Tag Archives: Private Practice Management

Private Practice Management

Making the ‘new’ normal: Five tips for providing teletherapy

By Andrea Chandler September 1, 2020

I awake, shower, dress and head into the office. I will see my first client of the day at 9 a.m., and I have arrived at my desk a half-hour early. I go to the office much earlier these days.

I start to ready myself and my space for work, spraying sage and lighting a palo santo stick to clear and bring in positive energy. I turn on my music, a surrogate noise diffuser, then close my eyes. Sitting in my high-back chair, I ask the universe again today to equip my mind, ears, eyes and words to support my clients in their healing journeys.

This is my new normal, but it is not so normal for me because my clinical office is now in my home. This is not a space that I originally set up to do private practice. Rather, it was a den I had designed for family escapism, reading, relaxing and spiritual grounding.

As I sit contemplating my schedule of clients for the day, I turn my attention to the bookshelves in the room. Among the different clusters of books sits a bobblehead doll of Jack Sparrow, a figurine of Ruth Bader Ginsburg, angel ornaments and angel sculptures. Also on the shelves, scattered and occupying space, are grounding rocks. Some are face-up so that I can see a word stamped on them from my vantage point: peace, calm, harmony, laughter.

I reflect on my past in-person sessions. At the start of sessions or during sessions, I would invite clients to select a grounding rock, hold it in their hands and set an affirmation, either verbally or silently, in harmony with the word on the rock. Or I would ask an anxious client to select a rock, and then I would guide them in a tactile grounding exercise. Most of my established clients know about the availability of the rocks — when they need to use them and how they will choose to use them. Among the comments I have heard from clients using a rock in session: “This gives me focus”; “It is comforting”; “I feel less anxious.”

On the table where the computer sits, there are writing pads I would previously give to clients to take home for journaling or suggest as a memory tool for those having trouble with remembering. In a corner of the sofa that sits along the far back wall of the den are several squeeze balls, which are great devices for releasing anxiety in session. In an off-white 5-by-6-inch box, sitting on the middle shelf of my computer workstation, are my business cards. These items all seem almost meaningless now because they are things I once provided for clients during in-person sessions.

Teletherapy vs. in-person

The reason that I now work completely from home, providing therapeutic services for clients by way of video and voice calling, is because I work with a population that is at higher risk for severe illnesses. This has been the protocol for many behavioral health workers for many months now. The current environmental situation dictates this change, and my obedience to moral and ethical obligations to clients guides me to protect and minimize harm.

I have found that teletherapy, telecounseling, telemental health and distance counseling — among other descriptives used to define the provision of remote mental health psychotherapy — takes a slightly different way of working with clients than does providing in-person sessions. I liken the two approaches to watching a movie versus reading a book of the same title.

An in-person therapy session, like watching a movie, involves the art of active listening. I am paying attention to what the client is saying while also focusing on their body language and behavior. The body language and nonverbal gestures can be picked up readily in in-person sessions.

On the other hand, I compare teletherapy with the way that written words in a book detail a story and convey information; it requires enhanced attentiveness to detail to see the full picture. I must use sharper observation to recognize the subtle messages of facial gestures and voice tonetics in teletherapy sessions.

Five areas of focus

Here are five areas of focus that have helped me make clients feel more comfortable and safer with the teletherapy process.

1) Distance counseling technology: Verification of a client’s identity and location are important. These things should be established before starting the first session and at the beginning of each session thereafter. Know that the person you are providing counseling service to is really who they claim to be and where they reside. In addition, know the definitions for the scope of practice and regulations for professional practice in both your state and the state in which your client resides because these items can differ between state licensure boards.

Ensure that the platform you are using for your teletherapy session is secure. Use applications that have an end-to-end (two-way) encryption capability. There are several good ones out there, but do your research.

Likewise, be careful not to use text messaging and email applications that are not compliant with the Health Insurance Portability and Accountability Act (HIPAA). Outside of the use of HIPAA-compliant text messaging applications, HIPAA does allow for texting clients on the condition that they have been informed of the risk of unauthorized disclosure and consented to communicate by way of text messaging. Both communication of the risks and consent from the client need to be documented.

Personally, I limit text messaging to clients to scheduling or confirming appointments. These text messages hold no personal client information, not even in the salutation. With email messaging, I never assume that the client has an internal email network with firewall protection. For this reason, all email correspondence that I send is by way of a secure messaging application.

2) Informed consent and confidentiality: In conveying aspects of the teletherapy process, counselors need to give clients a clear understanding of the therapy they are entering into and ensure that they feel comfortable and safe with the process. In this way, clients can make a choice to engage in therapy. The “consent for treatment” form should state the following at minimum:

  • Platform from which the counseling will be delivered (Zoom, Google, etc.)
  • Therapeutic modality that will be used (cognitive behavior therapy, solution-focused brief therapy, etc.)
  • Risks, benefits, confidentiality and boundaries involved in engaging in teletherapy, plus an acknowledgment that although measures will be taken to ensure the confidentiality of the session, there are no guarantees
  • Possibility of technology failure and alternate methods of service delivery
  • Location and setting of the practitioner, along with the practitioner’s credentialing and contact information

I have found it helpful before beginning sessions to show clients the confidential space in which I am working. I pan the monitor camera around the room so they can see the space I’m in is safe and free of distraction. Similarly, I encourage clients to use a quiet, calm space for their sessions when possible. It also helps for practitioners to be consistent with the counseling space location and background that clients see from session to session on their monitor screens. This allows clients to become comfortable with the predictability.

3) Technology slip-ups and client crises: Slip-ups inevitably happen, so it is wise to prepare as best you can before a session. First and foremost, test your video connection capability so that issues do not cause session delays. Unfortunately, some things cannot be anticipated, such as audio or visual problems in session. I have found it beneficial to address difficulties and concerns of this nature with clients in initial sessions and to plan together a backup alternative, such as having a phone session.

Just as with technology slip-ups, crisis situations can occur. It is important when conducting the initial client assessment that potential crisis situations for the client are discussed and a crisis plan is developed, documented and put in place. I ask an array of questions in considering the client’s risk for a crisis. As part of the crisis plan, it is important to have the client’s emergency contact numbers, local and national emergency crisis numbers, and language stating that the police could be called to provide a welfare check if the client’s safety is a concern.

A crisis can sometimes occur for clients at the end of an especially difficult teletherapy session. In these instances, I have used various techniques, such as relaxed breathing, having the person hold something in their hand and mindfully describe it, and the use of grounding exercises to help clients orient back to space, time and place.

4) Practical tips: At times, I have found myself focused on the computer’s video camera, checking my eye alignment so that I do not appear to be looking downward or too high upward. As a result, my awareness of the subtle movements and body language of the client has been obscured. Likewise, although I engage in active listening, I sometimes miss the tonetic detail of information being provided.

Some of the techniques I find most useful in keeping me attuned with the client in the therapeutic process draw on the principles of mindfulness practice. Having a moment-by-moment awareness of what is unfolding visually and tonetically allows me to help clients feel supported and understood.

When I mindfully remind myself to sit back from the screen, I see a wider area. I can better catch the slight facial expressions and eye gestures of the client and use these observations to reflect on helping the client gain awareness of the messages they are conveying. These days, I pay additional attention to noticing, understanding and noting what the client’s voice nuances, tempo, pitch and inflection are conveying. These hold equal importance with visual focus in creating a therapeutic alliance with the client.

5) Best self forward: Putting your best self forward begins with self-care. A great part of self-care is maintaining good boundaries, both inside and outside of client sessions. This includes establishing a clear line of demarcation between work time and personal time and creating a space of time between each scheduled client so that you are able to replenish your mind and body.

I like to replenish my mind through meditation and my body through movement. Meditation helps me create inner calmness and renews my focus. Fitting short exercise into my workday, such as a short cardio workout, walking the dog, and resistance-band exercise, helps me to reenergize. I also find great mental fortification in connecting with clinical colleagues with whom I can share challenges, problem-solve and get overall support.

In facing the changing times of our new normal, it is useful to know that we can move forward by being proactive in our thinking, preparation and approach. The more equipped we are, the fewer obstructions we will face. The fewer obstructions we face, the better we can be of service to our clients, upholding nonmaleficence, beneficence, justice and respect for the autonomy of the person.

