Tag Archives: Professional Issues

Professional Issues

Healing the healers: Counselors recovering from familial addiction

By Suzanne A. Whitehead October 8, 2019

It has been roughly 17 months since I wrote a piece for CT Online about my son’s struggle with addiction, and it is amazing how far he and our family have come since then. I felt compelled to write a follow-up, not just because he is my son, but also because in the past year, I have discovered that so many professional counselors’ and counselor educators’ family members suffer in silence.

Last year, I used an author pseudonym in my article. I did this for two reasons. First, out of respect for our son because he was still in residential treatment and I couldn’t ask him for permission at that time. Second, I wanted to preserve anonymity for both of us, afraid of the effects that discussing our story and revealing our identities might have. A lot has changed over the past year, however, and today, both my son and I are so much stronger for having the courage to speak out. We no longer hide behind the effects of this horrible disease. I have learned that by speaking up, the addiction no longer holds any power over our family. I hope in this article to offer some solace, support, understanding and love to those who are suffering in silence. We healers deserve to heal too, and my heart goes out to you all.

On Feb. 16, 2018, the police called us at 2:30 a.m. from the other side of the country — 2,600 miles away — to tell us that our beautiful, precious son had been found on the side of the road, passed out. We later learned that the heroin in my son’s possession had been laced with fentanyl–he had no idea. Heroin users never have any idea what they are truly getting. They assume it is the same product that they are used to, draw up the same “dosage,” and a few seconds after injection, it’s all over.  The police  told us  that they had found our son just in time. He was in the cab of his truck, his foot still balanced on the brakes, the heroin and needle next to his side, the tourniquet still strapped to his arm and accompanied by his faithful dog, who barked like crazy as the police pounded on the door. It is a miracle our son is still with us. It is even more miraculous that he now has over 14 months in recovery and in order to pursue what he calls his life’s work, is studying to become a substance abuse counselor.

I wish I could share with you the “miracle formula,”– a path that if everyone could just follow, they would be “OK.” If only … But, this disease of addiction doesn’t work that way. It has a mind of its own, and its victims must find the recovery that best works for them.

I attended the American Counseling Association Conference & Expo in New Orleans this past March and went to a session proctored by Geri Miller (author of Learning the Language of Addiction Counseling). She, along with two other presenters, Jennifer Kline and Ben Asma, tried to describe the nature of addiction to the audience: how tolerance builds up, how the brain becomes “hijacked” by the opioids, and the realities of withdrawal. They did an outstanding job  relaying what actually happens to a human being, and came as close as I’ve ever heard to describing the abject horror a person suffering from addiction must endure.

For those of us who have never experienced or witnessed a person in withdrawal (I am not a person in recovery, but am a licensed addiction counselor and professor who teaches addiction and counselor education), it is hard for people to truly understand its hell. My son had to go through it on the floor of a jail cell, writhing in agony. An addict no longer uses to get high – that ship has sailed a long, long time ago. They use only to avoid withdrawal.

When withdrawal starts, you begin to feel like you are becoming quite physically ill. Soon, you begin to sweat all over, then have uncontrollable bouts of freezing. Your skin begins to crawl; you start seeing double. Your gut aches as it never has. And then you begin to wretch violently.

Simultaneously, you lose control of your bowels, and getting to the toilet is no longer an option. The pain continues to grow as you lose the ability to stand up. Your stomach contorts and your head is in agony. You want to rip out your hair, your eyeballs, anything to make the wretched pain stop. You continue vomiting and soiling yourself, every few moments. There is no reprieve, no solace,  no hope. You are so “dope sick” now that you think you may die and loathe yourself so much that you no longer believe you are even worth saving. You know the one and only thing that will make this sheer hell on earth stop is if you can get some drugs in your system. You swear by all you have left within you that you will “quit tomorrow.” You must tell yourself this lie, because to realize that you can never quit on your own is too unbearable to fathom.

After several hours, or even a day or two of the above, you will do anything (just about) to get more drugs. You despise your very being, your reflection in any mirror, and the lies you constantly tell to the ones you love the most. Your shame and guilt seem insurmountable. Your spirituality is gone – it was one of the first things the drugs took away from you. There is no longer any hope, just the temporary relief of the heroin (or worse) coursing through your veins.

Each day, or several times per day, this hell is reenacted. Depending on tolerance, what you took, how often, withdrawals can start again in a matter of hours. When a person must detox without the benefit of using buprenorphine or a combination of buprenorphine and naloxone to slowly, medically and safely wean them off the substances, the hell can last for days or a week or more. Withdrawal from heroin use is rarely fatal; however, there are many serious side effects and people can die from dehydration. If they are not safely detoxed, their pulse often becomes thready, their PO2 oxygen levels drop, their blood pressure plummets and they may even slip into unconsciousness or start seizing. This is what happened to my son. The guards had to rush him back to the hospital after 36 hours to give him IV fluids. He was so gravely ill that he barely remembers this part. The hospital personnel patched him up and within a few hours, he went back to his jail cell. How we treat people who have unwittingly taken too much OxyContin and become victims of the pharmaceutical trade is unconscionable. It is now known that a person can become addicted to OxyContin within five days. And we treat these people, human beings, worse than wild animals.

To know my son survived this horror, alone, with nothing but Tylenol and something mild for nausea (which is vomited immediately), tears at the very fabric of my soul and violates all I hold sacred in this world. How he was treated was vile, but not uncommon. Many others who suffer from addiction and end up in jail receive the same treatment. They will face the legal system, as my son did, and pay for their crimes. But the horrendous lack of treatment, access to care or compassion, combined with the sheer inhumaneness they face, brings me to my knees. If people only knew…

There is no question that many people do horrid things when they become victims of addiction; the realities are painfully obvious. A cornerstone of recovery is the process of paying for  mistakes and learning how to make amends. Forgiveness from loved ones can come at a very heavy price, and forgiving oneself can ultimately become the hardest fought battle of all. Addiction is such a cruel, insidious disease, particularly because so many have such a difficult time in separating the behavior from the person. Understanding the horrible acts that some people commit, while also trying to see them as a person in severe emotional, physical and spiritual pain, is a significant and sometimes difficult juxtaposition. For those living with addiction, free will has been overtaken by the demands of withdrawal, and the self-deprecation that follows each usage is beyond daunting.

My intention in writing this piece is to help convey the utter destruction of opioid addiction and the ugly and purulent aspects of withdrawal. Once we truly understand this part of the disease, our entire paradigms change. It would be unconscionable to treat someone with cancer, heart disease, diabetes or emphysema this way. Yet we allow this to go on day after day after day. We lose over 116 dear souls to opioid overdoses in this country every day now, and the numbers continue to rise. We all share this plight because addiction can, and does, happen to anyone. Once we understand this, we can stop the blame and shame that has for centuries accompanied this disease and begin to proactively act.

Our son is still fighting this disease; he will for the rest of his life. So far, he is winning, but elements that test his recovery are always there. We continue to celebrate his victiories. The entire family went to his open Narcotics Anonymous meeting to watch him get his one-year keychain and cheered like crazy fools. The look of pride in his eyes said it all: it’s as if his life is now just beginning. He’s been volunteering 30 hours per week at a county outpatient and residential treatment center since September 2018 as he works on attaining his certification to treat those with substance use disorders. His compassion for those fallen is unparalleled; he “gets this.” His family couldn’t be prouder. What an incredible difference he is making in the lives of others every day. He is my hero, and I stand in awe of his contributions and bravery.

Narcotics Anonymous keytag (via newyorkna.org)

My other goal in writing this is to discuss the stigma that helping professionals face when our own loved ones confront addition. That reality persists, and when I feel brave enough to reach out, I have overwhelmingly found that so many others also suffer in silence. Because we are counselors, therapists, professors and educators, we—and others—believe that not only do we help heal others, we must somehow have all the answers and will always know and have the ability to intervene in cases of addiction — especially with our loved ones. The assumption (I surmise) goes that there is something gravely wrong with us when a loved one succumbs to addiction. Why didn’t we intervene and stop them? Unfortunately, it’s not a matter of becoming aware and then simply “stepping in.” Addiction is a bio-psycho-social-emotional disease, insidious in its approach, and deadly in its tracks. It is not exclusive and honors no perceived barriers — not religion, socio-economic class, ethnicity or any other categories or factors. Because secrecy, lying, excuses, stories, deception, and falsehoods are all part and parcel with this disease, even the most astute of us do not always recognize the signs of impending addiction. Before long, victims are well into their disease and, by necessity, the level of deception grows with each passing day. It’s called survival.

