Tag Archives: therapeutic alliance

Navigating white privilege in the counseling room

By Scott Gleeson September 8, 2023

older white man sitting at a table with a laptop and coffee cup, looking out the window

OPOLJA/Shutterstock.com

DeVona Alleyne, a licensed professional counselor (LPC) at Millennium Counseling Center in Chicago, says people of color who seek counseling services face a particular reality — the likelihood that the therapist sitting across from them will be white.

“The numbers are obvious,” Alleyne says. “There are far more white therapists than there are [nonwhite] therapists. So many clients would love to be seen by someone who looks like them, but unfortunately, that’s just not always possible.”

That stark reality puts the onus on white clinicians to own their white privilege. That ethical duty can be laced with hidden challenges if white therapists aren’t regularly building their self-awareness through reflection or assessing racial dynamics in supervision.

Alleyne knows firsthand that an unaware white clinician can induce emotional harm. Sitting in the client’s chair as a Black woman, she has experienced both subtle and not-so-subtle microaggressions with previous therapists.

“Most of my therapists have been white guys,” says Alleyne, an American Counseling Association member. “One therapist kept praising me as a high achiever, as if I were some sort of anomaly, not realizing that he unconsciously was having an idea of how I should present as a Black woman. And then I had a therapist tell me I should slow down and not do all these things I’m doing. But even that statement is in ignorance because he’s got to understand that I have to do these things to be seen as competent. I had to say, ‘I can’t do that. I’m Black.’ He said, ‘I never thought about your race.’ I said, ‘That’s a problem because you need to.’”

Sadly, clients often won’t broach their discomfort with an offending counselor, leading to a fractured alliance or distrust in the therapeutic process as a whole.

That’s concerning for Kyle Goodwin, a licensed clinical professional counselor (LCPC) in Aurora, Illinois, who wrote his dissertation at Northern Illinois University on “Christianity and mental health counseling: Voices of the Black-Negro American experience.” Goodwin’s research outlines how African Americans have long turned to religion over therapy. The data illuminates the essentialness of white therapists doing their due diligence to understand their privilege because of the walls that have to come down for some marginalized clients to seek counseling in the first place.

“It all starts with the education white therapists receive, but then it doesn’t stop there,” says Goodwin, an ACA member. “There’s got to be a lot of self-reflecting, and that’s all before even stepping into session. A white therapist has to be able to say, ‘Hey, I have some biases or prejudices that I didn’t even know existed.’ That doesn’t mean you’re a racist, but you’re prone to show up in a discriminatory manner. Being able to take constructive criticism and see knowledge gaps [in supervision] is important to avoid perpetuating toxic whiteness in counseling spaces.”

Naming the elephant in the room

George McMahon, a clinical associate professor in the Department of Counseling and Human Development Services at the University of Georgia, says one of the primary concepts he teaches master ’s students is the importance of white clinicians broaching and naming their whiteness early in sessions.

“As a straight, white male myself, it’s hard to imagine me being an effective counselor without considering and naming the racial dynamics when working with a marginalized client,” McMahon says. “It’s very important that a counselor states it explicitly first, without waiting for the client to bring it up. … By broaching, you’re letting folks know, ‘It’s OK to talk about this, and I’m aware of my own privilege.’”

Alleyne concurs, saying that as a client, she felt her walls come down as soon as her white therapist mentioned her race.

“My therapist who I see now asked me something like, ‘Do you think they were treating you that way because you’re Black?’ I thought to myself, ‘Oh, you really see me, huh?’ Then I felt like I could stop coding and start saying Black stuff. I stopped wearing makeup and no longer had to be performing in a white world,” she recalls.

McMahon says many white therapists walk on eggshells or wallow in guilt because of the harm that the white world has caused clients. But he believes these therapists have a unique opportunity to offer a corrective emotional experience on a micro level.

“When a client is around a therapist who they think wouldn’t understand them outside of counseling and then they do understand them, it can lead to the client feeling seen in a unique and healing way,” McMahon explains. “When you’re broaching, you can show the client that you’re always trying to be aware of your privilege by stopping a conversation to make sure they feel like they’re being heard. That humility can help to build a therapeutic relationship quicker. But broaching isn’t just a one-time thing.”

Kristin Miserocchi, a staff psychologist and groups coordinator at Washington University in St. Louis, wrote her dissertation at the University of Kentucky on the effect of therapists’ white privilege attitudes on client outcomes and the therapist-client relationship. She says broaching isn’t just about naming race; it’s about acknowledging how the macro world — outside the therapy arena — has benefited the white therapist and potentially harmed or disenfranchised the marginalized client.

“It’s most important for white therapists to know that they can live their whole life oblivious to their privilege,” says Miserocchi, an ACA member. “I’m a white person, and so it’s a privilege for me to walk around the world thinking … that I don’t have it better than anyone else and that everyone has the same experience I do. That way of thinking alone can be an enormous knowledge gap and lead to invalidating a vulnerable client.”

“I do try to call that notion out,” she continues. “I work at a university where a lot of times clients will ask for a clinician who matches them racially or ethnically. That’s because that matching represents safety. Knowing that, it’s important to state my awareness … [that] I’ve had experiences you’ve never had and even ask if this could be a potential barrier for us. This shows that I have empathy, but [I explain] why I’m stating it so that it doesn’t feel like it’s all about the differences between us.”

Katherine Atkins, an LPC and clinical training director at Northwestern University, says various barriers can stand between white clinicians broaching their privilege with clients from marginalized groups.

“It’s undoubtedly the elephant in the room that needs to be addressed. When I was in my master’s [program] in 2003, there wasn’t even a multicultural course at the time,” says Atkins, an ACA member. “I vividly remember going into practicum being supervised behind a two-way mirror and told to call this stuff out. I didn’t know how to navigate those conversations because I was colorblind and hadn’t engaged in deeper self-reflection about how I see the world.”

Atkins says her personal life — she is in a biracial marriage and has a biracial daughter — has deepened her empathy and broadened her worldview in ways that classes never could.

“For a while, my go-to in talking with my husband was believing that everyone isn’t aware and they’re not intending to do harm,” Atkins explains. “That’s a privilege that I can see from that lens. The same thing happens in classes I teach or oversee, where students try to justify their stance. That’s damaging to ignore history, to not speak about the truth that’s occurred in our society. Broaching is about regularly checking in with the client and regularly checking in with yourself.”

