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Professional Issues

Resisting a savior mentality

By Caitlin C. Regan December 5, 2022

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

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

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

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

A humble helper 

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

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

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

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

Empowering clients 

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

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

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

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

SynthEx/Shutterstock.com

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

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

Am I helping or saving?

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

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

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

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

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

 

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

 

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

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

Pushing back against fatphobia

By Bethany Bray November 30, 2022

“I feel fat today.”

This is a phrase that Justine Trumbetas, a licensed professional counselor (LPC) in Pennsylvania, says she often hears from clients who live in bodies of all kinds of shapes and sizes. And this seemingly simple statement contains a lot for counselors to unpack with clients. 

More often than not, this thought stems from weight stigma or bias that the client has internalized from external sources. This can include anything from an offhand comment a friend makes about needing to work out to “earn” her slice of birthday cake to a medical doctor who advises weight loss for a presenting concern that is unrelated to the patient’s body size.

Trumbetas, who specializes in helping female clients with anxiety and body image-related issues, says that when clients use language such as “I feel fat” or “I feel gross,” she uses it as an opening to help them begin to recognize their emotions and negative thought patterns as well as how these thoughts affect their value and self-worth. The first step is to replace the word “fat” with a more factual, accurate word, she notes.

“I tell them that fat is not an emotion, so we can’t feel it. And we work to replace that, find the word they need … and tap in to what they’re feeling, [such as] defeated, let down, sad. And then we dig into why they feel that way,” says Trumbetas, an American Counseling Association member who has a counseling practice providing online sessions to clients in Pennsylvania and Florida. “There’s much more than feeling fat. There is a lot more underneath it. Are they comparing themselves to other people [or reacting to] something that they saw or heard from others? Typically, when we dig in, I find that their worth is tied to their body and how others view it.”

Pervasive weight stigma 

Thin bodies have been idealized and prioritized in U.S. culture and society for centuries. This shows up in everything from themes in advertisements and television to the overuse — and misuse — of the body mass index (BMI) as a benchmark for health by medical professionals and others.

Weight stigma carries the message that “there’s something wrong with your body simply because of the size of it,” says Jennifer DiGennaro, an LPC with a private practice in Grand Rapids, Michigan. And it’s traumatic for an individual to be bombarded by a lifetime of messaging that implies that their worth is tied to their body size or ability to lose weight, she adds.

“We live in an eating disorder culture and a body-shaming culture,” says DiGennaro, who specializes in helping clients heal from trauma, body shame and eating disorders. “We carry this myth that everyone can control their weight,” she continues, but “there are many, many, many reasons that someone is living in a larger body, and it may have nothing to do with what they eat or how much they’re moving.”

When talking with clients and colleagues, DiGennaro finds that using different words to name this phenomenon can help others understand the stigmas surrounding weight, depending on the context and their familiarity with the issue. Weight stigma can also be described as fatphobia, fatmisia, sizeism, weight bias, weight-based discrimination, fatism or size bigotry. No matter what it’s called, fatphobia is “thinking you know things about a person simply by the size of their body, and we don’t,” DiGennaro says. “And arguing on that point is reinforcing weight stigma.”

When unpacking and dismantling weight stigma, it’s important — both for counselors and clients — to consider the full context of the messaging they receive about weight loss, nutrition, body size and related issues, says Kaitlyn Forristal, an ACA member and licensed professional clinical counselor who studied fatphobia’s influence on diagnosis decisions made by counseling graduate students in her 2018 doctoral dissertation. This includes the fact that many companies stand to benefit from keeping this stigma alive and prevalent, she adds, noting that the weight loss industry in the United States was worth $72 billion in 2018.

Trumbetas says that nearly all her clients use language in sessions that indicates they have been negatively affected by weight stigma. This ranges from describing feelings of worthlessness to noting that they had a “bad” weekend because they indulged and ate a slice of pizza, she says.

Her clients have often internalized microaggressions and messaging they’ve received from a number of sources, but she finds that the most influential are social media, their family of origin and the medical profession. Many clients talk about being raised in an atmosphere where the adults were always on a diet roller coaster, Trumbetas says, so it was common for them to make comments such as “You shouldn’t be eating that.”

She has also worked with clients who have stopped going to medical appointments because they don’t want to be judged and have assumptions made about them based on their weight. Because weight bias is deeply embedded in the medical profession, some doctors’ initial and go-to recommendation for larger-sized patients is to lose weight without finding out the context surrounding what’s bothering them, she explains. 

Reconnecting to self

The counselors interviewed for this article agree that clients who have been negatively affected by weight stigma often need a combination of counseling work that focuses on quelling negative thought patterns, tolerating discomfort and reconnecting to a body that external forces have caused them to disconnect with and hate.

An important first step is educating clients on what weight stigma is and how prevalent it is in our society as well as offering the message that “your worth, your identity and your value is not in your appearance,” says Stephanie Dutson, an LPC who specializes in helping adult clients with trauma, anxiety and body image-related issues.

Dutson says she often emphasizes to clients that a body is for living in, not for looking at.

She finds that weight stigma often causes clients to feel guilt or shame about what they are or are not doing to maintain their appearance. And that guilt or shame “affects a person’s health so much more than an extra 20 pounds does,” says Dutson, who lives in Birmingham, Alabama, and has a counseling practice providing online sessions to clients located in Utah, Wisconsin and Alabama. “The research shows time and time again that social life, stress management and moving your body in a joyful way — not weight or size — are what promote health. Diet culture really squashed that intuition for most people, and [unlearning weight stigma] comes back to trusting themselves and finding connection to intuitive knowing.”

