’re looking for.” 

In cases of suicidal ideation, DiLorenzo-Garcia finds it helpful to focus on the short term with clients. For example, she may say, “It’s a lot to ask you to live forever or live until next year, but right now, let’s talk about if you can live to tomorrow. What might that look like? Can you withstand the pain you’re going through just for tonight? What would it look like to survive and come back to school tomorrow?” 

The counselors interviewed for this article emphasize that it is critical to arrange for follow-up support after crisis sessions but say that involving law enforcement to conduct welfare checks on a person in crisis should be done only as a last resort.

Always follow up with a person who is in crisis, even if your session ends well and it sounds like things are going to work out,” DiLorenzo-Garcia stresses. Her agency contacts each client within three days after the initial crisis counseling session to make sure they are supported and doing well. In school settings, she also debriefs the adults involved in the student’s care (e.g., parents, school counselor) to ensure they are aware of the student’s needs and any next steps after a crisis counseling session.

Client safety

Meredith McNiel, an LPC who co-wrote the chapter “Crisis and Trauma Counseling With Couples and Families” in Introduction to Crisis and Trauma Counseling, notes that during crisis counseling, practitioners should focus on client safety through three lenses:

  • Feeling safe to express themselves fully in the crisis counseling session
  • Feeling safe at home and in the world outside of the counseling session
  • Feeling safe within their life, including protective factors and social connections

An important part of this focus, she says, is reminding clients (multiple times if needed) that the counseling session is a safe and confidential space to speak freely about what they are experiencing.

Clients may disclose dark and powerful thoughts, such as suicidal or homicidal ideation, during crisis counseling, and McNiel acknowledges that many counselors’ first instinct may be to refer these clients for more intensive care. However, practitioners need to push through this initial reaction to keep from breaking clients’ trust.

“If a counselor is worried or nervous or scared about handling a situation, the client will feel that,” McNiel says. “We need to be comfortable asking hard questions while keeping the client comfortable.” The counselor should allow the client to say what they need to in session and “hold that space” without trying to fix their situation, she stresses.

“In a suicide crisis session, many professionals might [automatically] think, ‘Where can we send you?’ and in my experience, that is an absolute last resort. If a client hears that they’re going to be hospitalized or referred out to someone they don’t know or trust, they can instantly lose trust with a counselor,” says McNiel, an ACA member with a private counseling practice in Austin, Texas. Instead, “allow the session to happen fully in the way the client needs to share or release and process, and go from there,” she advises. “I assure [the client] that if anything further needs to happen, we will decide that together. I will not take control of what’s going to happen. I remind them that they are in control of their circumstances.” (See more about the ethical guidelines regarding protecting clients from “serious and foreseeable harm” in Standard B.2.a. of the 2014 ACA Code of Ethics at counseling.org/ethics.)

Crisis counseling is “less clinical and more relational” than long-term counseling, explains McNiel, who was a crisis counselor at the University of Texas at San Antonio Academy for Crisis and Trauma Counseling during her LPC internship. Practitioners need to let clients share and talk through their experience “until it feels complete” — whatever that looks like for them. 

To ensure that a client’s safety and comfort are the primary focus in crisis counseling, practitioners must be so familiar with assessment tools that they don’t need to read the questions off a piece of paper or computer screen, says McNiel, whose doctoral research was on college counseling work with students who were suicidal. “[Instead of] saying, ‘Hold on, I’m going to grab this checklist and ask you some questions’ … ask questions in a relational way and fill out the assessment afterward rather than stopping the flow of a session,” she says. Counselors should be “getting answers [from the client] through conversation rather than interrogation.” 

For example, an assessment tool might prompt a counselor to ask the client, “Are you thinking about killing yourself?” Practitioners still need to ask direct questions about suicidal ideation, but couching those questions in a more conversational way aids in maintaining trust, McNiel notes. Alternatively, the counselor could say, “I can see and hear that you are really struggling with this situation. You’ve shared with me that you have thoughts about killing yourself, and that makes sense considering what you’ve been through. I’m wondering how close you are to doing that? How close are you to going home and following through [on those feelings]?” 

“The difference [in phrasing it this way] is the compassion in the language surrounding those really heavy questions,” she notes.

At the conclusion of a crisis session, counselors should talk through next steps with the client, including addressing what the client would do if things became worse and a crisis resurfaced after the session, McNiel says. If the individual is a long-term client, she advises scheduling their next session and letting them know how and when to reach the counselor during nonbusiness hours, as well as providing crisis hotline numbers.

Martinez agrees that in crisis counseling, practitioners should resist the urge to “fix” the situation the client is facing. In addition, counselors should avoid viewing it as a linear cause and effect. This includes thinking of suicidal ideation in binary terms of yes or no.

“We have to think of suicide in a much broader continuum, a range of pain and despair,” Martinez says. “[Society’s] fear and the stigma around suicidality makes us think about it as an on-or-off switch, but it’s more complicated than that.”

By definition, crisis is chaotic and messy, and the goal of a crisis counseling session is to de-escalate and share that burden, rather than organize or reorder it. Martinez illustrates this with a metaphor of a jumbled pile of sticks on the ground. A counselor’s instinct might be to gather the sticks and assemble a neat structure for the client, she says. Instead, crisis counseling involves allowing the client to pick up the sticks, one by one, and assemble them however they need to — even if it’s just into another pile on the ground that, to an outsider, looks equally as messy. “That’s much more powerful than us trying to figure out where the sticks belong,” Martinez says.

If a counselor approaches a crisis counseling session with the goal of tracking a client’s story in context, the counselor will miss the client’s full range of emotions — and the chance to connect and help the client bear that pain, Martinez says. “We can get caught up in [feeling that] ‘I need to make sense of the story.’ But that’s our need, our desire. The client may not need that or be ready for that. … When they talk and are listened to, they often begin to make sense of it themselves.”

Take Care of Yourself

The counselors interviewed for this article agree that it is imperative for practitioners who engage in crisis counseling to take steps to avoid burnout. In addition to regular self-care, this can include ongoing supervision or consultation with colleagues as well as other methods to combat feelings of isolation and empathy fatigue that can easily overwhelm practitioners whose clients share such heavy and troubling topics.

