Tag Archives: therapeutic alliance

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.

SynthEx/Shutterstock.com

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.

 

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.

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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.

Incorporating clients’ faith in counseling

By Lisa R. Rhodes November 2, 2022

A South Asian Muslim woman in her 20s lives at home with her Muslim family and has been struggling in her relationship with her parents. She feels they interfere with her ability to make decisions for herself and treat her like a child.

The woman decides to go to therapy. After listening to the client talk about the issue, the counselor says, “If you move out, this will no longer be an issue.” But this advice was not helpful, and this woman sought out a different clinician, which led her to Nadia A. Aziz, a licensed professional counselor (LPC) at the Empowerment Therapy Center in Manassas, Virginia.

“The client felt the counselor wasn’t informed on how to deal with issues in a culturally informed manner,” Aziz recalls. “The counselor failed the client by not incorporating [her] values” into treatment.

In South Asian cultures, which embrace the spiritual teachings of Islam, Hinduism, Sikhism and Buddhism, it is expected that adults live at home with their families until they either get married or move away for work or college, explains Aziz, who is South Asian and Muslim.

“A counselor suggesting moving out of a family’s home would be insensitive to the [client’s] cultural and religious needs because the client was not able to move out and it wasn’t a realistic expectation,” she says. 

 Aziz, a member of the American Counseling Association, worked with the young woman in therapy to set healthy boundaries and develop assertive communication skills so she could express her feelings and needs to her parents in a way that was respectful of her family’s cultural and religious beliefs.

An evolving practice

This scenario is an example of what many clinicians fear — not knowing how to respond to the religious and spiritual needs of a client. J. Scott Young, a licensed clinical mental health counselor and professor in the Department of Counseling and Educational Development at the University of North Carolina at Greensboro, says his research on religion and spirituality in counseling, which includes conducting counselor surveys, shows that many mental health professionals feel anxious and uncertain about incorporating a client’s faith into therapy.

“They don’t want to do anything unethical,” Young explains. “They’re worried that they don’t know what to do to help people with [these] issues.”

The uneasiness counselors feel stems from a long history of prohibiting the intersection of religion and spirituality in the therapeutic process. In the third edition of Integrating Spirituality and Religion Into Counseling: A Guide to Competent Practice (published by ACA), Young and Craig S. Cashwell point out that “religion has long been a highly controversial topic in the mental health disciplines.” They also note that Sigmund Freud and B.F. Skinner, two pioneers of psychology, considered religious and spiritual belief systems to be frivolous.

However, the counselors interviewed for this article all agree the counseling profession, and the mental health field in general, has evolved over the years to regard religion and spirituality as important additions to counseling education and practice. And they stress that with the proper education, training, and focused introspection into their own religious and spiritual beliefs, counselors can effectively bring a client’s faith into the therapeutic process, if that is the client’s desire for treatment. 

In 2009, the Association for Spiritual, Ethical and Religious Values in Counseling (ASERVIC), a division of ACA, developed the Competencies for Addressing Spiritual and Religious Issues in Counseling to serve as a guideline for counselors seeking to incorporate a client’s religion and spirituality into practice. The competencies work in tandem with the ACA Code of Ethics.

Jesse Fox, an ACA member and the current president of ASERVIC, says evidence-based research into the importance and efficacy of religion and spirituality have made them topics for therapeutic exploration. 

“The evidence base for interrelationships between spirituality, religion and mental health has grown exponentially,” says Fox, an associate professor of counselor education at Stetson University. “In the most recent systematic review in 2012 produced by Harold Koenig at Duke University Medical School, there were over 3,000 published peer-reviewed studies documenting the connection between spirituality, religion and health. In fact, the number of studies grows exponentially every year.”

This empirical work has mapped out how these domains — religion, spirituality and health — of human experience function psychologically, he explains. 

“The net effect is that mainstream mental health models have recognized that spirituality needs to be considered alongside of other dimensions of wellness like emotional health or physical health, as well as intersectional models of identity like race and sexuality,” Fox says.

Religion and spirituality continue to be important to many in the United States. According to a 2022 Gallup Poll, 81% of U.S. adults believe in God. Statistics such as this, Fox says, suggest that religion or spiritual matters will likely be “an aspect of a client’s identity” in counseling.

Young, an ACA member, says research has shown that people who have a faith or religious commitment that supports them tend to experience less anxiety and depression, more stability in their primary relationship, and more stability and commitment in their work and career. This commitment “seems to be sort of a buffer against some of the stressors that they might otherwise face,” he explains. “And if that’s that case, [it] sort of helps to support their mental health as well.”

People often use spirituality or religion to make meaning of their lives, notes Young, who treats clients at Triad Counseling and Clinical Services PLLC, which has offices in High Point and Greensboro, North Carolina. “In counseling, we talk to people about their childhood, their parents, their family drama … [and] their sex life — all these are very personal things for people,” he says. “At times counselors are hesitant to discuss spirituality or religion for fear that it is too personal or that they may misstep.” 

Know thyself, know the client 

The counselors interviewed for this article say that before attempting to bring a client’s faith into therapy, counselors should thoroughly explore their own religious and spiritual beliefs, or the lack thereof.

“If counselors have not taken the time, or realized the importance of taking the time, to know themselves — their values, their beliefs, their own spirituality and religious preferences — then that’s not going to be a good match for clients who have needs in that area,” says Amy Evans, a licensed professional clinical counselor in Minnesota. 

“The challenge is making sure we do not push our own values, worldview and perspectives on our client,” Evans stresses, which is something both the ACA Code of Ethics and ASERVIC competencies make clear counselors should not do. “To make sure we’re not doing that, we have to know ourselves,” she adds. 

Aziz says she was able to explore her religious and spiritual identity in undergraduate and graduate school, where she took courses in multicultural counseling and faith-based counseling, as well as other classes that encouraged self-discovery, self-awareness, and exploring one’s own values and biases in the realm of religion and spirituality.

Justin K. Hughes, a LPC in Dallas who offers religious/spiritual integration, most commonly for Christians, says he learned important tools for bringing a client’s faith into treatment from his own experience receiving counseling as an undergraduate student and from the counselors he worked with during his Christian seminary training and clinical internship. 

Hughes, owner of Dallas Counseling PLLC, says these mental health professionals set the model for him by being respectful and humble and always asking questions to assess his needs and learn more about his religious and spiritual experiences. He says he now mirrors these traits in his own practice. 