 

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For more on the ins and outs of telebehavioral health, see the American Counseling Association’s resource page for counselors: counseling.org/knowledge-center/mental-health-resources/trauma-disaster/telehealth-information-and-counselors-in-health-care

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Andrea Chandler is a licensed counselor with more than 12 years of practice. It is her passion and privilege to serve individuals through counseling and advocacy efforts. Contact her at Achandler123@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.

Grappling with compassion fatigue

By Lindsey Phillips August 31, 2020

Compassion fatigue presents a paradox for counselors and others in the helping professions. As Alyson Carr, a licensed mental health counselor and supervisor in Florida, points out, it compromises their ability to do the very thing that motivated many of them to enter the field in the first place — empathically support those in pain.

Empathy and compassion are attributes those in the helping professions are particularly proud to possess and cultivate. Yet those same characteristics may leave some professionals more susceptible to becoming traumatized themselves as they regularly observe and work with those who are suffering.

Jennifer Blough provides counseling services to other helping professionals as owner of the private practice Deepwater Counseling in Ypsilanti, Michigan. She says many of her clients experience compassion fatigue. One of her former clients, an emergency room nurse, witnessed trauma daily. One day, the nurse treated a child who had suffered horrendous physical abuse, and the child died shortly after arriving at the hospital.

This incident haunted the nurse. She had nightmares and intrusive thoughts about the child’s death and abuse. She started to isolate to the point that she had to step away from her job because she refused to leave her house. She couldn’t even bring herself to call Blough. She just sent a text asking for help instead.

Blough, a licensed professional counselor (LPC) and certified compassion fatigue therapist, asked the nurse to come to her office, but the nurse said she was comfortable leaving her home only when accompanied by her dog. So, Blough told her to bring her dog with her to the session. That got the nurse in the door.

From there, Blough and the nurse worked together to help the client process her trauma. Blough also taught the client to recognize the warning signs of compassion fatigue so that she could use resiliency, grounding skills, relaxation, boundary setting, gratitude and self-compassion to help keep her empathy from becoming unmanageable again.

Defining compassion fatigue

“One of the most important ways to help clients who might be struggling with compassion or empathy fatigue is to provide psychoeducation,” Blough says. “A lot of people don’t even realize there’s a name for what they’re going through or that others are going through the same thing.”

Blough, author of To Save a Starfish: A Compassion-Fatigue Workbook for the Animal-Welfare Warrior, didn’t understand that she was experiencing compassion fatigue when she worked at an animal shelter and as an animal control officer before becoming a counselor. After she started feeling depressed, she decided that she was weak and unfit for her job and ultimately left the field entirely. It wasn’t until she was in graduate school for counseling that she learned there was a name for what she had experienced — compassion fatigue.

According to the American Institute of Stress, compassion fatigue is “the emotional residue or strain of exposure to working with those suffering from consequences of traumatic events.” This differs from burnout, which is a “cumulative process marked by emotional exhaustion and withdrawal associated with workload and institutional stress, not trauma-related.”

Although compassion fatigue is the more well-known and widely used term, there is some debate about whether it is the most accurate one. Some mental health professionals argue that people can never be too compassionate. Instead, they say, what people experience is empathy fatigue.

In an interview with CT Online in 2013, Mark Stebnicki described empathy fatigue as resulting from “a state of psychological, emotional, mental, physical, spiritual and occupational exhaustion that occurs as the counselors’ own wounds are continually revisited by their clients’ life stories of chronic illness, disability, trauma, grief and loss.”

April McAnally, an LPC in private practice in Austin, Texas, is among those who believe that people can’t have too much compassion. Compassion involves having empathy and feeling what the other person does, but we have a screen — an internal boundary — that protects us, McAnally says. “Empathy, however, can be boundaryless,” she continues. “We can find ourselves overwhelmed with what the other person is experiencing. … So, what we actually become fatigued by is empathy without the internal boundary that is present with compassion.”

As Blough puts it, “Empathy is the ability to identify with, or experience, another’s emotions, whereas compassion is the desire to help alleviate suffering. In other words, compassion is empathy in action.”

McAnally, a certified compassion fatigue professional, also suggests using the term secondary trauma. She finds that it more accurately describes the emotional stress and nervous system dysregulation that her clients experience when they are indirectly exposed to the trauma and suffering of another person or animal.

Symptoms and risk factors

Anyone can be susceptible to burnout, but compassion fatigue most often affects caregivers and those working in the helping professions, such as counselors, nurses, social workers, veterinarians, teachers and clergy.

Working in a job with a high frequency of trauma exposure may increase the likelihood of developing compassion fatigue, McAnally adds. For example, a nurse working in an OBGYN office may have a lower risk of developing compassion fatigue than would an emergency room nurse. Even though they both share the same job title, the impact and frequency of trauma is going to be higher in the ER, McAnally explains.

Counselors should also consider race/ethnicity and contextual factors when assessing for compassion fatigue. Racial injustices that members of marginalized populations regularly experience are sources of pervasive and ongoing trauma, McAnally notes. And unresolved trauma increases the likelihood of someone experiencing empathy fatigue, she adds.

Carr, an American Counseling Association member who specializes in complex trauma and anxiety, and Blough both believe the collective trauma resulting from the COVID-19 pandemic and exposure to repeated acts of racial violence and injustice could lead to collective compassion fatigue for all helping professionals (if it hasn’t already).

McAnally, a member of the Texas Counseling Association, a branch of ACA, says the current sociopolitical climate has also affected the types of clients she is seeing, with more individuals who identify as activists and concerned citizens seeking counseling of late. She has found that these clients are experiencing the same compassion fatigue symptoms that those in the helping professions do.

Blough and Victoria Camacho, an LPC and owner of Mind Menders Counseling in Lake Hopatcong, New Jersey, say symptoms of compassion fatigue can include the following:

  • Feelings of sadness or depression
  • Anxiety
  • Sleep problems
  • Changes in appetite
  • Anger or irritability
  • Nightmares or intrusive thoughts
  • Feelings of being isolated
  • Problems at work
  • A compulsion to work hard and long hours 
  • Relationship conflicts
  • Difficulty separating work from personal life
  • Reactivity and hypervigilance
  • Increased negative arousal
  • Lower frustration tolerance
  • Decreased feelings of confidence
  • A diminished sense of purpose or enjoyment
  • Lack of motivation
  • Issues with time management
  • Unhealthy coping skills such as substance use
  • Suicidal thoughts

There are also individual risk factors. According to Camacho, a certified compassion fatigue professional, individuals with large caseloads, those with limited or no support networks, those with personal histories of trauma or loss, and those working in unsupportive environments are at higher risk of developing compassion fatigue.

In fact, research shows a correlation between a lack of training and the likelihood of developing compassion fatigue. So, someone at the beginning of their career who feels overwhelmed by their job and lacks adequate training and support could be at higher risk for experiencing compassion fatigue, McAnally says.

One assessment tool that both Blough and Camacho use with clients is the Professional Quality of Life Scale, a free tool that measures the negative and positive effects of helping others who experience suffering and trauma. Blough says this assessment helps her better understand her clients’ levels of trauma exposure, burnout, compassion fatigue and job satisfaction.

Regulating the body and mind

“Having an awareness of our emotions and experiences, especially in a mindful way, can serve as a barometer to help protect us against developing full-blown compassion fatigue,” says Blough, a member of ACA and Counselors for Social Justice, a division of ACA.

Part of this awareness includes being mindful of one’s nervous system and the physical changes occurring within one’s body. When someone experiences compassion fatigue, their amygdala, the part of the brain involved in the fight-or-flight response, gets tripped a little too quickly, McAnally explains. So, their body may react as if they are in physical danger (e.g., heart racing, sweating, feeling panicky) even though they aren’t.

If clients get dysregulated, McAnally advises them to use grounding techniques to remind themselves that they are safe. She will often ask clients to look all over the room, including turning around in their chairs, so they can realize there is nothing to fear at that moment. She also uses the 5-4-3-2-1 technique, in which clients use their senses to notice things around them — five things they see, four things they hear, three things they feel, two things they taste and one thing they smell.

Research has shown that practicing mindfulness for even a few minutes a day can increase the size of the prefrontal cortex — the part of the brain responsible for emotional regulation, McAnally adds.