To blame the person who is addicted for using their survival instincts is antithetical to any help we can give them. So too is to blame the family members and loved ones, no matter their profession. The isolation I felt this past year was heart-wrenching, lonely, judgmental, sad, destructive, and purposeless. I have also found that this sense of isolation is shared by many of my comrades. I am mentally exhausted from hiding in the shadows, fearing recriminations and judgments from those who refuse to listen or understand.

As I test the waters and disclose our story, I am buoyed by the knowledge that there are so many of us who need a voice. We need to raise awareness that this disease knows no bounds and its victims are all of us. It’s time to stop letting addiction win. It’s time to stop being its unwitting counterparts. It’s time to treat the addicted person, the family, and the loved ones with humanity and compassion —- the same way we treat others with any type of potentially deadly disease. I’m determined to not let my professional colleagues suffer in silence. I feel your pain; I understand. Now, let’s get the word out.

 

 

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Suzanne Whitehead is coordinator of the counselor education program at California State University, Stanislaus. Her main research interests include promoting increased access and humane treatment for those afflicted with substance use disorders; crisis and disaster counseling; and equity for DACA recipients, immigrants and refugees. Contact her at swhitehead1@csustan.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.

Counseling termination and new beginnings

By Victoria Kress and Marissa Marie October 2, 2019

When preparing for a symphony, a conductor will often tell the musicians that the last note is as important as the first; after all, the last note is what the listeners will take with them. For that reason, the final note of a symphony requires just as much artistry, thought and attention as the first note.

Much like the final note of a symphony, counseling termination requires a great deal of creativity and attention to detail. Although termination is an often neglected concept in the counseling literature, it is supremely important.

Termination is the term most commonly used to describe the process of finalizing or ending a counseling experience. Yet that word conjures up images of abrupt endings or even death, so we wish that a better phrase could be identified to describe counseling endings and transitions. Perhaps the words finale or commencement, or even the euphemism new beginnings, would better capture the termination process.

Many if not most of our clients have experienced traumatic or adverse life experiences. Thus, the termination process can be particularly triggering and take on an even more significant meaning for these populations. Because of its importance, we believe that the termination process merits a closer look.

Ethics and termination

Ethically, it is a counselor’s duty to prepare clients for the counseling termination process and to terminate services when clients are no longer benefiting from counseling. Therefore, counselors ought to be thinking about termination, even at a first session.

When the time comes to end the therapeutic relationship, it is natural for there to be feelings of grief and loss and even an adjustment period. Some clients may struggle to negotiate healthy boundaries and the termination of relationships. Furthermore, clients who have experienced abuse or trauma may be especially sensitive to relationship transitions. 

Ending a therapeutic relationship requires a great deal of thought. If done ethically and competently, termination can help solidify counseling gains, empowering clients to integrate their experiences and bravely face their next chapter in life. Termination can also help model healthy boundaries and a natural and appropriate end to a relationship. Effective termination provides clients with an opportunity for continued personal growth, whereas ineffective termination can actually harm clients.

Preparing clients for termination

To best prepare clients for termination, it is essential that counselors proactively address termination. Ideally, termination should be introduced during the informed consent process. In fact, by openly discussing termination from the beginning of counseling, counselors may help galvanize client motivation because clients will see counseling as something temporary that can be used to help them reach a defined set of goals.

By weaving the idea of termination into informed consent, counselors can also encourage and elicit client feedback regarding the progress being made in counseling. Thus, clients will be liberated from the fear of “disappointing” their counselor by raising the idea of ending counseling once they feel they have received what they needed from the counseling experience. Remaining transparent about termination, from the initiation of counseling, can help clients invest in reaching their goals while concurrently empowering them to voice when they feel they are ready to end counseling.

Counselor adjustment to termination

Just as clients often experience a tangle of feelings around the end of a counseling relationship, counselors themselves can have emotional reactions to termination. As counselors, we invest much time, emotional and intellectual energy, and dedication to helping our clients. After all, the lifeblood of the counseling profession is based on building a warm connection with those we serve. As a byproduct of this relationship process, counselors do indeed develop emotions and thoughts regarding their clients. Consequently, when the counseling relationship ends, there is an adjustment period for counselors too.

Ideally, this adjustment period would include a space for self-supervision, with counselors objectively evaluating their performance and efficacy with the client. Counselors can identify potential growth areas and reflect on their professional strengths as part of this process.

Before engaging in such objective evaluation, however, counselors may need to sort through their residual feelings of loss. These feelings may be further complicated by countertransference. If, for instance, a counselor’s personal experience aligned with that of the client who recently terminated, the counselor’s emotional reaction may be intensified. If there is a positive prognosis for the client, the termination process may catalyze feelings in the counselor of fulfillment, competency and even confidence. If, however, the client terminates abruptly or has a less than favorable prognosis, the counselor may experience feelings of incompetence and disillusionment, especially if the counselor’s lived experiences mirror those of the client. In these instances, counselors must make processing their emotions around termination a priority.

Although it is imperative to cultivate self-awareness surrounding countertransference throughout the counseling relationship, monitoring countertransference at termination may be especially important. Counselors ought to be cognizant of their emotions and willing to process these emotions, whether positive or negative, at the end of a counseling relationship.

In summation, while clients often experience grief and a sense of loss at the conclusion of the counseling process, counselors may also have emotional reactions to the termination process. Counselors should monitor these reactions, discuss them in supervision, consult with peers, and seek personal counseling if necessary to ensure that even as they adjust to the loss of a therapeutic relationship with a client, the quality of the services they provide to their remaining clients remains top-notch. Being aware that termination is a two-way street that affects the counselor-client dyad allows counselors to more effectively understand, and thus cope with, the emotions and thoughts that ending a therapeutic relationship may stir up.

Client ambivalence around termination

Even when counselors introduce the discussion of termination in the initial stages of the counseling relationship, it is natural for many clients to experience some anxiety and disillusionment with the idea. After all, the counseling relationship may be one of the only times, if not the only time, in their lives when they have experienced safety, trust, compassion and care. Given that these virtues are basic human needs, it makes sense that clients may be reluctant to end the counseling relationship.

Some clients may manifest this reluctance by continually raising “new” issues or concerns anytime the possibility of termination is mentioned. Clients may even return to the behaviors that led them to counseling initially. For example, a client who self-injures and works toward abstinence over the course of counseling may engage in self-injury again as the idea of termination nears. Rather than viewing this as a counseling failure, counselors should remember that, like counseling itself, termination is not linear.

At its core, termination involves the ending of a relationship, likely resulting in feelings of grief and loss. Thus, space should be made for clients to experience, rather than avoid, those feelings that come with the natural ending of a relationship. Encouraging clients to utilize the coping and emotional regulation skills they have gained over the course of counseling can assist in managing the emotions surrounding termination. This action also helps to reinforce the learning that occurred throughout the counseling process. Walking alongside clients as they grieve the loss of the counseling relationship allows them to experience the conclusion of a relationship in a nurturing and empathetic environment and helps them develop so that they can better manage future losses and transitions.

Counselors should continually assess for termination readiness when working with clients. One way to do this is to ask clients questions such as, “Do you think you are benefiting from counseling?” and “How will you know when our time here together is coming to an end?” Questions such as these set an expectation that counseling will end and serve to empower clients to help determine when it will conclude. By trusting clients and actively listening to their experiences and sense of how they are (or are not) benefiting from counseling, counselors help clients prepare for the termination process.

The termination process

When it comes to the actual process of termination, counselors can take many different approaches with clients. The interests and developmental level of clients and the content of counseling should all be considered when planning termination activities. Termination is often an ideal time to incorporate active, engaging and creative interventions that encourage clients to engage in active learning and reflection upon the counseling process as a whole.

Often, as termination nears, client engagement and enthusiasm in counseling diminish. By using active and creative termination interventions, counselors can inject new enthusiasm into the last several counseling sessions. Clients tend to more readily remember counseling interventions in which they are interactively involved.

