Tag Archives: Counselor Wellness

Counselor Wellness

Using the ‘tap in dedication’ technique

By Nicholas Salazar January 13, 2021

Emma quickly checks her watch as she turns her key in the lock. It’s 9:57 p.m. She sighs as she pushes open the door and quickly moves to her room to drop off her bags before heading to the kitchen to make dinner, her second meal of the day since leaving at 6 that morning. She fills up a pot and turns on the stove, dropping in some noodles before opening her laptop to check emails and begin working on her course readings. It’s 10:03 p.m.

Emma’s eyes glaze over as she skims through the endless screens of text, and her head nods until she is awoken by a text from her boss: “Hey Emma, I just had someone call off. Can you open tomorrow morning?”

Emma immediately replies, “Sure thing, see you tomorrow!”

She glances at the time on her phone — 11:13 p.m. She panics and runs to the stove to turn it off. Greeted by a pot devoid of water, she throws away the burnt noodles and closes her laptop. She has finished only one of her five readings, but she needs to be up early tomorrow morning for work. She has six hours of classes after that and internship the following day.

It’s 11:30 p.m. Emma lies in bed with closed eyes and an empty stomach. Her mind races thinking about the different clients she has been working with and how they are holding up. She considers which clients might have which urges — and what she could do to help them, if anything. She thinks about the classes that she didn’t complete readings for and wonders whether she can get by without doing the readings. She thinks about herself as a counselor and questions whether she can ever be successful if she is already struggling.

It’s 12:25 a.m. Emma is asleep, but she will wake up in three hours to get ready to do this all over again.

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As a second-year graduate student who is also working on-site at a residential treatment program, I have discovered it can be difficult to not let every piece of life bunch together and form one massive challenge. It seems that everything of which I am a part is geared toward becoming a mental health counselor. It can be hard to engage in clinical experiences and separate the emotional intensity I experience on-site from my schoolwork, personal life and all other aspects of life.

In our field, being emotionally present and available and working through the sensitive topics of other people’s lives is our daily bread. But being able to stay engaged with a client can be a challenge, especially when you are burned out from the day before, or the events of that morning, or the previous client — not to mention school, work and other life tasks. Taking time to check in with yourself, support yourself and separate one facet of life from another is a skill I have found to be useful when applied in a genuine and purposeful manner.

Overview

“Tap in dedication” is a technique adapted from theater creators when dealing with highly intimate work on stage. It has been used for scenes ranging from a staged slap to simulated intercourse, and the intended purpose is to allow the actors an opportunity to establish their readiness to engage in sensitive and potentially harmful work.

My experience with this technique stemmed from my theater work during my undergraduate studies under the direction of Carin Silkaitis and Gaby Labotka, the latter being a certified intimacy director with Intimacy Directors and Coordinators. They introduced the technique of “tapping in” to those of us in the show, focusing on respect, safety and well-being for ourselves and for those with whom we were working. We used this technique regularly during scenes of overt sexuality, abuse, trauma and death.

We would physically tap each other’s hands, like a “high-ten,” as a way to say to one another, “I am ready to engage in this work with you.” When work on that scene or sequence had been completed, we would perform this action again to provide a physical symbol that communicated, “We did the work, and now we are stepping outside of it to be ourselves.”

Adapting this technique for counselors to use is a nice fit because of the themes of respect, safety and well-being — something that we helping professionals are adept at offering to clients but may not always apply to ourselves. In the counseling profession, it is important to find ways to respect ourselves and our work because if we do not, it can become all too easy to face burnout, experience vicarious traumatization or even fail to respect our clients.

I coupled the technique I learned in theater with aspects of dialectical behavior therapy to allow helping professionals to engage in mindful participation in their careers while providing them the time to check in with themselves before and after a day’s work. In the case of a particularly difficult session, counselors can also use this technique quickly between clients. Depending on site regulations, it may even be used with some clients.

The goal of the technique as I describe it here is to provide a way for counselors, counselors-in-training and other helping professionals to deal with sensitive subjects, to be present and engaged for the difficult work they take part in daily, and to be able to “leave work at the door” when they reach the end of the workday. It can be detrimental for helpers to bring troubling work home with them because it can impede their self-care and have a negative effect on the relationships they have outside of work. Ideally, using this technique will make it easier for clinicians to allow themselves to be engaged fully in their work life while helping them to separate this time from their personal life.