Understanding white fragility

Robin DiAngelo coined the term “white fragility” in 2011 to describe discomfort by a white person when confronted by information about racial inequality. She further outlined its meaning in her 2018 book, White Fragility: Why It’s So Hard for White People to Talk About Racism. Among the key takeaways from the book is the notion that white people can immediately become defensive at the suggestion of racism or privilege.

Melanie Lindell, a licensed mental health counselor in Seattle, says she had to face her own white privilege when she moved to a predominantly African American neighborhood nearly three decades ago. Initially, she downplayed her level of privilege, reasoning that she had her own trauma background. But then she took the time to distinguish between her micro suffering and the macro trauma that has caused widespread pain to people of color.

“For white therapists, that initial defensiveness when someone … calls out your privilege isn’t necessarily the problem. It’s only wrong if you stop there and don’t do anything about it,” Lindell says. “Your defensiveness as a white therapist is more like a traffic light. It reveals something. It’s what you do with it next that matters.”

“There’s always room to say, ‘I’ve benefited from cultural racism, and I’ve had a leg up.’ That doesn’t take away from my trauma or experience. And it doesn’t need to be a shame spiral,” she adds.

McMahon says that sense of shame can initially be piercing for white clinicians because it is associated with a distinct feeling of failure.

“Counselors are particularly prone to white fragility because they get into this field wanting to be helpful and believe they’re good people who set out to make a difference,” McMahon says. “It goes against their identity if they’re confronted with this idea that doesn’t fit with how they see themselves. In other words, we’re prone to fragility because we care too much. It goes to the point of privilege is unearned. We didn’t do anything to create it, and there doesn’t need to be guilt attached to it. But it becomes a responsibility, particularly in counseling, to be part of a process to always be aware that oppression and power dynamics exist.”

Miserocchi says she has learned to lead with empathy as a way to mitigate her own defensive feelings that she believes are meant to be ironed out in supervision.

“We all want to help people, so when we hurt people instead, it’s the opposite of what we want to do,” Miserocchi says. “As vulnerable as I am learning that I hurt someone, it’s not nearly as vulnerable as a person who was hurt. It’s so important that I take ownership for any hurt I may have caused as a therapist. The fact that a client or supervisor is letting me know is generous of them. It goes a long way toward repairing those ruptures.”

Doing the work

Andrea Stiles, an LCPC at Klutch & Well in Chicago, says before white therapists can name the racial dynamics in a counseling room and build toward competency, they must find their own state of acceptance about their privilege.

“As an educator, supervisor and therapist, one of the things I see from someone struggling to manage their white privilege is an unwillingness to name their whiteness, not just in the room for the benefit of the client, but within themselves,” Stiles says. “When a clinician denies whiteness, for whatever reason, they’re denying what it means in the outside world and the type of impact it could have had on a particular client. That doesn’t just affect the counselor-client dynamic, it affects perception of a client for a diagnosis and a treatment plan.”

Stiles has often heard white colleagues in the field speak of their multicultural competency as if they’ve completed their training and are now equipped to treat clients from other cultures. Of course, it’s not that simple.

“In so many textbooks, it’s stressed that practicing multicultural competency is a lifelong journey. There’s no finish line,” says Stiles, an ACA member. “When therapists feel like they’re not done with something, that can be scary, but you’re missing the mark if you go into this work thinking awareness isn’t always ongoing. This goes beyond the white-Black dynamics too. This rings true for Muslims, Arabs and Jewish people. We should never stop trying to be attuned to a client’s culture.”

Goodwin views managing white privilege with clients as more of a responsibility or purpose than a form of progression.

“You’re not climbing a ladder of awareness about your whiteness,” Goodwin says. “I personally don’t believe in the term ‘multicultural competency.’ I believe in cultural sensitivity because competency insinuates that there’s this level to understand people of color. That ladder doesn’t exist. Culture is forever changing, and competency is a skill versus sensitivity, which is regularly and continuously choosing to set your power aside as a therapist. The reality is it would be a privilege for a white therapist to choose to not understand clients of color.”

Goodwin says an example of the need for white clinicians to regularly practice sensitivity comes with current events that traumatize marginalized clients on a macro scale, such as repeated news of police brutality toward people of color.

“I think the role of the white clinician is to acknowledge what’s happening in the world,” Goodwin says. “You don’t move forward unless you address it.”

Stiles says supervision plays a major role in holding white therapists accountable to regularly understand their privilege. Therefore, it’s essential for white supervisors to be comfortable bringing up racial dynamics with newer therapists.

“A lot of times what I’ll ask my class is, ‘Can you conceptualize this case from a culturally specific lens?’ It starts with the supervisor to help a therapist know that framework is necessary to cater treatment to a client’s culture,” Stiles says. “White supervisors have to acknowledge and lean into these things with inexperienced clinicians early on in development.”

One red flag Goodwin has noticed in supervisory sessions and other experiences is an unfair weight being placed on therapists from marginalized groups to educate white colleagues about privilege. “It’s not a person of color’s job to teach a white therapist about their community,” Goodwin stresses.

Alleyne says white clinicians in the field will often ask her what they can do to better immerse themselves in cultural awareness. She says as a Black client, she feels more emotionally held by a white clinician who doesn’t pretend to understand but also isn’t afraid to state what’s real in the world.

“I tell my white colleagues to start by noticing people of color in [their] orbit and try to engage,” Alleyne says. “Don’t just read about us in books that are written by white people. … No person of color in my opinion wants to hear, ‘I could never understand your experience.’ Well, duh. But state your awareness of discrimination that exists out there. Say, ‘Sorry you’re experiencing that.’ Because remember, Black people in particular are taught not to be angry or let those emotions out.”

Scott Gleeson is a licensed clinical professional counselor in the Chicago suburbs, specializing in trauma and relational dynamics. He spent over a decade writing for USA Today, where he won national writing awards from the Associated Press and NLGJA: The Association of LGBTQ+ Journalists. He’s collaborating on a book about fighting cancer with legendary broadcaster Dick Vitale, which is set to hit bookshelves in March 2024. His debut young adult fiction novel, The Walls of Color, comes out the following year.

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.

Cultivating patience in counselors

By Joanna Mercuri August 22, 2023

A woman stretched out on a sofa with a therapist; the woman is smiling

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Maia moved to New York City during college to pursue her dream of working in journalism. At 24, she had already found success in her nascent career, landing a coveted internship and then a job at a major news network. She was bright, introspective and candid, and she was my second client ever. (Maia’s name and identifying details have been changed to protect confidentiality.)