Moore suggests counselors take steps to maintain a balanced caseload and stay aware of how stress and burnout manifest for them personally. “Doing trauma and crisis work is heavy stuff. It can be super rewarding but super draining,” Moore says. “We carry [clients’] trauma with us, so it’s important to take care of ourselves. … Sadly, we need more and more counselors to do crisis work, and if you don’t take care of yourself, that’s one less counselor to help people who need it.”

It’s also important to remember that sharing the burden of crisis with clients is a gift, Larson says. A crisis counselor may be the only person the client feels they can talk to during their lowest moments. 

“It takes a lot of courage to pick up a phone and tell a stranger [a crisis counselor] that you want to die,” Larson says. “Always remember that it’s an honor and privilege to hear people’s hardest stuff — their deepest, darkest secrets.”

fran_kie/Shutterstock.com

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Contact the counselors interviewed in this article: 

 

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Crisis counseling via text message

People in distress send messages to the Crisis Text Line 24/7 looking for help and support. Its team of volunteers across the U.S. has had nearly six million chat conversations since the nonprofit organization was established in 2013.

How can aspects of crisis counseling be translated for use via text? Counseling Today talked with Ana Reyes, a licensed professional counselor and bilingual manager of clinical supervision at the Crisis Text Line, to find out more about the nuances of crisis counseling via text message. Read more in an online exclusive article here.

 

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Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at bbray@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.

What discomfort can teach you

By Shari Gootter and Tejpal June 16, 2021

Comfort is something we all seek. The notion of “being comfortable” is highly prized (and promoted) in our society. It is considered a major selling point if you are in the market to buy a bed, clothes, a car, a pair of shoes — almost anything. But the overvaluing of comfort in our lives can come at great cost.

Fizkes/Shutterstock.com

Our relationship with comfort and discomfort is influenced by our culture, our personal history and our personality. If we are born in a tradition in which failure is not an option and social success is the norm, we may challenge ourselves with long hours of work or study to avoid the discomfort of failure. If we are born into a family where depression or anger was part of the daily landscape, we may want to avoid these emotions at any price and dissociate when these feelings arise. Taking a deeper look at our relationship with comfort and discomfort provides us insight on our path toward acceptance and happiness.

Discomfort exists at many levels:

  • At the physical level, it may manifest as a headache, a digestive issue or a skin irritation.
  • At the emotional level, it may manifest as anxiety, worry or depression.
  • At the mental level, it may manifest as constant agitation, an inability to focus or ambivalence in decision-making.
  • At the heart level, it may manifest while experiencing loss, change or separation.
  • At the spiritual level, it may manifest as existential angst, lack of purpose or a feeling of disconnection.

Certain life events can be challenging and unfamiliar. If we are clinging to any form of comfort, we will limit our ability to adapt and grow. Through the years, the overpromotion of comfort, happiness and pleasure has created tremendous distortions. There is no tolerance for any amount of discomfort and tremendous impatience for any kind of pain. When comfort is the only choice, resilience and the ability to overcome adversity are lost.

Running from discomfort

If you want to stay centered and at peace, you need to stop running away from discomfort (or always running toward pleasure). Running from discomfort prevents us from being able to see and feel what is present. It holds us in a false state of reality and never allows us to know our true selves. On the other hand, being uncomfortable teaches us to transcend pain and pleasure, thus allowing us to be true to ourselves. It also allows us to see clearly when challenges occur.

The constant promotion of pleasure and comfort has contributed to the emergence of addictive behaviors. For example, many individuals use food, medication or gaming as a way to soothe their pain or “escape” their stress. This starts with a tremendous obsession of the mind that makes us believe there is only one way. When our mind gets frantic about one thing, there is no room for anything else and our behavior becomes extremely reactive. As soon as we grasp for more comfort, we become intoxicated. Intoxication does not necessarily have to involve a substance such as alcohol. We can be intoxicated with power or greed. As soon as we are intoxicated, we lose our intelligence and our ability to be present.

When you experience discomfort, we suggest that you stay away from labeling it, contracting and wondering when the pain will go away. None of us came to Earth to suffer, but none of us came to earth to run away from suffering either. Every time that you hit your limitations, you have the opportunity to unfold and open.

Mara, one of our clients, was struggling with tremendous discomfort. She was never satisfied with herself and experienced ongoing anxiety about her future. She dealt with her pain by consuming alcohol. After several years of doing this, Mara was no longer able to follow through with much of anything, and she ended up getting fired from her job. This was a much-needed wake-up call for Mara to realize that she needed help. When she first came to see us, she had a strong motivation to rid herself of her discomfort. But as she learned to develop a sense of compassion for herself, she grew more able to embrace her discomfort. Mara came to understand that when she was trying to cover up her discomfort, she was actually opening the door to self-destruction.

Accepting discomfort

Accepting our discomfort is led not only by bravery but by our heart center. At that moment, we choose to accept who we are. Our will does not help to heal our pain; our heart does. For Mara, getting fired was the saving grace. Others may go deeper into negative coping mechanisms that further enhance patterns of self-sabotage before determining to change their relationship with discomfort.

Often, when we experience discomfort, we perceive it as a threat. We want to separate from our discomfort to protect ourselves. When we do this, we create the opposite of what we are looking for. The more we separate from our discomfort, the more we separate from ourselves, and the more pain we experience as a result.

Underneath any discomfort, there is a fear. For some it could be the fear of missing out. For others it may be the fear of not being in control, or the fear of being overwhelmed and losing sense of self.

The longer we numb our discomfort, the more stuck we may feel. The longer we reject our discomfort, the louder our ego becomes. The practice of allowing discomfort is the practice of integration. Integration occurs when we allow our behavioral patterns, traits, emotional states and experiences to come together in a more unified and organized state. Without integration there is separation, and with separation there is distortion.

The purpose of pain is to awaken the heart, not trigger the mind. It is not about overcoming pain; it is about recognizing and being willing to learn from it.