Faith and self-disclosure

While it is important for counselors to feel comfortable with their own faith and belief systems, the counselors interviewed for this article agree that it is not necessary for clinicians to share this part of their lives with clients. If clients do inquire about their faith, they advise clinicians to be thoughtful in how they respond. 

Young, a past president of ASERVIC, says he doesn’t discuss his spiritual views in session unless the client brings up the topic, and even then, he is careful not to divulge too many details. 

“I have, on occasion, had a client who really wanted to know how I see these things, so I always preference [my response] with ‘We’re here for you,’” Young explains, noting that he will then try to explore what salience religion and spirituality holds for the client and what the client may be trying to learn by asking about his beliefs. 

Lemonsoup14/Shutterstock.com

 “I do not try to deflect or redirect if they are truly curious,” Young says, “but I do want to understand why it is important for them to know my beliefs.”

Aziz says her faith is evident in the photograph she posts on Psychology Today’s directory of mental health providers and her practice’s website. “I wear the head scarf, the hijab, [so] it’s kind of hard to miss,” she says. “A lot of times I do get contacted through those avenues, so I am implicitly disclosing that I am Muslim, and they are looking for a Muslim therapist.”

If clients inquire to know the specifics about her faith, Aziz says she always brings the discussion back to what the client is looking for and what they need in treatment. Although a discussion of Aziz’s faith may sometimes be helpful in building rapport with a client, she is mindful that it is not relevant to the therapeutic process. 

“A lot of times it is [about] setting boundaries with them,” she says, “and making sure they understand that the counseling session is not about me, it’s about [them], keeping the focus on them.”

Hughes, who specializes in treating obsessive-compulsive disorder (OCD), anxiety and related disorders, is a member of the International OCD Foundation, which has been examining the role of religion and spirituality in the treatment of OCD during the past couple of years. 

Hughes says he is “usually fairly open about being a Christian” with clients if they bring it up. For example, some of his clients have asked, “Are you a Christian?” “Would you be willing to pray with me?” and “I’m not very religious. Are you OK with that?” He only provides specific information if he feels it will be a therapeutic benefit for the client, which he notes varies case by case.

Counselors do not have to share the same religious or spiritual beliefs as their clients to be effective in therapy, yet for some clients, having a match in faith may matter to the client. Evans, an associate professor and program director of the master’s in counseling program at Bethel University in St. Paul, Minnesota, says research shows that what matters in practice is the quality of the therapeutic relationship and the counselor’s responsiveness to the client. 

“If a counselor is trained well and really considers the client’s worldview, culture and values — then that can be helpful to the [therapeutic] relationship,” says Evans, an ACA member. A counselor’s training and ability to modify therapeutic techniques to meet the client’s needs is what is most helpful in practice, she stresses, not the counselor’s faith.

Young acknowledges that a counselor’s faith may be important for some clients. If there’s not a match in faith, it may be barrier for some clients who may not feel as safe in the relationship as they should, he explains. But “as long as the counselor is open and meeting the client where they are [and] they’re not anti-religious or struggle with it themselves,” Young says, “it really shouldn’t make much of a difference.”

Broaching the topic

Counselors must first determine a client’s therapeutic needs to find out if they would like to include their faith in counseling. The counselors interviewed for this article suggest bringing up the topic of religion and spirituality in the first session and including it on intake forms. 

“One of the most important things is to … broach the topic,” Evans says. “If we don’t let clients know it’s OK to talk about it [religion and spirituality], they may not know it is acceptable to bring it up.”

Evans says counselors should also inquire about a client’s faith on the intake form. Then during the first session, they can ask open-ended questions in response to what clients have shared on the form. Evans provides a few examples of things counselors can say to initiate this conversation: 

  • It sounds like your spirituality/religion is important to you. 
  • How might you envision bringing your spirituality/religion into the therapeutic work we are doing?
  • You mentioned that spirituality/religion is an important part of your life. How might it relate to the therapeutic goals we have agreed to focus on?

Evans says partnering with the client to agree on goals, including goals surrounding the client’s faith, helps builds the therapeutic relationship so it can be effective and have positive outcomes for the client.

Aziz also brings up the client’s faith during the intake process. “I ask [clients] if there is anything they want me to know about their cultural or religious beliefs and if they are looking for faith-based counseling,” she says. 

Aziz notes that about 70% of her clients are South Asian and follow the teachings of Islam, Hinduism, Sikhism or Buddhism, and about 30% are from a different cultural background or faith. So she first works with clients to help them identify their own values. “That gives me a better understanding of what they’re looking for in session, and I tend to take the counseling sessions in those directions,” she says. 

Blending faith and counseling

Once counselors assess the religious or spiritual needs of the client, or the lack thereof, they can work with the client in treatment to resolve any issues or explore new insights. Young says bringing a client’s religion or spirituality into practice should be a collaborative process that is not one size fits all. 

One approach, he continues, is to ask open-ended questions that explore the client’s thoughts and feelings around their religious or spiritual practices and traditions. For example, he says counselors could ask:

  • When or where do you feel most connected to the larger whole?
  • What brings you the greatest sense of peace in your life?
  • What rituals, if any, do you practice that bring you comfort (prayer, meditation, walks in nature, etc.)?
  • Have you thought about using these rituals or practices to help resolve problems?
  • Do you have an understanding about a higher power? How is this helpful to you?

Evans co-authored, along with Jennifer Koenig Nelson, an article exploring adapting counseling to clients’ spirituality and religion, which was published in Religions in 2021. In it, Evans and Nelson argue that using the therapeutic approach of cultural humility to incorporate a client’s religion or spirituality into practice can result in positive outcomes for the therapeutic relationship and the client’s treatment goals. Citing Joshua Hook and colleagues’ 2013 article published in the Journal of Counseling Psychology, they define cultural humility as “having an interpersonal stance that is other-oriented in relation to another individual’s cultural background and experience, marked by respect for and lack of superiority toward another individual’s cultural background and experience.”

Cultural humility “relates to positive outcomes and reduces power dynamics in the [therapeutic] relationship,” Evans says. “The openness allows the counselor to step back and have the client determine what is most salient to them, rather than the counselor pushing for the client to focus on certain parts of their identity.” 

The counselor operating from a stance of cultural humility “allows for the client to determine if spirituality/religion is something important to them [or] salient to the work they are doing in counseling,” Evans continues. The client can then decide if they want their faith brought into counseling.