The technique

Practice self-care: Begin by entering or coming to the place where work will be done for the day. Next, take a moment for yourself by performing some action that is soothing and regulating for you. This could be making a cup of coffee or tea, enjoying a snack, reading a few pages of the newspaper, doing a crossword puzzle — anything you find that helps you feel relaxed or calmed. If this is a technique that you would like to use several times per day, between sessions or simply as it feels necessary, an activity that takes less time may serve you better.

Engage in mindfulness: Once you complete your self-care activity, it can be helpful to become grounded in your work environment. For example, take a few minutes to use a “five senses” grounding technique: Identify five things that can be seen, four that can be heard, three that can be touched, two that can be smelled and one that can be tasted.

Skills for distress tolerance can also be beneficial. An example is radical acceptance — taking time to accept one thing that you cannot change about how your day may go, while acknowledging that you can affect your own presence in the day. A technique such as one-mindfulness could be used to promote purposeful attention by focusing on one thing and allowing yourself to see, hear and appreciate it, whether it is physical, emotional or something else (e.g., a plant, a feeling, a thought). Any activity that helps you feel mentally at ease and instills feelings of calm and preparedness can be used for this activity.

An important consideration is to decide where and when you will engage in this process daily. For example, will you do it before you leave home? In the car or on the bus while traveling to work? Once you arrive at your office? From my experience of using similar techniques in theater, once the actions have been set, it is helpful to always do them the same way or as close to the same way as possible to preserve the integrity of the actions and process.

With practice, you will likely be able to engage in your self-care and mindfulness processes anywhere, although a change in environment or process initially could make it difficult to establish and maintain the mindfulness you hope to achieve. If you are in a position where you must travel regularly for your sessions, it can be helpful to have one specific action that you engage in prior to each session. It can also be useful to practice that action several times in settings that are calming before engaging in the activity in a more fluid and potentially stimulating environment.

Literally tap in: After you complete your grounding activity, you will literally tap in. This means to physically tap your hands on a surface or object. Your physical tap in signifies that you are mentally, emotionally and spiritually ready to be 1) devoted and engaged in the activities that follow in an effortful and conscientious manner, 2) fully present in your interactions and 3) aware of the effect that your effort and presence can have on clients and others.

Your physical tap in action serves to signify that your day has begun, and you will give conscious attention to all that occurs from that moment forward. Importantly, tapping in marks the time that is about others (rather than about one’s self), while the preceding actions were exclusively for the individual performing them (i.e., you). This can allow you to engage and deal with more demanding emotions and experiences by allowing you to acknowledge that this time is about being wholly devoted to another, just as the actions before were devoted to taking care of yourself. And in essence, you are taking care of yourself while caring for others because you have intentionally prepared yourself for your service.

Literally tap out: After your sessions, work or treatments are completed (or between sessions if content was particularly difficult), it is time to tap out — literally — just like you tapped in. This is a physical action in which you physically tap the same surface or object you used to tap in. It is important to use the same object every time if possible to symbolize the ending of the specific dedication to your work.

This tap out provides a physical action to close out of what has been occurring during your workday and allows you to engage with the nonwork you again. Additionally, this action signals that the feelings and emotions that may have come up during your work are meant to be kept in that specific time; they are not necessarily meant to exist beyond the scope of that session or that day.

Enjoy your post-tap-out activities: At this point, it is time to go about the doings of your personal life and nonwork time. This means to do anything you would normally do after work — exercising, playing with your children, grocery shopping, attending to your home, spending time with friends and so on — without interruption from what occurred during your work time.

Additionally, some people find it incredibly helpful to engage in some kind of self-care at the end of the day, similar to what they did at the beginning of the day. This might involve watching a specific show, enjoying some ice cream, doing another crossword puzzle — anything that can help you to decompress and relax. This activity can be done at any time but may be more useful to do soon after tapping out so that it can serve as a nice, calming cap to your workday.

Technique considerations

This technique was adapted from a theater practice used in scenes in which violence or intimacy was approximated that could cause effects similar to reliving traumas or increase actors’ emotional discomfort. It is important to recognize when something goes beyond the scope of dedication to work. It is up to counselors to use their best judgment to determine when an event may need further intervention to protect their well-being. Some subjects may be difficult to “leave at work,” and if this circumstance arises, it may be wise to seek support. If a counselor has a troubling response to a client’s trauma, it may be useful to discuss this in the clinician’s own therapy sessions or to process it with trusted colleagues or supervisors so as not to shoulder the burden alone.