Some spiritual traditions will bring discomfort to the core of their practice. The intent is to teach the practitioner to stay whole while in pain and to prevent the mind, led by the ego, from directing the experience. The focus is not on overcoming pain but rather on surrendering and allowing the experience of pain to expand where it wants to be. It teaches the mind not to separate but to allow. It teaches the mind to go beyond subject-object relationship. At that moment, there is an alchemy happening in the body, and one may shift from pain to bliss because the mind is not locked into form.

The practice of being uncomfortable

Regardless of your spiritual tradition and belief system, meditation is a great way to learn to be still with discomfort. Many people express difficulties when trying to learn to meditate and often give up, believing they are not good at it. The purpose of meditation is not to add pleasure or pain but rather to develop a neutral mind that allows whatever arises. Consistency in a meditation practice paves the way for acceptance and humility, which are two beautiful qualities of the heart.

If you are able to stay still during pain, without hoping for pleasure to come, you are free. If instead of fighting against the pain, you welcome it fully, you will shift and heal. When this happens, you will realize that pain and pleasure are not opposites, but simply sensations; you are now living beyond polarities.

Being uncomfortable does not always relate to pain or pleasure; our own fears and limitations can create great discomfort. To avoid discomfort, we may prevent ourselves from taking risks and put our self-development on hold. Some may feel stuck and have pushed the pause button, whereas others might operate on autopilot by staying with their to-do list. For example, some people may stay in a relationship or job even though they know it is no longer serving them. Both are forms of avoidance.

As we learn to allow pain to be part of our experience, we need to notice other possible scenarios that prevent us from learning about our discomfort. The first scenario is to be attached to our pain, allowing it to become our identity. At that moment, our life revolves around our pain, and this limits our ability to heal and make positive changes. The second scenario is to be uncomfortable with others’ discomfort. This steers us toward being “people pleasers,” constantly focusing on others’ well-being and avoiding being in touch with ourselves. Related to this second scenario, it can also be challenging to be around someone we deeply care for who is experiencing a great deal of discomfort. We may want to “fix it” or change it as a sign of love.

The practice of being uncomfortable teaches us to stay connected with ourselves, to be curious and open. It teaches us to be relaxed and surrender into the discomfort. The more we want to control our discomfort, the more stuck we become.

Allow discomfort to be part of your experience. Welcome it fully from the heart center. At the core of your pain or fear, you will grow and you will learn.

Practices

To become comfortable with the uncomfortable, we invite you to try the following practices. As with every practice, consistency and repetition are key to gaining insights and creating change.

Practicing in itself can create discomfort. It is when you are the least inclined to practice that it may be the most beneficial. Practice teaches you to go beyond your emotional reactivity. As you keep showing up for yourself, it will get easier.

Meditation Tonglen

Tonglen is a meditation practice found in Tibetan Buddhism and used to awaken compassion. Through acknowledging our own and others’ suffering, we open our hearts.

  • Sit in a comfortable position. Lengthen your spine and draw your shoulders down your back. Soften your face and jaw. Close your eyes.
  • Connect to one part of you that is in pain at a physical, emotional, mental, heart or spiritual level.
  • Notice the quality of your pain.
  • Imagine all of the people with a similar experience and inhale their pain. Do not be afraid to “inhale” others’ pain. You will not get more pain. In fact, you may feel some relief.
  • Exhale; send relief.
  • Repeat the process for at least three minutes.

Journaling

Some of you may be really reluctant to start this practice and others may simply love it. The benefits of journaling are priceless. It helps you process emotions or situations with more awareness and clarity. It is a safe container to express your voice. Research on journal writing therapy indicates positive outcomes related to identifying emotions and feelings and reducing stress. It can be a catalyst for change and healing.

  • Think of something that makes you uncomfortable. Is this new or old? What are the main emotions you are experiencing? What behaviors or strategies have you implemented? What did you learn about yourself?

Take action

Taking action is where the true learning takes place. You get an opportunity to truly assess your relationship with discomfort and stretch yourself.

  • Do something outside of your comfort zone.

 

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This article is based on a chapter from our book WAY TO BE – 40 Insights and Transformative Practices in The Heart of Being. For more information, go to www.40waystobe.com.

 

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Shari Gootter is a licensed professional counselor and certified rehabilitation counselor with decades of experience in designing and leading workshops for diverse populations. Her focus has been on helping people shift while going through losses or adjustments. She has also created programs for counselors that assist them in developing a framework that supports lasting transformation. Shari is a therapist in private practice and has taught yoga for decades. Contact her at sharigootter@comcast.net.

Tejpal has over 30 years of experience supporting individuals on their journey toward healing, life purpose and real joy. Tejpal blends her intuition, energy healing, creative processes, life coaching and yoga into her work. Tejpal was born in France and moved to the U.S. 25 years ago. She has worked with people from many cultures and traditions.

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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.

Counselors weigh in on weighted blankets

Compiled by Bethany Bray April 16, 2021

The COVID-19 pandemic has been accompanied by a range of intense emotions, and for many people, this includes acute feelings of uncertainty and worry. It seems some people have tried using weighted blankets to find comfort, as sales have increased during the pandemic.

Manufacturers often tout the blankets as a nonpharmaceutical method to help quell anxiety, sleeplessness, stress, restlessness, unease and other symptoms.

A 2015 Journal of Sleep Medicine & Disorders study by Swedish researchers found that subjects with insomnia who began using weighted blankets reported improved sleep quality, being better able to settle down to sleep and feeling more refreshed in the morning.

In the realm of professional counseling, how do these claims stack up? Are these blankets truly helpful for symptoms of mental illness? Are practitioners and clients talking about the use of weighted blankets — and their possible benefits — in counseling sessions?

CT Online collected thoughts on the use of weighted blankets from professional counselors across the U.S. Add your experience in the comment section at the end of this article.

 

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The challenge to weighted blankets is that they provide physical weight but not the compression or true pressure that many with attention-deficit/hyperactivity disorder (ADHD) and autism may be seeking. Although many people do report that a weighted blanket assists in reducing their overall stress and allows more effective sleep, I believe the question really should be: Does the weighted blanket actually create those improvements, or are the reported positive changes actually due to the weighted blanket causing us to sit still for a little bit?