In their article, Evans and Nelson suggested an adaptation to Hook and colleagues’ guidelines for integrating cultural humility into therapy that focuses on religion and spirituality. Their revised guidelines are:

  • Remain humble when engaging with clients around spirituality and religion.
  • Do not assume you understand the client’s spirituality and religion based on prior training, knowledge or experiences.
  • Explore spirituality and religion with the client to determine what is positive and what might be detrimental in relation to their beliefs.
  • Remain curious about the spirituality and religion of the client as it relates to the presenting issues and ask questions when appropriate.

Aziz finds creative ways to incorporate the client’s faith into session when appropriate. If a client is having a hard time controlling their anger, for example, she may integrate the client’s religion into a breathing and mindfulness exercise to help them learn to respond to stressful situations in a healthy way. 

In this scenario, Aziz would first ask the client to come up with a word or phrase that is connected to their faith and has a calming effect. The client must be able to repeat the word or phrase with ease. A client may choose the word “patience” as their mantra for breath exercises, for example, because it reminds them of the Islamic scripture “God is with those who are patient,” Aziz says. 

She would ask the client to relax and clear their mind of any thoughts. Once the client is settled, she would ask them to take four deep breaths in through the nose, hold for a count of six and then breathe out through the mouth for a count of six. While engaging in this breathing exercise, they would focus on repeating their mantra in their mind. This exercise is a helpful way for clients to calm their body and mind and focus on inner peace, Aziz notes. 

Asking clients to select a mantra that resonates with them makes it more likely that they will follow through with the practice on their own, Aziz says, because it helps to make the practice personal to them. And that approach works with clients whether they are religious or nonreligious, she adds. 

“If the client requested faith-based counseling, they usually gravitate toward phrases that have religious significance” to them, she says, noting that she may also talk to the client about why the phrase is important to them.

The guided imagery “wise being” exercise (see lifepluswork.com/guided-imagery-wise-being) is another technique that counselors can adapt to incorporate a client’s religion/spirituality, Aziz says. This technique, she explains, allows clients to tap into their own faith and values.

Aziz begins the exercise by asking the client to imagine a safe space where they would feel comfortable having a personal conversation with someone they view as a wise being. The purpose of the conversation is to allow the client to discuss their problem or issue with the wise being without judgment and to receive guidance from the wise being on how to resolve or approach the problem, Aziz says.

“A lot of times people might pick a spiritual guide based on their faith,” Aziz says. For example, a Muslim client may select the Prophet Muhammad, a Christian client may select Jesus Christ or a Buddhist client may select Buddha.

After the client selects their wise being, Aziz asks them to imagine the guide walking toward them to begin the conversation. “It is almost a spiritual moment for them to have this conversation,” she notes. They “may have felt the presence of their spirit guide” during this exercise. And the exercise often provides clients with clarity or helps lead them to what they want to discuss in counseling, she adds. 

Aziz leaves the decision to share the details of this conversation with her up to client. Sometimes, it takes clients a few sessions before they are ready to share what they felt or experienced in that moment, she says. 

If a client chooses to discuss the exercise with her, Aziz often asks, “Why do you think [the] wise being said what they said?” Then together they process the client’s feelings about the wise being’s message and its meaning. She asks, “How are you going to incorporate [the wise being’s advice] into your life?” 

Overcoming challenges

Integrating a client’s faith into session may not be easy for some clinicians. Young reminds counselors that they don’t have to be an expert on a client’s religious or spiritual beliefs to be effective.

“Counselors don’t have to have the answers for [a] client’s faith questions,” he says. “It is an important part of faith development for people to struggle with questions that do not have clear answers.”

Young advises counselors to remember that staying present for the client, being curious about their experience and not projecting their own values onto the client can help to navigate the ups and downs of practice if they are focusing on a client’s faith or another area of the client’s life. 

Hughes says counselors must be willing to meet challenges and make reasonable mistakes when bringing a client’s faith into practice, and they must be willing to use compassion to correct themselves. But when counselors deal with religious and spiritual sensitivities, they don’t feel they have any space for errors.

Counselors don’t want to violate the code of ethics, Hughes says, but even if they’re doing therapy competently, they may sometimes ask irrelevant questions or make a human gaff. For example, he once worked with a Jewish client who often brought details about her faith into therapy. But when he attempted to define the Hebrew word “shalom” in reference to the client’s therapeutic goals, the attempt “fell flat,” he recalls.

“I have studied some of the original Hebrew and knew what I was talking about technically,” Hughes explains. But the client “corrected me from her personal understanding, and because I am neither Jewish nor living her life, she had the right to define what the word meant to her in relation to her goals.” This exchange highlights the need for communication and questions as well as the importance of never taking things for granted, he adds.

Fox, executive director of the Episcopal Counseling Center in DeLand, Florida, says navigating a client’s faith can be challenging for counselors when they realize the diversity of religious and spiritual perspectives. 

“You encounter a myriad of worldviews, practices, frameworks of meaning, [and] it can be daunting about where to start,” Fox says. It can be hard for counselors to “discern when a client’s religious or spiritual life has become unhealthy,” or if the real dangers of imposing their values onto the client have become evident, he adds.

Fox and Aziz recommend counselors find a mentor or supervisor or seek additional training if they have questions or want guidance on discussing faith with clients. “I think there’s a lot of benefit to talking to colleagues and supervisors [to get] a different opinion or view of things,” Aziz says.

Be curious

The counselors interviewed for the article agree that clinicians should take advantage of opportunities through professional channels and in their community to learn more about the diversity of religious and spiritual traditions of their clients.

“We learn best by engaging with individuals who are different from us,” Evans says. “Get out there, get to know people, … and be curious.”

She suggests attending different religious services and reaching out to local religious leaders who are open to sharing information about specific religious and spiritual practices.

“[Do] what makes sense clinically,” Evans says. “Start exploring things. … Take the time to be curious and investigate and interact with people outside [your] regular circle.” 

Most professional trainings about religion and spirituality are Christian in nature, Aziz notes, so counselors who are seeking guidance about other religious or spiritual traditions should consider reading books or researching multicultural blogs. 

Evans, Fox and Young recommend counselors take advantage of the resources offered by ASERVIC, including Counseling and Values (their official publication and one of the oldest peer-reviewed journals on the topic of spirituality and religion), their annual conference and webinars. 

Fox serves as co-investigator of the Spiritual and Religious Competency Project (srcproject.org), an initiative funded by the John Templeton Foundation, which aims to provide mental health professionals with basic competencies to address the spiritual and religious aspects of their clients’ lives. His team of researchers are “testing methods of training mental health professionals in spiritual and religious competence” and are tracking how mental health professionals may utilize this training nationwide. They are also “using implementation science to discover the best ways to make this type of training more likely to happen in mental health care in the future,” he says.