Using this technique can take up a fair amount of time depending on the self-care actions the counselor chooses to use. Given that reality, it can be useful to find a quick-and-easy action, or to incorporate parts of the technique into one’s daily routine so that it does not become a burden to the user. However, taking the time needed to prepare for one’s day is imperative to staving off burnout and to increasing wellness.

Although this technique is not intended as a catch-all for reducing stress, it may prove useful in helping to establish firmer boundaries between personal life and work life, which is a common stressor among counselors. The goal is not to fix every stressor that clinicians may experience, but rather to provide an opportunity for clinicians to have a solidified and intentional process of entering and exiting their daily work in a demanding field.

In the event that a counselor must travel between environments during the workday, it may help to tap in and tap out before and after each client and to use travel time for a bit more mindfulness. Especially because of the variety of possibilities, such as traffic or accidents, that can occur when traveling between places, practicing mindfulness during the journey may be helpful in terms of keeping travel stress separate from your work. Additionally, using this technique can allow helpers to reduce personal stressors that often are carried over into work with clients, thus enabling a fruitful and intentional work experience.

Suffice it to say there are many situations that may not benefit from the ability to tap in and tap out. Using this technique ultimately comes down to each person’s discretion. It is simply meant to give them increased autonomy in how they choose to handle their time in a helping profession.

Getting started

Ask yourself the following questions to get started with the tap in dedication technique:

  • What would it be like for you to intentionally tap in to your workday and tap out of it? Do you have any hesitations? What can you do to resolve those hesitations?
  • What self-care routines would you like to use to start your day? Which ones are you doing already?
  • Mindfulness is an integral part of preparing to tap in. What mindfulness practices do you have established on which you can draw? If you do not participate in mindfulness, do you have other religious or spiritual practices that you might use (e.g., prayers, religious texts, songs)?
  • Where will you tap in at the beginning of your work and tap out at the end?
  • What does it mean to you to practice your work in a conscious way?
  • What practices do you want to establish if your work life enters your personal life after you have tapped out?
  • What resources do you possess to process particularly difficult clinical workdays? Jot them down and use your list when you need it.

 

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Nicholas Salazar is a second-year master’s student at Marquette University in the Department of Counselor Education and Counseling Psychology. He works part time and is an intern at Rogers Behavioral Health in Oconomowoc, Wisconsin. Contact him at nicholas.salazar@marquette.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, go to 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.

Paths to wellness

By Rebekah Lemmons December 9, 2020

I have been working in the mental health field since 2010, and in that time, the topic of wellness has come up often across an array of settings. In my professional counseling roles as an instructor, supervisor, trainer, consultant, therapist and manager, I have witnessed a growing need for wellness practices. And as I have learned more about the impacts of stress on the brain, I have come to better understand the necessity of all professional counselors having strong wellness practices.

Counselor wellness is essential to providing quality services to our clients. I have been able to observe counselors with strong self-care practices who balance boundaries well and maintain strong professional helping relationships with their clients. I have also witnessed the opposite end of the spectrum, in which therapy progress is hindered due to counselor issues such as burnout, compassion fatigue, vicarious trauma and overcommitment to myriad duties.

The dynamic nature of wellness

Wellness and burnout are not mutually exclusive. Instead, they operate more on a continuum. So, rather than viewing counselors as “burned out” or “not burned out,” we should understand that many counselors oscillate between various levels of wellness and burnout. It is common to see many professional counselors cycle back and forth between varying stages of wellness and burnout. A particular therapist might present with symptoms of burnout during a specific period of time but be well and maintaining strong self-care practices during another period of time. Because of the dynamic nature of wellness, counselors need to revisit this topic frequently.

The theme of self-care has become a hot topic over the past decade. From articles and books on how to promote self-care to ways to address burnout, the professional helping fields have been inundated with information on burnout, compassion fatigue, vicarious trauma and associated subjects. Even with these themes being more openly discussed in graduate programs and across supervision settings, many counselors could still benefit from practical strategies designed to increase overall mental health and well-being.