Maia sought counseling for bulimia, which she developed as a teenager, at the training institute where I was a counseling intern. Her eating disorder had waxed and waned over the years, but it had become significantly worse three years earlier in the context of an abusive relationship. Although this relationship had ended, the trauma continued to haunt her. When she started counseling, she was motivated to put bulimia behind her; she had already gone 30 days without bingeing or purging. She also wanted to stop drinking because it often triggered bulimic behaviors. But most of all, Maia wanted to reclaim her sense of self after being with a man she said “broke her mind.”

At first, Maia’s candidness came as a relief. As a novice counselor, I was still apprehensive about silence in the therapy room; I feared it would appear as if I didn’t know what to ask or do next, which in fact was usually the truth. My supervisor often urged me to practice patience with my clients. She noted I tended to fill silences with concrete coping skills (e.g., “Have you tried deep breathing?” “Do you know the 5-4-3-2-1 technique?” “Let’s talk about distress tolerance.”) or multiple-choice questions about what a client might be feeling, rather than asking short, open-ended questions that encouraged them to unearth their own insights.

“Don’t rush in and try to fix things,” my supervisor advised. “Listen and try to understand.”

Don’t rush to fix

My first session with Maia went well — perhaps too well. She was forthcoming about her bulimia, alcohol use and trauma, but then she canceled her appointment the following week. I wondered if we had approached too much too soon. Over time, this scenario became a pattern for us. Maia would come to a session, speak honestly and openly about all that she had been feeling and reflecting on during the week — practically purging her feelings in the room — only to cancel her next session as well as any makeup session we attempted to schedule. Her cancellations were so frustratingly consistent that it was a happy surprise when she did come to a session.

On the evening of our fourth session — which by then was supposed to have been our seventh — I planned to broach the topic of her cancellations. I intended to explore them in a way that I hoped would elicit any apprehension or ambivalence about therapy without shaming her for the frequent absences. She already carried plenty of shame without adding therapy itself to that burden. When she sat down, however, she was visibly upset. Over the weekend, she had gone to a bar with her co-workers and drank until she almost blacked out. She regretted breaking her promise to herself to stay sober, and in her disinhibited state, Maia confessed romantic feelings to a female co-worker. When Maia disclosed this part of the story, she began to sob. For years she had been questioning her sexuality but never revealed this to anyone. She had been terrified to acknowledge this piece of herself. What would it mean for her going forward? What would her religiously conservative Midwestern parents think?

In the span of 45 minutes, Maia revealed one of the most hidden pieces of herself, leading us to have an open and honest conversation about her sexual identity. At the end of our session, she agreed to attend an Alcoholics Anonymous meeting and was excited to continue this conversation. I asked what we could do to help ensure she kept coming to therapy. She assured me that she would make therapy a priority because she realized how much relief it brought her and how much she needed to talk about these things.

When she walked out the door and I sat down to write my notes, I was full of energy. Although I was pained by the distress this secret caused her, I was also humbled that this young woman felt safe enough to confide in me. This session with Maia gave me the sense that we were on the precipice of something important. I thought, “She is intelligent, motivated and dynamic, and she is willing to take concrete steps to achieve her goals. Maybe I will witness the beginning of real change in this person.”

But an hour before our next session, I received a familiar call. Maia wasn’t going to make it. We rescheduled for later in the week, but she canceled that session as well. I was deflated. Had the revelation been too much? Should I have seen this coming? Could I have done something more to mitigate the aftermath of such a session?

Two weeks later, Maia made it to another session and confirmed some of my suspicions. The session had been too much for her, and she had become depressed and overwhelmed and didn’t feel like coming to therapy. She admitted that she usually dives into problems — as she had done in previous sessions — but revealing her queerness had not had the same effect. She told me she needed to proceed more slowly and create a safe space for herself. My heart sank when I realized that this was precisely what we had neglected to do in therapy. From the start, Maia shared her most searing vulnerabilities in sessions. And eager to help, I let her.

In this moment, I recalled how one of my graduate professors had compared therapists to a mountain guide. We can steer clients toward more gently sloping paths and offer reasonable expectations about what may be approaching. We can even remind them to stop and take a breath. Although we cannot make the climb less difficult, we can help grant safe passage. If I was going to help Maia make the long trek toward recovery, we were going to have to put some guardrails in place. Otherwise, therapy would leave Maia feeling as painfully exposed as all her other attempted coping mechanisms.

Unfortunately, I did not get the chance to acknowledge my mistake and repair the therapeutic relationship with Maia. After one more no-show, she wrote to say that she was grateful for the opportunity to begin thinking about these issues, but she had too much going on at work to commit to therapy.

Growth takes time

Both new and seasoned counselors know the discomfort of sitting with a client’s pain while feeling powerless to intervene. My own feelings of incompetence as a new counselor will often creep in, compounding the problem. At 30 years old, I have accumulated multiple rounds of professional and educational beginnings: acclimating to life away from home as an undergraduate, starting my first “real” job as a reporter in Scranton and working in a public relations office where I pretended I knew what my editor was talking about when he asked me to do a “prewrite.”

Now, here I am again, starting over in a new career as a counselor. I feel the anxiety and confusion that often comes when starting a new position and learning new skills. But unlike previous jobs, I do not get to endure these growing pains from the privacy of a cubicle; my supervisors, instructors and clients all witness my naivete.

In Learning From Experience: A Guidebook for Clinicians, Marilyn Charles explains how anxiety compels us to tether ourselves to something familiar and knowable, such as behavioral techniques, coping skills or clever interpretations. These impulses, while often well-intentioned, can be unhelpful to clients. “Our need to find anchors — and signposts to guide our way — can make us jump too quickly on ‘meanings’ as saturated elements that leave little room for growth,” she writes.

It is tempting to forge connections and meanings for clients to provide immediate relief and illustrate our empathy and understanding. But if we truly want to help our clients, we must first be fully present so that we can develop an understanding of their world as they experience it.

I have learned alongside my clients that deep, intrapersonal change cannot be rushed. Change can be frightening, even when we are the ones initiating it. We are leaving behind the familiar with no guarantee that we will arrive somewhere better. Maia did not know — could not know — whether processing her trauma or reckoning with her sexual identity would bring her more solace than what bulimia and alcohol offered, albeit temporarily. Likewise, I have no idea whether enduring the growing pains of becoming a therapist will ultimately bring personal meaning and professional satisfaction. What is familiar may be unfulfilling or outright painful, but at least we know what we are getting.