Blough often uses the square breathing technique to ground clients and get them to slow down. She will ask clients to breathe deeply while simultaneously adding a visual component of making a square with their eyes. They breathe in for four seconds while their eyes scan left to right. They hold their breath for four seconds while their eyes scan up to down. They breathe out for four seconds while their eyes scan right to left. And they hold their breath for four seconds while their eyes move down to up.

Counselors can also teach clients to do a full body scan to regulate themselves, Blough and Camacho suggest. This technique involves feeling for tension throughout the body while visualizing moving from the head down to the feet. If the person notices tension in any area, then they stop and slowly release it.

Camacho once had a client lean forward and grab the armrest of the chair they were sitting in while talking. She stopped the client and asked, “Do you notice you are gripping the armrest? Why do you think you are doing that?”

The client responded, “I wasn’t aware of it, but I find it comfortable. I feel like I’m grounding myself.”

Camacho, an ACA member who specializes in posttraumatic stress disorder, trauma, and compassion fatigue in professionals who serve others, used this as a teachable moment to show the client how to ground themselves while also having relaxed muscles. She asked the client to release their grip on the chair and instead to lightly run their fingers across it and focus on its texture.

Carr finds dancing to be another useful intervention. “Engaging in dancing and moving communicates to our brains that we are not in danger. [It] allows us to develop and strengthen affect regulation skills as well as have a nonverbal, integrated body-mind experience,” she explains.

Creating emotional boundaries

Setting boundaries can be another challenge for helping professionals. Blough says many of her clients report feeling guilty if they say “no” to a request. They often feel they have to take on one more client or take in one more animal. But she asks them, at whose expense?

Blough reminds clients that saying “no” or setting a boundary just means saying “yes” to another possibility. For example, if a client wants to schedule an appointment on Thursday night at the same time that the therapist’s child has a soccer game, then telling the client “no” just means that the therapist is saying “yes” to their family and to their own mental health.

Blough and McAnally recommend that people create routines to help themselves separate work from home. For example, clients and counselors alike could listen to an audiobook or podcast during their commute home, or they could meditate, take a walk or even take a shower to signify the end of the workday, Blough suggests. “Anything that helps them clear their head and allows them to be fully present for themselves or their families,” she adds.

People can also establish what Carr calls an “off switch” to help them realize that work is over. That action might involve simply shutting the office door, washing one’s hands or doing a stretch. At the end of the workday, Carr likes to put her computer in a different room or in a drawer so that it is out of sight and mind. Then, she takes 10 deep breaths and leaves work in that space.

Exercising self-compassion

“Because a lot of helping professionals are highly driven and dedicated, they tend to have unrealistic expectations and demand a lot from themselves, even to the point of depletion,” Blough says. “Having low levels of self-compassion can lead to compassion fatigue, particularly symptoms associated with depression, anxiety and posttraumatic stress disorder.”

In other words, self-compassion is integral to helping people manage compassion fatigue. “Self-criticism keeps our systems in a state of arousal that prevents our brains from optimal functioning,” Carr notes, “whereas self-compassion allows us to be in a state of loving, connected presence. Therefore, it is considered to be one of the most effective coping mechanisms. It can provide us with the emotional resources we need to care for others, help us maintain an optimal state of mind, and enhance immune function.”

According to Kristin Neff, an expert on self-compassion, caregivers should generate enough compassion for themselves and the person they are helping that they can remain in the presence of suffering without being overwhelmed. In fact, she claims that caregivers often need to focus the bulk of their attention on giving themselves compassion so that they will have enough emotional stability to be there for others.

People in the helping professions can become so focused on caring for others that they forget to give themselves compassion and neglect to engage in their own self-care. Blough often asks clients to tell her about activities that they enjoy — ones that take their mind off work, help them relax and allow them to feel a sense of accomplishment. Then she asks how often they engage in those activities. Clients often tell her, “I used to do it all the time before I became a professional caregiver.”

She reminds them that they can help others only if they are also taking care of themselves. That means they need to take time to engage in activities that relax and recharge them; it isn’t a choice they should feel guilty making.

Self-regulating in session

As helpers, counselors are likely to experience symptoms of compassion fatigue at some point. This is especially true for clinicians who frequently see clients who are dealing with trauma, loss and grief.

For McAnally, that experience came early in her career. During practicum, she had a client with a complex trauma history who couldn’t sleep at night. In turn, McAnally found herself waking up in the middle of the night, worrying about the client. She knew this was a warning sign, so she reached out to her supervisor, who helped her develop a plan to mitigate the risk of compassion fatigue.

It almost goes without saying that counselors should take the advice they give to their own clients: They should establish a self-care routine. They should seek their own counseling and support. They should set boundaries and find ways to recharge outside of work. And they should exercise self-compassion.

But counselors also need to find ways to self-regulate during sessions. “If you are tense and you’re hearing all of these heavy stories, you’re at a much greater risk of being vicariously traumatized,” Blough says. Self-regulation can provide a level of protection from that occurring, she notes.

Blough often uses the body scan technique while she is in session. Doing this, she can quietly relax her body without it drawing the attention of her clients. In addition, as she teaches relaxation skills to her clients, she does the skills with them. For example, she slows her own breathing while teaching clients guided breath work. That way, she is relaxing along with them.

Likewise, McAnally has learned to be self-aware and regulate her nervous system when she is in session. If she notices her heart rate accelerating and her stomach clinching when a client is describing a painful or traumatic event, then she grounds herself. She orients herself by wiggling her toes and noticing what it feels like for her feet to be touching the ground. She also looks around the room to remind her brain that she is safe.

McAnally also uses internal self-talk. She will think, “I’m OK right now.” As with the body scan, this is a subtle action that clinicians can take to ground themselves without the client even being aware that they are doing it.

Helping the helpers during COVID-19

Recently, Carr received a text from a counseling mentor who has been practicing for 40 years that said, “I am falling apart. I am lost. I don’t know what to do, but sending a text to someone I trust felt right. Write or call when you can.”

Carr quickly reached out, and her colleague said he was experiencing a sense of hopelessness that he hadn’t in many years. He worried about his clients and feared he wasn’t doing everything he could for them. He was also anxious about finances; several of his clients had become unemployed because of the COVID-19 pandemic, so he started seeing them pro bono. All of this was taking a toll on him personally and professionally.

Before the pandemic, McAnally managed her compassion fatigue symptoms in part by checking in with other therapists who worked down the hall from her office and by participating in in-person consultation groups. Now that she is working from home full time because of the pandemic, she says that she has to be more intentional about practicing self-care and accessing support. She calls her colleagues to check in, practices mindfulness, and schedules breaks to go outside and play with her dog.

Even when counselors recognize that they need help, they can encounter barriers similar to those their clients face. For instance, they may not be able to find in-network providers, and only a small portion of the hourly rate may be covered by their insurance. This problem made Carr pose some questions: “Who is helping the helpers right now? How can we take care of others if we aren’t able to more easily take care of ourselves?”

Then she decided to take action. She created Counseling for Counselors, a nonprofit organization dedicated to raising awareness about the emotional and psychological impact on mental health providers during a time of collective trauma. The organization’s aim is to generate funding that would allow self-employed licensed mental health professionals in need of treatment to more easily access those services.

“Although the heightened state of anxiety around the pandemic may have exposed this critical need, the demand for quality, affordable mental health care for counselors is ongoing,” Carr says. “Counselors are not immune to trauma and, now more than ever, licensed mental health professionals need access to mental health services in order to effectively treat the populations we serve and to continue to play an instrumental part in contributing to the well-being of society at large.”

Fostering compassion satisfaction

People in the helping professions often feel guilty or ashamed about struggling with compassion fatigue. They sometimes believe they should be immune or should be able to find a way to push through despite their symptoms. But that isn’t the case.

“I think the biggest takeaway when it comes to compassion fatigue is that it’s a normal, almost inevitable consequence of caring for and helping others. It’s not a character flaw or a sign of weakness. It’s not a mental illness. It affects the best and brightest and those who care the most,” Blough says.

For that matter, compassion fatigue isn’t something you “have” or “don’t have,” she adds. Instead, it operates on a spectrum, which is why it is so important for helping professionals to be aware of its warning signs and symptoms.

Blough acknowledges that compassion fatigue is always present in some form for her personally. She often manages it well, so it just simmers in the background. But sometimes it boils over. When that happens, she knows to regulate herself, to increase her self-care and to get support.

