Tag Archives: Professional Issues

Professional Issues

Stepping into recovery

By James Rose June 13, 2018

After many years of working as an accountant, I decided to enter counseling as a profession in my “retirement” years. After four years in graduate school, including two years of clinical work at an addictions recovery center, I began my new professional career this past January. Here is how it began.

 

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It was my third day as the evening counselor at Ashley Addiction Services. A clinical aide called me and said, “We have a patient here who wants to leave now. He’s calling his girlfriend to get a ride, and he is looking for someone to punch so he can get kicked out. Would you come down?”

The patient was a young man I had met during my training period the prior week. “You look stressed,” I said.

“Of course I’m stressed!” he screamed back.

I coaxed him out of the clinical aide’s office to a quiet place where we could talk. He told me he was on the withdrawal drug Suboxone. He wanted to go out and get high, then quickly get enrolled in another facility so he wouldn’t disappoint his mother.

“Your mother’s opinion is important to you,” I said.

“Of course,” he said.

“What about your dad?” I asked.

“He’s dead,” he told me.

I asked him to tell me more. He had been using for seven years. This was his fourth stay in a recovery facility.

“What happened seven years ago?” I asked.

“Nothing,” he said.

“When did your dad die?” I asked, following a hunch that there might be a link.

“Five years ago,” he said.

No link, I thought.

I had been working in addictions recovery for two and a half years at that point. I spent most of my life as an accountant, working in grants administration at various universities. At age 58, I had a near-fatal heart attack, and during my recovery, I knew that I had to change course in my life. Counseling had always fascinated me, and I had been in and out of therapy myself for about seven years. I made the decision six months after the heart attack to make a major course change in my life and study counseling. I enrolled in the pastoral counseling program at Loyola University Maryland, the same school where I had earned a Master of Business Administration 26 years earlier.

As part of my counselor training, I had worked as an addictions counselor at the Westminster Rescue Mission. I remembered a story about another patient I had worked with there who reminded me of my current patient. I shared that story with my current patient, explaining that my former patient’s parents divorced when he was 5. His dad lived only a few blocks away after the divorce, but he rarely saw his dad. Sometimes his father would tell him he would take him fishing on a Saturday morning, so this young boy would get up early, get dressed, assemble his gear and wait all day at the living room window for his dad to come. His father never came.

My former patient started shooting heroin when he was 18 and continued to do so for the next 24 years. After working with this patient for a year, he said to me, “Until we talked, I never understood the connection between what my father did and my addiction.”

Something in this story seemed to resonate with my current patient. So I asked him again, “What happened seven years ago?”

“That was the year my dad got sick,” he said. “He got diabetes and had to have his foot amputated. He was my rock.”

And then it hit him: the link between his dad’s sickness and death, and his own addictive behavior. He jumped out of his chair, threw his arms around me and shouted, “You just saved my life!”

I breathed a sigh of relief. It was a heady moment for me. We both knew an important bridge had been crossed. We talked a little while longer, then went for a quiet walk outside.

 

An epidemic of loneliness

People talk of the tragedy of the opioid epidemic. And the tragedy is painfully real. One of my patients lost two friends during his first weekend in recovery, and he believed that if he had not come in for help, he too would be dead. Another patient found his best friend dead from the dope he had shared with him. A third patient stood before the entire patient community and told us that he had lost 42 friends to overdoses in one year, and he knew that if he did not come in for help, he might well be next.

And yet from my perspective of working with people in addiction, the opioid epidemic masks a deeper epidemic. The epidemic I see every day is an epidemic of loneliness.

It is so ironic. We have never been more connected. We have cell phones, email and FaceTime. We can meet anyone, anytime, anywhere. The world I live in today reminds me of the futuristic world I saw pictured in science fiction comic books when I was a kid. And yet, rather than being more connected, we seem more distant from each other than ever before.

I believe that we all need a deep sense of connection with other people in our lives. Emotional connection is an essential part of being human.

People in recovery are in a state of inner conflict. They simultaneously want to recover and stop abusing drugs and alcohol, while at the same time they have cravings to continue to use. When they stop using, once they get through the painful physical symptoms of detoxifying, the painful emotions that led them to use in the first place tend to rise to the surface. Often, there is a painful event or painful circumstance in their lives that caused them to use in the first place.

Substance abuse is often a coping strategy, a way of easing pain, and very often it is some painful event that triggered their addiction. Substance abuse serves a function in their lives; it reduces their pain enough to enable them to cope and carry on with their lives. In that way, it is similar to taking a pill to get rid of a headache. Of course, the circumstances are far more drastic.