Working with Maia showed me that what matters is building safety into the change process. We can help clients become familiar with signs of distress and overwhelm in their body and learn to view these signs as an invitation to slow down or pause and return to a calmer, more regulated state. I also learned the value of being patient. Both counselors and clients need to allow themselves time to adjust to new surroundings or situations. With each small adjustment, we gain confidence in our ability to cope, which in turn gives us the courage to press on.

I no longer rush to fill silences when working with clients. I have learned to slow down, and I teach my clients the therapeutic value of being patient with themselves and counseling. I continue to learn, along with my clients, how to become mindful of distress and overwhelm, give myself permission to slow down or take a break and, most of all, manage expectations about the meandering and often lengthy nature of deep change.

Growth takes time, no matter how much we want it to happen. Trusting that what we are doing now will pay off in the future can be difficult. The best thing we can do is cultivate patience with ourselves and remember, “Don’t rush in and fix. Listen and try to understand.”

Joanna Mercuri is a license-eligible professional counselor in northeast Pennsylvania who specializes in eating disorders and the intersection of religion and spirituality and mental health. She holds a master’s degree in pastoral mental health counseling from Fordham University and a certificate in the integrated treatment of eating disorders from the Center for the Study of Anorexia and Bulimia in New York. Contact her at joanna.mercuri@gmail.com.

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

Building rapport with clients experiencing psychosis

By Tina C. Lott April 13, 2023

a person looks off to the side with her hand over her mouth and the other by her head; another person sits across from them with a notepad

Ground Picture/Shutterstock.com

When discussing working with clients experiencing active psychosis, I once had a counseling student ask me, “Dr. Lott, what’s the point of trying to build a relationship with a client who isn’t even sure they are on the same planet as me? I mean, does it really matter at that point if I get to know them?” Taken aback, I responded, “If this client were your loved one, would you still have this question?” This exchange helped the student realize the importance of seeing clients from a place of compassion, no matter their symptoms, but it also made me wonder how often other students and counselors have pondered this same question.

In a traditional counseling session, building rapport is one of the most important tasks that the therapist will have. Rapport building helps the client feel welcomed, heard, seen and validated and helps improve the therapeutic process. In addition, research supports the notion that the counselor-client therapeutic alliance has a significant impact on treatment outcomes. Thus, regardless of the issues clients bring to session, the relationship bonding between the therapist and the client is essential.

But what about clients who are actively experiencing psychosis? Should therapists take the same time and effort to build a relationship with them? The straightforward answer is a resounding yes, but unfortunately, many clinicians do not always intentionally practice this.

Research studies indicate that counselors agree on the importance of rapport building with this population. So, if counselors know that this is important, then why do some struggle with this when it comes to working with individuals diagnosed with active psychosis? Nearly all the supervisees I have worked with have told me that they initially had a difficult time building rapport with clients experiencing psychosis. Because this process can be challenging and unique for clients with severe mental illnesses, I offer insights from my own experiences on why building rapport is important for this population and effective strategies on how to do it.

The need for rapport building

Throughout my research and work with the mental health community, I have noticed many articles implying that individuals living with severe mental illnesses are violent or dangerous and that caution should be taken when working with this group. Some articles talked about the importance of managing a hostile environment and being aware of exit doors and ways to call for help should things escalate. Although this is possible in some cases, hostility and danger have not been my experience when working with this population, and I have worked with some of the most severe forms of psychosis. In most cases, I have not felt threatened or on edge when working with this population. This sort of thinking is more prevalent due to the stigma associated with severe mental illness. I have found that people are often afraid of what they do not understand, and therefore those with severe mental illnesses are often ostracized, discriminated against and stereotyped.

During my 11 years working with clients experiencing severe mental illnesses, I have found that my rapport with clients supports them in treatment by helping them adhere to medication (when applicable and desired) and engage in services specifically designed to help reduce symptomatology. Clients who are experiencing active psychosis are likely to be skeptical of anyone outside of their world. Some symptoms, such as paranoia and severe anxiety, may have convinced them that others, especially mental health professionals, do not have their best interests in mind. Often, their reasons for suspicion and skepticism are warranted. Many clients with severe mental illnesses have had negative and often traumatic experiences with the counseling profession due to well-intentioned but poorly trained or unaware clinicians. Therefore, the odds are against us when it comes to building the therapeutic alliance.

Even though it is challenging, I’ve found that building a therapeutic alliance with this population is one of the most effective interventions counselors can implement. In addition, it can be a positive interaction that counters any potential negative mental health experiences clients have had in the past. It is safe to say that regardless of whether a client is experiencing active psychosis, having someone that they trust is always helpful when it comes to the treatment plan, emotional and psychological commitment, and their overall well-being. And for clients with severe mental illnesses, it is a necessity.

There are many benefits to creating a strong therapeutic alliance, but here are three main reasons why rapport building is important for clients with severe mental illnesses:

Trust creates relationships and relationships can lead to progress. A client’s trust in their mental health professional provides an opportunity for the client to receive care. No matter how severe one’s psychosis may present, trust is important when it comes to adherence. If a client does not trust their team, they are less likely to engage in the services offered to them. Clients need to know that mental health professionals have their best interests in mind and that the goal of counseling is to help them find relief from the symptoms that may have caused them to seek or receive treatment. Building a trusting relationship with just one mental health professional can help clients de-escalate when they are in a state of crisis, assist with medication and therapy adherence, and encourage the client to be an active change agent when addressing collaborative treatment plan goals.
A sense of connection and belonging can build community. Those with severe mental illnesses often feel alone and misunderstood, which can cause them to self-isolate. Research has shown that people diagnosed with severe mental illnesses tend to connect with others who have severe mental illnesses because they do not feel a sense of belonging with people who do not have similar diagnoses. According to Patrick Corrigan, the program director of the Honest, Open, Proud program (which aims to reduce the self-stigma associated with mental illness), one of the best ways to understand people with severe mental illnesses is by forming connections, having conversations and engaging in shared activities with them. Counselors can establish a healthy connection with this population by engaging in the client’s community as an observer, remaining curious by asking questions, dispelling biases and stereotypes, and working with the client in a benevolent and nonjudgmental way. When counselors approach clients from this perspective, clients are more willing to allow the counselor in, which helps foster an authentic relationship and a sense of community.
A strong rapport positively affects treatment outcomes. In the first edition of his book The Basics of Psychotherapy: An Introduction to Theory and Practice, Bruce Wampold said the therapeutic alliance is one of the most important aspects of the counseling process and it often leads to favorable outcomes. This continues to be true today. Wampold stressed that the stronger the alliance early on, the better the outcome. The trust developed between the counselor and the client is a sacred and unique connection that happens within the counseling session, and it creates a safe place for the client to express their inner thoughts without judgment. For some clients, it may be the first time they have experienced a healthy relationship. Individuals with severe mental illnesses have most likely felt betrayed by the mental health system and are therefore reluctant to share how they truly feel. For example, a client once told me that he did not want to share how he felt because he feared he would be hospitalized or punished. After taking the time to reassure the client that I was there to listen and support him, he started to share his true emotions. Gaining the client’s trust could help uncover many other symptoms that get in the way of the client living their optimal life. Lessening of the severity of symptoms and connecting the client to the appropriate resources, in turn, can reduce their need for mental health services and address symptoms that may have led to hospitalization in the past. In other words, the bond formed between the counselor and client has the potential to decrease the cyclical impact of overutilized mental health services because clients are listened to and validated.