This slowdown during our typically fast-paced day might be a significant reason so many of us truly believe that weighted blankets help. Trend or not, I think weighted blankets show true promise in helping people learn to be more mindful of their busy lives.

I have found that weighted blankets appear to provide minimal benefits to kids with ADHD or autism. Although many of the kids I work with do enjoy the weight, parents nor children typically report significant benefits. In fact, although a large number of my families have purchased weighted blankets, very few use them on any consistent basis. I believe this is due to the concept of weight versus compression.

Although the weight can feel good, for the kids I work with, it does not provide enough sensory input to make a difference. Instead, they often seek compression or pressure.

Although weighted blanket [retailers] often talk about the “pressure” it provides, the difference is in the details. It does provide pressure, but not the deep pressure that many with ADHD or autism are seeking in times of dysregulation. In fact, kids with tactile and or proprioceptive sensory behaviors often seek out deep pressure to help regulate their nervous system. This means they often need more than what a weighted blanket can provide.

I have found that my kids who do like weighted blankets use all the weighted blankets in the house and they are oftentimes using three or four weighted blankets at once! This means the weight they are seeking is much higher than the 10% of their own body weight [that is the recommended guideline].

Although weighted blankets are definitely a trending item, I fully believe they are here to stay. However, they will probably be most useful for those who like to sleep with extra blankets purely because they like the [feeling of the] weight. For everyone else, I think compression items are often the way to go.

  • Michelle Tolison, a licensed clinical mental health counselor and owner of Dandelion Family Counseling in Charlotte, North Carolina. A registered play therapist, she works with children who are twice-exceptional (particularly those with ADHD).

 

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As a child therapist, I’ve long known that occupational therapists use weighted blankets to help children with sensory issues and anxiety, including children with ADHD and autism spectrum disorder. These blankets have moved into the mainstream, but just because they’re popular does not mean they can be used to help children without first consulting a medical doctor or an occupational therapist.

A weighted blanket provides deep pressure to the body, which can help induce relaxation. However, there are physical safety concerns when it comes to children and weighted blankets. They shouldn’t be used on a child younger than 2 years old. The child needs to be able to remove the blanket themselves, and their head should never be covered. If the pellets fall out of the blanket, they can be a choking hazard. Parents should always supervise their child when using a weighted blanket.

The American Occupational Therapy Association advises against sensory-based interventions, such as weighted blankets, unless children have been thoroughly assessed. In my opinion, professional counselors are not trained to provide sensory assessments nor suggest sensory-based interventions. Suggesting a weighted blanket as an intervention for a child would be outside of the scope of our practice and could be considered unethical.

If a parent has concerns about their child’s anxiety, hyperactivity, autism, sensory processing disorder, or just an inability to go to sleep and stay asleep, I encourage them to speak to their pediatrician before they utilize a weighted blanket. Their pediatrician may recommend an evaluation by an occupational therapist.

  • Pam Dyson, a licensed professional counselor supervisor and registered play therapist supervisor in Spring Hill, Tennessee, who offers virtual play therapy supervision and consultation services.

 

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During the COVID-19 pandemic, there’s no doubt that mental health symptomology is on the rise, most commonly anxiety and depression, but also for people diagnosed with autism and ADHD, since it seems to be much more of a struggle to regulate one’s emotional/behavioral state during these uncertain times. Interestingly enough, it’s also been noted that the sales of weighted blankets have increased during the pandemic. Coincidence? I think not.

Adding weight/pressure to our large muscle groups (with a weighted blanket) activates the body’s proprioceptive sensory system. Activating this system increases both dopamine and serotonin in the brain, helping people to feel more emotionally regulated, calm and in better control of their emotions and behaviors.

Dopamine is our main “feel good” neurotransmitter and main “focus” neurotransmitter. When there is an insufficient amount of dopamine being produced, retained or transported, it’s like there is a “reward deficiency syndrome” occurring. Therefore, the brain requires increased stimulation to obtain a sense of satisfaction/reward, which can be seen in the hyperactive response of those with ADHD or autism when they sensory-seek (spinning around and around) or when they novelty-seek (hanging over a two-story banister). Due to these struggles, they tend to seek excessive proprioceptive input with the intention to calm their nervous systems — but in maladaptive manners. Their excessive movement can come across as chaotic to themselves and disruptive to others.

During a pandemic, with an increased amount of time at home and without the full structure of school, clubs, organized sports, etc., that in itself can cause these symptoms to increase. A weighted blanket can assist in the retention of dopamine so these people don’t need to seek stimulation in such maladaptive manners and therefore can remain more in control of themselves. This means that a weighted blanket can be beneficial for people with autism and ADHD who have difficulty planning their movements and regulating their level of arousal. When they feel pressure from a weighted blanket on their large muscle groups, it can actually give them this proprioceptive input in a more organized manner, leading to increased attention, less internal chaos and less disruption to others.

Serotonin is a neurotransmitter that helps soothe us when we feel stressed. Serotonin is also involved in our survival mechanism to help regulate our sleep, food cravings/appetite and sexual desire. It’s involved in memory, mood/irritability levels and sensitivity/insecurity/self-confidence levels. With an insufficient amount of serotonin being produced, transported or retained, people tend to feel anxious, irritable and can have difficulty sleeping. A weighted blanket can add proprioceptive input to help retain serotonin in the brain, so one can feel calmer, soothed and more self-confident and self-secure.

Physical containment from a weighted blanket can help facilitate emotional containment [and] a sense of stability and promote behavioral regulation. (Think about it as a similar concept to “swaddling” a baby to soothe them when they are upset and to help them sleep.) It’s no wonder that the sales of weighted blankets for children and adults are on the rise during a time of uncertainty.

  • Donna Mac, a licensed clinical professional counselor at a school in the Chicago area that specializes in helping students with emotional disorders, higher-functioning autism, secondary learning disabilities and other health impairments.

 

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More than one client has reported an improvement in their sleep after using a weighted blanket (or even multiple regular, heavy blankets if they couldn’t afford a weighted one) at home to give them a sense of pressure. Given all that we know now about how trauma impacts the body, it makes a lot of sense to look at as many sensory modalities as possible when working with this population.