Regardless of the specific intervention used, termination is an ideal time to incorporate an optimistic, empowering and future-oriented approach. Counselors can compassionately empathize with clients who are reluctant to terminate while concurrently encouraging them to see the end of counseling as a new adventure in which they can apply the skills they have learned throughout counseling. Assuming such a tone as a counselor assists clients in developing a future-focused orientation. This may help propel them through the natural grieving process that often accompanies the ending of a counseling relationship.

Creative termination activities 

A variety of creative termination techniques can be used with clients. Ideally, the counselor can dedicate several sessions to fully processing and exploring the termination process. A few examples of creative termination activities follow.

One-way trip for trauma: This activity can be used with clients who have worked on trauma issues or those who have worked to let go of something while in counseling. Clients can take the materials that they have accumulated throughout the counseling process that are associated with their trauma narratives — writings, journals, worksheets, illustrations, etc. — and either rip them up, color over them, or simply fold them neatly.

After the materials are collected, counselors should provide clients with a small box or container (these are easily obtained from everyday recycled products or by purchasing them in bulk on the internet). Next, clients can be given a variety of tape. Clients then
place their trauma narrative materials into the container, tape the container shut, and decorate the container as they see fit. At this point, counselors can process with clients how their traumatic past need not dictate their future. Clients can then discuss how leaving the counseling relationship symbolizes their having processed and worked through their trauma.

This intervention can also be paired with a “new beginning” celebration to signify the start of a new chapter in clients’ lives. Although shifting the language from “termination” to “new beginning” may seem like nothing more than a euphemism, the language is immensely important. Helping
clients who have a history of trauma understand that they do indeed have a future, despite the pain and hopelessness they have endured in the past, is a powerful intervention.

Sticker chart/memory book: Younger clients may struggle to fully grasp the concept of termination or to engage in metacognitive reflection on the counseling process as a whole. Thus, with these clients, more developmentally appropriate and artistic interventions are often indicated. For instance, a sticker or picture chart could be maintained throughout the counseling process, with clients placing a sticker on the chart each time they come to counseling. Clients can even draw pictures, along with using the stickers, to illustrate a “story” of their time in counseling. As termination approaches, clients can further illustrate their chart, review what they have learned so far, and place more stickers on the chart signifying their achievements in counseling.

Another effective approach is working together with younger clients to create a memory book with pictures, words, stickers and decorations that will help them remember their time in counseling in a more concrete manner. Both of these interventions allow child clients to take a tangible item with them as they end the counseling process.

Aloha lei (hello-goodbye) activity: Counselors can explain to clients that the word aloha means both hello and goodbye. Counselors can then discuss with clients that every end is the start of a new beginning, as is the case with the end of counseling.

For the activity, paper flowers can be cut out (clients can select the color of the materials to enhance autonomy). Clients can write effective coping skills, memorable counseling experiences, or other notable takeaways on the flowers. Next, punch a hole in each flower and thread them along the string. Family members or caregivers can also be involved in the process (with client consent), adding their own flowers to the lei. The lei can then be given to the client as a parting gift. This intervention involves creativity and metaphor in a way that summarizes the counseling experience while actively involving the client.

Building blocks: This activity can be tailored to clients of any age. During the final session, counselors can bring a number of building blocks, Legos, Jenga blocks, or other toy blocks to session. Clients can then construct a tower or creation of their choosing. Each block in the creation can represent a powerful moment in counseling, a coping skill clients now possess, or another skill clients have learned during counseling.

As the height of the tower increases, clients may become anxious, especially as the tower begins to lean. If the tower ultimately falls, the counselor can explain that, given the clients’ fundamental skills — the skills they assigned to each block — the tower can be rebuilt. This intervention helps clients understand that even if they experience the inevitable “falls” of life, they possess the fundamental “building block” skills to rebuild. This intervention is a tactile and empowering activity for the end of counseling.

Goodbye letter: There are many variations of a goodbye letter that can be used as the counseling process comes to a close. Counselors can provide a letter template with certain blanks to be filled in, or they can simply provide a blank piece of paper on which clients can write their own letter. Adding prompts or sentence stems for clients to complete can add a degree of structure to the letter.

There is flexibility in terms of the letter’s point of view. Goodbye letters can be written from client to counselor, from counselor to client, or even from the perspective of the process of counseling itself being personified. Possible writing prompts include “One thing I remember from counseling is …” or “The most memorable moment of counseling was …” Although counselor creativity can yield limitless possible prompts, it is important that the goodbye letter be narrowed to focus on the most relevant moments of the counseling process. It is also important to keep the activity strengths-based (as is the case with any termination activity).

Survivor tree: Survivor trees can serve as a creative intervention to foster and celebrate resilience in the final stage of the counseling relationship. They can be either simple or complex, depending on the clients’ developmental abilities. Survivor trees may be drawn out to explore clients’ areas of growth (the branches), clients’ future hopes and aspirations (leaves and buds), coping skills that clients have learned in order to stay grounded (the trunk and roots), and even what struggles clients have worked through in counseling (dead leaves beneath the tree).

As the tree grows and expands on the paper, the counselor can weave in the idea that trees survive multiple seasons every year. Some seasons leave barren branches, whereas other seasons are rife with leaves and buds. Nevertheless, the tree survives and continues to bloom, even after a cold or barren season. Clients can then reflect how their resilience has allowed them to overcome previous barren seasons. They might also reflect on how the skills they learned in counseling can help engender resilience during future difficult seasons of life. Taking the example of the tree eventually blooming despite the adversity of winter, clients can explore how they can go forth in life and bloom beautifully, no matter the adversities they face.

Making a case for counseling: With this activity, clients are invited to create a “case” and fill it with various objects to help them summarize and conceptualize their experience in counseling. Depending on the client’s interests, the case can take on a variety of forms (e.g., a purse, an athletic shoebox, a favorite cereal box). Client autonomy can be reinforced by allowing clients creative license in decorating and designing their cases.

Clients can be encouraged to include various objects in the box that they find important and valuable to the counseling process (e.g., a grounding stone, a worksheet with coping skills, a journal). Furthermore, clients can create decorative scraps of paper to add to the box. These papers can include notable moments in counseling, emotions surrounding the counseling process, skills learned, or other tools with which the client can face the future trials and travails of life outside of the counseling relationship. If family members or significant others are involved in the counseling process, they can also add items to the client’s case (if the client agrees to their participation). This intervention is relatively open to interpretation and can include myriad creative avenues to help clients gain closure.

New beginnings

Regardless of the specific intervention used, termination is a vital part of the counseling process. During termination, counselors should convey a great deal of warmth and compassion to clients, while simultaneously aiming to empower them and promote their self-worth.

To reiterate, it is important to understand that semantics matter. The word termination conjures up brutal images of loss. In truth, the end of counseling is really the start of a new beginning; it is as if one chapter is closing and counselors are handing the pen off to clients to write their own next chapters. In so doing, counselors play their role in helping to ensure that the next chapter will be a good one.

The end of counseling, just like the end of a symphony, is not simply the end. Rather, it is a resounding note that acts as a gateway to new beginnings.

 

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Victoria Kress is a professor at Youngstown State University and a licensed professional clinical counselor supervisor, a national certified counselor, and a certified clinical mental health counselor. She has published a number of journal articles on counseling termination and further addresses the topic in her textbooks, Counseling Children and Adolescents and Treating Those With Mental Disorders. Contact her at victoriaEkress@gmail.com.

Marissa Marie is a licensed professional counselor working at Youth Intensive Services in Youngstown, Ohio. She uses trauma counseling with those who have been involved in the sex trafficking industry. Contact her at mgray@youthintensiveservices.com.

 

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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.

Counselors as human beings, not superheroes

By Bethany Bray September 23, 2019

I’m only human after all

I’m only human after all

Don’t put the blame on me

Don’t put the blame on me

These lyrics played over and over on radio airwaves in 2017 as the rock-and-blues-infused single “Human,” by British singer-songwriter Rag’n’Bone Man, topped the charts.