The project’s early research has found that more mental health training programs are open to including religious and spiritual studies, but staff lack the training to confidently teach and supervise students, Fox explains.

“Over the next five to 10 years, we are hoping that through our efforts we see this gap close so that every client who brings religion and spirituality into their counselor’s office will be met with competent help,” he says. 

Young is also hopeful about what the future holds for the integration of religion and spirituality within counseling. He says the more research that is done in this area and the more conversations that takes place among counselors, the more possibilities there are to expand the reach of religion and spirituality in clinical practice for the benefit of clients.

 

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Lisa R. Rhodes is a senior writer for Counseling Today. Contact her at lrhodes@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.

Confidentiality comes first: Navigating parent involvement with minor clients

By Bethany Bray October 28, 2022

What is said between a counselor and an individual client is confidential, even when the client is a minor. But parents often want to be kept in the loop about their child’s progress in therapy. This can put the counselor in a tricky situation, especially when the parents want to control or influence the counseling process.

The only scenario in which counselor-client confidentiality can be broken is in situations that necessitate protecting the client or others “from serious and foreseeable harm,” such as suicidal intent. (For more on this, see Standard B.2.a. of the 2014 ACA Code of Ethics.)

Marcy Adams Sznewajs, a licensed professional counselor (LPC) who often works with teenage and young adult clients at her group therapy practice in Beverly Hills, Michigan, says she empathizes with parents who ask about what she’s covering in counseling sessions with their child. However, she finds it helpful — and necessary — to offer a firm explanation of counselor-client confidentiality whenever she begins counseling a young client.

Sznewajs says that she emphasizes to parents that she will let them know if their child discloses anything that will put the child in danger. She also makes it clear to both parties that she will only invite parents into the counseling sessions if the young client grants permission.

This conversation is often not what the parents want to hear, Sznewajs admits, but it is important because it spells out the boundaries of what the counselor is obligated to tell the parents and reassures the client that their privacy will be respected.

Sznewajs stresses to families that they all must trust the process for her work to be effective.

“It’s important for the teenager to trust an adult with these difficult thoughts and feelings, and legally and ethically I have to keep it confidential,” says Sznewajs. “I’d be doing my client a huge disservice [if I disclosed session details to the parents]. That’s not only unethical, it’s damaging — and what does it teach the kid? That this person that you’re supposed to trust, you can’t.”

The feelings behind the questions

Parents’ concerns and questions about the work their child is doing in therapy are often rooted in fear, says Martina Moore, a licensed professional clinical counselor supervisor with a mediation and counseling practice in Euclid, Ohio. Not only do parents worry that the challenging behaviors that caused their child to seek counseling, such as rule breaking, isolation, defiance or problems at school, will have negative long-term outcomes in the child’s life, but they might also feel these issues are a reflection of their parenting abilities.

“Parents sometimes have such anxiety about their children it’s [gotten] to the point where they are increasing their child’s anxiety,” notes Moore, president of the International Association of Marriage and Family Counselors, a division of the American Counseling Association.

Although Moore makes a point to validate these fears with parents, she also emphasizes that it’s good for the child to grow and build autonomy through counseling on their own. She applauds parents for seeking help while explaining that she needs the freedom to work with the child alone for the counseling process to work.

“I also spend time with parents to dig into what their fear is. They’ve come to counseling [with their child], so they must believe that there is benefit in this process,” Moore says. She emphasizes to parents that they need to trust the process. “I spend a lot of time with parents getting their buy-in,” she notes.

In addition to fear, parents may also struggle with strong feelings of shame for having a child who is engaging in risky behavior and failing to thrive.

Le’Ann Solmonson, an LPC in Texas who has extensive experience working with children and adolescents, says she makes a point to acknowledge and normalize parents’ feelings of vulnerability and worry. If appropriate, Solmonson says she will sometimes disclose that she’s experienced similar feelings when her adult children sought therapy.

“No parent is perfect, and you worry over feeling like they are talking [in therapy] about what you’ve done wrong,” says Solmonson, the immediate past president of the Association for Child and Adolescent Counseling, a division of ACA. “It’s a very vulnerable thing to have your child go to counseling. You can’t help but feel that it’s a reflection on you as a parent and feeds into fears that you’re ‘screwing your kids up.’”

Navigating the balance

Counselors often need to get creative and act diplomatically to keep parents in the loop while maintaining young clients’ confidentiality and trust.

When parents insist on being involved in their child’s counseling, Moore negotiates with both the parents and client to find a plan that they all agree on while staying within ethical boundaries.

This was the case for a teenage client Moore once counseled who had substance use disorder. The parents were worried about their child and wanted to be involved in the counseling process. Moore facilitated a discussion and, eventually, they all came to an agreement that Moore would work with the teen alone but would let the parents know whenever the client had a relapse or break in recovery, she says.

Keeping lines of communication open and having regular check-ins with parents is beneficial to the counseling process with young clients, Solmonson notes. She often prompts child or adolescent clients to identify one small thing they are comfortable sharing with their parents at the conclusion of each counseling session, such a breathing technique they learned or new words they discovered to describe their emotions. This keeps the parents in the loop while ensuring that the client maintains control over the process.

When parents are left completely in the dark about their child’s work in counseling, it can exacerbate worry, cause them to “fear the worst” and catastrophize about what the child might be saying, Solmonson adds.

Sznewajs notes that talking with young clients about keeping their parents updated also provides the opportunity to check in with the client and ask what they feel is going well. She sometimes begins by asking the client how they feel things are going in counseling and transitions to what (or if) they would want her to share with their parents about their progress.

Disclosure of life-threatening behavior

When a young client is engaging in risk-taking behaviors that are life threatening (i.e., suicidal actions, self-harm), ethically, parents need to be brought into the conversation, says Hayle Fisher, a licensed professional clinical counselor and director of adolescent services at a behavioral mental health provider in Mentor, Ohio. While this is crucial to do, it can also impair the therapeutic relationship with the teen, she adds.

Fisher finds the vignettes in the 2016 British Journal of Psychiatry article “‘Shhh! Please don’t tell…’ Confidentiality in child and adolescent mental health” particularly helpful for examples on navigating these conversations. She keeps the following notes for herself, drawn from that article, for situations when she must disclose a young client’s harmful behavior:

  • Tell the client what you (the counselor) are planning on disclosing to the parents, with an emphasis on the full context of why you need to. Ask for their feedback on how they might like to edit what you plan to say.
  • Talk through the potential benefits and costs of disclosing to the parents. Ask the client how they feel about the disclosure and consider their views as you move forward.
  • Validate any fears the client may have about the disclosure, such as losing access to resources and freedoms, feeling blamed or ashamed, or being concerned that the police or social services will become involved.