As a personal anecdote, I have a nephew on the autism spectrum, and there was a dramatic change in his behavior after he started using a weighted blanket to improve his sleep quality at night. I do realize that the plural of anecdotes is not data, but I’ve certainly had enough positive feedback from people to suggest it to clients as an option to explore.

  • Kirsti Reeve, a licensed professional counselor at a group practice, Transcendence Behavioral Health, in Royal Oak, Michigan. She specializes in working with self-injury, teens and trauma and is also a certified drug and alcohol counselor.

 

 

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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.

COVID-19 and the ‘casino effect’

By Todd Monger April 15, 2021

Providing mental health services during a pandemic is a perspective changer. A few weeks ago, I happened to work with three clients back-to-back, providing counseling services through telehealth. COVID-19 has opened a door, and a necessity, to being creative in how we provide services and mental health support. It has also revealed an interesting parallel.

As I worked with these three college students who were struggling with issues related to depression, isolation, lack of energy and anxiety, I realized they were all engaging in counseling from the same environment: a basement or bedroom from which they had not left the entire day. Not because of the debilitating effects of a clinical diagnosis, but rather because they had no need to.

It is well known that casinos spend significant resources honing the psychology of their gambling venues to tap into the gamer’s five senses. Casino designers create an environment that lulls their customers into a trance during which they can lose their financial capital as quickly as they lose their sense of joy, self-esteem and inner peace. There are no clocks or windows. Scents are used that research has shown can increase gaming up to 53%. Customers are well-stocked with free drinks and snacks. All of this is done with the purpose of encouraging gamers to pull that lever or roll the dice one more time.

It has occurred to me that COVID-19 has had some similar effects on our psyches. If recognized, we might use these observations to inform our understanding of some of the mental health pitfalls that our clients are currently experiencing, similar to the way we are informed of the trappings of organized gaming.

Time

Casinos work hard to keep customers hooked to their games. One way this is done is to remove anything that informs the player of time. Clocks and windows are almost never seen because these objects would risk informing those on the gaming floor that they have been there too long or have other things that need their attention.

The coronavirus demanded that many of us work or attend school from home. It has become apparent that our living conditions can affect our mental health in ways we do not readily recognize. Many people’s workstations reside in dark bedrooms or basements in which natural light is limited or eliminated completely. To improve contrast and reduce screen glare, those who are working or attending school from home may draw their curtains. The information that daylight provides about the time of day — morning, noon, night — is effectively lost.

It used to be common to get our news and entertainment via predictably scheduled TV shows and movies. Some even carried time stamps (the 6 o’clock or 10 p.m. news, for example), prompting us to consider our proximity to bedtime. Now we stream our news and television shows with little thought given to a set schedule. We routinely engage in “binge-watching,” which is akin to staring at a slot machine as it rolls around and entices us with “just one more pull” before we go (and then still don’t leave). Whether it was beating rush-hour traffic, catching a school bus, coming home from work or attending evening activities, these actions subtly informed us about the time of day and regulated us biologically, providing a healthier existence until the threat of COVID-19 arrested these tells.

COVID-19 is affecting our sense of time and, as such, impacting our biological regulation of sleep, diet and exercise — three ingredients that can help either protect us against or make us more susceptible to depression and anxiety. For these reasons, I recommend that individuals pay greater attention to their work and entertainment environments. Set structures that encourage relocation and movement. Although it is potentially less convenient, consider watching your entertainment on a different screen and in a different room than where you work or sleep.

Maintain morning rituals and evening activities that help inform what needs to be happening at each point in the day. Consider investing in a dawn simulator alarm clock, and be mindful of the sunrise and sunset and how they can be included in one’s daily schedule. Committing to a balanced and regulated lifestyle during the pandemic will promote improved mental health, rest and rejuvenation.

Comfort

If you want to help a person lose their money, or their mind, keep them as comfortable as possible. Casinos provide free food and drinks, with incredible customer service, so that gamers never feel the pressure to leave. It’s a sedentary existence to sit at a slot machine or a card table as it eats away at hard-earned resources.

In a somewhat similar fashion, the COVID-19 pandemic has restricted us to our living areas. At first, this was a celebrated comfort for some — easy and seemingly weightless. Those few extra minutes in bed. Never having to get out of your sweatpants. Your living room becoming your office, your entertainment center and your bed. Days and weeks can go by as groceries are delivered to one’s house.

Suddenly, leaving home for any small amount of time feels like a chore or, worse yet, home has become a security blanket and leaving becomes anxiety producing. The more comfortable we are, the more everything else seems like “work” — and certainly less pleasurable.

Metaphorically, I have thought of this as being akin to an astronaut whose “antigravity muscles” (neck, calf, back) begin to atrophy due to underuse after five to 11 days in a weightless environment. Upon returning to Earth, gravity suddenly feels like a heavy weight, and what previously seemed normal is now crushing, unpleasurable and anxiety producing. To mitigate these known effects, astronauts intentionally exercise every day while in outer space, using resistance bands and other adapted machines to keep muscles working.

In a similar way, individuals need to keep working out their social and mental muscles. I fear that when the COVID-19 pandemic is finally over, some people will struggle with the “gravitational pressure” of social engagement because that muscle has atrophied through underuse during this time of physical distancing.

Mental stimulation

Casino floors are loud. Between the lights, colors, bells, sirens and laughter, it’s little wonder they are often referred to as “playgrounds.” Upon first entering such a place, it seems filled with possibility and excitement, but it doesn’t take long for that sound to become numbing. Research on gaming design tells us that casino games are made to “sound like winning” to increase a person’s drive to engage. Casinos, from the games to the artwork, are designed to draw one in like a moth to a flame. I imagine this is similar to receiving a “like” on a social media account, the new dopamine hit of the 21st century.

It is no surprise to hear that living through COVID-19 is boring. So many people and places we took for granted have been taken away or locked down. The world has been filled with fear, and in many cases, technology has been the answer to keep us safe.