One way to provide such information is within the framework of a practical model. Some models found in current counseling articles do address self-care components. However, models could more holistically include self-care components that tie into larger wellness frameworks as an area of growth. Many clinicians verbalize an array of variables that inhibit effective self-care practices. On that basis, I have conducted qualitative research to identify themes related to what gets in the way of wellness. From interviews with master’s-level counselors, I have learned the importance of expanding wellness models to include the array of factors that contribute to self-care or a lack thereof.

A proposed wellness model

From this research in 2019, I and my fellow researcher, Steve Zanskas, developed a three-tiered model for self-care that identifies levels of responsibility targeted at providing an integrative way to increase the effectiveness of wellness pursuits. This model looks at wellness accountability through the lens of individual, supervisory and organizational responsibility. This mirrors feedback provided during interviews with 77 counselors discussing what helps and what hinders their self-care.

This model also provides practical approaches to increasing our awareness of the self-care domains that influence wellness. The model was titled Paths to Wellness based on the idea that wellness pursuits are similar to a journey with many roads leading to the same destination. When we view wellness as a journey, we are able to acknowledge the individuality of self-care pursuits and the layers of wellness that can help to buffer negative professional hazards.

Wellness domain: Individual level of responsibility

Practical wellness check-in:

  • What makes me feel recharged?
  • What stresses me?
  • Where do I feel stress in my body?
  • What recharging activities do I need to do when certain stressors occur?
  • Do I have a balance of self-care activities across various domains (physical, emotional, intellectual, financial, social, etc.)?
  • What can I do to increase balance among my self-care domains?
  • Do my values as a person align with the work I am doing?
  • Does my job overall give me a sense of satisfaction?
  • What job factors are increasing or decreasing my overall wellness?
  • What changes can I implement to help me become present and peaceful?
  • What resources and supports do I need to make these changes?
  • Do I have regular check-ins with myself to reflect and make needed adjustments to my wellness plans?

Wellness domain: Supervisory level of responsibility

Practical wellness check-in:

  • Does my supervisor practice self-care and model overall wellness?
  • Does my supervisor discuss self-care and check in on my overall wellness?
  • Does my supervisor respect my individual self-care needs and support my self-care endeavors?
  • Does my supervisor support the use of vacation, sick leave and other paid time off?
  • Does my supervisor provide coverage for time off?
  • Does my supervisor provide a positive work environment?
  • Does my supervisor facilitate teamwork and a positive team culture?
  • Does my supervisor support time off for mental health?

Wellness domain: Organizational level of responsibility

Practical wellness check-in:

  • Does my organization provide paid time off for vacations or hobbies?
  • Does my company provide resources to staff for growth and development?
  • Does my company encourage a positive work culture?
  • Does my company regularly obtain and utilize employee feedback?
  • Do leaders communicate openly and honestly with employees?
  • Does my company care about me as an individual?
  • Does my company promote work-life balance?
  • Does my company provide benefits related to wellness activities (gym reimbursements, health coverage, paid sick time, employee assistance programs)?
  • Does my company have policies and processes in place specifically targeted to promote wellness?

Model usage

The Paths to Wellness model can be used across counselor roles and functions by clinicians, supervisors, counselor educators and organizational leadership. Benefits of this model include use as an assessment and evaluation tool as well as a resource for reflection on further wellness development.

Counselors can use this model as a tool for evaluating their own levels of wellness, helping to inform them of both weak and strong areas related to self-care. In alignment with this, this framework can empower professionals to strategically weigh the benefits and drawbacks of their choices on their overall wellness to make the best decisions for their own self-care at that moment in time.

In the professional realm, counselors could use this evaluation tool when they are asked to consider a new position or added role opportunities or when considering a move to a different employer. New professionals could use it as they decide where to begin their work. The tool can help counselors evaluate how a potential new role or task might affect their self-care and wellness pursuits across individual, supervisory and organizational domains. Such evaluations can provide counselors with a framework to make decisions that align with their wellness goals.

Supervisors can use this tool both at the individual level for themselves and at the supervisory level. The supervisory level aims to assess the current level of wellness modeling and promotion they are providing to their supervisees. The counseling profession regularly promotes supervision and consultation as a positive way to buffer negative client impacts associated with burnout and a lack of overall counselor wellness. The level to which supervision assesses for and positively addresses needs related to self-care and wellness may greatly influence the gains from attending regular supervision.