To maintain trust and a therapeutic alliance with young clients, Fisher emphasizes that it’s important for a counselor to give the client as much control as possible over how this communication will occur. If the disclosure happens during an in-person session and the parents are nearby, she gives the client the choice to either stay in the room or step out and wait in the lobby when she invites the parent(s) in to tell them.

Fisher also gives young clients the option to tell their parents before she does. However, this is only appropriate if the client’s risk of harm is not imminent, Fisher stresses. In this scenario, she tells the client that she will call at a certain time the following day to speak with their parents, check in and provide support for the parents and client.

“This option is especially powerful,” Fisher explains, because it “reinforces the adolescent taking accountability for their actions, increases communication skills and fosters independence in the situation so they are not dependent on the counselor for navigating conflicts with their parents.”

Sznewajs also takes a collaborative approach when it’s necessary to break confidentiality to inform a client’s parent or guardian about harmful behavior or intent. She says she tries to take the client’s feelings into consideration while modeling firm boundaries.

Although not having the conversation with the parents isn’t an option, client can choose how and when it happens, Sznewajs explains. She offers to involve the parents in person, call them on the phone, do a video chat during the counseling session or wait until after the session ends.

Sznewajs says she explains to young clients: “I want to make sure you stay safe, so we have to bring your parents into this conversation.” She adds that she tries to “do it in a collaborative way, even when it [the situation] is dire.”

 

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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.

Taking a clinical selfie

By Bethany Bray October 25, 2022

“But first, let me take a selfie.”

This phrase, which was first popularized in The Chainsmokers’ 2014 breakout hit song “#Selfie,” has become a common saying in today’s culture — and one that is sometimes used to satirize younger generations who can’t seem to experience something without documenting it with a self-portrait.

On the surface, the act of taking a selfie can seem shallow or self-promotional. But Amanda Winburn and Amy King, both counselor educators who have a background as a school counselor, say that when used intentionally and in a structured way, selfies can become a therapeutic tool and a way to spark self-reflection, engagement and connection with younger clients.

“We know that children are engaged in” taking selfies, says Winburn, a licensed school counselor, licensed professional counselor and registered play therapist. “So why not take the positive attributes of this practice and expand upon it” in counseling?

Selfies in session

Winburn and King, who have presented on the therapeutic power of selfies at conferences of the American Counseling Association and the American School Counselor Association, have used selfie activities as a therapeutic intervention in individual and group counseling settings.

“This is just one more way we could give children and adolescents an opportunity to express themselves and narrate their story,” says Winburn, an associate professor of counselor education at the University of Mississippi. “We try and incorporate [clients’] worlds in our work, and selfies are an everyday part of our world and everyday part of expression for children, adolescents and adults. It really is the new self-portrait.”

However, Winburn and King stress two important caveats to this work:

  1. Practitioners should take care to ensure that any selfies captured in sessions are not taken with a device that is connected to the internet (i.e., not the client’s personal cellphone) so the images cannot be shared or used in a nontherapeutic context.
  2. Practitioners must obtain consent from a parent or guardian to capture the image of any client under the age of 18.

King, a certified school counselor and provisionally licensed professional counselor in private practice in Mississippi, uses a tablet computer that does not have internet access to allow students and clients to take selfies. She prints the selfie images and keeps them in a client’s file to refer to during sessions and deletes the images from the device. The tablet and client files are kept in a locked cabinet in her office when not in use, she explains.

Tapping into self-expression and boosting empathy

Having young clients take selfies during counseling sessions can serve as a visual and relatable way for them to track their progress in therapy, Winburn and King suggest.

Selfies can document physical aspects of improvement and growth in ways that a client may not notice without a visual record, such as smiling or holding their head up more, sitting tall and appearing more confident, Winburn explains.

When she was a school counselor, King once used selfies to help a student who was struggling with self-confidence. The student kept the printed selfies that she took in counseling sessions in a journal, to which she added notes and drawings. When King and the client talked about her therapeutic progress and looked through the selfies together, the young client was able to recognize that she looked happier and more confident in her progression of photos throughout the year.

She was able to note that she had gotten taller and that her smile was brighter. “She was glowing because she was looking at herself in a really positive way and reflecting about that,” King recalls.

King, a lecturer in counselor education and supervision at Boise State University, finds that students love to look back at their progress in counseling, and by using selfies, young clients can visualize that progression of moving away from having a tough time to having a better outlook on their situation or life.

In addition to strengthening expression and self-confidence, using selfies in this way also provides an opportunity for counselors to explore and process clients’ feelings of self-doubt or self-criticism, Winburn says. In therapy, selfies can be a visual portrait of a client’s narrative and a discussion starter for work that increases self-awareness and emotion recognition.

Winburn advises counselors to ask clients questions to understand the motivations behind their self-expressions and explore if they are trying to portray themselves differently than they really are. For example, she says clinicians can ask, “How does seeing that image make you feel?” or “What makes you feel that way?”

Winburn asks her counseling students at the University of Mississippi to take a selfie at the beginning and end of their day for an entire week. She tells her students, “It’s a way to step out of your comfort zone and process how you were feeling [that week] and how you portray yourself.” Then they reflect together in class on the story their selfies tell, which can be quite eye-opening, Winburn says.

King also used selfies in group counseling with second grade girls during her time as a school counselor. The group’s focus was on building confidence, communication, friend making and social skills. Learning to give and receive positive affirmations — to oneself and others — was an important component of this group work, King notes.

King, assisted by graduate counseling interns, had each group participant take a selfie with a school-issued tablet computer. The student would first look at the selfie themselves and then share it with the group. This activity allowed participants to open up and talk about the feelings their selfie elicited and, in turn, prompt group members to offer positive feedback.

It was a powerful experience that boosted the second graders’ empathy, reflection and listening skills and their ability to consider others’ perspectives, King says. The students would listen, connect and make comments such as “your eyes are really sparkling in that one,” she recalls.

After the group had been meeting for a little while, teachers and recess monitors at King’s school began to report that the students who were in her counseling group started to have more positive interactions during recess, she says.

Using selfies in counseling can help children actively learn and foster positive feelings about themselves as well as learn about individual and cultural differences in group settings, King notes.

“There’s no right or wrong way to make a selfie,” she adds.