Given the role they play in helping others to overcome challenges and live their best lives, professional counselors are sometimes assumed to themselves be impervious to life’s challenges. But in truth, they’re “only human after all,” not superheroes. The personal and intense nature of professional counselors’ work can spill over into their lives outside of the office — and vice versa. And the very skills and instincts that make them good counselors, including a passion for helping others, can leave them vulnerable to “what if” thinking and even burnout if left unchecked.

“One of our strengths is also one of our weaknesses. We have a lot of emotion and empathy, and we have to channel it. It can be like a river that overflows its banks,” says Samuel Gladding, a professor of counseling at Wake Forest University and a past president of the American Counseling Association. “It’s kind of like water and a spigot. If you don’t turn off the water in your house, you either run out of water or pay a very high price to the water company. If you don’t cut off your thoughts about clients, you also pay a very high price.”

Clinical counselors may routinely second-guess whether they are doing enough to help clients or wonder how a client who is no longer under their care is now doing. If left unchecked, such thoughts can become all-consuming and impede on a counselor’s personal relationships and overall wellness.

Neither are counselors automatically immune to the problems with which clients struggle, from anxiety and depression to grief, trauma and unhealthy coping behaviors. Holding a counseling degree or license also doesn’t guarantee that practitioners will make all the right decisions when it comes to their own personal relationships. A misunderstanding with a spouse or partner or a discipline issue with a child can seem all the more frustrating for a professional counselor who works on relationship building and communication with clients on a daily basis.

Learning to manage such issues often comes with time, as counseling professionals gain experience. But it also takes a measure of intentionality, from consulting with colleagues and engaging in professional development activities to practicing good self-care and setting boundaries, Gladding says.

It’s also helpful to accept that it is not a matter of if: Personal and professional issues will intertwine, and challenges will crop up throughout a counselor’s career. The key, Gladding says, is recognizing them and being open to growth — the same mindset that counselors use with their clients.

“We, as counselors, have our struggles,” he says. “If we’re wise, we acknowledge them, are aware of them, and work with others to resolve them and open up. Like Albert Ellis said, we’re fallible human beings. We’re not going to be perfect, and we’re going to make mistakes.”

Blurred lines

It’s likely that counselors will face a personal crisis, loss or upheaval at some point (or at various points) throughout their careers. Counselors are no strangers to mental health disorders, divorce, trauma, addiction problems, and other issues that bring clients to therapy. In most situations, however, it is not feasible for counselors to stop working until their personal issues resolve.

The 2014 ACA Code of Ethics does not address this scenario directly. However, it does caution against practitioner impairment (see standards C.2.g. and F.5.b. at counseling.org/knowledge-center/ethics). Professional counselors are called to “monitor themselves for signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing professional services when impaired.” At the same time, the ethics code urges counselors to help colleagues and supervisors recognize when they are impaired and to “intervene as appropriate to prevent imminent harm to clients.”

This begs the question: How does a counselor know when he or she is becoming impaired? Self-awareness and honesty — with self and with colleagues — are imperative, Gladding says. Warning signs will be different for each individual but might include feeling hesitant or reluctant to go into client sessions or experiencing intense emotions, including anger, during and after sessions.

“Just like we would report a client who is a danger to themselves or others … when we see our colleagues or fellow counselors being impaired or not doing well, we have a responsibility to confront them, talk about it, and offer them help,” says Gladding, a licensed professional counselor (LPC).

Practitioners need to know their own boundaries and to be able to recognize when they are “tiptoeing on boundaries” that can signal impairment, says Jessica Lloyd-Hazlett, an LPC and an assistant professor of counseling at the University of Texas at San Antonio. Being able to admit that you’re impaired as a counselor is difficult but vitally important.

Lloyd-Hazlett experienced the depths of grief after her mother passed away in June 2018. She continued teaching through the summer, but that fall, she found herself feeling irritable, becoming easily overwhelmed, and “struggling to simply show up to class and be in front of students.”

She could still push herself to do what needed to be done, but on most days, she struggled, Lloyd-Hazlett recalls. It was then, through a combination of self-awareness and some gentle intervention and support from friends and co-workers, that she realized she needed to take a step back and seek counseling herself.

“The things that you want to sweep under the rug, those are the hardest and are the things that are going to come back and bite you,” says Lloyd-Hazlett, a member of ACA. “Realize that. Recognize when you’re trying to sweep things away.”

Although it is vital to have a support system in place, Lloyd-Hazlett says no amount of preparation will fully shield counselors from situations that can cause professional impairment. That’s why it is important for counselors to be able to recognize when they’re in over their heads and to be willing to seek help.

“In our profession, one of our responsibilities is being well so that you can bring yourself [to clients and students] authentically,” she says. “My mom’s death was a huge experience, but we have little ones all the time that give us a chance to practice self-care and self-reflection. Have an ongoing willingness to practice what we preach. [Self-care and self-reflection] can be buffers prior to coming into something severe. At the same time, there’s a measure that you can’t prepare for. It’s going to be hard and nasty. It’s important to have those skills and practices to be able to come back to, and [to] seek outside help.”

When helpers need help

Lloyd-Hazlett had assumed she was ready for her mother’s death because she and the rest of her family had so much time to prepare; her mother had been ill for more than 20 years with multiple sclerosis. When she visited her mother in hospice for the final time, they were able to share a special connection and say goodbye, even though her mother had lost the ability to speak.

Cognitively, Lloyd-Hazlett understood grief, both from her counselor training and from having personally counseled clients who were grieving. But when her mother actually passed away, Lloyd-Hazlett found that she wasn’t as prepared for it as she had thought. She describes the experience as a “ripping open,” as something that shook her to her core.

Lloyd-Hazlett was in a work meeting when she got the phone call telling her that her mother had passed away. Despite her mother’s many years of declining health, the news still came as a shock to Lloyd-Hazlett. She recalls returning to the work meeting and trying to function until a co-worker pulled her aside and urged her to take some time for herself to process the news.

Lloyd-Hazlett recommends that counselors dealing with personal issues make a point of identifying the “safe people” in their lives who won’t shy away from talking with them about tough topics and personal struggles. Determine who can “help you recognize what is going on and be there with you — not try and fix [you], but provide hope,” she says, adding that she learned that recommendation in a grief support group.

Many factors have played a role in bolstering Lloyd-Hazlett through her grief, but she says the most important was making the decision to seek individual and group counseling for herself. It was freeing, she says, to participate in group work simply as “Jessica, who is grieving her mom,” instead of “Jessica, the counselor.”

In addition, the experience of being guided and cared for by another practitioner helped her let go of nagging thoughts and feelings of “I should be able to do this,” she says. It was liberating to accept that she did not have answers at that time in her life, she adds.

Another aspect of Lloyd-Hazlett’s healing process has been learning to label her struggles as grief instead of shortcomings. After the death of her mother, Lloyd-Hazlett initially felt a sense of shame that she was somehow slacking or falling behind in her work as a counselor educator. Supportive co-workers suggested to her that she might want to rethink and adjust the schedule of classes she had set for herself. After seeking help and attending counseling, Lloyd-Hazlett came to realize that her need to lighten her workload now and then was a symptom of grief, not a personal failure on her part. In the months that followed, she canceled classes on a couple of occasions or had someone else fill in for her when she needed a break.

Lloyd-Hazlett says the experience of processing her mother’s death while working has taught her that personal struggles “are going to happen in our lives and our careers as we develop and grow.” It has also allowed her to experience the full length and depth of the grief that often brings clients to counselors’ doors, while giving her greater appreciation for the supports in her life, including her co-workers, friends and loving husband.

In addition, it has sparked an interest in providing grief work or hospice counseling to clients at some point in the future. For now, however, Lloyd-Hazlett knows she has more grieving of her own to do before she is ready to help those going through their own seasons of loss.

“The human experience is hard. It’s OK, and it’s good and beautiful,” she says. “There’s going to be loss and change [during a counselor’s career]. It’s going to be part of the process. There’s a reason why our code of ethics talks about these things. It’s not that you’re a bad counselor; it’s that life intersects.”

Challenges at home

Counselors need to remember that, as Irvin Yalom has written, counselors and clients are “fellow travelers,” says Doug Shirley, a licensed mental health counselor (LMHC) with a private practice in the Seattle area. “It’s important to tear down the model that helping professionals are healed and well. We are all on a healing path and have needs and vulnerabilities,” says Shirley, an assistant professor of counseling at the Seattle School of Theology & Psychology.