Strategies for building rapport

I think that depending on the environment, the culture of the clients you are working with and the clinician’s skill set, there are many ways to connect with clients with severe mental illnesses, including those experiencing psychosis. In my extensive work with this group, I have found that the following strategies work exceptionally well.

Get on the same page as your client. The counselor and the client should always work collaboratively toward the client’s stated goals. Frequent check-ins to make sure that the goal has not changed are important when it comes to assessing progress. When counselors make goals for the client as opposed to with the client, a therapeutic disruption occurs, resulting in the client not being an informed and active change agent toward their goals.

When working with psychosis, establishing a common goal may require the counselor to be more flexible and creative in their approach. For instance, I worked with a client who heard voices and her main goal was to stop her voices from disrupting her while she studied. Of course, I could not guarantee that she would achieve this goal, but what I could do was offer ways in which the client could learn to tolerate the voices so that she could still study. So we adjusted the therapeutic goal to focus on learning coping strategies to distract her from the voices.

Counselors have the responsibility to make sure that treatment is geared toward the client’s benefit, wellness and preferences. When this alliance is in place, treatment outcomes can improve.

Stop talking and listen. One of the most effective interventions for working with any client, especially those who are experiencing psychosis, is to listen to the message that the client is trying to convey. When working with psychosis, there is some truth in even the most delusional of statements. I once worked on a psychiatric unit and had a client who believed that the devil lived in his rectum. Most of the mental health providers that he had encountered before me dismissed this statement, often attributing it to his psychosis. When I did my assessment of him, I asked more questions about this “devil.” I asked what it looked like and why it might have chosen to live in his body. Although his response was tangential and disorganized, I learned that this “devil” was really the client’s way of telling us he had been sexually abused. This “devil” was a result of trauma. It represented one of the most detrimental moments in his childhood. Had others mental health professionals listened and been more patient, it is possible that his trauma could have been addressed much sooner.

Hold back your urge to assess and evaluate. Over the years, the agenda in the counseling profession has been clear: Diagnose and then move the client through the treatment process. So it has become second nature for clinicians to walk into a session, assess a client, assign a diagnosis for billing purposes and move on to the next client.

The problem is that clients can see right through this. They can tell when there is an agenda or when they are a part of this system. Clients come to the session to feel heard and validated. They do not want to be a part of the “mental health assembly line.” Clients who have had a long history of being a part of the mental health system often feel like just a number or another item to cross off a counselor’s checklist. This has decreased their trust in the mental health profession. In addition, it has made clients not want to disclose and tell their stories because they are in the room with yet another entity who will write it all down, not thoroughly address what was shared, and then move them through therapy without ever really addressing the core issues or providing resources for dealing with what they shared.

Clients are constantly asked to be vulnerable and do not always get what they need in return. Clients with severe mental illnesses have often experienced significant trauma in their attempts to address their mental health needs, so having a counselor who is curious, welcoming and nonjudgmental can create for a strong foundation for a therapeutic alliance. Diagnosing is necessary, but it does not have to come before a therapeutic relationship is built.

Do not argue with delusions; they are a symptom of something bigger. When working with clients who experience symptoms such as delusions or hallucinations, I have seen new and even seasoned counselors get into a power struggle with clients. This never ends well, and it greatly diminishes rapport. Counselors who enter a power struggle often focus on the wrong things in session. This is especially true with clients who present with psychosis. It is human nature to debunk something that seems untrue. When aware, it is even natural to debunk things that are irrational. But this is not ideal in the beginning stages of rapport building. When working to build rapport, telling a client that their delusions and perceptions are not real is like saying you do not want to hear what they have to say. It communicates that you are another person in their life who is not listening to them.

Instead, if counselors focus on the symptoms that are getting in the way of the client’s everyday goals, they could help the client make more progress. For instance, I once worked with a client who believed that people put snakes in her soup. Because of this, the client would not make or eat any soup. Instead of confronting the client and making a case that there were no snakes in her soup, I focused on the foods that she enjoyed eating. Last time I checked, you cannot starve from not having soup as a part of your diet, so I focused my attention on the symptoms that mattered in her day to day and did not spend energy debating about delusions that had no real bearing on her well-being. I have found that when we concentrate on helping clients focus on their personal goals and everyday functioning, some of the psychotic symptoms tend to take a back seat and are less of a disturbance.

In her master’s thesis, “Best practices of building therapeutic alliances with clients living with psychotic disorders” (published by St. Catherine University in 2017), Nicole Rominski expressed similar thoughts when she stressed the importance of focusing less on diagnostic criteria and challenging delusions and more on the distress that the symptoms cause because this is the more significant issue. Doing this does not mean the symptoms go away, but they are less likely to consume the client’s attention, which would be a positive outcome for many clients with psychosis.

Ask how you can assist and do what you can to help. Our main role is to assist, advocate and support the clients that we work with. If you work with clients who are actively experiencing psychosis, you may wonder what they would need to feel supported. That’s a great question, and the client is the person best suited to answer it. Asking a client how you can be of support to them or what you can do to help them can open the doors in two ways. First, the client understands that you want to listen to them and you are there to help them. Second, it helps build trust between you and the client, especially if it is the first time a mental health professional has directly asked them this question. Even if you cannot support them in the exact way they want, you can still listen, provide resources that address their needs and show the client that they matter.