For supervisors within agencies, this model can help to facilitate increased worker satisfaction by allowing supervisors to better understand and address individual differences that occur within staff groups. This promotes an approach of all staff receiving what they need to support their wellness versus using an “equality standpoint” that provides all staff with the same resources regardless of individual need area.

Organizational leaders can use this model as a screening tool to evaluate the potential wellness impacts associated with each agency policy, process and procedure. Leaders can then advocate for specific policies that better foster employee wellness.

Ideally, policies and procedures would be designed based on feedback gathered directly from agency employees. Regular check-ins with employees and program evaluations designed to get specific responses can provide leaders with employee perspectives. These perspectives can then be used to update and revise wellness-related measures. Furthermore, leaders can model wellness pursuits to help infuse a wellness focus into the fabric of their organizations. This may include leaders showing that it is truly OK to take breaks, set boundaries with time off and maintain healthy habits.

Through agency, employee and supervisory collaboration, wellness gains are possible. Integration across these domains is vital to the successful implementation of self-care pursuits. Because of the dynamic and complex nature of counselor roles and demands, wellness endeavors and need areas should be evaluated often. The Paths to Wellness model serves as one approach that can facilitate wellness promotion and integration. Furthermore, the model can be added to current wellness strategies or used along with other self-care assessments.

With awareness and accountability across individual and systemic levels, wellness cultures are developed. These cultures then begin to thrive as wellness is intentionally integrated into daily practices. This can lead to a ripple effect, with the counseling profession serving as a model for wellness integration throughout other organizations.

 

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Rebekah Lemmons strives to improve outcomes for children, emerging adults and families. For the past decade, her practice and research have primarily been based in the nonprofit sector, with an emphasis on conducting program evaluation, teaching, engaging in service leadership, consulting and providing supervision to clinicians. Contact her at rebekahlemmons@yahoo.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, go to 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.

Voice of Experience: The hurting counselor (an update)

By Gregory K. Moffatt October 7, 2020

In 2018, I published a Member Insights article in Counseling Today titled “The hurting counselor.” I received more feedback on that article than anything else I’ve ever written, and it went on to become the most-viewed article posted to CT Online at any point in 2018. Nearly all the responses I received were comments about how counselors had (just like me) neglected self-care until crisis slapped them in the face and they realized they didn’t have the tools to deal with it.

In that article, I described a time when my marriage was failing and how, at the same time, my self-care had been sorely neglected. Even though my own story was a part of that article, my real point was to petition readers to take self-care seriously. Fortunately for me, at the end of the article, I gratefully noted that my marriage had been salvaged. Healing was slow and setbacks continued, but things improved.

Sadly, I’m here to tell you that a very painful tragedy has found me once again, and I’m devastated. I’ll leave the specifics of my painful situation unspoken because if I told you what it involves, then some readers might think to themselves, “That doesn’t apply to me.” The specifics of my situation are not why I am writing this follow-up article, any more than my original article was just about the sadness of my failing marriage. Let’s just say that I’m hurting as much as one can hurt and still survive.

But just like before, my purpose is to address the importance of self-care. I religiously practice what I told readers about in “The hurting counselor” two-plus years ago. My separation that I wrote about at the time had happened almost a decade prior, and it nearly crippled me. I couldn’t eat or sleep, and I scarcely could get through each day. My compromised self-care nearly did me in.

But since that time, I’ve been practicing everything I wrote about in “The hurting counselor,” and now that I’m yet again facing a very painful experience, I’m so glad I did. The follow-up is that self-care is not only helpful but crucial.

Don’t get me wrong. The tragedies of life are always hard: the loss of a child, the humiliation of arrest and jail, failed relationships, crippling physical illnesses, etc. The timing of my current situation, coming as it does in the midst of the coronavirus, the beginning of a very challenging school year at my university, and a generally hard time of life, makes it worse.

My days are difficult and my nights are even harder, but I’m managing reasonably well — unlike the time I wrote about previously — because I’ve practiced our ethic of self-care. The unavoidable pain of personal crisis won’t defeat me as it nearly did years ago. I have a therapist, I play, I eat right, and I rest as well as I can. All the keys to reasonable self-care.

As noted above, self-care is not an option. It is an ethical obligation. The excuse that “I don’t have time” to exercise, go to therapy, eat well or take a day off is not only untrue, it is irresponsible.