Keeping an open mind

King and Winburn acknowledge that counselors can sometimes be skeptical of using technology in sessions, especially mediums such as selfies that can have negative connotations. However, they feel that when used in an ethical and appropriate way, selfies can strengthen trust and the therapeutic alliance with young clients.

It can also be a way to model that technology can be used in a positive way, to build each other up, King adds.

“Make sure you’re using safeguards to keeps clients safe, but try it [using selfies], embrace it and be open to it,” Winburn urges. “Especially with adolescents, counselors need to be playfully engaged and aware of where they are. This is an active way of embracing the world that they live in and meeting them where they are.”

wavebreakmedia/Shutterstock.com

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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.

Breaking the silence around the childhood sexual abuse of Black men

By Lisa R. Rhodes August 30, 2022

In October 2019, Tyler Perry, the multimillionaire writer, actor, and movie and television producer, shared painful details from his childhood in an interview with People magazine. “I don’t think I ever felt safe or protected as a child,” Perry recounted, as he explained how his father, who he later learned was not his biological father, routinely beat him with a vacuum cord.

In addition to the physical abuse, Perry disclosed that by the time he was 10 years old, he had been sexually abused by three different men and a woman — all of whom were known by his family. 

“It was rape,” Perry said in the interview. “I didn’t know what was going on or the far-reaching effects of it.”

Perry is not the only Black male public figure to reveal that he was sexually abused as a child. Other Black male public figures, such as gospel singer Donnie McClurkin, have come forward to reveal the harmful impact of this early trauma. Despite these public disclosures, the silence that surrounds the childhood sexual abuse of Black men is deafening. 

“In many homes and social circles, the topic is still avoided — it’s taboo,” says Robin D. Stone, a licensed mental health counselor in New York City and a survivor of childhood sexual abuse. “In some cases, men haven’t shared with anyone that they’ve had this experience, that they have this history.”

The fact that it is taboo means that Black boys who have been sexually abused rarely, if ever, tell anyone that they have been violated and the silence continues into adulthood. Stone, a member of the American Counseling Association, says the impact of childhood sexual abuse on Black men leaves them with psychological wounds that they learn to “pack away” for years.

The silence surrounding this issue makes it difficult to know how pervasive it is. According to a 2006 study by the Centers for Disease Control and Prevention, about 1 in 6 boys in the United States were sexually abused before age 18. And the Children’s Assessment Center acknowledges that race and ethnicity are key factors, with Black children being almost twice more likely to experience child sexual abuse than white children. 

Rebekah Montgomery, a licensed professional counselor and owner of Dove’s Heart Counseling LLC, a practice with offices in Ann Arbor, Michigan, and Detroit, agrees that sexual assault and any form of sexual abuse are rarely discussed in the Black community.

“You can learn proper coping skills, you can reframe your brain, but it is still going to be something that can trigger later in life,” says Montgomery, an ACA member who counsels Black male survivors of childhood sexual abuse. “When you awaken those sexual feelings as a child, especially before puberty, you develop unhealthy ideas about what sex is and what’s appropriate and not appropriate.”

Building trust and safety

The counselors interviewed for this article all agree that to build rapport with Black male clients, counselors must be willing to engage in direct, honest and open communication, which creates an environment where the men feel safe enough to trust the therapeutic process. 

“I feel when they come [to counseling], they want to say something [about the sexual abuse], but you have to build their trust because they live in a country where — because of the color of their skin — they don’t trust because things have worked against them in very purposeful ways,” says Damion Davis, a licensed professional counselor in Addison, Texas. 

“In some cases, African American men don’t trust counselors who are of a different race than they are because they assume that there won’t be a cultural understanding,” he adds. “If there’s not a cultural understanding, then they don’t feel comfortable disclosing things.” 

Davis focuses on creating a strong relationship with his clients. During the first session, he works to establish trust with his clients by asking them about their family connections, where they went to school or college, and where they grew up. He also allows clients to ask him questions, such as about his credentials and educational background. And he keeps a photo of his wife and daughter in his office to remind clients that he is human.

“It’s about mutual transparency,” says Davis, an ACA member and founder of the Davis Counseling Center PLLC. 

Montgomery says a personal connection is also important in her efforts to build rapport with clients. She discusses the ethics of counseling, confidentiality and her responsibility to ensure a client’s physical and emotional safety with every client who comes into her office. She also lets clients know that during therapy they can express whatever thoughts or feelings they may have.

“My office is a judgment-free zone. All thoughts and emotions are welcome,” Montgomery says. “I like the office to feel comfortable enough for you [the client] to feel the way you need to feel, at least for that hour.”

Montgomery says she is also open to clients asking questions about her credentials and counseling experience. “They want to know they’re in good hands,” she says. “They need to get to know me just as well as I need to get to know them.”

Counselors should also acknowledge if there’s a gender or racial/ethnic difference between the counselor and client, advises Stone, owner and founder of Muse and Grace Mental Health Counseling Services in New York City. Acknowledging any differences upfront can help create a safe space for male clients to share their experience or to ask the counselor questions, she explains.

“If there’s an elephant in the room, talk about it,” she says. “It’s there whether you name it or not.” 

Montgomery recommends counselors “take on the role of an expert learner” when providing treatment for clients of diverse backgrounds. “You have to be aware enough to listen and learn and apply your therapeutic techniques on a case-by-case basis,” she says. “It has to be an equal exchange of awareness, growth and learning to make it comfortable and [to] help them feel comfortable in the therapeutic environment.”

Disclosing the abuse

The results of this early trauma can lead Black men to seek counseling — but for reasons other than sexual abuse. Montgomery says some of the reasons why Black men come to her practice include anger management, depression, anxiety and sexual dysfunctions. Clients may come to counseling because they were caught looking at pornography while they were at work and are in danger of losing their jobs or because they’re having intimacy problems with their wives, she adds. 

Although these symptoms can often be traced to childhood sexual abuse, many men are often unaware of the origins of their problems, Montgomery notes. “During the therapeutic process, experiences with sexual assault emerge and often get identified as a feasible cause of their mental and emotional concerns,” she says.

The counselors interviewed for this article say a client’s reaction to the realization of childhood sexual abuse can result in a tacit attempt to accept the trauma, conflicted feelings about the experience, doubts about their intrinsic worth or concerns about their sexual orientation.

“Sometimes it’s a confirmation,” Montgomery says. “They’ve already been kicking around the idea. They never thought of it [the trauma] as being [sexual] abuse, but after we confirm that they were sexually abused, they say, ‘Yeah, I kind of figured it.’”