As we continue to use our digital “slot machines” to connect to the world around us, one unintentional effect is that we steadily increase the amount of access we have to passive, yet exciting, communication. It reminds me of learning how food can become a delivery system for sugar, which tastes delightful and delivers an immediate energy rush, but leaves one feeling tired and sluggish soon after. And when we feel tired, we consume more sugar for a quick pick-me-up, resulting in a vicious cycle. Under the COVID-19 pandemic, when our brains feel bored, we are tempted to watch more lights, more colors, more bells to stimulate away the silence and isolation. Much like in a casino, this can trick us into feeling like we are winning when, in reality, we are running ourselves into the ground due to a lack of true novelty.

Dopamine, sometimes referred to as the pleasure neurotransmitter, is actually increased when we think of or engage in something that is novel. Technology can be an amazing delivery system of novelty. However, during this time, it is important that we also find novelty outside of the “casino.”

I have challenged clients to create their own journals titled “Things I learned during COVID-19” and then fill them with experiences, activities and photos. Creating novelty does not have to be hard. It can be as simple as making your own campfire and toasting s’mores, cooking or baking, or learning something new. The process of both planning and physically doing new tasks increases movement and engagement and uses our entire neuro-network to improve mental health. The process of delayed gratification —thinking about something exciting or interesting in the future —also increases dopamine.

Living life in a pandemic is challenging in so many ways. But if we allow it to, it can also birth creativity, intentionality, resiliency and new insights. Even though we find ourselves wandering around our homes in a seemingly numb state at times, it does not have to mean that “the house always wins.” My encouragement to you and those you love is to close the laptop or smartphone, get up from the bells and whistles, step away from the artificial lights, and walk outside to reconnect with a world that is missing you.

 

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Todd Monger is a licensed professional clinical counselor, national certified counselor and approved clinical supervisor who has been providing clinical services for 20 years. He currently serves in private practice at Stable Living LLC, where he provides equine-assisted psychotherapy. He has also served as the executive director of student development at North Central University in Minneapolis for the past 17 years. Contact him at todd@stableliving.us.

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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.

Money on the mind

By Laurie Meyers April 7, 2021

Money is the dirty little secret of American society. The unspoken social contract is that, like Voldemort, it shall not be named. We may joke about winning the lottery, but we don’t reveal the strained financial circumstances that underlie that pipe dream. Modern life is not cheap. Unfortunately, many workplaces and professions do not reflect this reality. Could we be making more money? Who knows? Many companies forbid their employees to discuss salaries with co-workers.

Meanwhile, our consumerist culture makes it easy for money to fly out of our wallets and onto our credit cards. Financial experts (some of whom sound a bit like scolds) urge us to maximize our contributions to our retirement plans and have savings sufficient to sustain us for six months or more of unemployment. These are worthy goals, but most Americans find them challenging to achieve.

A 2019 survey by the personal finance company Bankrate found that approximately 28% of Americans had no emergency savings and only 18% had enough to live on for six months. And a 2019 report by the U.S. Federal Reserve revealed that 25% of nonretired workers possessed no retirement savings at all. Surveys show that a large share of Americans — including those who earn higher salaries — live paycheck to paycheck. Many people get by with the help of a credit card — or three or four. A recent poll by CreditCards.com showed that almost half of Americans (47%) currently carry credit card debt. And even though being in hock to credit card companies is so common, carrying that kind of debt is still associated with a lack of financial responsibility. 

Just set a budget! Track your spending! Stop buying that daily Starbucks latte!

It’s not the latte. And the one-size-fits-all financial advice on offer by cable talking heads and in best-selling books doesn’t typically work. Not just because people’s financial obligations are different, but because managing money isn’t only about the numbers. The way we spend — and save — is tightly entwined with emotion and driven by learned behaviors and beliefs whose existence we are frequently unaware of, according to experts who study neuroeconomics. These factors can prevent us from effectively managing our money.

The mental health consequences of financial difficulties can be significant. Even before the recession caused by the COVID-19 pandemic, Americans frequently rated financial worries as one of their top sources of stress. This past October, the fourth in a special pandemic-oriented series of “Stress in America” surveys from the American Psychological Association revealed that nearly 2 in 3 adults (64%) said money was a significant source of stress in their lives.

Financial difficulties can cause stress and depression. Stress and depression make it harder to tackle money problems. It becomes a vicious cycle — particularly for those who are already living with mental health problems.

Enter financial therapy, which the Financial Therapy Association (FTA) defines as “a process informed by both therapeutic and financial competencies that helps people think, feel, communicate and behave differently with money to improve overall well-being through evidence-based practice and interventions.”

Financial therapists primarily come from the mental health, coaching and financial fields. Some of them are mental health professionals who realized that money plays an important role in overall well-being and decided to become trained to offer financial therapy in addition to their regular practice. Others are financial professionals who realized that they needed to be able to handle the emotional aspects of money and received additional behavioral training or, in some cases, became licensed mental health practitioners.

All of the sources Counseling Today spoke to for this article are licensed counselors who offer financial therapy to existing clients who express interest or as a stand-alone service. They use a variety of tools to help clients understand their internal money narratives, identify behavioral patterns, and process the emotions that are getting in the way of setting and working toward their financial goals.

The field developed out of a body of research on neuroeconomics. Psychologists Ted Klontz and Brad Klontz and financial planner Rick Kahler are widely considered the “grandfathers” of financial therapy.

Early lessons learned

Research by Klontz, Kahler and Klontz suggests that people begin developing money beliefs — and potential future problems — in childhood. These attitudes are often developed through experience and observation rather than parental instruction.

That’s because many families don’t talk about money, notes American Counseling Association member Elaine Korngold, a licensed professional counselor in Portland, Oregon. Children grow up in families not knowing how much money their parents make, how much (or how little) different jobs pay, and what level of income is necessary to cover basics such as rent/mortgage, utilities and food — let alone how to set up and follow a budget, she says.

Although parents usually talk about and teach their children essential life skills such as driving, anything to do with money is often kept secret, says Korngold, who worked in the financial sector before she became a counselor. This not only leaves children uninformed and unprepared but also reinforces the societal perception of money as a taboo topic. As a result, many adults who struggle to manage their finances simply don’t know how to seek help or are too ashamed to ask for it, she says.