It is easy for a negative experience to overshadow a helping professional’s entire day and push aside any positive aspects. That’s why Blough and McAnally both recommend setting aside time daily to list three positive things that happened at work. A counselor or other helping professional could focus on the joy they felt when they witnessed an improvement in their client that day or when they witnessed the “aha!” moment on their client’s face.

Blough often advises clients to journal or otherwise reflect on these positive experiences before they go to bed because it can help prevent rumination and intrusive thoughts that may disrupt sleep. Celebrating these “little victories” will help renew their passion for their job, she adds.

As Blough points out, “Empathy can definitely lead to compassion fatigue, but if properly managed, it can also foster compassion satisfaction, which is the antithesis of compassion fatigue. It’s the joy you get from your work.”

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.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.

Marathon vs. sprint: Building a sustainable career as a professional counselor

Compiled by Bethany Bray March 27, 2020

Professional clinical counselors who sustain their careers over decades have literally thousands of clients come through their doors. There’s no denying that the job is rewarding, but the daily grind of helping people overcome trauma, loss, addiction and other “heavy” challenges can wear on even the most resilient of practitioners.

This begs a question: How do counseling professionals maintain their energy and motivation across the years? What does it take to stay fresh and inspired day in, day out, rather than growing stagnant over time?

Lynda Diane Noffsinger, a licensed clinical mental health counselor supervisor in Winston-Salem, North Carolina, has found that her answer to this question is to stay curious. Noffsinger has been a professional counselor for close to three decades but says she is still learning every day. Just last year, she earned her credential as a certified eating disorder specialist.

Noffsinger has worked as a counselor in a variety of settings — at a mental health hospital, at a residential substance abuse program, at a college counseling center and in a private practice that she owned for 20 years. She says each role taught her not just new counseling skills and techniques but also more about herself.

For instance, when she worked briefly as a clinical counselor at a residential and outpatient eating disorders program, “I learned that I do not like an administrative role. I missed direct counseling, and I missed the community I called home,” says Noffsinger, a member of the American Counseling Association since 1999.

Most recently, in her role as a counselor at a practice that specializes in helping adults and adolescents with mood disorders, she immersed herself in a 30-hour online training program in dialectical behavior therapy. “From this work experience, I’ve learned I’m a clinician, and that’s what I do best. I have spread myself too thin at times, experienced burnout at times and, some days, I’ve ended the day bone-tired,” Noffsinger says. “However, since 1993, I wake up every workday and, as Viktor Frankl would say, I know what my purpose is and [that] my life has meaning. Twenty-seven years later, I still love the counseling profession.”

What does it take to stay fresh, inspired and energized over the long haul of a counseling career? Counseling Today recently collected insights about career longevity from American Counseling Association members of varied backgrounds and practice settings. Read their thoughts below.

What has kept you energized across the years of your career? How have you avoided stagnation? Add your voice to the conversation by leaving a comment at the bottom of this article.

 

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In my 33rd year of private practice, I am grateful for a profession where we can work as long as we choose and our clients often see working with an older counselor as a good thing.

Compared with the early years of my practice, my clients have become a more diverse group. Half my clients are under 40. They come from a variety of ethnicities, races, religions and sexual orientations. My days are both busy and varied — what one client brings to therapy looks very different from the previous client or the next one. Along with continuing to work on my professional skills, maintaining cultural competence and relevance helps keep my professional life from becoming too routine. My clients challenge me to see life from fresh perspectives.

For more than 15 years, I’ve been part of a small peer supervision group. The group has been an enormous gift. We support and challenge each other and provide different points of view. As someone in a solo private practice, relationships with peers have helped me avoid feeling isolated or stale.

In talking with newer counselors — and in reflecting on my own development — I’ve often thought that counselors prioritize caring for clients over self-care. That’s hazardous. I’ve learned not to be endlessly accommodating of clients’ need to reschedule if that would overload my schedule and leave me exhausted. And I’ve learned to become comfortable with the business side of my practice.

As a young counselor, I knew I wanted a practice where my clients and I would make decisions about our work without interference from insurance providers. Choosing not to sit on insurance panels meant that my practice grew more slowly. In the early days, I worked part time for nonprofit [organizations] to make ends meet. Having a vision of how I wanted to work has allowed me to build a practice where I can earn a comfortable living while also maintaining reduced-fee spaces for limited-income clients.

Someone told me early in my career that the world doesn’t need any more “burned out do-gooders.” I have taken that advice to heart, and I’m grateful to my younger self for the faith, patience and commitment needed to build a professional life that sustains me while allowing me to be useful to my clients.

— John Ballew, a licensed professional counselor (LPC) with a solo private practice in Atlanta

 

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What an honor it is to have been providing counseling services for over 35 years. I may be simply lucky, but I’d like to think that the fact that I have never experienced burnout and am still in love with my profession has more to do with an intentional emphasis on taking care of my own mental health.

There are a number of intentional activities that have sustained my balance, hope and energy for the profession over three-and-a-half decades. The most potent of these might be to stay in my own lane. Regardless of the job I do, I recognize that others will do it differently and not comparatively. I’ve both supervised and provided counseling for other professionals who find their energy zapped, their attitudes hostile and their work disrupted due to a comparative evaluation of colleagues as either better or worse in some area of the job.

An early mentor of mine encouraged me to realize that what another [counselor] does — except in cases of gatekeeping — is none of my worry and that others might rise if they feel support and care. This has led me to celebrate my peers’ work, to be open to learning from them, and to generally feel positive about heading into the workplace in each of the venues [in which] I’ve been honored to work. The closest I’ve come to burnout involved colleagues who were unjustly negative. It’s truly an art to turn that around.

This leads me to the second most powerful agent of enthusiasm building: learning. I am a lifelong learner. I deeply value finding new theory, technique, strategy and skill and, even more, a deeper understanding and wisdom regarding the human condition. I just reread, along with one of my Gonzaga classes, [Viktor Frankl’s] Man’s Search for Meaning to jump-start our trek of discovery this semester.

This is related to a third factor: I mix up my work and the populations I serve. I teach, provide community prevention services, crisis intervention, group work, couples and family work, and individual counseling with as diverse a set of individuals as I can in my community. It’s never dull, I am never bored, and I am constantly learning more about each person and about humanity at large. I’m constantly reminded to advocate where needed but to not turn my attention to embitterment.

  Elisabeth Bennett, a professor at Gonzaga University who has had a counseling practice treating couples, families and individuals in Spokane, Washington, for 35 years

 

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Sixty years ago, with new graduate degree in hand, I was hired as a school counselor. My counseling career had begun. Over the years, it has taken different shapes as jobs, settings, responsibilities and functions changed. Then, 21 years ago, I gave up tenure, license, income and position to retire. From the beginning to the official end of my active career, I have been energized, shaped, nurtured and sustained by an intense fascination with people.

My graduate education, combined with my fascination, shaped the way I interacted with people when I wore the hat of counselor or educator. Focusing on how people communicate and relate as casual friends continues to hold my attention. In both my professional and personal life, I have worked to be aware of that fuzzy line that separates intense conversation from therapeutic response, and I have worked hard to respect boundaries — both for myself and for the person or persons in the other half of the communication.

Early in my graduate education, I was given the maxim: “Counselor, know thyself.” It has been a guiding principle. Throughout my active career, regional and national conferences fed me with new ideas, refined techniques, and gave me rewarding interactions with professional colleagues and friends. I have always tried to have a group to whom I felt some accountability and who could assist me in that self-knowledge arena. In retirement, I have a regular group of friends to keep me grounded but without the professional expectation.

In retirement, I increased my volunteer activities in noncounseling situations that still required that I be a listening, caring individual. As example, for several years I facilitated a group of caregivers who met to share the pain and stress accompanying that role. I was facilitator, not group therapist. It worked for them and for me and was richly rewarding.

There came a day when I realized that my hearing loss and my inability to keep all the details of a conversation in my mind were affecting my facilitation skill. I knew myself. And I knew that my performance fell short of my expectations. Knowing myself means knowing what to do; it also means knowing when to quit.

I have had a good professional life. The fascination with people that moved me into my career remains high. It continues to sustain me in retirement. I hope it will continue to do so.

  Brooke B. Collison, an emeritus professor of counselor education at Oregon State University and a fellow and past president (1987-1988) of ACA

 

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When I started my counseling training in 1990, I knew I wanted to pair expressive arts therapies with counseling. That has helped me build a long-term career. We artists recognize creation as a metaphoric marathon versus a sprint. The first draft of an art project does not have the rich depth of the final product.