Humanize the experience and share the client’s story with the treatment team. Once you have done the important work of taking time to listen, validate, empower and advocate for your client, share what you have learned with the interdisciplinary team. You have an insider’s view of what the client is experiencing. You have deciphered the hidden messages within the delusions and gotten to the core of the message that the client is trying to share. It is important to make sure that others who will be working with this client know this information as well.

This approach also benefits the client in three ways. First, sharing the client’s story humanizes them and allows their diagnosis to take a back seat to who they are as a person. In other words, we see the person first and not just their diagnosis. This does not mean that symptoms will be ignored and unaddressed; instead, understanding the client in context is crucial to effectively treat their symptoms. Second, sharing this information also helps family, friends, mental health providers and others know how to approach the client, which in turn can help the client feel safe. And it saves the client from having to repeat their story. Third, the treatment plan will be more individualized for the client now that their symptoms can be understood and addressed in context. In turn, health professionals can better understand and target the underlying causes of distress, thereby improving the client’s mental health and well-being.

Conclusion

There are many reasons why it is important to build a trusting bond with our clients. For those with severe mental illnesses, building rapport is the most important step when it comes to seeing positive change and progress. Stigma has exacerbated some of the most harmful myths associated with clients living with severe mental illnesses and has caused significant misunderstandings related to how to establish a rapport and working relationship with them.

I am thankful to the student who bravely asked about the point of trying to build a relationship with a client in active psychosis. Not only did it help me realize how common it is for people to contemplate this question, but it also motivated me to provide some clarity and understanding regarding this population and the challenging work that comes with it. I am grateful to the hundreds of clients I have worked with that have taught me how to remain curious, compassionate and solution focused to address their needs and wants from the counseling profession.

Tina C. Lott holds a doctorate in counselor education and supervision and is a licensed clinical professional counselor, certified alcohol and other drug counselor, national certified counselor, approved clinical supervisor and board-certified telemental health provider. She serves on the board of directors for the National Board for Certified Counselors’ Center for Credentialing & Education, and she is an academic program coordinator and core faculty member at Walden University. She has a YouTube channel specific to addressing stigma and all things mental health. In addition, she is an independently contracted therapist at PATH mental health, a mother of two fantastic kids and wife to her life partner. Contact her at tina.lott@mail.waldenu.edu.

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

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

The loss of our ‘humanness’

By Suzanne A. Whitehead February 24, 2023

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Recently, I needed to undergo some medical tests in a hospital-based clinic. I arrived a few minutes early and was eventually called inside for my tests, which required four separate parts. Immediately, as I put the swaying, open-backed gown on, I began to feel my humanity slowly slipping away. I now looked like all the other patients in similar attire, and I felt the loss of myself as a human being. I started to feel like an “it” to be worked on. I had felt this way previously for other exams and tests — this was just a “refresher.”

I was prepped, injected and told to wait again; my questions went unanswered. Inside myself, I could feel my anxiety starting to well up and get the best of me. I was finally led to another room and told to lie on a table. The table was cold and uncomfortable and hurt my back, and the feeling of somehow being an “it” to be worked on, not a human being any longer, returned. I was told to raise my arms over my head, and the technician quickly left the room.

The overhanging equipment suddenly whirred noisily and began getting closer and closer to my chest and head, increasing my uneasiness. The machine rotated a bit overhead; I couldn’t see around it at all. I suddenly felt claustrophobic and a bit panicky, and finally called out for the technician after several minutes. He answered from an adjoining room and asked what was wrong.

I said I was feeling a bit anxious, asked what this test was for and asked how long it would last. He answered bluntly, “It’s for the tests you’re having.” He then aimed a fan at my head to help “with people like me,” he stated. I immediately felt demoralized again and was told it would be another five minutes under the whirring machine.

I was finally released from the “jaws” of the overhead machine. As I started to rise, I felt dizzy at first, perhaps because I had my arms stretched over my head for several minutes. I was escorted out of the room and sent back to the waiting room, again, alone with my thoughts. (It’s been my experience that human beings do not like a void of information. We try to obtain it the best way we can, and when that fails, we begin to make assumptions, which are often inaccurate. It’s simply what people do and is part of the human condition — if only the medical profession acknowledged that.)

There sat the others, all waiting for their time under the machine. I didn’t dare tell them not to worry, our eyes never meeting. Internally, I felt scared about what the tests could reveal and what else was in store. The same concern seemed etched on the faces of those in that waiting room. I wondered, “What if someone had just taken the time to explain what was happening to us and what we were about to experience?”

Taking time to connect

As I sat there worrying, waiting for my next exam, I began to wonder, “As counselors, do we take time during the essential beginning session to discuss with our clients what counseling is really all about?” Often, clients don’t know what to expect from counseling. Ours is a relatively new profession, and many clients, for example, did not even have counselors in their schools when they were growing up. Or the counselor role was so diminished, they rarely met them in person. Moreover, many schools did not even employ counselors until recently. Are we selling our clients short by taking it for granted that they simply intuitively know what to expect?

My diagnostic testing felt demeaning. With no sense of control, I felt a bit overwhelmed. In the end, I just wanted it all to be over. So, I sullenly complied with every command, didn’t ask more questions and couldn’t wait to leave. The experience — which was more psychologically than physically painful — left me with a bitter taste in my mouth, and I never wanted to return.

The parallels with counseling jumped out at me. Do our clients feel the same sometimes? Is that why many don’t want to return? For instance, according to Joshua Swift and Roger Greenberg, in a meta-analysis published in 2012 in the Journal of Consulting and Clinical Psychology, 1 in 5 clients end psychotherapy prematurely. As counselors, do we spend the necessary time to understand the culture and concerns of our clients, as well as address their fears?

Those special medical technicians who do take the time to develop a human connection first make all the difference in one’s experience. Can we say the same for ourselves as counselors? As human beings, we all crave human connection; it is the very heart of counseling. For the sake of time, are we rushing through this vital aspect of the process?

How we treat our clients

I am reminded of the many times I got extremely busy as an agency clinician and, later, as a school counselor in my own career. I would see the long line waiting at the door of our school counseling offices or sigh a bit when one of my clients finally disclosed that huge revelation they’ve been holding back the last six sessions, with five minutes left in our meeting. My heart would sink as I realized I couldn’t go over the session time because my next client was waiting. During those times, I remembered that as counselors, we are instructed not to get “too close” to our clients for fear of losing our objectivity.