But even when parents don’t explicitly teach their children about money, they are still imparting lessons, says Kathy Haines, an LPC in Marietta, Georgia, who is training to become a certified financial therapist through FTA.

An integral part of Haines’ financial therapy process is exploring the financial beliefs held by a client’s family of origin. Haines, an ACA member, asks questions regarding whether money was ever discussed, who managed finances in the family and how. “Were there fights about money?” Haines asks. “Spoken or unspoken messages such as don’t have credit debt? Work hard so that you can take care of yourself?”

Similarly, Korngold asks clients about the spending behaviors they observed growing up. Did it seem like the family was always just making it until payday, or was there any financial cushion? If the family found itself with more money than usual, what did they do with it? Put it in the bank? Take a vacation? Buy a TV?

Jennifer Dunkle, an LPC in Fort Collins, Colorado, whose specialties include financial therapy, asks her clients to write their “money story” by answering a variety of questions: What are your earliest memories concerning money? What did you learn from your family about money? Specifically, what did you learn from your father? From your mother? What experiences did you have with money as a young adult?

These messages and experiences contribute to what Klontz, Kahler and Klontz call “money scripts” — unconscious beliefs that shape our financial behavior.

Money narratives

Dunkle, like many financial therapists, also gives clients the Klontz Money Script Inventory (KMSI) assessment.

“Most adult money scripts are based on earlier life experiences,” she says. “In order to make lasting changes to budgeting, spending, savings and investing plans, it is very helpful to learn more about our underlying beliefs and values in regard to money.”

The most common money scripts include beliefs such as:

  • More money will make things better.
  • Money is bad.
  • I don’t deserve money.
  • I deserve to spend money.
  • There will never be enough money.
  • There will always be enough money.
  • Money is unimportant.
  • Money will give my life meaning.
  • It’s not nice or necessary to talk about money.
  • If you are good, the universe will supply all your needs.

Dunkle explains that Klontz, Kahler and Klontz group money scripts into the following types:

  • Money avoidance: Avoiding dealing with money and rejecting personal responsibility for one’s financial health.
  • Money worship: Believing that a financial windfall or increased income will be the solution to all of one’s problems; being focused on the inward value of the accumulation of money.
  • Money status: Being overly concerned with the idea that self-worth equals net worth; believing that money conveys status; wanting to always have the next new, big-ticket item; and being interested in the outward display of one’s wealth to others.
  • Money vigilance: Being watchful, alert and concerned about one’s finances. Those who are money vigilant are much less likely to avoid their financial matters, overspend, gamble and engage in financial enabling.

Klontz, Kahler and Klontz say that the scripts themselves are not “good” or “bad.” Rather, they are simply indicators of behavioral influences.

“For example, someone who has the belief that ‘I deserve to spend money’ might run up a lot of credit card debt despite not being able to actually afford their purchases,” Dunkle explains. “The script, ‘It is not nice or necessary to talk about money’ could lead to money secrets between spouses. Believing that ‘If you are good, the universe will supply all of your needs” may result in not doing adequate planning and saving for retirement.’”

Working toward change

Dunkle uses motivational interviewing to help clients recognize the adverse effects their financial habits are having on their lives.

“The goal of motivational interviewing in financial therapy is to elicit ‘change talk’ by using the skills of open-ended questions, affirming, reflective listening and summarizing,” she explains. “When clients hear themselves talk about potential changes, they start to believe that change is indeed possible. For example: ‘Getting my finances under control would help me sleep so much better at night.’”

To facilitate the process, Dunkle might ask someone who is money avoidant an open-ended question such as, “What is that like for you, seeing those unopened credit card statements pile up on your desk?”

For someone whose script is money worship, she might make an affirming observation such as, “It sounds as though working 70 hours a week in order to earn more income is really starting to get to you. It’s no wonder that you feel worn out.”

With a money status case, Dunkle says she could listen and reflect back by stating, “What I hear you saying is that you believe that your value in the family comes from showing your relatives how much you earn and how much you own, not from who you are as a person.”

For a client whose script is money vigilance, she might observe and summarize with a statement such as, “Wow, it sounds as though you feel exhausted, thinking that you need to check your accounts every night before you can relax and go to sleep.”

Haines also uses the KMSI as one of her tools for uncovering the narratives that drive clients’ financial behaviors. She breaks down narratives into thoughts about skills or situations and core beliefs about worth.

“Step one for both is to become aware of those narratives,” Haines says. “This can be difficult because they run so quickly in the background that we often don’t even know they are informing our behavior. Slowing down and becoming curious about our own thoughts and beliefs can be difficult, but [it] is a necessary first step.”

Haines asks clients to write down their thoughts — which she reminds them are not facts. When reviewing their collection of thoughts and beliefs with them, she asks clients to consider the following questions:

  • “What leads me to believe this is true? Is it from my own personal experience or maybe from some other influential person in my life who has told me this?”
  • “Is it always true? Is there evidence to the contrary?”
  • “If I can’t see evidence of it being true, can I hold the possibility that it’s not true?”
  • “If there is evidence of it not being true, how are those instances different, and how can I intentionally bring more of that?”

For example, many clients believe that they will never be able to manage money, Haines says. “I would ask, ‘What leads you to believe this is true? Are there instances where you have made good financial decisions that align with your values and what you want? What was different about those times? What prevents you from doing more of that? Are there skills that you need to learn? Do you need to ask for help? Is there fear involved?’”

“Once we go deep into the genesis and meaning of the narrative, it can go in any direction,” Haines says.

When a client’s narrative is about worthiness or “deserving” something (such as money or a higher paying job), Haines uses a similar, but less structured, process. “I usually ask those clients to slow down, take a few breaths, close their eyes and ask internally, ‘Whose voice is this?’ Is it yours, or is it someone else’s?” Haines notes that it is almost always someone else’s voice, such as a parent or caregiver or another figure who holds meaning for the client into adulthood.

“We then will unpack whatever comes up,” she says. “I might suggest that those who gave [the client] the message of unworthiness around something — either directly or indirectly — were struggling with their own sense of self and meaning in the world and [it] has absolutely nothing to do with my client.”