Artists recognize that the path of producing a work of art — like an actual marathon in comparison to a sprint — travels a variety of landscapes such that the path often doubles back on itself. You revisit various aspects of each work of art and massage each aspect until each art piece feels completed.

Others, of course, have spoken of the art of counseling. I add to their words as I invite the dance of creation, which is different than a marathon or a sprint because creation involves movement that is more varied than running. When we are schooled, we are advised to do our own therapy, and that is key.

As we do the energetic dance of relationship with our clients, those dances will stir the dances we have shut down. Stephen Porges’ polyvagal theory and Peter Levine’s understanding of trauma patterning help us recognize the burst of intense feeling that awakens moves that have been mired in shutdown.

When we lose interest in expanding our movement repertoire because we sense an intense awakening, we may push ourselves to work robotically and eventually burn out. When we risk the drama, we awaken a presence that brightens our time with our grandchildren [and] helps us appreciate the journeys of our adult kids and those of our lovers. Finding presence allows us to pause to snuggle with our cats and walk our dogs around the block.

  Dee Wagner, an LPC and board-certified dance therapist at The Link Counseling Center in Atlanta for 26 years

 

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What does it take to sustain a counselor over the long haul of a professional career?

For me, it has taken a lot of work on myself and paying attention to my needs outside of the counseling chair. If I have put my mask on first for oxygen, I am much more able to help others with theirs. When I haven’t done so, I struggle more, I stagnate more, and I find myself more frustrated. I also have truly come to believe that everything you ask a client to do, you better have done yourself. Whether that’s a sand tray therapy exercise, an expressive art technique, thought stopping, or getting to the gym, you have to do the work too.

What has kept you passionate?

There are two things that have really kept me passionate. First, every kid and family I have worked with and their willingness to show me their world and be vulnerable. This inspires me each day, and I try not to forget it. Second, supervising counselors-in-training, seeing them wade through this wonderful process, and being a part of their professional journey.

What are some lessons you’ve learned?

I think the biggest lesson I have learned so far is that I really feel like I know less and less each day. What I mean by that is I have learned to trust the process and pay attention to when I am trying too hard. When I first started practicing, I had no idea what this phrase “trust the process” meant. Now, I can feel it, see it, and have really come to appreciate it.

What does it take to stay fresh, day in, day out, and avoid stagnation?

Kids in the playroom always keep things exciting. Moreover, I try to remember that counseling is difficult for people, and I will never be doing them a service by merely making them feel good about themselves. Care is only shown in the tough stuff. Remembering that it is an honor and privilege to do this work always pulls me out of a jam in my own headspace.

  Quinn K. Smelser, an LPC, registered play therapist and doctoral candidate in counseling at George Washington University who has specialized in play therapy and trauma training. She is also a clinical instructor at Loyola University Maryland, where she teaches school counseling students and will soon offer play therapy courses.

 

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When you’re at the beginning of your career is probably when you have the most stamina. You’re excited, you’re pumped, and you have great ideas. You’ve spent years and years learning and deciding on what you’ll do, and you’ve been dreaming about the day when you’re finally there. You get the career, and the hardest part in the beginning is [that] you still have to learn some more. You must master the specifics about your colleagues, your location and your administration. More importantly, you have to learn what you’re capable of. The first few years is more learning, and you need the patience to dedicate the time to observe. Whenever a race is started, we all fight the instinct to jump out of the gate, but you need patience and persistence if your goal is long term.

As you’re learning the career and carefully collecting knowledge, it’s important to build up your reputation, also known as your street credibility or “street cred.” You build up your reputation by showing up, being reliable and completing tasks. Be careful not to overcommit because if you miss deadlines or turn in inferior work, that becomes your reputation. The learning years help you figure out what that perfect balance will be — how much you can handle, what you can complete quickly, and what requires more effort and dedication on your part.

Once you have a good reputation and you’ve figured out the key players, you build up your crew, your squad, your allies, etc. Finding this group will help you brainstorm when you’re stuck, vent when you’re fed up and considering quitting, and inspire you to keep going. How do you meet these amazing people? Professional organizations. Attending conferences, meeting like-minded professionals and joining committees is where you’ll find these treasures. Stay in touch, and make the effort to stay involved with each other in between conferences. Having good people in your inner circle is worth their weight in gold.

Lastly, create healthy boundaries. We are not only our careers. We are family members, we are artists, we enjoy hobbies, and we’re involved in our communities in different capacities. Make sure you are getting fulfilled in all areas of your life, and dedicate time to all the things that matter. Practice makes perfect, and you will find out the equations and quantities that work best for you.

  Margarita Martinez, an academic success counselor and curriculum chair for student development at Northern Virginia Community College who also serves as vice president for Latinx concerns for the Association for Multicultural Counseling and Development (AMCD), as secretary of the Virginia Counselors Association, and as co-chair of the strategic plan committee for the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling

 

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The person of the counselor is one of the most important elements in the counseling office. Participating in one’s own counseling, then, is crucially important. Creating a space to address one’s own past hurts and current relational self makes a counselor more able to see and to have compassion for themselves and for those sitting across from them.

When I participate in my own counseling, it helps me to remember what it is like to sit in the waiting room, in that awkward space of waiting, with ambivalence and yet longing to be seen. It helps me to remember the anxiety over what to say or how to answer a difficult question. But most importantly, tending to my own ongoing healing creates a generativity in me for this work. It produces more space within me to care for others in deep and authentic ways.

Also, we must continue to cultivate our own interests. This year I have been on a growth edge, learning how the feminine body holds stories in its fiber and its tissues. I have found a renewed sense of excitement as I learn. Learning can be fun, and it can also be restorative. Such learning, then, has a direct impact in the counseling room. When I am excited and growing, my work with others is much more fluid and energetic.

In addition to the above, gathering a good community of people around oneself bodes well for long-term health. Health is found in belonging. Counseling is often isolating, and it can be an easy place to hide. Such hiding and isolation are the stuff of guilt and shame and not of health and healing. Because of such potential workplace hazards, I have a consult group of friends and colleagues whom I respect. They are people who push deep into my life and into my work. They are people who challenge me and know my inner world. I would not be able to do the work I do without having these people — and others like them — in my life, caring for and loving on me, in my goodness but also in my messiness. Honesty with my consult group turns into honesty in my counseling office, all the while keeping me grounded in remembrance of how hard it is to be vulnerable.

  Laura Wade Shirley, a wife, mother of three, licensed mental health counselor (LMHC) and teacher in Washington state. She worked with children and families in community mental health for three years, prior to opening a private practice in 2003. Since 2006, she has also taught and supervised students at the Seattle School of Theology & Psychology in practicum and case conference classes.

 

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When I reflect on lessons learned to sustain my counseling career, two thoughts come to mind. The first is accepting who I am and who I am not. The second is the importance of a peer group whom I can be completely vulnerable with.

We often talk to our clients about being true to themselves. Previously, I was comparing myself to other counselors, which is not mentally healthy. I saw other counselors were receiving the most up-to-date training in their niche areas, and I wondered if I was doing enough. However, in checking in with myself, I was setting myself up for burnout. Comparing myself or going for training because I see others doing so, not because it is my area of specialization, is not what is going to sustain me for the long haul. However, I also know the importance of avoiding stagnation. It is then that I realized I need to attend my own training to keep my clinical skills sharp, while focusing on pursing additional training in my own area of focus. One cannot be an expert in everything. I had to be true to myself, just as we ask of our clients.

The second realization I had is how invaluable a group of peers is who will listen and not judge. In Irvin Yalom’s book Becoming Myself, he discusses a peer group he met with where they could talk about anything that might be impacting their practice while [still] respecting client privacy. This could range from personal problems to countertransference. While I am an advocate of counselors attending their own counseling as needed, I have also found my group of peers — whom I know I can have honest discussions with about myself, or them with me — to be the primary source of keeping me fresh and available, day in, day out, to my clients. Having peers who are available and nonjudgmental is fundamental.

Having a solid identity as a clinician and knowing who my people are, are major factors in not only sustaining my career but maintaining my inspiration and motivation.