Many of Dutson’s clients have strong feelings of shame or disgust associated with their bodies, especially with parts that are often sexualized or idealized in popular culture and media (such as the abdomen, chest and arms), she notes. Dutson focuses on helping clients who feel this way regain comfort and feelings of safety with their body, including “tuning in” to parts of their body that they’ve “tuned out” or disconnected with because of weight stigma, she says. 

For example, she may ask a client to gently touch or look at parts of their body that they have tuned out (e.g., a soft belly post-pregnancy) in a mirror at home. Then Dutson processes the experience and emotions the client felt at their next session. She also encourages them to spend more time doing this exercise as they become increasingly comfortable with their body. The aim, Dutson says, is to help clients gradually reconnect to their body.

Many clients have such negative feelings associated with their body that they aren’t able to look at their entire body in the mirror at first. She encourages them to start small with a handheld mirror to view one part of their body, such as an arm or leg, and eventually add additional areas.

“I tell clients to expect some feelings of discomfort, but to try and find an area of the body or [amount of] time that is moderately uncomfortable while still tolerable so they don’t become flooded or overwhelmed,” she explains.

A powerful aspect of these exercises, Dutson notes, is helping clients recognize and begin to fully feel emotions — including discomfort — in their body. “I don’t know a client with body image issues that is entirely comfortable with their emotions because emotions are so often experienced within the body,” she adds.

Trumbetas also finds mirror work helpful, and often suggests that clients focus on learning to thank their bodies for its strength. She prompts clients to think of things that their body has done for them, such as allowing them to smell their favorite scent or heal from sickness or surgery.

This is quite a perspective flip for individuals who have harbored animosity toward their body for a long time, she notes.

If a client makes a comment such as “I hate my thighs,” Trumbetas says she would prompt the client to spend time looking in the mirror and thanking those thighs for getting them where they want to go and being able to do things like climb stairs or walk their dog.

“Being kind to yourself in this way can be a foreign concept,” she acknowledges. “I tell my clients consistently that to get comfortable, you have to become uncomfortable.”

As clients practice looking at their body in the mirror, she suggests they take an empowering stance she calls the “Wonder Woman pose.” To do so, the client meets their own gaze while standing with their hands on their hips, holding their head high, chest out and shoulders down. Trumbetas will model the pose for clients during sessions and encourages clients to try it with her. Standing in this way can decrease anxiety and boost confidence, she says.

Trumbetas says she receives a lot of positive feedback from clients about the Wonder Woman pose, and many report that it’s helpful to do whenever they’re feeling anxious or need to feel better about themselves and reconnect to their own power.

Identifying triggers

Reconnecting to oneself in counseling allows clients not only to better understand their own emotions but also to pinpoint how it feels when they are affected by negative messaging about body size and appearance, notes Dutson, an ACA member.

“Understanding the core emotion of what a trigger brings up for you gives you a better road map of how to deal with that emotion,” she explains. “Most of the emotions that come up around body image are disgust, shame, anxiety or guilt. And when clients have that [emotional] self-awareness, they can ask, ‘What is the core emotion that I’m feeling?” 

She then guides them to find ways to care for themselves when shame and other painful feelings arise, such as focusing on empathy and self-compassion.

For example, a client may be visiting an aunt who makes a comment that the client has gained weight since she last saw her or talks incessantly about her own weight loss behaviors or successes. Dutson will process this interaction with the client and prompt them to identify the emotions they felt and how they would like to handle a similar situation in the future.

She finds it helpful to prompt clients to track the moments that produce a visceral or intense emotional reaction regarding body size. Depending on the client’s situation and preference, she has them recount triggering situations to her verbally or write down details in a notebook or journal. She then guides clients to think about who was there, what was said, what emotions rose to the surface, what they were doing and feeling leading up to the interaction, and other aspects surrounding this triggering experience. Clients who reflect in this way eventually notice common threads of people or topics that activate them, she notes.

It can also be helpful, Dutson says, to suggest that clients write out a script or statements they’d like to use the next time they are in a triggering situation. Depending on where they are in their healing, this can include asking the other person not to talk about weight or body size in that way.

Trumbetas also helps clients identify and manage triggers, and one of the first things she does with clients who have been affected by weight stigma is to suggest they do an “audit” of their social media accounts to unfollow people and pages that spread body-negative messaging.

DiGennaro adds that helping clients talk about messaging related to weight stigma also requires counselor practitioners to suppress the urge to reassure or comfort clients who make statements such as “I feel like people are judging me.” A counselor’s role, DiGennaro emphasizes, is to be honest because people may very well be judging the client. Instead of offering reassurance, counselors can help the client unpack how they feel about such thoughts, recognize their origins and become intentional about the relationship they have with these thoughts and the way they affect their mental health, she says. Then they can help clients find and set boundaries to keep from internalizing harmful messaging going forward.

DiGennaro often helps clients plan for social interactions or family gatherings by guiding them to explore their values and identify what they are and are not willing to disclose or talk about.

“It’s a huge piece of healing work to first know what you need and want, then be able to put it into words and ultimately decide to share it with the appropriate people,” she says. 