One of the vulnerabilities that can easily throw counselors for a loop, says Shirley, is when challenges arise in their personal lives that also fall directly in their professional wheelhouse. That might include a discipline issue with a child, struggling to connect with a spouse during a disagreement, or missing the cues that a loved one is sliding into substance use or mental illness.

Counselors might find themselves frustrated, thinking, “Why can’t I figure this out?” notes Shirley, who wrote an article for Counseling Today in 2012 titled “Why counselors make poor lovers.” The skills that practitioners hone to become good counselors — such as keeping a professional distance from clients’ emotions — can actually hinder their ability to make personal connections if they’re not careful, he says.

Adding to the issue is that counseling professionals typically spend their workdays seeing clients (or teaching students) who are paying — even clamoring — to hear their thoughts and feedback. It can be jarring to come home and find that they aren’t capturing their spouse’s full attention or that their teenage son or daughter views them mainly as a conduit to obtain permission to play video games or go out with friends, Shirley notes.

“We’re all people before we’re professionals. But sometimes the cart gets before the horse — sometimes the professional comes before the personal — and it keeps us from the more advanced and sophisticated work of being human,” says Shirley, a member of ACA. “We can amass a lot of head knowledge about people, psychology, health and wellness, but it doesn’t necessarily help us to attend to our own wounds.”

Shirley met and married his wife, who is also an LMHC, when he was in his late 20s. They had both spent years building their professional careers and developing their counseling skills before they met each other. However, the couple soon discovered that their counseling skills did little to help them find intimacy and connection. In fact, they were often a hindrance, Shirley remembers. As a result, they had to unlearn some of the boundary setting that their counseling training had instilled in them.

What has helped, Shirley says, is counseling, both individually and as a couple. Shirley and his wife have continued to see counselors throughout their 15-year marriage and are “doing better than ever,” he says.

Shirley recommends that counselors find a practitioner who has experience with or specializes in working with helping professionals. “We [counselors] all have this defensive structure that makes us a lousy client,” Shirley observes. “So often I’m sitting there [in counseling] and thinking, ‘Oh, I know what he’s doing here,’ wink, wink. Will I answer his question honestly [or play into his technique]? We need a therapist who understands that and won’t defer to that.”

Similarly, if counselors don’t learn to step out of the “head knowledge” gained in a graduate counseling program, it can detract from their personal interactions, Shirley asserts. “We become very top-heavy. We have all of these facts and theory, but it’s not wisdom and patience and vulnerability. Those aren’t typically the things of graduate training programs,” he notes. “For me, as an intellectual, it doesn’t always help me when I’m talking with my wife or my sons. If I have information that should help me navigate the situation and I don’t allow myself to not know [that information], I overreact and walk away with some sense of guilt or shame.”

Shirley says his best interactions with his family happen when he shuts off his counseling skills and intentionally works to “know better.” This was the case in a recent conflict with his 12-year-old son, during which Shirley’s initial reaction was to turn to discipline. But a family trip to see the new Lion King movie, where Shirley watched the father-son dynamics of the story’s main characters play out on screen, sparked a realization that allowed him to take a step back from his professional knowledge.

“As a dad, I was inclined to be too firm, too reactive, before connecting relationally and personally with my son,” Shirley says. “There needs to be a resonance between parent and child that is palpable to the kid, and that’s what was [missing] with my son. I was reacting instead of knowing better and practicing what I preach.”

Shirley appreciates the reminder he often hears from his own counselor to take “three steps back” — a call to be an observer in personal interactions. “Because counselors have set ourselves up to be knowers, we’re not very good at allowing ourselves to receive. Often, the hardest work is to be willing and able to receive,” he says. “In our personal relationships, we need to remember that all of our work is to receive from others. I’m a much better husband when I can hear and listen and receive from my wife, as opposed to feeling that I know all the answers and know what’s going on. It’s being open and taking a step back when needed.”

Leaving it at the office

“It’s so easy to go home and think about a session you just had and what you can suggest next time, the tools you can use, and how to best help [a client],” says Ashley Waddington, a provisionally licensed LPC who works in a private group practice in the Columbia, South Carolina, area.

The challenges that counselors’ humanity can bring — concern for clients who have left their caseload, second-guessing themselves, “what if” thinking, empathy fatigue — often have no black-and-white answers. Professional community, personal therapy, boundary setting and self-care become all the more important when work begins spilling over into the personal realm.

The counselors interviewed for this article cite the following ideas and techniques as being particularly helpful when it comes to counseling professionals wrestling with their humanity.

>> Connect with peers: Waddington, an adjunct instructor in the counseling education program at the University of South Carolina, is a big proponent of supervision, not only for the hours required by graduate programs and state licensure boards, but across one’s entire career. She currently has three supervisors and finds it vitally important to talk things through with professionals of various perspectives. “Counselors are lucky to have the practicum experience. Not every profession gets that,” says Waddington, who recently served as co-chair of the ACA Graduate Student Committee and co-presented a session on “survival tips” for graduate students and new professionals at the ACA 2019 Conference & Expo. She also finds support via a Facebook group for counselors in private practice, where members bounce ideas off of one another, ask questions, and share tools and techniques.

Shirley also recommends that counselors debrief with other counselors via regular consultation. He is part of a long-standing professional consultation group that meets regularly in his area, but he also seeks additional input if challenges arise between meetings. He believes it is important for counselors to consistently pursue consultation, even when things are going well, he says, to gain perspective and to benefit from the rhythm of meeting regularly with fellow counselors.

In a similar vein, Gladding recommends that counselors attend professional development events such as ACA’s annual conference to stay up to date and to seek feedback from peers on challenges that are unique to the profession. For counselors who aren’t connecting naturally with their co-workers, or for those who work alone or in a setting dominated by colleagues from other professions, Gladding shares a little advice (via lyrics from Gloria Estefan): “Get on your feet, get up and make it happen.” Counselors need to be more intentional about finding community, he says, whether online, through travel to state or regional conferences, or by other means.

“Don’t let yourself be in isolation,” Gladding says. “That almost [never leads] to good mental health. We learn from others and thrive when we’re social. We’re not lone wolves; we’re gregarious. That’s how human beings are.”

>> Write it down: Transferring one’s inner thoughts to the page can help counselors process what they’re feeling, quell rumination, and spark self-reflection. “I keep a journal, and I would be the first to say there’s research out there that [maintaining] a journal helps keep us healthier in the short and long run,” Gladding says. “It helps us be more attuned to how we’re doing and how we’re living.”

Journaling can also spur deeper thought about what is and isn’t under a counselor’s control, Gladding says. “We can check up on [clients], but if we can’t, we let it go. In the end, we don’t have complete control over people. They’re not robots,” he says.

The same process applies to people and events in counselors’ personal lives. “My oldest son and his wife are teaching French in Casablanca, Morocco. I can’t obsess about that too much, even though it’s such a long way away and a land with different customs and culture,” Gladding says. “I have to trust that they can do that and do it well.”

>> Shake it off: Maintaining a schedule of back-to-back client sessions, each with the potential to bring intense and heart-wrenching issues to the table, can be draining, both mentally and physically, for counseling professionals. Clinicians who are intentional about resetting themselves between each client are more likely to keep sessions from blending together and may be better positioned to head off burnout.

Waddington had a supervisor who kept a feather duster in her office so that she could figuratively dust herself off after each client. The ritual helped her visualize closing the prior session and preparing herself for her next client, Waddington explains.

In between clients, Waddington often steps outside, stretches, or even lays on the floor of her office to reset and clear her mind. She also finds that leaving her office and finding another secured area to record client notes after an appointment helps her find closure and “finish” the session.

It can also be helpful, Waddington suggests, for counselors to take a shower once they get home, not necessarily because they’re dirty, but to “wash off the day.” They can visualize rinsing away the heavy topics and client issues they have been wrestling with all day.

“By simply using the basic cognitive approach of reviewing our day, picking out the emotions we felt, and using them to uncover our dysfunctional thinking and belief systems, we can address them so the day’s detritus can be left at the office and not remain in our head,” says Robert J. Wicks, an ACA member, professor emeritus at Loyola University Maryland, and author of numerous books, including The Inner Life of the Counselor. “When you go to the bathroom in a restaurant, there is a reminder [to wash your hands]. The same can be said metaphorically of counseling. We need to psychologically and spiritually decontaminate ourselves before returning to the rest of our lives.”