  Deanna Johnston, an LPC who owns a private practice in College Station, Texas

 

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When I think about [career] sustainability, I think about feeling appreciated and respected by my immediate supervisor and included by my colleagues with whom I have a trusting and supportive environment. And, of course, I need to feel compensated for my work and feel that I am valued by the institution in terms of my pay. With those things in place, I’ve always felt that I can tackle the tasks at hand and be creative. That being said, I have enjoyed collaborating with colleagues, early career professionals and students at all levels — undergraduate, master’s and doctoral.

This is how I would define workplace sustainability and job satisfaction. These are my most critical factors in remaining in a career for the long haul. This has been especially true for people of color and members of other marginalized groups. Research findings have suggested that we are far too often not supported by our peers nor by our supervisors and, as a result, we become targets of workplace bullying and implicit bias. This has led to the exodus of many talented counselors [and] counselor educators who are pushed out of promising careers.

What keeps me passionate about the work are, by far, my mentoring experiences. In every position that I’ve held, I have tried to pass on my knowledge about leadership, research, teaching and relationship-building. It has been a tremendous pleasure to see my former students acquire jobs and begin mentoring others. I feel content knowing that there is another generation of counselor educators and practitioners who have embraced the ideals that I have shared and wish to pass on these ways of being to others. I am thrilled to see how they have owned and advanced my research and teaching philosophy. And I am constantly challenged by new ideas and beliefs that they hold.

My most important lesson learned is that I am only a cog in a wheel. I have contributed to the profession to the best of my ability, but my ultimate goal is to be replaced by more energetic and passionate early career scholars and practitioners. I love to stay, but I’ll love to go even more. Generativity is a good thing.

  Cirecie A. West-Olatunji, a professor of counseling and director of the Center for Traumatic Stress Research at Xavier University of Louisiana. She is also editor of the Journal of Multicultural Counseling and Development and a past president of both ACA (2013-2014) and AMCD.

 

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There are many things that I have worked on in order to prevent burning out. One of the main factors in preventing burnout has been maintaining strong boundaries when it comes to my family. It is necessary for me to put my family first and not allow my work to overshadow them. The first thing I did after establishing my LLC [limited liability company counseling practice] was to purchase a separate phone so that I could shut it off when necessary. I do not take on more clients or supervisees than my schedule can handle, and I have learned to say “no.” This can be challenging when, as counselors, we just want to be there for everyone.

What has kept me passionate? Clients. Listening to, processing and being a part of clients’ stories gives me life. There have been times in my career when I was not seeing clients due to school or pregnancy. When I stepped back into the counseling space, I was renewed and reminded of what I love about being a counselor. I have also found that working with students and young professionals has been rejuvenating. I can recall being in their shoes. Assisting them on their journey to become a counselor is immensely rewarding.

A valuable lesson that I have learned is to live each moment of your process rather than completing things simply to check boxes. I did that, to a degree, early on in my training and career. I have since learned the importance of growing with each experience and not for a moment thinking that I have it all figured out. Continuing to learn from my peers, my clients and my mentors is a process I will never outgrow.

Education and learning have always been central in my life. Staying interested in what is new or on the horizon helps me to avoid stagnation as a clinician and supervisor. I can always try something new — or even something old in a new way. Working with populations that I love and feeling that I am helping others in some small way allow me to continue without feeling my work is mundane.

Clients and supervisees will never cease to amaze me with their stories, their strength and their resilience. I feel honored to be able to be a small part of their story.

  Christina McGrath Fair, an LMHC at GentleWave Counseling, Consultation and Clinical Supervision in Stuart, Florida

 

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The challenge to remain fresh depends greatly on my ability to effectively manage my time. Revelations surrounding my career — sex therapy — are an everyday occurrence, with issues ranging from sex education [and] advocacy [to] societal influences and legislation. My task is to discern how much time and energy are placed on the given subject. One day, a legislative bill threatens the rights of sexual minorities; the next day, multicultural interventions for the trans community are explored.

Human sexuality is so fluid, any staleness on my part would deem me an ineffective counselor. I often choose topics [to explore] that I am unfamiliar with or that are highly controversial. The opportunities to stay fresh on things relevant to sexuality are ubiquitous. It is just a matter of allocating the appropriate time to the appropriate issue.

I truly believe that I embarked on my counseling career decades ago, although I have been seeing clients for [only] two years. A long-term counseling career is synonymous with a long-term parenting career or long-term partner career. Counseling, similar to parenting and partnering, is innately what I do and have done for years. The particulars — CEUs, licensure, certifications, etc. — are the extenuating factors, but I have been educating, advocating, learning and counseling for years.

For me, building a long-term counseling career comes as natural as breathing. The less organic aspect is establishing a business based on my counseling career. Fortunately, my awesome support system and deep respect for entrepreneurship allow me to feel optimistic and excited about building a business around my career as a sex therapist.

Sustaining my motivation or passion for sex therapy is relatively easy. I don’t have to plan for it or think about it. When I awake in the morning, I’m reminded of the importance of intimacy and communication with my partner. As I interact with my daughters every morning, I’m reminded of the importance of sex-positive messages that occur throughout their formative years, particularly as they develop their sexual identities. When I talk or listen to people about their insecurities or their level of dissonance, I’m reminded of how misinformation, society, trauma and self-perceptions can adversely alter the trajectory of a beautiful soul.

There is no plan or preemptive thought of how to stay motivated. Life is gracious enough to constantly remind me that people deserve to exist without the harsh barriers that impede sexual wellness.

  Cheryl D. Walker, a sex therapist and associate professional counselor in private practice in Atlanta

 

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The climb to a successful career as a licensed mental health counselor has been both challenging and satisfying.

As a middle-aged woman returning to higher education, this was my first challenge as I struggled just with that decision. Did I really want to dive in, and would I be ready for the rigor of learning? Would I do well with the time and expense commitment? Would my children and husband be supportive … and was it truly OK to be self-full? I knew it was now or never as the clock ticked on.

I know now it was the right timing and decision. I know appreciating the classroom learning, possibly for the first time in my life, was a huge benefit because I could fully direct my focus without the distractions of starting and caring for a young family.

No sugarcoating here: Working in agencies was truly brutal from a systems perspective. I took some solid lumps by inadvertently stepping on management toes. The challenge of working with clients, while most important, became second to fulfilling the job requirement of productivity. I remain very grateful to have survived the mill-type atmosphere of clients in and out. I gained such amazing clinical experience and somehow managed to be regarded as a good counselor professionally. I would encourage people going through this portion of the climb to connect with counselors, co-workers and physicians with whom they feel commonality because they will be your future collaborators and colleagues in private practice or agency [work].

What sustained me was keeping my focus on my professional goal to be a licensed counselor and eventually to own my private practice. I look back and realize I was strong even when I felt inadequate or resource-less. I’ve learned these feelings are transient and never fixed, so I trust the journey.

Seeking your professional “peeps” in regular monthly meetings that you commit to in your schedule is golden and leads to the gifts of shared respect, as well as referral pools for your — and their — clients.

I’ve learned to value what I still need to learn, [including] aspects of private practice not covered in my education or practical work and the business end of owning a business. [I recommend that counselors] hire out what you don’t know or aren’t great at until you learn it yourself. Also, keep up with learning new theories because the freshness of exploring interesting trainings [will] always complement what you know so well already. My practice is eclectic because I enjoy variety, and it has been truly exciting.

The best advice I can give now that I’ve been self-employed for a while is to allow yourself regular self-care with vacations or staycations filled with calm, fun and levity. The balance is needed, not at all a luxury.

  Lena Kieliszak, an LMHC in private practice in Rochester, New York

 

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We all sing the songs we need to hear. By trade, I am a counselor educator and a counselor whose practice is made up largely of clients who are serving in helping, healing or ministry positions. Really, in many ways, my clients are people just like me.

So, what’s your song? Kindness? Self-compassion? Tending to empty thought patterns? Engaging in better self-care? It is our humanity that frees and guides us in our work with others. It is our humanity that breeds care and compassion, the hallmarks of neural/psychological/interpersonal integration, per Dan Siegel. Because I am human, I have needs and wants, not all of which get met. I know what it means to suffer. I know what it means to experience pain and to wish for ways to relieve it or deny it. I know what it’s like to find myself returning to unhelpful patterns of thinking and acting, time and time again. Because I am human, I have a song to sing.