DiGennaro sometimes invites clients to constructively use the anger they may feel about issues related to body weight and size. “There is a lot to be angry about with the way our bodies and feelings about food have been manipulated by diet culture,” she says. “One pattern I often see is when a client takes the unconscious anger evoked by weight stigma and turns it against themselves with punishing or chaotic food behaviors. So once the anger becomes conscious [through counseling,] I tell clients to channel that appropriately outward. Feeling and acknowledging rightful anger allows for the setting of essential boundaries to protect from further harm from weight stigma.”

Rethinking restriction

Helping clients identify and work toward goals is often an important part of counseling. But what if a client is focused on a goal to diet or lose weight?

The first thing to remember is that it is outside of a professional counselor’s scope of practice to advise clients on nutrition, exercise, weight loss or other topics related to physical health. (For more, see Section C of the 2014 ACA Code of Ethics at counseling.org/ethics.)

Weight loss is not a behavioral or mental health issue, DiGennaro stresses. Whenever a client mentions a goal of weight loss in a counseling session, she uses that opportunity to dig into why they want to set that goal — and what outside influences might have contributed. She uses motivational interviewing and asks questions such as “What would it mean to you if you lose weight?” to explore the client’s underlying reasons.

Knowing the reasons behind their weight loss goal will also help counselors determine the best approach for the client. Maybe the client says they want to lose weight because of negative comments they’ve heard from family members. “If you dig into it, they might be actually fine with their body, but they’re sick of hearing comments at family gatherings,” DiGennaro says. “In that case, we need to work on boundaries.”

Another client, however, may realize that their core reason for wanting a smaller body size is a desire to feel more confident. In that case, DiGennaro says she would focus on counseling techniques that boost the client’s self-confidence without attaching it to their weight or body image.

“Food and body issues are often the tip of the iceberg,” DiGennaro says. “I have never worked with a person who discovers their heart’s desire is to be thin. It’s always more along the lines of finding peace, receiving love and finding meaning in life.”

Similarly, Trumbetas says that when a client mentions in session that they’ve lost a certain number of pounds, she avoids praising or encouraging them, which would reinforce weight stigma. Instead, she responds with a question such as “How does that make you feel?” to explore the context of the client’s statement.

Trumbetas uses these conversations to emphasize that weight and health do not mean the same thing, and that “fixating on one aspect of health leads to unhealthy thinking,” she says.

Clients sometimes tell her, “If I can only lose this amount of weight, I’ll be happier.” But she reminds clients that being thin will not magically make them into someone they will love. Instead, she focuses on helping them learn to avoid comparing themselves to others and strengthen their self-love (both love of their body and their whole self).

DiGennaro is a certified intuitive eating counselor, so she also offers clients who talk about dieting psychoeducation on intuitive eating and explains that research indicates that most people who diet eventually gain the weight back, plus extra.

“Trying to control your body [via dieting] often comes from a place of punishment and restriction. I see it as ultimately a disconnection from self,” she says. “Instead, I help clients get curious about what it might be like to reconnect to themselves from a place of nourishment, self-care and truly listening to their body. And this is complex work because often … there were protective reasons they had to disconnect from their bodies and reconnection must be done in a trauma-informed way.”

DiGennaro acknowledges that this perspective shift does not come easily for clients, and it often takes many sessions before they begin to replace the unhealthy thought and behavior patterns they’ve adopted to cope with a lifetime of weight stigma.

Dutson also focuses on helping clients shift their perspective away from a restrictive view of taking things away (including food) to one that allows them to consider adding supportive elements to their life. To do this, she often prompts clients who are healing from the effects of weight stigma to identify and add things to their life that bring them joy, nourishment and comfort. This can be anything from dancing to their favorite song to connecting with a supportive friend.

There is so much more to wellness than body size, and the importance of social support is often one of the biggest contributing factors that clients overlook, especially those who have negative feelings about their bodies, Dutson adds.

“Asking ‘how can we add meaning, nourishment and joy to the body?’ is a more realistic and hopeful approach [to wellness] than restriction and taking things away,” she says.

Unlearning bias as a practitioner

Hilary Kinavey and Carmen Cool, co-authors of the 2019 Women & Therapy journal article “The broken lens: How anti-fat bias in psychotherapy is harming our clients and what to do about it,” note that researchers and mental health clinicians alike have reported on the “prevalence and negative implications of weight stigma in psychotherapy” since the 1980s.

“It is our lens, our gaze and the assumptions behind it that are the problem,” wrote Kinavey and Cool, who are both LPCs. “Diagnosis by sight is inaccurate and essentially biased. We simply cannot know who engages in overeating and who engages in restrictive eating based on the size and shape of the body in front of us. As professionals, it is our ethical duty to unpack and address this prejudice and to shift our focus and commitment to the human being who inhabits the body.”

The counselors interviewed for this article also recommend that counselors consider their own internalized weight bias to ensure they don’t inadvertently reinforce those biases in their interactions with clients.

“No one deserves to be treated badly because of their body shape, size or ability,” Trumbetas says. “If a counselor has their own negative views, they need to look inward and work on themselves — with another therapist if needed.”

Weight bias creeps into counseling, Dutson says, when a practitioner makes assumptions about a client based on their body size, such as how active clients are, how they feel about their body or what they might need to address in therapy. In turn, this can influence the questions clinicians ask (or don’t ask) and the issues they cover with the client.

staras/Shutterstock.com

“We have to recognize as counselors that we live in a society that values certain bodies over others, which can be ableist and elitist,” Dutson says. “We need to understand how marginalizing it can be to leave those beliefs unchecked. It’s not a stretch to say that our culture believes that certain genes, illnesses and conditions [that affect body size] are somehow inferior.”