“I often will use the visual of newborns in a hospital nursery,” Haines continues. “Are some of those newborns born worthy and others unworthy? This helps them to see that feeling unworthy of something is just an internal narrative, not an absolute truth. I might ask, ‘What will it take for you to feel worthy? How will you know when you are worthy? Think of someone you care deeply about. Now decide when and what they are worthy of.’ That usually feels really uncomfortable for them [the client]. Then I reflect back that’s exactly what they are doing to themselves.”

Haines adds another common belief about money and success is that people who are rich are greedy and achieved that higher position because they didn’t care what they had to do to get there. “In essence, not having integrity,” she continues. “I have seen this a lot. An individual feels strongly about honesty, integrity and not being greedy. They want to succeed, but the people in the positions they want don’t seem to personify integrity. So, the position is out of alignment with their values, and their behavior will not support moving up. We then work on how they can create their own visual of how to be in that position from a place that aligns with their own values.”

Where does the money go?

Overspending is a problem that financial therapists see frequently. Clients show up at Haines’ office wondering why they are always in debt despite making an adequate salary. She helps clients identify what kinds of things they are purchasing and why.

“I’ve had clients who wanted to participate in getting together with friends, perhaps for dinner and drinks, concerts, plays, etc.,” Haines says. “They couldn’t really afford to do these things, but as humans, our need for belonging is so strong that we will do almost anything to fit in. I try to help my clients identify what they get out of these activities. It may be good conversation, advice, laughing together, intellectual stimulation or just not feeling lonely. We then brainstorm other ways to get these needs met, but without having to spend money they don’t have.”

“For instance,” she continues, “instead of expensive dinners, they could meet for coffee and have the same connection and conversation without the cost. If it’s intellectual conversation, maybe starting a book club. One idea that came up was to meet at a park and bring a lunch. The atmosphere is better than a restaurant, and it doesn’t cost anything.”

A possible downside is if the clients’ friends don’t want to make those changes. Then comes the difficult decision of whether the client will commit to living within their means and risk losing the relationship(s) or continue to overspend and remain in the safety of the relationship. This adds another layer of exploration about whether those relationships are, in fact, healthy and reciprocal, Haines says, but the overarching theme remains identifying what those dinners or other expensive activities are providing to clients and how some of those needs might be met in other ways.

“I will add that knowing and having a visual of the ‘why’ [the necessity] of changing financial behavior is always present,” Haines says. “Coming back to that assists with getting over the hurdles of change.”

“Keeping up with the Joneses” is another common spending impetus. Society encourages competition, such as having a nice car just because “everyone else” drives a nice car. But Haines asks clients if that really fits their core values.

“If you value a nice car and if you have one, that’s great, but if you buy a nice car because everyone in the neighborhood has a nice car, that’s going to create turmoil,” she says. For Haines, financial therapy is all about helping clients achieve what they want, not what other people think they should want.

ACA member Edward Kizer, an LPC whose specialties include financial therapy, says many of his clients are aware that they are engaging in compulsive shopping as a method of self-soothing or self-care. He teaches them simple techniques such as belly breathing to reduce their anxiety and also asks clients to think about what shopping gives them.

“If I’m expressing a need through retail therapy, what is that, and how can I feed that?” he asks. “What feeds you? Is it being creative? Is it the outdoors? How do [you] get back to nurturing yourself?”

Impulsivity is a significant driving factor in compulsive spending, says licensed professional clinical counselor Denise Kautzer, who is also a certified public accountant and specializes in financial therapy. She has clients track their spending and encourages them to follow the “24-hour rule,” which involves waiting for 24 hours after seeing something that they want to buy. In the end, they may still end up purchasing the item after giving it more consideration, but adopting this approach cuts down on impulse buys, she says. In addition, because spending often makes people feel good, at least temporarily, Kautzer helps clients identify other things that bring them joy.

Seeing the whole picture

Clients can’t manage their money if they don’t know where it’s going — or where it’s needed. Part of the financial therapy process is identifying expenses and assets: money in and money out.

Brian Farr, an LPC in Portland, Oregon, whose specialties include financial therapy, introduces what he calls a “snapshot” in the first session. “It’s a simple expenses and income and debt worksheet, not a budget or spending plan. Just a snapshot of what a typical month looks like,” he says. “It’s to help introduce them to the reality of their household finances.” Farr’s clients tell him this exercise helps give them clarity and motivation.

Like the other financial therapists Counseling Today spoke to for this article, Farr does not see himself or offer himself to clients as a financial planner. Instead, he helps clients understand their finances and develop a system to help them meet their goals.

“The freedom around money is coming up with some method that makes it visible,” Farr says. Once clients have that picture, he helps them be realistic about what they can and cannot do. That involves identifying how much money comes in and then giving each dollar a “job.”

He finds the youneedabudget.com website useful because it offers helpful videos and allows people to categorize not just their everyday expenses, but also infrequent but large expenses such as holiday gifts, a pet’s yearly checkup at the vet or car maintenance. Clients can then look at the money coming in and evaluate where it needs to go.

“If 60% already has a job to do, stop thinking that it’s yours to do with what you want,” Farr tells clients. He advises them that when they know how much of their money is discretionary, then they can make more realistic choices.

Asking clients about financial health

Many counselors don’t like asking about money. In fact, several of the professionals interviewed for this article noted that counselors often fall under the “avoidant” category when it comes to money scripts. But financial therapists say that it’s essential for counselors to be aware of money stress.

“We all have money stress,” Haines says. “I don’t know a person who doesn’t have money stress at some point in their lives. … It affects everybody.”

Counselors need not create an elaborate process to uncover a client’s money worries, Haines says. “It could be as simple as putting a question on your intake form such as: Are there financial concerns that are impacting you?”

Haines also urges counselors to listen for nuggets of information, such as clients mentioning that they hate opening their mailbox because it’s always full of bills. “You can just ask the question, ‘What impact does that have on you?’” she says. Money troubles are something that most people don’t talk about, even with their friends, so counselors can serve as that trusted person clients share those fears with, Haines emphasizes.

Haines and Kautzer both say that one of the most critical parts of their work as financial therapists is giving people hope.

 

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Laurie Meyers is a senior writer for Counseling Today. Contact her at lmeyers@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.