Montgomery says confirming childhood sexual abuse often starts with asking clients how the experience made them feel. “Most Black men recognize that the sexual abuse can cause conflicting feelings,” she says. “At the time of the abuse, they may have been conflicted by their physical enjoyment and the emotional toll the abuse left.” 

“Most men never disclose their sexual experiences, so we explore the unspoken rule of keeping the abuse a secret,” she continues. “We explore [state] laws that define sexual abuse/assault, including the age of consent, the difference between molestation and rape, and [the] potential consequences for someone who sexually abuses children.” 

Davis, a clinical assistant professor of counseling at Southern Methodist University, says he is often the first person his clients have told about their abuse. “It’s really hard [for them] to accept the fact that the abuse happened because it leads to feelings of low self-esteem, inadequacies and, of course, anger,” he notes. “They feel this way because being sexually abused for them is very emasculating. It makes them question their manhood. A lot of people, but definitely Black men, like to feel a sense of control.” But when the abuse happened, they felt they had no control over their circumstances, Davis says. 

It’s OK to express emotion 

Counselors may first have to help Black men understand that they are allowed to have feelings and emotions about the experience. Stone, author of No Secrets, No Lies: How Black Families Can Heal from Sexual Abuse, notes that boys, particularly Black boys, are raised to believe that expressing emotions and anything other than the binary feelings of anger/happiness or weakness/strength is not allowed. 

The taboo about childhood sexual abuse is so persistent because “many boys continue to be socialized in ways that leave them little room to be vulnerable and to express vulnerability,” Stone says. “If they aren’t able to access their feelings, they struggle socially and grow up to be men who struggle socially.”

Montgomery notes that hiding or suppressing emotions has been a survival strategy for African Americans, especially boys and men. Historically, expressing feelings or emotions carries a serious threat of violence and death — from lynching to being shot or killed by the police, she says. 

Montgomery learned that Black men can put up a wall of defense against feelings and emotions when conducting research for her doctoral dissertation, which explored connections between the low use of professional mental health services by Black men in the inner city and their exposure to chronic trauma.

“I was pretty shocked by the results,” she says. All 10 of the men she interviewed for the study recognized that they had experienced some form of trauma, such as police brutality, violence and the implications of racism. But they did not consider how being guarded toward others, expressing pent-up anger, being defensive or declining to address mental health issues such as depression or anxiety can be a problem, she says. 

Montgomery says the men responded to the trauma by developing a “coat of protection” that served as a valuable tool for survival. And she says she sees this same “coat of protection” in Black men who have survived childhood sexual abuse. Her study reinforces the importance of helping this clientele to express and process their feelings and emotions. 

When clients have a hard time expressing how they feel about the abuse or don’t know what word or words may fit what they are thinking or feeling, Montgomery asks them to do a Google search for “feeling words” on their smartphone, and then together they explore educational websites (such as psychpage.com/learning/library/assess/feelings.html) that list different feeling words, along with charts and pictures, to help them define the word or words that best describe their emotions or feelings. 

Some clients have a limited vocabulary to describe their feelings, Montgomery says, and this exercise helps them overcome that by increasing their vocabulary and awareness about the complexity of emotions. For example, they learn that sadness can also be described as disappointment, and someone who is mad may be resentful. And it reminds clients that “they have emotions and feelings and its OK,” Montgomery adds.

“We spend time identifying emotions and giving them a name,” she continues, “and we try to find the word that best fills in the blank” of how they feel about a situation or experience.

After selecting a word from the list, discussing its meaning and talking about whether it matches their emotions or feelings, clients can say, “I’m feeling disrespected right now” or “I’m feeling jealous right now.” And once clients can correctly name what they are feeling and understand its meaning, they will “always know what that feeling is in every situation,” including experiences from their past, Montgomery says. 

Monkey Business Images/Shutterstock.com

She also recommends using trauma-focused cognitive behavior therapy (TF-CBT) with this population. Although TF-CBT is typically used with clients who are under the age of 18, she says these techniques can also be beneficial for Black men who have experienced childhood sexual trauma because it will help them learn healthier ways to cope with the trauma. This approach allows them to process their feelings and emotions rather than avoid them, reframe thoughts and behaviors resulting from the trauma, develop new behaviors and skills that bring a more desired or healthier outcome, and create healthy relationships, she explains. 

Stone says that incorporating poetry and bibliotherapy into treatment can also help survivors process emotions. She often uses James Pennebaker’s expressive writing framework with clients who have experienced trauma. “His research shows that expressive writing helps to ease psychological and physical symptoms related to trauma and other disturbing experiences,” she notes.

This framework asks “the client to write their deepest emotions and thoughts about a disturbing experience for 15 to 20 minutes a day over four days,” Stone says. “I then invite them to reflect on what they wrote (not necessarily to share it with me) and to consider how what they wrote makes them feel, where they feel it in their body and what, if any, changes they may want to make in the way they think or in the way they are living.”

To help clients connect to a fuller spectrum of feelings, Stone also has clients practice connecting their experiences to feelings and then their feelings to bodily sensations. She uses a feeling wheel, similar to the one developed by Gloria Willcox, to help clients explore what their body feels like when they experience certain emotions such as insecure, embarrassed, bored or proud. This helps the client identify feelings and “become more fluent” in expressing how they feel, Stone explains.

Davis recommends counselors normalize clients’ feelings of anger, shame, guilt or embarrassment about the abuse. Normalization, he explains, helps to break down the stigma  associated with being a survivor of child sexual abuse. “It helps them to know that they were victimized, but they are not victims,” he says.

Counselors need to affirm these clients, Davis says, and let them know they can work through the trauma of the experience and deconstruct some of the negative stigma that is tied to being a Black man who was molested. 

“I tell them [clients] how they feel is appropriate because someone has taken advantage of them and together, we’re going to build them up from there,” he says. “I let them know they’re not the only man who has gone through this. … I remind them that the worse part of what they’ve gone through is over. They are in recovery mode.”

Reframing the narrative 

Davis uses narrative therapy to encourage clients to tell their own story about the abuse. This approach, he says, can help clients “define the trauma in their own words and control the details of it.” He says it’s not necessary for him to know the exact details of the sexual act, but it is important to hear the client’s story because survivors attach meanings to the experience and to the abuser.

“Many times, they don’t realize that the meanings they have attached are very negative and they assign it to themselves. They don’t assign it to the abuser,” he notes. So he works with clients to help them explore the meanings they have attached to the experience, and together they begin to pull away the layers so clients can see what happened to them without assigning negative thoughts and feelings to themselves.