Forristal, an assistant professor of clinical mental health counseling at New England College in Henniker, New Hampshire, agrees counselors need to do their own work to recognize and unlearn harmful beliefs about weight and body size. “Unless we intentionally and actively unlearn fatphobia the way we do with unlearning racism and other stereotypes, we are at risk for perpetuating this harm to our clients and communities,” she stresses.

A good first step counselors can take to combat this, Dutson says, is to decouple morality from food and body issues — both in the language counselors use in session with clients and in the way they think about things personally. This includes the questions a practitioner asks during the intake process with new clients, she adds.

Food is not good or bad, and it can be a comfort without inducing guilt. Counselors should refrain from talking about their own body or weight loss in sessions or asking leading questions of a client that reinforce weight stigma, Dutson says.

Instead, she advises counselors to borrow from mindfulness techniques and approach food and body issues from a nonjudgmental, observational lens. “We’d all benefit more from that,” Dutson acknowledges, “and modeling that for your clients is very powerful.” 

Forristal says that refraining from making assumptions — either positive or negative — about a client based on their body size or shape is a good start toward ridding professional counseling of weight bias. Weight stigma is a barrier to care and help seeking, so counselors who want to combat this should mention on their website and other promotional materials that eradicating fatphobia is a goal of their clinical practice, she adds.

In their article, Kinavey and Cool suggested that counselors ensure that their office space is accessible and welcoming to larger clients, which includes having chairs that accommodate a larger person comfortably and a waiting room that does not include decor or reading materials that reinforce fatphobia, such as fashion magazines.

Forristal also encourages practitioners to address any power imbalance that can affect the therapeutic relationship such as the counselor having a larger body than the client or vice versa. A client with a thin body, for example, may not feel comfortable reporting the extent of their issues with a counselor who is larger out of fear of offending them.

Counselors should not hesitate to check in with clients and ask how they feel about discussing body image issues with a practitioner who is a different size from them to ensure that they are comfortable, Forristal adds.

“We can never address these issues if we’re too uncomfortable or unwilling to broach them in the room with clients,” she says. “If a fat client expresses body image concerns to a thin counselor, the counselor can name that they hold privilege as a thin person and check in with the client about their reactions around that. Much like it doesn’t help to take a ‘colorblind’ approach when working with BIPOC [Black, Indigenous and people of color] clients, it isn’t helpful to ignore the differences in body size and power in the room.”

 

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Resources for counselors who want to learn more:

  • The National Eating Disorders Association’s page on weight stigma: nationaleatingdisorders.org/weight-stigma
  • The Association for Size Diversity and Health: asdah.org
  • The National Association to Advance Fat Acceptance: naafa.org (Visit the “learn” menu to download a brochure with suggestions and guidelines specifically for therapists.)
  • Hillary Kinavey and Carmen Cool’s 2019 Women & Therapy journal article, “The Broken Lens: How Anti-Fat Bias in Psychotherapy is Harming Our Clients and What To Do About It”: org/10.1080/02703149.2018.1524070

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

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

Voice of Experience: Self-assessment and professional growth

By Gregory K. Moffatt November 17, 2022

A soon-to-be fully licensed clinician sat across from me for one of our last supervision sessions. I told him the same thing I say to everyone when they get to this point. After today, you will have your license in your hand, and depending on the nature of your practice, you never have to talk to another mental health professional again for the rest of your career.

Although it is improbable that any clinician will literally never speak to another person in the field, it is not at all improbable that they may not have any “supervision” for the rest of their career. That should make us all shudder. I regularly present trainings — often on supervision, ethics or both — at conferences. I can tell who is there to learn and who is there just to get a piece of paper that says they sat in a room for five hours. I wouldn’t want my counselor to be in the latter group.

I want the newly trained clinicians I supervise to see the ethical responsibility they have for their own self- assessment, competence and professional growth. Those who isolate themselves in their own practices and see clients day in and day out, are at risk of being the same counselor a year from now that they are today. They won’t have someone sitting across from them each month asking them “What are your strengths and what are your weaknesses?” like I do with my supervisees.

Using a 10-point scale, I evaluate my supervisees using nine areas of competence: ethics, theory, diagnostics, case presentation, clinical skills, documentation, diversity, self-care and remediation. I ask my supervisees to rank where they are in these nine areas during the final weeks of supervision, and they almost always rate themselves higher that I rate them.

I know why. They are very good at the things they know and the issues they face regularly. But what they lack sometimes is a recognition of what they don’t know — questions they don’t even stop to ask.

For example, when I asked one clinician, “On a scale of one to ten, where are you in your understanding of the Diagnostic and Statistical Manual of Mental Disorders (DSM)?” she gave herself a nine. But when I probed a bit, she admitted she hadn’t even looked at the latest edition, DSM-5-TR, and didn’t know what changes had been made. She is a competent clinician who knows what she needs to know with the clients she sees every day. But she didn’t know what she didn’t know. That is why supervision, consultation and training are critical.

Some clinicians are just lazy and unethical. They won’t grow because they don’t want to. I can’t do much about them.

But others fail to pursue professional growth because they don’t know any better. Evidence of weak professional growth might look like the following: You see your continuing education requirements as “hours you have to get” as opposed to opportunities for growth. If this is the case, I have concerns about your professionalism.

Some clinicians wait until the month their license renewal is due and then scramble to get any continuing education credits that meet their state requirements. Hmmm, that doesn’t scream “professional” to me.