Although being objective is vital to the counseling relationship and the client’s well-being, does it also mean that we must sacrifice their humanity? Sadly, I have worked with some physicians, nurses and respiratory therapists (one of my former professions) who have become cold, distant and indifferent to their patients. They have absorbed the “lesson” about not getting too close to their patients all too well and have become detached when their patients don’t respond well to their interventions or ultimately die. It allows them to not “feel” and to go on with their “routine” activities as if they were working on “machines.” Their patients know, though, and are left feeling demoralized, defeated and not heard — just like I was during my exams.

The ability to have empathy is the cornerstone of being a counselor and a counselor educator. Without this ability, we are doing our clients and students a disservice and, possibly, irreparable harm. To a degree, the ability to have empathy for the “least deserving” of our clients (e.g., individuals who have committed murder, rape or child abuse) is what sets us apart from those who are not counselors by trade. If we reject our clients for the behaviors they have committed, then we too have lost our sense of humanity for them and will judge them, harshly, just as society has.

As counselors, we never have to condone or agree with a behavior that a client has done, but we do have to see them as a human being, deserving of our care, and believe in their willingness and abilities to want to change. If we also reject these clients for the behaviors they have committed, then we have endorsed their beliefs of self-loathing and pity. We reinforce their negative self-beliefs that they are unable to ever heal and that they are undeserving of comfort, compassion and understanding. Arguably, we doom them to repeat their behaviors by our rejection, disdain and judgment. If we don’t believe in this fundamental aspect of counseling — that all persons can change and deserve our respect — then, sadly, it may be time for us to find a new career.

Finding our own balance

Not getting “too close” to our patients or clients is a self-protection mechanism. It is fundamentally a correct premise, but humanely flawed. Finding a balance between objectivity and empathy is the key. Whether we are treating patients or clients, the same premise applies. It is essential to their well-being and, I posit, to yours as well that you find your balance and always reevaluate and assess it. If you feel yourself becoming resentful toward some of your clients, or feel too rushed with them, or feel that you are becoming too preoccupied with the time spent on them, challenge yourself to be proactive to take the internal steps to work on this.

If the system needs changing, find the courage to be the voice for your clients. If working with clients in a group setting makes more sense, initiate that adjustment. If challenging the status quo requires speaking up, do so for the sake of your clients. Remember the basic tenets of your code of ethics — to always advocate for social justice, equity and cultural competence. If you need more training, obtain it. If you need more supervision, don’t be afraid to ask for it. Not only will you be following the ethical principles of self-care and wellness, but your clients will benefit from your self-investment tenfold.

If any of this resonates with you as a clinician, that is a healthy response. Human beings were not designed to be “garbage bags,” to continually just stuff our feelings until we are about to explode. If we do so outwardly, we are accused of just being too angry and emotional; when the implosion is internal, it can lead to deep and unresolved depression. No one wants to feel like they are not being listened to, are not being heard and are simply “taking up another’s time.”

If you can relate to having felt this way during a medical exam or trip to your doctor, then you can relate to what it may feel like being a client and being afraid no one will understand you. Some clients can get past some rudeness or hurriedness of staff, but they won’t do so with you as their counselor. The adage that a person may not remember everything that you say but will definitely remember how you made them feel is so true.

When we are treated as less than human, we lose our humanity. For those who do it to us, unconsciously or not, they do too. Our treatment of each other becomes rote, mechanical and unattached. The preambles to the ethics codes for both the American Counseling Association and the American School Counseling Association share the principles of autonomy, beneficence and nonmaleficence; these are essential tenets to practice our counseling craft and to live by. A basic premise of counseling is to form a therapeutic relationship of trust. It is incumbent upon all of us as counselors and human beings to always remember to do just that.

Best wishes to each of you.

Suzanne A. Whitehead is an associate professor and the program coordinator of the counselor education program at California State University, Stanislaus. She is a licensed mental health counselor, a retired school counselor and a licensed addiction counselor. Contact her at swhitehead1@csustan.edu.

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.

Resisting a savior mentality

By Caitlin C. Regan December 5, 2022

When I first began counseling as a teenager, I often did not connect with the clinicians sitting in front of me. They lectured me. They told me what I could and could not do. They told what I should and should not feel. Needless to say, that approach was not effective.

But when I was 23, I started working with a psychiatrist who had a different style. She provided me with information about my condition, and then she would ask how I related to that information, what I felt, if that made sense or if I was connecting with it. She didn’t tell me what I could and could not feel or what I should and should not think; she just allowed me to be myself.

This different approach allowed me to make a lot of progress. She was the first practitioner to diagnose me with bipolar II disorder because she was the first one I felt comfortable telling about my earlier manic episodes (which I later learned are actually hypomanic episodes). I felt like I owed her a lot because of how much she helped me during therapy.

During one of our last sessions together, I thanked her for all she did for me and told her how she had saved me and changed my life. She stopped me and said, “I didn’t save you; you saved yourself. You’re giving me credit I haven’t earned. Give the credit to yourself. You’ve done the work, you’ve taken the knowledge and made change with it, and you’ve made a difference for yourself.” Her words in that session have always stuck with me even as I now sit in the therapist’s chair working with my own caseload of clients.

A humble helper

I too have clients who thank me at the end of counseling for the difference I have made in their lives and for saving them, but I always remember to do the same as was done for me. I do not take credit for my clients’ triumphs and successes because it is not mine to be had. I take extreme joy when I witness clients have revelations and make progress, but I do not hold it as my success. It is theirs; they have rightly earned it. As a clinician, my role is to provide clients information and the tools they need to be healthy. I have modeled empathy for them by being a shoulder to cry on and an ear to listen, which made them feel heard. So many who have come my way have not felt or had empathy in their life for the longest time. But I am not the one doing the work, making the choice to change and putting behavioral change into place, so I cannot take credit.

As clinicians, we are not saviors. Instead, we should strive to be helpers. We do not enable clients or have them so reliant on us that they cannot choose or change for themselves. Instead, we work with our clients to help them move toward self-empowerment. I love being a counselor; I am blessed to be able to do it each day because seeing changes in clients’ lives unfold before me is a powerful experience.

It is important for clinicians to remain in a humble mindset and give clients credit for their successes. I see many clinicians who take this path and clients are more thankful for it. I once had a client, who after I told them it was not my credit to take, turned back to me and said, “Thank you. I do need to give myself credit when it is earned and stop giving my credit and my power away to people.” The client patted themself on the back and walked out the door. We worked together for several more sessions, and the client’s confidence continued to bloom to the point they no longer needed counseling, and I was thrilled to witness their success.