Davis also encourages clients to “think about their thinking” and “put negative thoughts on trial.”

He once worked with a client in his 30s who was molested by another man when he was a teenager. When disclosing the abuse, the client said, “I should have known better.” 

Davis helped the client put that thought on trial. They discussed how the client felt sad, embarrassed and angry at himself because he thought he should have known how to prevent the abuse. Davis then asked him, “What evidence do you have that this thought is true?” 

Davis also asked the client to image a child who is the same age he was when the abuse occurred and if he would blame that child for being sexually abused by someone they trusted. The client said he wouldn’t blame that child. So Davis asked, “But you blame yourself?”

Reframing the issue in this way, Davis recalls, helped the client consider alternative truths about his own abuse and realize he was being unfair to himself in his thoughts and feelings about the abuse. 

Montgomery says she tries to reframe unhealthy behaviors in her work with clients who have been sexually abused. One client, in his late 40s, came to see Montgomery because he was angry and didn’t know why he felt this way or how to process those feelings. The client did not recognize that he had been sexually abused as a child or that his feelings of anger were due to the death of his abuser, she says. 

This particular case was complex, Montgomery continues, because the client grew up in an environment wherehe was exposed to women in the adult sex industry, and from the time he was a teenager, some of these women routinely had sex with him. Crime and violence were also a part of his environment, which compounded the trauma, she adds.

Montgomery learned that he had also been abused by a female family member, but he viewed all of these sexual experiences as a “rite of passage” into manhood. Montgomery says the client told her that he’d had sex with “hundreds of women,” but he did not recognize that legally he had been violated by his female sex partners. 

Black men often have a hard time seeing being abused by a woman as sexual assault or rape, Montgomery explains. “If you’re sexually abused by a woman, it’s like, ‘Congratulations! Good for you,’” she says. 

Hypersexual behavior can be a response to the trauma of being abused as a child and it can lead to unhealthy behaviors if not addressed, Montgomery notes. This particular client did not understand how years of indiscriminate sex with multiple partners as a youth was an unhealthy behavior that posed a danger to his well-being, she says.

Montgomery used psychoeducation with him to discuss the risks of hypersexual behavior, such as sexually transmitted infections, pregnancy, emotional baggage from multiple partners and problems with true intimacy in relationships.

Montgomery and the client also focused on harm reduction in session. She says they discussed what needs the client felt were being met when he had the desire to have sex with multiple partners and how he could meet those needs in another way. The client decided that when he felt the need for attention or to be loved, he would choose to have sex with only one or two partners rather than multiple women, go the gym or shooting range, or spend time with his children. 

The goal, she says, was to redirect the client’s energy from unhealthy behaviors to more positive choices. “We tried to help him tie his emotions to his behavior,” she explains, and to change that behavior so he wouldn’t cause harm to himself or others. 

Counselors may also have to help Black men who were sexually abused by a man process their feelings and emotions around their own sexual orientation. Because of negative stereotypes associated with homosexuality within the Black community, some Black men “may feel like their manhood was tainted because of what happened to them,” Davis says. Cognitive restructuring and psychoeducation about sexual orientation, he notes, can help clients articulate what their sexual desires are and learn that they, not the sexual abuse, define their sexuality. 

He also tells clients, “An experience that happened to you, that was not your choice or free will, doesn’t define your sexual orientation.” 

Reclaiming power 

Disclosing childhood sexual abuse can also result in victim blaming or self-blame, Stone notes, and blame can even come from peers or family members. There’s often the belief that the survivor “should have done something” to prevent the sexual act or in response to the abuse, she says. 

Stone advises counselors to help clients think about what it meant to be small and/or vulnerable and how much “social capital” they or the people who perpetrated the abuse had in their family or community. “I use ‘social capital’ to speak to the extent that one is known and trusted and has influence in a social dynamic, such as a family,” she explains. 

Boys are most often abused by someone who has social capital in the community, such as a coach, minister or family friend, Stone says. She suggests counselors discuss how much power or social capital the client thought they had in the situation by asking them, “Who do you think would have listened to you? Who might have taken you seriously? Who do you think would have been on your side if you had told them what had happened to you?”

Counselors can also acknowledge the strength it took for the client to survive the sexual abuse and to seek counseling, she adds. “It’s a radical act of self-care” to seek professional help, Stone notes, and counselors need to say so.

Davis says the low self-esteem that clients experience can also lead to feelings of fear and anxiety. “You feel you’re always on pins and needles because you’re waiting for the next thing to happen to you,” he explains. 

Davis uses imagery exercises and reframing thoughts to help men break from a victim mentality and reclaim their power. Approaching it this way allows clients to learn to “separate themselves from what happened to them,” he says. “I have them imagine who they were when the abuse happened, and I have them imagine who they are now, standing by that person.”

He also helps clients understand that because they were children when the abuse occurred, they couldn’t protect themselves. He then asks clients, “What are you and I going to do now to protect that 12-year-old you?” This question, Davis says, can lead to a discussion on ways the client can create healthy boundaries and a sense of safety so they aren’t afraid they will fall victim to sexual abuse again or be taken advantage of by others. 

“Many times, when a person experiences trauma, they get stuck there,” Davis says. “But I help them by reframing their thoughts and [bringing them] to the present day.”

Reaching out to black men

The counselors interviewed for this article all agree that the profession can do more to encourage Black men to come forward and seek mental health treatment. Montgomery suggests that counselors of diverse backgrounds and specialties advertise the fact that they treat people from marginalized groups and that they specifically treat men who have survived childhood sexual abuse. 

The Black men she interviewed for her doctoral study suggested some possible ways to improve the Black community’s access to mental health support services that she says can also apply to outreach efforts concerning sexual abuse for all Black men, particularly boys. These solutions include promoting the idea of positive mental health services in elementary schools; normalizing discussions about mental health, sexual abuse and other traumas; providing interventions for coping with and calming emotions early in life; and encouraging and normalizing help-seeking behaviors.

Counselors need to be “in places where Black men are,” Davis stresses. He plays in a basketball league with other Black men, and because many of them know that he is a counselor, they sometimes ask questions about mental health issues. When they do, he connects them with other mental health professionals who can help them. Davis also suggests clinicians reach out to universities and colleges, Black Greek fraternities and Black churches to find and connect with people who may be in need of counseling services. 

The counseling profession should reach out to Black men, he says, instead of waiting for this clientele to “reach out to us.”

 

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Lisa R. Rhodes is a senior writer for Counseling Today. Contact her at lrhodes@counseling.org.

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