If a counselor doesn’t see the need to regularly meet with other professionals in the field, discuss cases or ask for someone to look over and evaluate their work, then it sounds like someone who thinks they have “arrived” and have nothing else to learn.

When it comes professional growth, I practice what I preach. A few years ago, a married couple came to me in an attempt to repair their seriously broken relationship. It was an incredibly complex and challenging case for me. Even though I’ve been in practice for decades and started my general practice in the 80s as a family therapist, I’m not a licensed marriage and family therapist (LMFT), so I wasn’t fully confident I was seeing everything I needed to see with this couple.

I sought supervision from a LMFT I trusted. He was humbled at my request because he was my former student and former supervisee. But he had far more experience in the marriage and family arena than I did. I consulted with him for months about this case, and happily the marriage survived.

In addition to seeking supervision when needed, I also evaluate myself using the nine areas of competence that I use to evaluate my supervisees (i.e., ethics, theory, diagnostics, case presentation, clinical skills, documentation, diversity, self-care and remediation).

My challenge to you is to rate yourself on these nine areas and, even more important, have a colleague rate you as well. If you don’t have a colleague who knows you well enough to evaluate you, then that tells you that you have some work to do.

Colored Lights/Shutterstock.com

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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.

Confidentiality comes first: Navigating parent involvement with minor clients

By Bethany Bray October 28, 2022

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

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

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

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

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

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

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

The feelings behind the questions

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

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

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

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

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

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

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

Navigating the balance

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

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

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

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

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

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

Disclosure of life-threatening behavior

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

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

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

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

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

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

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

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

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

 

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SeventyFour/Shutterstock.com

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

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

Learning to be fierce in the face of intraprofessional challenges

By Emily St. Amant October 5, 2022

I started my counseling program in 2007, so after working 15 years in the field, I have … thoughts. One of the most difficult things for me along my career journey has hands-down been dealing with other people. And I am not talking about my clients; I’m referring to other professional behavioral health providers. Looking back, I’ve had some truly memorable encounters that taught me what no book, class or training ever could. 

I want to preface this with the acknowledgment that the people whose actions I’m discussing here aren’t all good or bad. There’s a spectrum ranging from having a bad day to having a bad character, and we all bounce around on that to some extent. I’m sure others could reflect on some of my less-than-stellar moments, where I was acting out of a bruised ego or was simply hungry, and I took out my own stuff on others. We all have a shadow side. Pretending we don’t is what gets us into trouble and what causes real harm to others.

In general, I do not feel we are preparing counselors to work in an agency or organization with other types of treatment providers, other types of professionals and even our fellow professional counselors. I don’t have time to address all of that in this article, so I’ll focus on one key area I personally wasn’t adequately prepared to navigate: my working relationships with others. This is especially true in times when there was a value or priority conflict between me and the other person. There is a certain idealism that plagues training programs, including ones in the counseling field.

I have learned a lot from my experiences working in various agencies and organizations over the years. I’ve encountered people who were exceptionally kind, generous, compassionate, patient and wise. And I’ve also encountered people who shocked and angered me with the lack of empathy and respect they showed to myself and others. Later, I realized I was more disappointed and hurt than surprised or angry. I have encountered several individuals in the workplace who, if nothing else, clearly demonstrated the kind of person I do not ever want to be.

With this article, my goal is to empower other clinicians to protect themselves and be better prepared to effectively manage difficult situations in the workplace. At the same time, I hope that we will all do a better job of ensuring we are not acting in such a way that others need to protect themselves from us. Let us never be cut off from hearing what others have to say — whether it’s about our attitude, work performance and quality, or the way our behaviors affect others. And we need to stay open-minded about what others know that we do not yet understand. I admit I have failed in this endeavor in the past and will certainly fail in the future, but I think the key is to be sincere and genuinely not want to. I never want to be remembered by others as someone who hurt them or let them down.

For me to be the best counselor I can be, I can’t stop reflecting on my own personal and professional demons, deficits and errors. I can’t stop being open to feedback and seeking out opportunities for growth. Being a counselor isn’t just a professional identity or set of skills to master; it is a way of being. Who I am as a human being is shaped and molded by the values of the counseling profession. We counselors all in turn shape and mold what it means to be a counselor. Who we are as counselors not only impacts the care we provide our clients but also shapes our experiences in the workplace, the broader health care field and our world.

Learning the hard way 

Something I wish I’d been explicitly told is just because you work in mental health doesn’t mean that everyone you encounter in the workplace will care about you. In fact, if you work with enough people for enough time, you are guaranteed to cross paths with someone who does not have your best interest in mind. They will not care about your success, well-being, and physical and mental health if it gets in the way of their agenda or bottom line. Even in a nonprofit setting, people still report outcomes of some kind to their managers, financers and stakeholders, no matter what impact this has on you. Even if you play a vital role on a team that collaborates on initiatives and projects, that doesn’t always mean you will be given credit or that the workload will be distributed equally. There will always be people who are willing to sacrifice your health and career for their own benefit. They may use you to build themselves up while also holding you back or to avoid having to do the work themselves or face the consequences of their own actions. Some will see you only through the lens of what you can do for them. It’s almost as if they’re asking, “How can I use your labor, skills and expertise to shape my own reputation? How can you make me look good?” People in more powerful positions and people who hold greater influence will essentially ask you, “How can you help me?” I have had almost that exact question directed at me explicitly, but more often that intention goes unspoken. We should be cautious to avoid creating exploitative and harmful power dynamics. We should be asking those we supervise, manage and work alongside, “How can I best serve and uplift you? How can we work together toward the greater good?”