>> Get by with a little help from your friends: While professional connections can be a vital part of a counselor’s support network, connections with friends who aren’t helping professionals can be equally as valuable and refreshing, Shirley notes.

Spend time with “those who will stick with you through the bad and good and tell the truth,” he says. “Friends who aren’t counselors are key. These are the people who will keep us sane and give it to us straight. They often have their feet on the ground more than we do.”

Wicks agrees, asserting that counselors need “a robust and balanced circle of friends” to be able to thrive. He goes into more detail on this topic in his book The Resilient Clinician. Practitioners can benefit from encircling themselves with a variety of personalities, Wicks says, including friends who will challenge their thinking; be sympathetic and supportive; keep a counselor from taking themselves too seriously through good-natured teasing; encourage a sense of wonder; provide guidance without giving answers; and spur them to be their best.

>> Take care: The introduction to Section C of the 2014 ACA Code of Ethics urges counselors to “engage in self-care activities to maintain and promote their own emotional, physical, mental, and spiritual well-being to best meet their professional responsibilities.”

When it comes to self-care, it’s important to have a plan in place before challenges arise. Not only will the methods that counselors find effective vary from practitioner to practitioner, but a self-care routine will also need to evolve to meet changing needs throughout a counselor’s career.

Gladding suggests that counselors be intentional about spending time engaging in hobbies that help them decompress and find connection. Perhaps that’s singing in a choir, playing golf, watching birds — whatever piques their interest, he says.

Wicks advocates for alone time and spending time in reflective silence and solitude. As she has navigated her grief journey, Lloyd-Hazlett has found yoga helpful, as well as trying new things such as entering some of her paintings into a local art show. Waddington recharges through reading books on mental health topics in her personal time (she recommends Yalom’s The Gift of Therapy and The Grief Recovery Handbook by John W. James and Russell Friedman).

Shirley emphasizes the importance of wellness, including nutrition, exercise, getting enough sleep, and drinking enough water. These elements are often the first things to go when counselors get stressed, he notes.

Finding spiritual community is also essential, Shirley adds. The community doesn’t necessarily have to be a religious one; it can include spiritual connections found through group yoga classes, volunteering in the community, or other means, he says.

>> Keep it real: Professional boundaries must be maintained, but occasionally, “being human” in interactions with clients or students can be a powerful way to connect, Lloyd-Hazlett says. When it comes to self-disclosing to clients or students, such as mentioning that she is struggling with a loss, Lloyd-Hazlett says she lives by the philosophy “less is more.” However, self-disclosure, when done appropriately, can also serve as an example for others to be honest and open about their own struggles.

“The question needs to be, is this going to benefit my client? What is my motivation for wanting to disclose?” Lloyd-Hazlett says. “Being a human and having a human experience is so important to the counseling relationship. We can do that through different ways, including self-disclosure. When you’re struggling, just showing that and acknowledging that can be very powerful. What that disclosure looks like depends on the client or topic and where you are in your process.”

Counselor training teaches practitioners to remain professional and keep an emotional distance from clients while in session. However, Waddington urges counselors not to hold back if they are connecting with a client during an intense moment in session.

She recalls one client who was grieving the loss of her sister, who had died tragically in an automobile accident. The client’s pain was so raw that she couldn’t bring herself to say her sister’s name out loud. Waddington found herself with tears streaming down her face in session and apologized to the client for losing her composure.

But in their next session together, the client thanked her. “She said, ‘I’ve never had someone cry with me like you did. That was the first time I felt really heard, and [I knew] you understood what I was saying,’” Waddington recalls.

>> Know that you are enough: Waddington leaves notes for herself in her office with positive messages such as “You are enough” and “You just need to show up today.” These simple reminders help her curb overthinking and the urge to come into sessions with a mindset of fixing clients. “You don’t have to have this crazy technique to do with a client. Showing up is enough. … It’s not [our] job to fix them but to show up and work with them where they are,” Waddington says.

It’s a lesson Waddington has learned over time. She recalls one client who was severely depressed and unable to work. He left his house only to come to therapy once per week. Initially, she worked with him on big goals to improve his situation, including applying for jobs.

Waddington finds it helpful to check in periodically with clients in session to see how they are feeling about their work and progress in therapy. During a check-in with this client, he gave Waddington feedback that served as a reality check for her: You can do less for me. The client was feeling guilty about his lack of progress, and his self-esteem was taking a dive as a result.

After some self-reflection, Waddington changed her approach, working with the client on smaller goals and steps that could help him feel better day to day. In turn, his quality of life improved, she says.

“One thing I’ve had to learn and practice myself is that you don’t have to have all the answers and be the solution [for clients],” Waddington says. “[That’s] not our job. It’s our job to show up and listen.”

When self-doubt kicks in, Shirley urges counselors to remember that they’re part of a bigger picture. “When we get hung up on ‘Did I do that right?’ remember that we’re all in this together and doing the best we can do. Rumination and anxiety are really common when we’re in the messy business of helping people. Whatever we’re doing, we’re doing the best we can do. And, quite frankly, sometimes that is enough. And when what we have to offer isn’t enough, we need to go out and get extra support through referral or consultation, etc. That’s not a reflection on us as people, it’s just information.”

Boundary setting off the clock

Years ago, when Gladding was a new practitioner with a young family at home, a couple he was counseling called him on a Sunday afternoon with an urgent request to see him for an emergency session.

“I agreed to see them — and soon realized that they weren’t in crisis. They just wanted to blame each other for some things,” Gladding recalls. “I learned from it and [eventually] said, ‘I’ll see you during office hours, but I can’t see you now.’ That was a mistake on my part.”

It wasn’t the last time a client would contact him outside of working hours. In one instance, a client even showed up at his home on the weekend. While it’s certainly possible for clients to spiral into crisis situations at any time of day or any point of the week, Gladding says he has learned the importance of prioritizing boundaries. If clients contact him outside of working hours, he makes sure they’re stable, ensures they have crisis hotline numbers, and agrees to see them at the next possible opening during business hours. “I don’t want to downplay [clients’ pain], but boundaries have to be there, or we don’t do anyone any good at times,” Gladding notes.

The same goes for family members or friends who approach him for advice because he is a professional counselor. Gladding says he typically uses humor to diffuse the situation and redirect their questions. There is a reason that ethics guidelines urge against counseling family members and friends — because counselors simply cannot be objective in those situations, he says.

If Gladding notices an issue going on in the lives of those he knows personally, he says that he might make a gentle observation to them about what he’s seeing — without engaging in a counseling intervention — and offer to connect them to another counselor.

“I have a colleague who is always saying, ‘Check yourself before you wreck yourself.’ I like that because we can get into trouble if we get too much into something that’s happening” in the lives of family or friends, Gladding says.

Waddington sees such situations as opportunities to coach family members and friends on the benefits of professional counseling, and then supporting them through the process of finding a counselor clinician.

“When anyone knows that you’re a therapist, the floodgates open,” Waddington says with a chuckle. “People will start sentences with, ‘In your professional opinion …’”

In those situations, Waddington has a phrase that she responds with: Do you want my ears, do you want my advice, or do you want me to step in?

“Then, I am clear about what they really want from me. Often, they just want me to listen. I can listen all day, but it’s not my job to be your therapist, and I don’t want to be,” she says. “Often, I will say, ‘Let me help you find someone to talk to.’ … It’s not my job to help my cousin get through this [problem], but it is my job to help them find help.”

 

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Contact the counselors interviewed for this article:

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

Books (counseling.org/publications/bookstore)

 

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

Letters to the editor: ct@counseling.org

 

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

Advice for the highly sensitive therapist

By Lindsey Phillips September 20, 2019

Erica Sawyer, a licensed mental health counselor and art therapist in private practice in Vancouver, Washington, knows firsthand the benefits and challenges of being a highly sensitive therapist. (Approximately 20% of the population has an innate temperament trait referred to as sensory processing sensitivity; individuals with this trait are categorized as “highly sensitive people.” Right after graduate school, she started working 40 hours a week at an enhanced care facility for adults with severe and persistent mental illness. She quickly realized that the constant needs in the 16-bed locked unit were overwhelming for her.