Unlike the situation I found myself in all those years ago, today I’m making better decisions because I’m in better condition and I have the strength to do it. I will weather this storm with clarity of thought and resilience of heart. Neither of those things is possible without regular self-care. Fortunately, I’ll also be in reasonable condition to continue working with my clients, my interns and my supervisees. They will never know that I’m in the midst of a crisis unless I tell them.

If we are not taking care of ourselves, we will make poor decisions in all sorts of areas. We will stay in toxic relationships and dead-end jobs or work too many hours. Our lack of clarity will make it hard to see the damage we are doing to ourselves. I know that in my prior life of poor self-care, I could not have weathered this current hurricane. Today I’m so strong, even though daily I’m feeling vulnerable and battered.

I often tell stories about my life, my clients and my practice in my column, but this particular article is as personal as it gets. I’m not just processing my current pains with you, however. Because of the outpouring of responses I received from my original article on self-care, I know that self-care is a problem and a challenge for many therapists. It is imperative that we tend to it so that we are adequately prepared when we are facing deep hurts — as we all inevitably will in one way or another.

My testimony here will hopefully convince you that there is a good reason to take care of yourself. And I want you to know that I not only practice what I preach to you, but that it works.

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Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.

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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.

Primum cura te ipsum: First, heal thyself

By Samuel Kohlenberg August 17, 2020

During this bizarre and painful epoch beset by pandemic, racial trauma and social injustice, there is a growing emphasis on clinician well-being and self-care, and rightfully so.

Countless articles and blogs have been written about self-care for counselor clinicians, and here is one more. Why write another one? Because as a counselor educator and supervisor, I want to sell you on a goal other than being OK enough to work. Because avoiding burnout is not enough. We need to set the bar higher to competently render care. Make no mistake, this is an ethical issue.

Like many, perhaps, I have always found Latin venerating in a way that underscores the importance of a phrase or idea. Whether carved into cornerstones or encircling university seals, the tradition has gravitas. One idea I find worthy of such reverence, as it pertains to psychotherapy and behavioral health, is that clinicians need to “do their own work.” Therapists need to heal.

Whether it is through traditional talk therapy or other means, therapists need to attend to their own trauma, developmental journeys and growth. While the oft-cited phrase attributed to Hippocrates, “primum non nocere” (first, do no harm), is a vitally important doctrine in mental health, I am suggesting that there is an overlooked and more sequentially vital step in terms of primacy required to avoid doing harm: that therapists confront and deal with their own issues.

Although therapists are often told that they need to take care of themselves and “do their own work,” I do not believe there is enough understanding regarding why this is so crucially important. Yes, it benefits the therapists, it may mitigate burnout, and it may increase professionals’ longevity in the field. But from my perspective, not enough emphasis has been placed on the idea that people who are not OK do not make competent therapists.

This is not to say that people who have endured trauma or have previously met criteria for a behavioral health diagnosis should not pursue jobs as therapists. Far from it. Many of the best therapists I know are as good as they are in large part because of the difficult roads they have had to walk.

There are many ways to describe how therapists doing their own work might affect them professionally, but I am going to focus on three ideas:

1) Your nervous system is an instrument for attachment work and relationship, and it is shaped by how much work you have done.

2) Doing your work helps you project less and become more aware of your projections.

3) Having done the work means being able to genuinely relate to what your patients are going through instead of just understanding. (Note: Although I say “patient,” please feel free to substitute “client.” The reason I prefer patient is that I feel it better emphasizes the connection between the physical and psychological realms, and given the field’s current understanding of the interconnection between the two, I intentionally use language that fits in both lexicons.)

The nervous system

In a typical stress response, a perceived threat can activate the amygdala, leading to the release of epinephrine and coordinating a sympathetic response to the stressor. Typically, this sort of sympathetic activation means that you are no longer using the circuits associated with optimal social engagement (consider, is it harder to tell how other people feel when you are angry?).

The social engagement system is characterized by the feeling of social connection, the ability to read social cues, eye contact, voice modulation and comfort. All of these things shut down when we go into sympathetic activation as part of a stress response.

Imagine a therapist who has yet to “do their own work” sitting in their office listening to their patient describe a traumatic event. Even if an activated therapist gives no obvious facial expression or gesture, how do you think the person sitting across from them will be affected by the therapist’s nervous system switching gears from social engagement to fight-or-flight?