When clients gain courage, confidence, strength and self-esteem in counseling, they are able to apply those skills outside the session and continue to have success even after their time in therapy ends. It will also better prepare them to face and overcome challenging moments and disappointments and move back toward living and thriving. Roy Baumeister and colleagues’ research, published in Psychological Science in the Public Interest in 2003, shows that people with high self-esteem are better able to overcome challenges. Encouraging clients to take credit for the success they have while in treatment is another way clinicians can work to increase a client’s self-esteem. In turn, helping clients increase their self-esteem allows them to make greater strides not only in treatment but also after they leave a clinician’s care.

Empowering clients

If we work from a belief that we are “saving” clients, then we are stripping them of their ability to be empowered. Empowerment is a key aspect to any mental health treatment. The strengths-based approach in counseling, created by psychologist Donald Clifton, works on the premise that focusing on a client’s strengths, rather than their faults, allows them to see all they are capable of and develops their belief in themselves and therefore their success. Helping clients see the capabilities that lie within is the essence of clinical work.

Moreover, if a clinician assumes the role of a savior, the client’s setbacks and successes becomes theirs as well. This belief makes it the clinician’s fault if they do not “save” a client. Clinically, we cannot make clients put actional and behavioral changes into place. We can help them learn how to make changes, but they have to want and choose to do so for themselves. So, when a client does not choose healthy actions, clinicians should not blame themselves, and at the same time, when clients do choose healthy actions, we should not take the credit for being their savior. We can rejoice with our clients for making healthy decisions that will help them progress and grow, but it is not fair to take away the client’s empowerment and say we saved them.

I do not think that clinicians who take on this savior mentality are trying to strip clients of their empowerment. They are excited when they see clients have success, but when they assume this “savior” frame of mind, they get caught up in the wins and lose sight of their role in empowering the client. We as clinicians must constantly remember the importance of empowering the clients, not ourselves, to improve our work and therapeutic relationship with clients.

As clinicians, it is our role as to encourage, empower and guide clients as they begin to make changes and healthy life choices. We walk beside them on their journey to remind them of all they are worth. When clients are able to walk ahead in their journey because they have grown and changed and no longer need us by their side, it is something they earn themselves.

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When my psychiatrist taught me to give myself credit, it allowed me to further my successes because I realized I was capable of empowering myself. If she had just said “thank you” when I gave her the credit, then I may still believe that she alone is responsible for my progress and not recognize the hard work I put into those sessions to help me develop a healthy frame of mind that now allows me to help others. Her assuming the role of a savior would have done more harm than good. What do I mean by this? I have seen how detrimental it can be to the recovery of clients when clinicians take on the role of savior. Clients in this situation become dependent on the counselor and believe they won’t be able to progress without that clinician. They may even think they are only able to make progress with the help of others rather than believing in their own ability to change.

By assuming the role of helper, we can help clients learn to do things for themselves and give themselves proper credit. They grow in their self-esteem and belief in their own capability, rather than relying on yet another person telling them how to live and function. Clinicians need to work to remove the role enabling has played in many of our clients lives or the low self-esteem that has created the belief of not being able to do for themselves. When clients are enabled, often by clinicians and others in their lives, it leads to clients not taking responsibility for their good or bad choices. In addition, enabling often leads to lower self-esteem because clients do not feel like they are in control of their own lives. As clinicians, it is not our responsibility to “fix” people but to help people recognize all the wonderful pieces that already lie within.

Am I helping or saving?

Maybe you are asking yourself, “Am I helping or am I saving? How can I even tell?” To answer that, you first need to explore your underlying motivations by asking, “Do I rejoice in my clients progress because I am excited for them or because I think it makes me look good?” If any part of you is saying because it makes me look good, then that is a good sign you are assuming the role of the savior.

The truth is that much of what counselors do is not about looking good. As an addiction counselor, I walk away from a lot of my sessions not feeling all that great because in addiction treatment, it is more common for clients to relapse or leave therapy against medical advice than for them to complete treatment and go on to celebrate 10 years of sobriety. At times, it does cross my mind, “What am I doing wrong? How can I fix it?” In these moments, I need to meditate and remind myself that I am no one’s savior, and I am there to help clients when they are ready to do their own work to make change. I have to constantly remind myself not to assume this role of savior because it’s easy to feel pressure to “fix” people and think you are responsible for their success.

Another way to determine if you are saving or helping is to think about how you respond when a client thanks you for helping them. Do you remain humble and appreciative and then remind them of all the work they have done for the success they have earned? Having clients thank me for the support I show them is always a wonderful part of my job, but every time a client thanks me, I remind them of my motto, “This is credit I have earned, don’t give my credit away.” Within a week of working with me, my clients can easily repeat that motto, which helps them realize they are the ones who deserve the credit because they are the ones doing the work.

I also do not want to diminish the work that counselors put into their sessions. Our work is hard and a labor of love. We watch every day as people grow, change, regress, learn, experience heartbreak and so much more, so it takes a lot of our own strength to do what we do. We deserve credit for our part as well, but clients should not be the ones to pay us that credit. It is essential clients build their own credit when working with us. Our validation should come from our loved ones, supervisors and bosses, so we can focus on helping our clients and not make the session about us, which is unethical. We cross boundaries when we look to clients to validate us, and this is another reason to wholeheartedly allow clients to have the credit for their own growth, which is 100% theirs.

Early on in my counseling journey, I had many clinicians who assumed the role of the savior, and it led me down a path of believing that I needed others to save me. It wasn’t until several years later when I had a clinician point out that I earned the credit myself that I was able to take the first step toward the empowered road I now walk. I am able to accept and ask for help when I need it, but I am also empowered to save myself and know how worthy I am as a person. Knowing my worth each and every day is the best gift I have ever allowed myself to receive, and every client out there deserves the same. As a counselor, I am now in a position where I can pass that message on to my clients and show them their credit is theirs to keep. It is a great honor to work in a helping profession, and it is important to always remember that we are helpers not saviors.

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Caitlin C. Regan is a 35-year-old mental health and addiction counselor in Juno Beach, Florida. She has been living with a mental health diagnosis since she was a teenager, and through electroconvulsive therapy and daily self-care, she has been successfully living with it for over eight years. As a teacher and counselor, she has over 13 years of experience helping those with mental health and addictions. Her passions include helping others, mental health, seeking social justice, and spending time with her friends, family and two dogs. Follow her on Instagram and Pinterest @caitlins_counseling_corner or on her YouTube channel at Caitlin’s Counseling Corner. Contact her at caitlinscounselingcorner@gmail.com.

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