“It was very intense,” Sawyer says. “There were times I couldn’t even get out the door to take a break because there was a crisis with a resident trying to leave the facility, so we couldn’t open any of the doors. So, on my break time, I had to sit in an office where there were constant interruptions.”

Sawyer tried to escape the overstimulation by visiting the restroom, but she couldn’t stay long in there because there was only one bathroom in the entire facility and other people needed it.

On the positive side, she found she was able to connect with many of the residents in a way that surprised and baffled the other therapists. She realized, however, that being good at this type of work didn’t mean that it was a good fit for her.

In fact, Sawyer says she was on a path to quick burnout, so she determined to figure out what she could control — such as her work environment, her hours worked, and the type of clients she saw — and start making changes.

She went from a full-time inpatient position to a part-time outpatient position, but even that was too much because of the hours needed to get all the work done for her caseload of 70 people. “The quantity of clients, along with being assigned the higher needs cases, was far from optimal,” Sawyer says. “I was experiencing my own anxiety and had to go out to my car and do some tapping [therapy] to just manage the day.”

Now, Sawyer is working part time in her own private practice so that she can control the amount and type of clients she sees and the days and times she works. She also lets clients know that she can’t guarantee a response to an email after 5 p.m. Highly sensitive therapists have to recognize their stress points and the environments that aren’t conducive to their temperament because it’s not good for them or their clients, she adds.

Because highly sensitive people process more deeply, counselors with this trait may have difficulty leaving work at work, notes Heather Smith, a licensed professional counselor and an assistant professor of human development counseling at Vanderbilt University. It’s important for highly sensitive counselors not to compare themselves to counselors who do not have this trait, she says. Instead, they have to figure out their own needs and best practices. For example, they may need to see fewer clients per week or work fewer hours.

Elaine Aron lists some possible self-care practices for highly sensitive therapists on her website:

  • Practice “The Five Necessities” — believe your trait is real, reframe your childhood in light of this trait, heal from past wounds, don’t try to live like the other 80% of the population without the trait, and find a group of other highly sensitive people
  • Reduce therapy work time (ideally, no more than 20 hours a week)
  • Screen clients
  • Have downtime
  • Don’t take your work home
  • Charge clients appropriately
  • Find a good consultant
  • Seek out your own therapist
  • Take frequent vacations

Julie Bjelland, a licensed psychotherapist in private practice in California who specializes in working with people who identify as highly sensitive, recommends that highly sensitive therapists see no more than 10-12 clients per week. “You can’t see seven clients in a day as a highly sensitive person and be well because you’re taking in too much information,” she notes. Bjelland also suggests other ways that these therapists might reduce potential overstimulation and burnout. For example, they could increase their fees and see fewer clients per week, or they could see clients three or four times a week and then have three or four days off.

Smith, an American Counseling Association member who researches the sensory processing sensitivity temperament trait, advises highly sensitive therapists to create healthy habits to reduce overstimulation and to give their brains extra time to process. For example, counselors could schedule breaks between sessions, or they could make a point to finish their work notes before leaving for the day to avoid continuing to process this information when they get home. “Some of these practices can help over time to decrease the susceptibility to burnout,” Smith says.

Louisa Lombard, a licensed professional clinical counselor in private practice in California, makes a point to practice self-care habits. For instance, she takes a 30-minute break between clients so she can finish writing her notes, eat a snack, or engage in activities that she finds soothing, such as meditation or using essential oils.

Sawyer, also an ACA member, has colleagues who perform a ritual of literally washing their hands between clients as a way of letting that session and all of its associated information go down the drain before the next client.

Even though highly sensitive therapists have particular needs that must be addressed to avoid burnout, they also bring unique gifts to therapeutic sessions. Highly sensitive counselors “are well wired for this type of work,” Smith notes. “They’re going to process information more deeply. There are new research findings that suggest they have more mirror neuron brain activity and, thus, possibly stronger empathy.”

These counselors often have deep intuition and more attunement with others, and they tend to make clients feel safe and easily build rapport with them, Sawyer adds. As she points out, these qualities are “huge assets in being a good counselor.”

Bjelland, an author and global educator on the highly sensitive person, agrees that highly sensitive therapists have a lot to offer to clients because of these qualities. She finds that these therapists often have a strong connection with clients, are able to pick up on patterns and connections, and sometimes know things even before their clients do. She has had clients who weren’t able to reduce their anxiety even after working for years with other therapists. But within two to three weeks of working with her, their anxiety started to decrease.

Bjelland says highly sensitive therapists can benefit from thinking about the way that healers used to operate within a tribe: They had their own hut, and after they did their healing, they would spend a lot of time alone. “If you see one client, you’re going to need to process that session and then … rest and restore after that session,” Bjelland says. “Because if you take care of yourself well in this field, you can be a powerful healer.”

 

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Look for a related article, “Finding strength in sensitivity” in the October issue of Counseling Today magazine.

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist living in Northern Virginia. 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. 

Maintaining motivation as a counselor

Compiled by Jonathan Rollins September 3, 2019

As a whole, professional counselors are known to be driven by their desire (many might even deem it a calling) to help others. But as is the case in any job or profession, that internal sense of motivation to show up day after day and perform to the best of one’s abilities can sometimes wax and wane.

And let’s face it. Counseling is not just any profession. Yes, the intrinsic rewards can be great, but there are some inherent challenges to being a “helper” for a living.

Counseling Today recently contacted a handful of American Counseling Association members to ask them how they maintain their motivation levels in a profession that can be demanding, draining and exceedingly rewarding — all at the same time.

Note: Some responses have been edited slightly for purposes of space or clarity.

 

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Meet the counselors

The following members of the American Counseling Association agreed to share their personal insights regarding maintaining motivation as a counselor:

  • Mary Barros-Bailey is a bilingual certified rehabilitation counselor, a national certified counselor, a diplomate of the American Board of Vocational Experts, and a certified life care planner in Boise, Idaho.
  • Aaron Norton is a licensed mental health counselor, licensed marriage and family therapist, certified clinical mental health counselor and certified rehabilitation counselor working at Integrity Counseling Inc. in Largo, Florida.
  • Kathryn L. Bright is a licensed professional counselor, parental responsibilities evaluator (known in other states as a child custody evaluator), and parenting coordinator/decision-maker in Boulder, Colorado.
  • Anita B. Wright is a licensed professional counselor and national certified counselor. A retired principal, she opened her counseling private practice, Anita B. Wright, Counseling, Tea and Therapy PLLC, in Winterville, North Carolina, on a part-time basis in 2018. She is also the dean of middle school and special education/English language learners at Winterville Charter Academy.
  • Aaron J. Preece is a licensed professional counselor who works at High Country Behavioral Health in Pinedale, Wyoming.
  • Summer R. Collins is a licensed professional counselor intern currently practicing under Cristina Sevadjian (LPC-S) at Sparrow House Counseling, a group private practice in Dallas.

 

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What originally motivated you to enter the counseling profession?

Aaron Norton: To echo the most common answer I get on this question from graduate students in clinical mental health counseling, I was very driven to a profession that enabled me to help people. On deeper reflection over the years though, I do not think I could consider this answer thorough and honest if I didn’t add that I wanted to continue learning more about mental health to better understand my own mental health and wellness.

I first saw a counselor at 19 years of age, and I’ve seen a few others over the years. They were instrumental in helping me to heal from experiences in my personal life, and those experiences were so invaluable to me that I very much wanted the opportunity to pay it forward.

Anita B. Wright: My transition from teacher to school counselor was a natural progression. It was clear that the needs of the students I served required more from me. My instructional role toward academic proficiency could not be achieved without having first attended to the social/emotional realities [of the students].

Summer R. Collins: What originally motivated me was to help alleviate the intensity of people’s emotional pain. I experienced emotional distress in a capacity I never had before during my first year postgrad when my mother and then my grandfather were both diagnosed with cancer. I was also grieving the loss of my career as a competitive collegiate swimmer while facing these family members’ cancer diagnoses, and it all felt like too much. The relief and peace I felt in seeking help through my own counseling motivated me to become that same safe place for others experiencing pain.