Imagine for a moment a scared child running to a parent or caregiver and being met with warm eyes, a soft smile and a soothing voice. Now imagine the same child being met with scared eyes, decreased facial muscle tone and a flat voice. In which situation is the child going to be more OK?

Similar dynamics play out in therapy. This means that therapists’ ability to stay in their social engagement system affects patients’ likelihood of being OK while doing things such as trauma work. Part of a therapist’s work is using their nervous system to help resource a patient’s nervous system. For some, it will take significant and ongoing work to be able to do this well. 

Awareness

Awareness and projection share a simple relationship: The more aware you are of your projections, the less likely you are to inadvertently allow those projections to affect your relationships with others.

Regardless of theoretical underpinning, modality or clinical philosophy, virtually all types of psychotherapeutic work regard the relationship between therapist and patient as instrumental. Thus, if the therapeutic relationship itself is one of the primary means by which therapists ply their trade, and a lack of awareness can lead to one’s projections interfering with relationships with others, there is an argument to be made that therapists are on ethically dubious ground if they practice without having cultivated enough awareness and done enough work to overcome this potential pitfall.

You are missing your patient if all you can see is your projection. You are not going to realize that it is a projection if you have yet to cultivate enough awareness. 

Relating

There is a difference between understanding what someone is going through and being able to truly relate to it. While psychotherapists are undoubtedly an empathetic bunch, helping someone engage in the process of developmental therapeutic growth beyond where you yourself have grown is no easy task.

Imagine for a moment a 40-year-old in the midst of an existential crisis. Now imagine an empathetic and well-meaning 14-year-old attempting to help that 40-year-old. Unfortunately, a developmental stage is not always as clear as chronological age, and this can lead to blind spots for clinicians that may negatively affect quality of care. Being able to genuinely relate to what your patients are going through is important, and the 14-year-old is going to have a heck of a time helping the 40-year-old.

Keep doing your work

The thing that all of the above ideas boil down to is relationship. It is your job to ensure a helpful clinical relationship, and the relationship itself is the greatest clinical tool that you have. Ensuring that this primary tool is going to be functional, let alone optimal, can require time, effort and a willingness to endure the discomfort necessary for growth.

Of course, more basic day-to-day self-care is still important for fighting burnout and for resourcing one’s self, especially when you are tasked with taking care of others and especially during times in which nobody seems to be OK. The invitation, the challenge, the mandate, is to not stop at “resourced.”

Aim higher. Embrace catalysts for growth and development. Get comfortable with discomfort when it means a potential breakthrough. Do it for you. Do it for them. Do it like it’s your job.

 

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Samuel Kohlenberg is a clinical psychophysiologist, licensed professional counselor and behavioral health educator specializing in the treatment of stress. He is a master of education in the health professions fellow at Johns Hopkins University and a postdoctoral fellow at Saybrook University and works in private practice in Denver. Contact him through his Facebook page or through his website at denverstressclinic.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.

The revised meaning of self-care in the wake of COVID-19

By Scott Gleeson August 4, 2020

Practicing proper self-care is often the prescription that professional counselors will share with their clients to help manage life stressors and mental health symptoms during their day-to-day lives.

That emphasis has taken on new meaning over the past several months as self-care routines have been offset by quarantining measures from the COVID-19 pandemic. Suddenly, sleeping patterns were thrown off by newfound anxiety. Routine pleasures such as listening to a podcast or playlist during the morning and evening commute disappeared as working from home became the new norm. With gyms closed, people were forced to adjust their exercise routines and workout habits. Typical avenues of social escape — restaurants, movie theaters, salons — were also closed. Even parks and hikes were off-limits in some states for a time.

In spite of the limitations, self-care has never been more meaningful given the conditions that people found (and, in some cases, still find) themselves in. Stephanie Burns, an associate psychology education professor and coordinator of the clinical mental health counseling program at Western Michigan University, says the unprecedented times prompted unprecedented human responses.

“Two things were happening at once for clients coming into therapy: They were going through their own already-existing struggles of depression and anxiety. Then there’s the trauma from what this crisis brought. Trauma is really about anything providing discomfort or distress to where an individual feels overwhelmed. It’s not something as obvious as getting hit by a car. Consciously, you can think some of this doesn’t bother you. But in the subconscious mind, trauma can exist. Everyone lost something from COVID. People lost jobs, loved ones and, by and large, their daily lives.”