Ego is a thing. You will work with people who lack awareness of or concern for how their own behaviors impact others around them. Some therapists I’ve worked with have appeared to be two separate people: They act one way in front of management and their clients and a completely different way with their peers or subordinates. Some people will be averse to any feedback, act spitefully or haughty, or seem to be easily threatened for no clear or rational reason. I’ve encountered other clinicians whose behaviors and/or explicit statements communicate they think they are superior because of their training, education, theoretical orientation, clinical focus or specific profession. Egos are walls. They get in the way of us being able to engage with others productively and deeply. One thing I’ve realized is that if you’re dealing with someone’s ego, you’re more than likely fighting a losing battle.

You will also encounter co-workers, managers, supervisors and directors who have poor boundaries. You may witness workaholism be glorified and rewarded, and you may have unrealistic performance expectations placed on you. People are routinely punished and shamed for attempting to strike a healthy work-life balance. This can happen directly; for example, I had a past manager say to me that if I didn’t work 60 hours in a week (without overtime pay, mind you), I “didn’t care about the kids.” The retaliation for boundary setting can also happen indirectly with people being fired for “not being a good fit” or being passed over for promotions if they don’t routinely work overtime. You will also see firsthand why ethical codes are necessary regarding boundaries with clients. There’s a reason codes explicitly state not to do something: Counselors are really doing those things. 

You will meet other mental health providers who plain and simple are not healthy themselves. There is a level of gatekeeping that should happen within the mental health professions, but the gray area between observably impaired and functionally problematic is inadequately addressed in practice. There is a difference between being a “wounded healer” and not being on a healing path at all. I often use the metaphor of a “healing train.” None of us will ever get to the destination of being completely healed and perfect; what matters is staying on that train and resetting ourselves when we veer off track. Yes, practitioners are trained and have skills that are helpful to their clients even if they have never experienced a specific clinical concern themselves, but this is not the same as a counselor who believes they can be an effective provider without doing their own personal work. We all have our “stuff,” and many of us are drawn to the helping field because of our own personal experiences. No matter how much training and education we receive, if we aren’t doing the deep and difficult work of examining our own weaknesses and healing from our traumas and pain points, then we put our efficacy as a clinician at risk. This is why self-care is an ethical imperative for counselors. We can’t lead others somewhere we’ve never been before.

Truths that guide me 

These lessons have taught me a few truths along the way — ones I wish I had known from the start because they could have guided me as I managed difficult interactions or situations.

The first and most important truth is that most of the time how other people treat me has nothing to do with me. We are all working out our own “stuff” in the best ways we can, and we often experience someone wrestling with themselves as they impact us negatively. Just because someone is educated, charming, brilliant, credentialed, licensed, published or highly renowned doesn’t mean they are immune to the human experience.

You will never know everything, and that is OK. It is genuinely OK that you can’t be the best at everything. This should be obvious, but I think this is at the heart of a lot of defensiveness and problematic interpersonal behavior. Everyone turns to counselors and therapists for answers and solutions, but we ourselves are fallible, limited human beings. That is not just OK — it’s why we are so good at what we do in the first place. Because we are imperfect human beings, we can help other imperfect human beings find meaning, purpose, joy and peace. So it’s OK to not have a perfect answer to why things are the way they are and how to best live, change and cope. When we refuse this truth and believe that someway, somehow we have managed to be special and the exception, then, of course, it will be uncomfortable and painful to be confronted with the reality that implies otherwise because we will always fail at perfection. If it feels unbearably embarrassing and shameful when others find us out, which will happen, then that is something to carefully examine and reflect on. We are setting ourselves up for failure if we place unrealistic expectations on ourselves, and in turn, we are also setting those around us up for failure because this will without a doubt morph into unrealistic or even exploitative expectations of other people. This shame can lead us to act out and engage with others in harmful ways. The work of being a counselor calls for radical self-compassion, but this is impossible without also reflecting on who we are in relationships and how we are extending that compassion to others.

Success is collective. By lifting others up and supporting them, we ourselves benefit. By sabotaging or disenfranchising others, we hurt ourselves as well. I need to make sure I am doing my best to live this truth by how I engage with others, and I need to be prepared to set boundaries and make needed changes if others in my life are not. I would have left some relationships and jobs much sooner than I did if I had only believed in myself and my intentions more. Do not trust anyone who acts in a way that pushes others down in any way; just because you aren’t their current target doesn’t mean you never will be. If someone doesn’t give credit where credit is due, they are a selfish person who will never be your true ally or partner. If someone seems frequently jealous and doesn’t get excited about the success of others, they may very well be more likely to try to hold you down and sabotage your health and success. Collective action is required for success, and this has to include communities holding people accountable for their actions and inactions when needed. We should all aim to align ourselves with people and organizations that are doing the work to uplift those around them and to stand up for others as well.  

Boundaries are everything. Boundaries help us navigate the reality that we are responsible for both ourselves and each other. Yes, the adage “with great power comes great responsibility” is true, but any level of influence comes with responsibility, no matter how small or insignificant it may seem. All too often we do not acknowledge the real impact we have on each other as humans, possibly to assuage our guilt and enable our avoidance of this burden of responsibility. Any encounter between two people is an opportunity for either healing and growth or, alternatively, harm and suffering.  