I hope it can be said that I am far more human than I was when I first started this work 20 years ago. If we are all on a journey of becoming who we already are, then engaging with the work of others has offered me tender moments of being mirrored in my own humanity. The reality is that I need connection just as much as my clients do. Our profession has nomenclature — countertransference, getting triggered or activated, projection, collusion, etc. — that can tend to pathologize the humanness of the encounters we may experience with those who sit across from us. But part of the rich delight in doing this work — and part of what has allowed me to log 20 years at it and to be ready for another 20 more — is that I get to hear myself say things that I need to hear as much as my clients [need to hear them]. The frame of counseling and the counseling relationship holds not just my clients, but me too.

For me, what’s most sustaining is what inevitably comes when I am full and receptive: [being] open to hearing, in whatever form and from whatever voice possible, the song I need to hear. My humanity, my work and my longevity in the field all depend on it.

  Doug Shirley, an LMHC with a private practice in the Seattle area and assistant professor of counseling at the Seattle School of Theology & Psychology

 

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Early in my career as a professional counselor, I began to see that stepping into the world of [my] clients on a regular basis with my full attention and whole heart could leave me depleted and carrying concern for these clients long after the sessions were over. In response, I took care of myself by journaling, drawing and painting to allow space for my mind to simply be and to process my experiences. I began to set boundaries to remind myself when I could just be “Adele,” take care of my own needs, and engage in living life to the fullest.

There were times I took a break from the counseling field and worked in other similar people-oriented fields, but I missed that deep personal meaning from the counseling experience. So, I sought variety in the positions or environments in which I could engage in this role rather than stepping out of it completely. Through time, I also found a wider range of ways to express myself and release tension, stress or worry, such as running, taking drawing classes and enjoying acupuncture or massage.

Later, I invigorated my therapeutic approach by becoming trained in using sand tray therapy to bring clients’ experiences to life in ways they could not simply tell me. Seeing the power of clients exploring their experiences in the sand and seeing their issues in a new way was so exciting. Most recently, I became certified in yoga to apply the powerful healing effects of mindfulness, meditation and release of tension. Invigorating my counseling practice by attending more specialized workshops allowed me to draw upon new methods and delivery of a range of treatment strategies that are impactful, effective and, at times, even fun.

Compassion fatigue from the demands of this role can take its toll on counselors. During my doctoral studies on this topic, I uncovered that counselors continually engage in empathy but may not find ways to close the deep concern needed to draw upon empathy. This was a real “aha!” moment for me. No supervisor had ever quite framed it for me this way. So, I developed ways to extend client empathy with purpose but then to step back out of it with clear intention.

Focusing on growing, being curious, and engaging in self-care has helped me to stay buoyant while navigating these powerful and deeply fulfilling experiences over the past 25 years.

  Adele Logan O’Keefe, an LPC and owner/director of Sage Counseling & Wellness in Lexington, Virginia

 

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I have managed my own private practice since 2006, and maintaining meaning and engagement has been a purposeful and intentional goal. I enjoy the marketing aspect of being a business owner, and I have made it a priority to stay current with technology and move into areas that do not come naturally to me, such as blogging and social media.

Thanks to Twitter, I follow meaningful cultural shifts worldwide. I listen to radio stations and podcasts with differing political views, as well as trending corporate leadership. Our mental health care reach is limitless, with DIY videos on YouTube, numerous virtual specialty groups on Facebook, and compelling personal disclosure at the hands of terrific authors with diverse backgrounds. I enjoy reading the Stoics as well as firsthand accounts of military culture from Navy SEALs [and of] high-achieving athletes — true psychological warriors reminding me to be the best version of myself.

It is healthy and appropriate to recognize my own areas of expertise and competence (therapists can be ambitious and confident too). As I learn my strengths and feel confident in that footing, I am more comfortable admitting to areas that need more growth and insight.

I so appreciate colleagues who have become friends. We chat often, consult, meet for walks and coffee. This is integral to my well-being and mental health. Private practice is a lonely proposition, and no one should go it alone.

I recently organized an open house for my office building. It was a true hodgepodge of small business owners with the primary goal to provide public awareness. The secondary gain was cross-referred business and a budding community.

An annual live continuing education training is always beneficial, and preferably not in my own backyard. Most recently, I drove an hour away, checked into a hotel and ordered room service (an act of self-care). The next day brought new friends and colleagues.

I encourage fresh ideas and the continued advancement of our field, such as Silicon Valley’s tech money currently being invested in psychedelic research.

My daily unwind is a meditative, 1,000-piece puzzle in the evenings. If my family feels like chatting, they can find me there. A completed puzzle gives me a sense of accomplishment. Every piece found its niche and is perfect in the end.

  Christina Neumeyer, a licensed marriage and family therapist in Carlsbad, California

 

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My identity as a professional counselor has grown in importance to me over the years as I’ve come to witness and experience the extraordinary need for our work and the positive impact we can make for individuals, families and communities. Witnessing growth, change and increased well-being with clients has been a sustaining factor in my ability to stay fresh, passionate and engaged during my career. Also, the ability to shift my focus from being a school-based counselor to becoming a health educator/coach while using my skill set and strong commitment to wellness has fed my ability to sustain. Becoming more involved in cross-cultural trainings as a trainee and then facilitator has been integral these past few years to actively address injustices and inequitable situations that clients suffer from. I feel strongly compelled to do this work as our world becomes more challenging to live within for so many people.

Keeping myself well so that I may do this work includes intentionally eating healthfully, physically moving my body in ways I joyfully anticipate regularly, drinking lots of water, getting adequate sleep and rest, receiving supportive supervision and personal counseling, and pursuing my pleasures as often as possible (time with family and friends, reading, traveling, and playing with my kitten, Daisy).

I never want to leave the profession because it is a part of me. I think I will always want to do this work in some capacity for at least a bit of time as I age.

Knowing what I know now, I could give this advice to myself at the beginning of my career: “Relax! You’ve got this. You are well-suited to share love and support with those you encounter. Take care of yourself as well as you encourage others to do for themselves.”

  Julie Bloomfield, an LPC and health educator and coach at Henry Ford Allegiance Health in Jackson, Michigan

 

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

 

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.

Can you hear me now? Ways to reduce sound transfer between rooms

By “Doc Warren” Corson III February 24, 2020

Many of us who own or work in a counseling office have been there: We do everything we can to make sure that our client’s personal information is safe and secure. We train staff on confidentiality, buy expensive cabinets to house client charts and related documentation, and may even have an electronic medical records system so that we are compliant with all privacy laws. But then, sitting in our office, we notice that we can practically hear the heartbeat of the clinician in the office next door. How can we maintain privacy for our clients if the sound transfer is so bad?

If you are building or remodeling, there are many things that you can do, and we will explore some of those ideas in a bit. But what if you already have an office and cannot afford or are not allowed a full remodel? Fear not, there are a few things you can do to reduce sound transfer without breaking the bank. The best part is that most of them are easily undone should you leave your current digs.

Ideas to reduce sound transfer in offices that can’t be remodeled

  • White noise machine or a radio: Placing a white noise machine or a radio in waiting areas will help reduce the ability of others to hear what is being said in your office. These items can be placed in the counseling office themselves if needed, depending on the level of sound transfer.
  • Rugs: If you cannot do wall-to-wall carpeting, then throw rugs can help absorb noise. A thick rug is best, but be sure to consider tripping hazards and client mobility. Wheel chairs, canes and walkers do well on flat surfaces, whereas shag or fuzzy rugs can impact mobility, so give it some thought prior to purchasing.
  • Seating layout: Do not face seating directly toward the door because this will direct sound to the door opening, which is the most vulnerable spot in most offices. Instead, have the seating face a wall so that the sound carries toward the walls rather than toward door openings. This will help reduce the amount of sound transfer from vulnerable door area gaps. This is especially key should you have a hollow core door.
  • Fabric placements: Drapes or wall hangings can help absorb sound and reduce transfer. Also add pillows to furniture — the more the better, so long as they do not get in the way.
  • Drop ceilings: If your office has drop ceilings, you can put insulation above the ceiling tiles to help reduce sound transfer.
  • Wait times: One way to reduce the chances of people hearing what is happening in the clinical office is simple and free: Stagger the times of sessions so that one session is likely to be over before the next client arrives. This works regardless of the number of offices and requires just a bit of coordination.