On the positive side, the pandemic’s conditions have presented new opportunities for self-care for many people — with extra time at home for projects such as painting, playing music and experimenting with cooking and baking, more quality time with pets, additional emotional space to journal and a renewed premium on daily walks.

“There’s such a protective element to our routine, and our emotions get caught up in that pattern,” says Eric Beeson, president of the American Mental Health Counselors Association. “By being at home for several months, we had to readjust by finding normal in the abnormal. Normal had to be reconceptualized.”

That concept of normal was flipped upside down for clinicians too. The same focus on self-care needs to extend to therapists in their own lives and can be a unique blind spot, according to experts. Burns says she often reminds her counseling students that self-care works both ways and to practice what they’re so often taught to preach to clients.

“As counselors, when aspects of the client start matching you, then we run the risk of aligning with them and assuming what’s working for us is working for them,” says Burns, a member of the American Counseling Association. “Because of COVID, we were all going through the trauma and the grief process of our everyday lives at the same time. We cannot as clinicians expect to not be impacted by all this at the exact same time on a personal level. Then we add the extra layer of vicarious trauma from clients with intensified needs where we take on their pain. That all adds up to extra layers that cannot be neglected.”

“There’s been an overall shift in how we think about self-care as clinicians,” Litherland says. “Particularly during COVID, we should be asking ourselves, ‘How can I meaningfully and effectively engage in clinical work? Personally and professionally, am I able to buffer any side effect of burnout and compassion fatigue?’ Maybe we need 15-20 minutes in between each client because of our added pressures. Pace certainly matters for us because the speed of life right now feels fast.”
Gideon Litherland, a licensed clinical professional counselor at Veduta Consulting in Chicago and a Ph.D. candidate at Oregon State University researching supervision effectiveness, says emotional pace is an area for clinicians to pay attention to in working with clients.

Litherland adds that with the heavy increase in telehealth sessions during the pandemic, self-care has become even more integral. “The volume can take its toll,” he says. “Particularly when we’re connecting through a computer screen, a video monitor, it’s a different mode of attending for us. We’re working harder to extract more information from limited data. The sessions might be doable, but the wealth and richness aren’t as easy to pick up as in person.”

Carol Park, CEO and founder of the virtual platform company Thera-LINK, says telehealth was already on the rise before the coronavirus pandemic. But shelter-in-place orders prompted a huge increase and reliability on digital therapy. The benefits for both clinicians and clients can be widespread, but Park notes that she’s found treating virtual sessions slightly different than in-person sessions can be helpful for clinicians’ self-care.

“People who were having struggles pre-COVID, now they were needing connection even more,” Park says. “Telehealth really has filled that void for clients. For therapists, it’s important to know that you’re not quite getting that neuroconnectivity element. You sort of lose that sixth sense. As a therapist myself, I’ll leave feeling a little bit more depleted. You work a little bit harder.”

As states have started to gradually open up establishments and shelter-in-place orders have lifted around the country, private practices and therapy businesses are also opening their doors. With some clients returning to work, that gradual adjustment can be mended in the therapy room.

“I think one of the most important things is being gentle with ourselves, accepting that things are different,” Litherland says. “We’ve all been through something. We have to look at what previously worked for us and feel out how it fits into a new reality.”

Beeson, who is also a licensed professional counselor in West Virginia and a professor at Northwestern’s Family Institute, says the initial concept of easing back into day-to-day life as a clinician (mirroring the process many clients were experiencing) was interrupted by current events. The killing of George Floyd while in the custody of Minneapolis police officers sparked nationwide protests and, from Beeson’s perspective, put a renewed focus on clinicians’ roles being about more than just sitting in the counselor’s chair.

“When you look at wellness models, they’ve become accentuated more now,” Beeson says. “Continued racism and violence and health care disparity have always been there. But they’re highlighted more now. So, my sense of getting back to normal might be more cannonball-like considering the sense of urgency I feel in my role as a professional counselor, leader and person. Sometimes that sense of purpose can be part of our self-care too. As we come back to our daily lives, things have changed. There’s a need to collaborate and come together now more than ever.”

 

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Scott Gleeson is a licensed professional counselor at DG Counseling in Downers Grove, Illinois, and Chicago. Contact him at scottmgleeson@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.