Personal relationships, workplaces and workplace relationships are all vital parts of our lives that have the potential for great positive impact as well as negative or harmful consequences. I like to think of the range in terms of spice levels:

  • Mild: unhealthy
  • Medium: toxic
  • Hot: abusive
  • Scorching: violent

Anyone in a mild to moderate situation has the choice to stay and accept things as they are or work for positive change. If it’s hot or scorching, the only real way to get relief is to get away and seek emotional “burn” care.

Not all “defensiveness” is bad. It’s unacceptable how a lot of us are taught to “manage” our defensive behavior. It’s upsetting when you are confronted with someone pointing out how sensitive you are to constructive feedback, but early in our counseling careers, we need to know that our internal emotional protective system isn’t our enemy. We need to be taught to trust ourselves, to listen to how we feel and to know that sometimes defending ourselves and others is what we absolutely need to do. By not teaching this balance of managing unhealthy defensiveness, that’s often ego-driven, with the reality that there are other people who can and will harm us if we don’t protect ourselves, we set a lot of people up to essentially be conditioned to be complicit in their own abuse or oppression. Yes, we need to remain open to feedback that’s constructive and comes from someone who genuinely cares about us, but we also need to have discernment and the wisdom to know what feedback we should absorb and what we should shield ourselves from.

We must take responsibility for setting our boundaries, and we must allow others to do the same. Remember the only thing you can really control are your own words, actions and reactions, including how much you tolerate other people and situations. Emotional responses are automatic and unconscious, and although we have influence over these responses, we can’t expect ourselves to have complete control over them. They exist for a reason, and one of the main reasons we have intense emotions and anxiety is to protect ourselves. 

I’ve had clients who have asked me to help them “just deal with” the situation that’s causing them harm, but as the saying goes, “You can’t heal in the same environment that is making you sick.” Leaving is often the best solution in relationships that cause us harm, be it with an intimate partner or an employer. I now realize that when I stayed in an unhealthy or harmful situation, I was not taking responsibility to care for myself or to consider how I was affecting the other person or environment. I am not referring to what could amount to blaming the victim of abuse or the recipient of boundary violations for another’s action; it is absolutely inappropriate to place any level of responsibility on the receiver of another’s behavior. However, by staying in an unhealthy environment or indirectly enabling unhealthy behaviors, I was essentially teaching that person that what they were doing was acceptable because I stayed put and tolerated it. I was not doing my part to stop them from not only harming me but also negatively affecting others. Oof! 

It’s important to know where the line is between what you are responsible for and what the other person is responsible for. Without this line, it can be a slippery slope toward excusing, enabling and even rewarding unhealthy behaviors in the workplace and our personal lives. 

If you set enough boundaries, you are guaranteed to get pushback. And it will be uncomfortable. To take a lesson from Nedra Glover Tawwab’s book, Set Boundaries, Find Peace: A Guide to Reclaiming Yourself, the only people who have a problem with others setting boundaries are the people who are benefiting from another’s lack of boundaries. We need to be prepared for how others may react when we stand up for ourselves and refuse to be taken advantage of or treated poorly. 

People who see relationships as only transactional or who want to use you for their own purposes will absolutely get irritated or angry for your refusal to comply with their attempts at control or manipulation. Often to further manipulate the situation in their favor, they label the boundary setting or the accompanying response as the problem. This allows them to preserve their reputation at the further expense of the other person being harmed. 

All too often, we blame the person reacting to another’s behavior instead of addressing the source. This criticism, invalidation and punishment of the reaction to abuse is what is called “reactive abuse.” This line of reasoning can also be taken to its logical conclusion and turn into excusing and enabling harmful or outright criminal behavior (for example, blaming the victim of assault for what they were wearing). This is commonly discussed in the context of abusive intimate partner relationships. However, I’ve seen this play out in the workplace, and it can lead to ruptures in trust and morale and causes real psychological harm. 

Abusive behavior is always the fault of the person doing the abuse. Unhealthy behaviors are always the responsibility of the person acting inappropriately. How we manage these encounters to protect ourselves and others are, in fact, our responsibility. By standing up for ourselves, setting boundaries, and leaving harmful and abusive situations, we are also helping others. We are teaching others what’s right and what’s wrong and what they can and cannot get away with.

Not everyone deserves access to your softness. Too often I believe counselors and healers of all kinds are expected to be “nice” and to be available for everyone for anything all the time. This is far from what’s healthy, sustainable or realistic. Just because we’ve chosen a helping profession doesn’t mean we have to sacrifice our own well-being, safety or sanity. It’s taken me years to learn and truly believe that yes, I am kind and sweet and silly, but I am not “nice.” I am fierce. And that fierceness is not a flaw; it is one of my most valuable strengths.

A part of who we really are is defined by how we meet life’s most uncomfortable and distressing challenges. As counselors, we will experience some of these challenges in the workplace, so we need to be prepared to navigate these and to support others as they navigate them as well. We need more humanity, compassion and humility built into the systems that train and cultivate providers whose very effectiveness depends on their own humanity, compassion and humility.

I leave you with these three reminders: You are not a leader if you don’t build up those around you, those coming up behind you or those who are in your charge. You are not successful if you hinder the success of others. You are not a healer if you are not allowing yourself healing.

 

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Keep pushing to be better

I’ve learned so much from people who have shown me grace and patience. They showed me what’s possible and what I want to be. And I’ve also realized what I do not want to be from those who were self-focused, judgmental, and, to be perfectly blunt, haughty and elitist.