 

Building or redesigning offices with sound in mind

You might rent or lease a building that allows you to build an office to suit your needs. In certain cases, the building owner may even assume some or all of the costs. In other cases, you will own the building and have the ability to remodel as you desire, so long as you follow building codes and secure the proper permits. Whether you are doing the work yourself or will simply supervise the project, here are some things to keep in mind to reduce sound transfer and increase overall privacy.

  • Acoustical substitutes for wallboard: In some areas, it may be beneficial to not use traditional wallboard (Sheetrock) and instead to use one of the specialty acoustical boards on the market. Each offers superior sound deadening, but they can be expensive (five to 10 times the material cost of traditional wallboard). In all of the offices that I have transformed, we opted to use these products once, on one very sensitive wall.
  • Acoustical putties, sealers, etc.: Often used with the substitute board, acoustical putty is used to seal around any cutouts in the board such as outlets, light fixtures, etc. The sealer goes on all wall studs and any surface with which the wallboard will come into contact. It cuts down on sound transfer. I have used this only in the most problematic areas where I used acoustical wallboard.
  • Solid core doors: Although they are more expensive than hollow core doors, solid core doors offer more sound deadening/sound deflection. Some solid core doors are made of solid wood, whereas others offer a composite interior that is designed to block more sound. The choice is yours because both have much to offer. Should your office be very problematic, doors designed to block sound are the way to go. In recent remodels, we have chosen to install prehung exterior doors that come with weatherstripping for our offices. While they are designed to keep air out, they also offer superior sound deadening compared with general interior doors that are on the market, and yet they cost about the same as a good quality interior door.
  • Wall-to-wall carpeting: Hard wood or other hard surface floors are beautiful and can last a lifetime compared with wall-to-wall carpeting, but carpeting does more to absorb sound than hard surfaces can.
  • Sound-deadening insulation: If the walls have not yet been built or are going to be opened up, sound-deadening insulation is a must. Materials for an average-size office will cost hundreds of dollars but will also offer some of the most effective sound deadening. When framing new walls, building codes may allow for 24-inch spacing of the wall studs. However, it is often far more cost-effective to stick with 16-inch-on-center setup, meaning that every wall stud is installed 16 inches apart from the one next to it if measured from the center of the stud. This is the most commonly used spacing for walls that are being insulated. As such, the cost of the insulation for 16 inch is far cheaper.

It is important to remember to do all walls, including the interior walls, to have effective sound deadening in the office. Whenever possible, also ad sound-deadening insulation in the ceilings and floors.

  • Doorway placement: Doorways can be one of the biggest sources of sound transfer. If you have the option, avoid having office doors open directly into waiting areas. Instead, try to have a hallway between so that any sound that may escape does not go directly into the waiting area. If this is not possible, see the earlier suggestions for seating layout and white noise machines.
  • Avoid trendy: More and more old buildings are being converted from factories into office spaces. These areas are often beautifully urban and ultra-trendy. One of the biggest drawbacks to these spaces, however, is the trend to build the walls only 8 feet tall even though the ceilings may be 14 to 20 feet.

Our current office was once designed to look like a barn, so some of the space once had two-and-a-half-story-tall walls. Instead of open air at 8 feet, we added a ceiling. It helped prevent sound transfer and also added 1,600 square feet of additional office space on the new floor above.

Failing to close the overhead area tends to give you a glorified cubicle because the gap between the walls and the ceiling allows for sound to move freely. In a sense, these spaces are even worse than cubicles sound wise because cubicles often have soft materials on their walls to help absorb sound. Some even come with doors and ceilings for added privacy. No sound machine, carpet or other items can overcome several feet of open space (unless the noise machine is set very loud, and that would also affect the session space).

Should your space have very tall ceilings, spend the money to bring the walls up to meet them, or have a lower ceiling built on top of the walls.

  • Supervise the build: Some of us will tackle all or most of these jobs ourselves and do well. Many of us, however, lack the time or ability to take on some of these tasks. Should you hire all or some of the work out to contractors, do not be shy about making your requirements and desires known. Go out to the job site and supervise every aspect of the build. Make sure that sound-deadening insulation is used in every area (there are many brands with various levels of deadening, so be sure that the right one is used for your project).

Sometimes, a busy crew might neglect some of the cavities that require custom cuts to the insulation. Other times, they may honestly forget to install something that you ordered. Whatever the case, having you there with the plans can help ensure that the build goes as desired. Remember that in most cases, a mistake is just that — so present it to the contractors in a polite manner, without accusation. Whenever possible, find a contractor with experience in sound abatement because that should increase the likelihood of the process going smoothly.

Sound transfer remains a large issue for many offices, whether for-profit or nonprofit. With a bit of research and planning, much can be done. A little elbow grease and some creativity can take you far.

 

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“Doc Warren” Corson III is a counselor, educator and writer, and the founder, developer, and clinical and executive director of Community Counseling of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). He is certified as a counselor and counsellor supervisor in the United States and Canada. Contact him at docwarren@docwarren.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.

Voice of Experience: Billing guilt

By Gregory K. Moffatt February 18, 2020

I am a very poor bookkeeper. I will admit that up front. I am capable, but I just don’t enjoy managing the finances of my clinical setting. Perhaps more importantly, for many years I felt guilty about charging my private practice clients.

Therefore, I was hesitant to mention overdue balances or to expect payment from my clients at the time of service. It just felt awkward. If clients didn’t pay their bills, I often would let their accounts slide into history and eventually ended up closing their files with an amount due in the ledger.

Then one day, many years into my practice, I got some new accounting software and decided to clean up my old books. For no reason other than curiosity, I went back through all my overdue accounts and was stunned. The total owed by overdue clients was in the thousands of dollars.

Granted, this was over a long period of time — more than 10 years — but those individual accounts that I let slide had added up. I could have bought a new car with that money. Fortunately, my private practice was not my primary source of income. Otherwise, I very likely would have been operating in the red.

It is uncomfortable asking for payment, but this seems to be true only for counselors. Can you think of any other service in which the vendor is hesitant about asking for payment? I can’t. Whether they are plumbers, mechanics, dentists, morticians or babysitters, people get paid for providing a service.

Nearly all of my new counselors, interns and supervisees express some hesitation about charging clients. One experienced counselor, in fact, asked me to look over her revamped informed consent. Her fees were clearly listed.

“You aren’t charging enough,” I told her.

“Really?” she said sheepishly. “I don’t want to be greedy.”

I asked her what her time, education and experience were worth. She had two degrees, was fully licensed both as a professional counselor and as a marriage and family therapist, and had several years of practice under her belt. Yet her fees were the same as when she was still in supervision.

I asked, “Are you providing a service that has value to your clients?” Of course, she said yes.

“Then there is nothing wrong with being paid what you are worth, at least within the market standards.”

She decided to raise her rate — and she deserved the higher fees. She also saw no change in her client base. In other words, none of her clients questioned paying a rate consistent with the standard in the field. As it should be.

One of my colleagues who has run a successful private practice for many years taught me something on this topic. She had a basket in her waiting area with a sign: “Check goes in the basket before you come back” (to the therapy room).

These days, her sign probably says something like, “Payment on my cash app must come through before therapy starts.” I don’t know. But the point is that she set an expectation for payment that was reasonable and clear, and people lived up to her expectations.

Even though my informed consent said payment was due at the time of service, I wasn’t clear about what my expectations for my clients were. My practice demonstrated vague expectations, so my clients back then lived down to them.

I completely understand why we feel guilty about charging as professional counselors. After all, we are helpers, not mercenaries. But few things in life are free.

If a client balks at my fee, I’m happy to provide referrals. I’m also very generous with pro bono hours — as are most therapists. But I no longer feel any guilt about charging my clients or my supervisees. I’ve invested in my career, it costs me money to run my practice, and I’m good at what I do.

“How much is your marriage worth to you?” I asked one potential client who hesitated at starting marriage counseling. (Sometimes I asked, “How much does a divorce cost?” That usually put things in perspective.)

“I guess it is worth $150 an hour,” he said, referring to the fee his therapist was charging. And it was worth it for the therapist too. She used her expertise to help heal a damaged relationship just as a physician might use medication or surgery to help the body heal.

Regardless of whether you have a sliding scale or a fixed rate, accept third-party payments or are cash only, you are providing a service. You spent time, money and energy developing and maintaining your expertise. You deserve to be compensated.

 

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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.