Mary Barros-Bailey: Serving people with disabilities, particularly Portuguese and Spanish speakers.

Kathryn L. Bright: As an angsty yet dauntless teen, I longed to help those less fortunate than me, in particular my first boyfriend. He had left home, quit school, and ended up in a juvenile facility. At 18, he was convicted of marijuana possession and given the choice to go to jail or join the Army. He chose the Army. After a year in Vietnam as a foot soldier, he returned to the U.S. with severe posttraumatic stress disorder, depression and anger issues.

My parents scorned my choice of boyfriend, but I saw so much good in him beyond his troubled façade. One day, while imploring my mother to let me see my forbidden Romeo so I could help him, she curtly retorted, “You’re not qualified to help him.” From then on, the seed was planted in me to become qualified — through education and experience — to help people deal with traumas and life’s dramas.

I’m also gifted with being a highly sensitive, empathic, intelligent woman who grew up in a dysfunctional Southern family in the ‘50s and ‘60s. Good counselors were hard to come by then. The ones who were available greatly benefited me, making a huge difference in my own struggles and motivating me to share that benefit with others.

Aaron J. Preece: I spent 12 years in a deep depression, the last 1.5 years with daily suicidal ideation and related challenges. I then began working as a staff member in a wilderness therapy program and, while helping the clients, found many tools that I too could use and benefit from.

 

We’re all aware that counseling can be a challenging profession and that counselors sometimes face the risk of burnout. What has helped you maintain your motivation level as a counselor long term?

Mary Barros-Bailey: I always understood that I could grow professionally in a variety of directions. Initially, I started as a master’s-level vocational rehabilitation counselor with a private practice in California. Within a couple of years, I landed in Idaho, started a single-person private practice that I still run today, and entered a doctoral program. My love for rehabilitation counseling led me to become professionally involved at the local, national and international levels; to serve on accreditation and credentialing boards; to chair federal government panels; to teach [as an] adjunct for four universities; to research, publish and present in areas of my interest; and to develop a forensic practice where I have had cases north to Canada and Alaska, from California to Maryland, and as far south as Brazil, thus stoking my other love — travel.

I have learned that it’s OK to say “no.” Every few years, I take a self-imposed sabbatical from attending or presenting at conferences, joining any committees or teaching a class. I keep up with technology that has made me very efficient and allowed me to practice in ways I never dreamed possible when I started as a counselor. I’m still very excited about the challenges posed by counseling and where I’m going professionally, particularly in forensic practice.

Kathryn L. Bright: Self-care is the biggest help. That includes healthy lifestyle choices such as regular exercise, sunshine and fresh air, along with meditation, social interaction, consultation with colleagues, and continuing education.

Aaron J. Preece: Balance. I do not take my work home with me if at all possible. I also involve myself in social, religious and community programs not related to counseling. Also, nurturing and maintaining relationships with family and friends on a weekly basis.

Anita B. Wright: Absolutely the work. The intrinsic stories. Having the privilege to join the journey.

Summer R. Collins: What has helped me maintain motivation as a counselor long term is to view my career as an endurance race. I know there will be parts of the race that will feel more daunting and challenging, and I can expect that. But I can also expect … the “runner’s high” of different victories that I know I’ll experience in the field when I get to witness clients making lasting changes with improved emotion-regulation skills and cognitive flexibility.

Aaron Norton: I keep a collection of artifacts — letters, cards, drawings, emails, etc. — from clients who have expressed their gratitude for my help over the years. I can look at them anytime that I want a reminder of why I do what I do.

Additionally, I try to practice healthy self-care. When I was a student in my clinical mental health counseling program, I took a class on the art and science of personal change. We were required to create and implement a personal change project using the knowledge we acquired during the class. My goal was to exercise regularly — a goal that I had not ever been able to consistently practice prior to that class. I implemented my change plan, and I have continued it without any lapses for the past 13 years. In my humble opinion, all counselors should exercise regularly, although that regimen may look very different from person to person.

I also regularly spend time with family members, friends, my partner and colleagues doing things that have nothing to do with my job, and I start every day off with my daily Stoic meditation. I try to practice healthy eating, do not hesitate to take vacations and time off, spend time in nature and with pets, participate in weekly peer consultation, stay very connected to my colleagues through professional associations, implement time-saving organizational measures, and enforce boundaries with my clients.

 

What is the biggest threat to your sense of motivation as a counselor?

Summer R. Collins: The biggest threat to my sense of motivation … is that our work as counselors cannot be measured and graded. I can question whether or not I’ve made an impact and if my work has meaning when I’ve had a particularly difficult week.

Kathryn L. Bright: Self-doubt creeps in from time to time, making me second-guess myself and lose confidence in my considerable abilities, thus slowing me w-a-a-a-y down.

Aaron J. Preece: Supervisors who expect unrealistic goals or results. Lack of variety in my job.

Aaron Norton: At the present time, I am finishing a doctoral program in counselor education and supervision. This is simultaneously a joy and a burden. Sometimes, when I am busy at work on my dissertation, or when I’m feeling particularly stressed or overwhelmed, I feel less psychologically available to my clients. I view this, however, as a very temporary problem.

Anita B. Wright: The weight of the therapeutic process as the [person’s] pain and vulnerability are being tempered via me.

Mary Barros-Bailey: Apathy. I like variety — clinical and forensic practice, teaching, research, writing and innovation.

 

What one to two things currently energize you about your work as a counselor?

Aaron J. Preece: Our community began a prevention coalition in which I am deeply involved in substance abuse and suicide prevention work. I also enjoy learning new tools or techniques for approaching clients.

Anita B. Wright: Earning the sweet spot of trust as the therapeutic relationship develops.

Aaron Norton: My colleagues energize me. I have met such wonderful friends in our field. The clinical mental health counseling specialty is, to me, a tribe of sorts, and I enjoy having a place in this tribe. I belong.

Second, those moments when clients seem to “get it” have always been a consistent source of energy for me.

Mary Barros-Bailey: Innovation in assistive and instructional technologies and with counseling techniques, such as new methods in integrated behavioral health.

Kathryn L. Bright: When clients accept, practice and benefit from what I offer. When I see that “aha!” lightbulb shining brightly behind eyes filled with insight and gratitude. When colleagues show confidence in my work through their referrals.

Summer R. Collins: One thing currently energizing me is learning new treatment skills for working with clients with posttraumatic stress disorder and witnessing firsthand the effectiveness of this treatment and the healing I’ve seen my clients experience.

 

Are there any particular techniques, tricks or strategies that you use to stay motivated?

Aaron Norton: I start every day off with a daily mediation from Stoic philosophy, the ancient philosophy that essentially informs cognitive behavioral theory. I also like to read about or listen to people in our field whom I very much look up to. I attend a great deal of workshops, retreats and training programs in our profession, and I always leave feeling energized and ready to get back to work.

Kathryn L. Bright: A daily practice of the techniques of self-knowledge helps me focus my attention within to experience peace and fulfillment. Taking time each day to enjoy that experience puts me in touch with my innate strength, clarity and wisdom. That helps me, more than anything else, to maintain my motivation as a counselor and an optimistic outlook on life. A sense of humor helps too.

Summer R. Collins: One trick I use to stay motivated is to continue staying connected with my colleagues in this field. I recognize my need to connect with others who understand the difficulties that come with being a counselor. Relating with them and being able to share hits and misses is a very helpful and important thing for me. It gives me grace for myself as I continue to seek to become an effective and helpful counselor to my clients.

Anita B. Wright: Continuous learning of clinical language and effective therapeutic approaches.

Aaron J. Preece: Exercise is my Prozac. I make a diligent effort to exercise at least three times a week — more if possible. I also work in the yard; keep involved in community music programs, Scouts, religious attendance, and youth programs on a volunteer basis; eat healthy; read; and make sure to get adequate sleep. Generally, it is about stress. I manage my low-level stress every day so big stresses don’t immediately overwhelm me.

Mary Barros-Bailey: The personal strategic plan format I cobbled together with a variety of resources over the years has become my go-to when I’m in a motivation hole and need to shovel myself out and reenvision.

 

 

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Jonathan Rollins is the editor-in-chief of Counseling Today. Contact him at jrollins@counseling.org

 

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