Some of my most painful and anxiety-filled moments with managers, co-workers and educators in the mental health field have taught me that I never want to:

  • Be someone who can’t be taught something new and is unable to value perspectives that differ from my own.
  • Advocate for “the way things have always been.”
  • Argue that “it’s really not that bad so nothing needs to change.”
  • Support something because “I made it through it, so everyone else should have to also.”
  • Hire people who are experts at something I am not and then fail to listen to or consider their input and feedback.
  • Assume I know what is best for another person.
  • Manipulate or coerce others into doing something against their will.
  • Use an offer of “feedback” or an explanation that I’m “just trying to help” as a way to rationalize violating someone’s boundaries.
  • Forget we all carry unseen burdens.
  • Doubt the validity of anyone else’s sincere effort or report of emotional pain.
  • Yell at a colleague. (Yes, really.)
  • Expect those I manage or supervise to meet my social and emotional needs.
  • Jump to conclusions and assume I’ve been told the whole story.
  • Throw someone else under the bus to make myself look good.
  • Make promises I can’t keep or say yes when my actions say no.
  • Disregard the needs of others and forcefully try to get my way.
  • Punish or delegitimize someone because they defend themself when they have been wronged or harmed.
  • Publicly call out people for what they’ve done wrong or criticize others in front of colleagues.
  • Tell someone else they are providing inadequate or subpar care or work because they aren’t doing things my way.
  • Look down on other helping professionals in the field who provide services to people in other ways aside from psychotherapy.
  • Consider myself a superior clinician because “I do a deeper, more meaningful and more important” type of therapy.
  • Promote the further disenfranchisement and oppression of already marginalized people.
  • Fail to look at the whole person and their situation.
  • Cause someone more harm because they were already struggling.
  • Put my own pride and ego ahead of anyone else’s health, success or well-being.
  • Fail to use my power to stop someone from hurting or mistreating others and enable them to continue perpetrating harm.
  • Allow unsupportive, counterproductive and inadequate people to persist without consequences or be rewarded.
  • Make others work harder and longer hours to pick up my slack, or if I’m their manager, tolerate someone being ineffective and causing an inequitable workload to be placed on others.
  • Offer mentorship but fail to mentor and focus on my own advancement instead.

I’ve also had the privilege to work with some from truly inspiring and wonderful people. I’ve witnessed many examples of bold and commendable actions that have left me amazed, and looking back, there have been so many seemingly quiet and mundane encounters that really were so important and affected me more than I realized at the time. These encounters taught me that I always want to strive to:

  • Give credit where credit is due.
  • Help others network and introduce people who may share common interests or support each other professionally.
  • Show others how much they mean to me.
  • Be there for others when they need it most.
  • Genuinely care about others, not just their work performance but their humanity.
  • Listen with patience and kindness when others express their concerns and how their work environment is making them feel.
  • Ensure others feel connected and that they know they belong.
  • Tell people you see how hard they are working.
  • Praise in public. Offer constructive feedback and conduct disciplinary actions in private.
  • Show up and be present during meetings.
  • Keep my word and do what I’ve said I’ll do when I’ve said I’ll do it.
  • Recognize if the success and/or advancement of others depends on me in any way, and if it does, then act accordingly and timely.
  • Remind people to care for themselves and encourage them to do things they enjoy outside of work.
  • Set boundaries and have a life. Log off on time, take time off, etc.
  • Stand up for myself and others.
  • Speak the truth to those who have more power than I do.
  • Make work fun and connect meaningfully with those around me.
  • Push back against things that are unethical or fraudulent.
  • Leave relationships and jobs that I’ve outgrown or those that are toxic and harmful.
  • Trust that others are doing the best they can.
  • Give support when it’s asked for and when it is not.
  • Take responsibility for my actions.
  • Be true to myself. By letting my playfulness, weirdness, creativity and passion be seen, I give others permission to be true to themselves as well.

Becoming the best version of yourself requires work and self-reflection. Here are some reflection questions I offer specifically related to the topic of hand:

  • What would it be like if I let go of my need to be perfect?
  • What would change if l gave myself permission to get things wrong while I am trying to get things right?
  • Am I living out my values in all my relationships?
  • How do I impact my clients, peers, mentees, co-workers and supervisees?
  • How do I see those I serve, manage and supervise? Am I seeing them as individuals I have responsibility for, or do I only see them for what they can do for me or how they reflect on my personal reputation?
  • How am I supporting and building up those I counsel, manage, supervise and work with?
  • Do I really have this person’s best interests at heart? If I do not, what am I willing to do about that?
  • What am I doing to ensure my clients, co-workers, peers, supervisees, mentees and others feel truly safe, valued and uplifted?
  • What boundaries do I need to strengthen?
  • Am I taking on anything that is actually someone else’s responsibility?
  • How can I be fierce and brave? Am I ready to take on the challenge of being assertive?
  • How can I prepare myself in case I experience pushback and negative consequences when setting boundaries and speaking truth to power?
  • Am I doing my part to take responsibility for how I impact others?
  • Am I open to receiving feedback? No, really, am I?
  • Are my own needs met? How am I ensuring I am getting my needs met and in a way that is healthy?
  • What am I doing to care for my own mental health, physical well-being and overall life satisfaction?
  • What priorities do I need to shift? What do I need to do more of? What do I need to distance myself from or let go of?

 

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Emily St. Amant is a licensed professional counselor and board approved clinical supervisor (in Tennessee). She serves as the counseling resources and continuing education specialist in the Center for Counseling Policy, Practice and Research at the American Counseling Association. Contact her at estamant@counseling.org. 

 

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

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