I asked one user why he used heroin, and he said it was better than committing suicide. It was hard for me to argue with his logic. From his perspective, heroin use had the positive aspect of keeping him alive, of keeping him from killing himself by his own hand. That is part of the reason that it is so hard for people to give up their addiction. It serves the positive function in their lives of keeping them alive, allowing them to continue to function, in spite of their pain. It numbs out their pain, however temporarily.

Unfortunately, in numbing out their pain, it numbs out all of their other emotions as well. This is why it is nearly impossible to have a meaningful relationship with someone who is addicted to a substance. Meaningful relationships require an emotional connection. How can one have a meaningful connection with someone whose emotions are chronically numbed out?

 

Breaking the cycle

The damage of addiction spreads out like the ripples in a pond, far beyond the individual who is addicted, to affect all the other people in that individual’s life — friends, family members, co-workers. Children of parents who are addicted grow up with parents who are emotionally unavailable. These children’s lives are shaped by the experience of emotional unavailability, and so the cycle continues.

Breaking that cycle of emotional absence is at the heart of the work I do. When patients stop using, the emotional pain that led them to use in the first place reemerges, and they often are as unequipped to deal with that pain in the present as they were in the past. As their counselor, I help patients to identify past trauma and try to find a new perspective through which to see it.

One way of looking at emotions is to think of them as predictions of what is about to come. If you enter a house filled with the aroma of freshly baked chocolate cookies, you might find your mouth starting to salivate and your stomach starting to rumble — physical signs that your body is preparing for you to eat something yummy. A sudden scream in the night might make your body straighten, your muscles tense, your eyes widen and your ears perk up — all signs that your body has gone into a high state of alert for possible danger, usually accompanied by a sharp rush of adrenalin to be ready for fight or flight. Again, these are the physical signs of anticipation of and preparation for predicted danger.

Emotional pain evokes different bodily reactions. We may feel a loss of appetite, a heaviness of heart and a wish to isolate. The triggers for emotional pain may be less obvious to a person than is the smell of cookies or a scream in the night, but they are certainly quite real to the person experiencing them. And the pain can be overwhelming.

This is where substance abuse comes into play. Often, emotional pain comes about when a person has lost someone with whom they had an important emotional connection in their life, and that emotional connection has been broken. If a parent has died or moved away, a loved one has betrayed you or a traumatic event such as a rape or murder has occurred, there is no way to undo the event. The pain of such events can be overwhelming.

Drink or drugs can provide a means of easing the pain enough that the suffering person can get on with their lives, but they cannot undo the event. Many people find solace over time and find ways to cope with the pain without resorting to drink or drugs; however, many do not. Because drugs numb the pain without addressing the loss, a person remains stuck within the loss, and so the need for the drug endures.

The damaging paradox of a person who uses drugs to deal with the loss of emotional connection is that drugs eliminate the possibility of creating new emotional connections, which are the very thing the person needs to heal. Drugs numb out all emotions — both the painful and the joyful ones — and without the ability to feel the full range of emotions, any new, real emotional connections are impossible to create.

 

Searching for ‘meaning’

Being with a person in the initial stages of recovery from substance abuse is an awesome experience. As a counselor, I face them in that moment of transition in their life. I know I cannot fix or heal anybody. The thing I can do is to be present with them, offering what guidance and presence I can as I try to help them find healing within themselves.

Often, that is a matter of helping them name and identify those hard emotions that arise within them — the ones that led to substance use in the first place. Once the emotions are identified, then we look for the event or the circumstance in their life that brought that emotion into play. This is the moment when the hard stories come out, the stories of heartache and loss. And then it is a matter of looking at the meaning those stories have had in their lives.

It is the meaning we place on our stories that give them their emotional charge. A child whose parents divorced and whose father moved away might, as a child, believe in some unnamed way that they are worthless. After all, dad delivered the message, in the most obvious way possible, that they were not worth sticking around for. I have known many people struggling with addiction who had just that circumstance in their lives, and that sense of worthlessness was at the root of their addiction.

In this work, we can look at stories like that and change the meaning. The meaning might be that dad was a troubled man. It might be that dad and mom had a bad marriage and their breakup was necessary. It might be that dad had to go away on a job or for military service. By reframing the story, we can change the meaning, and when we change the meaning, the emotions that accompanied that story can change.

This was the case for the young man whose story I shared at the beginning of this article. For him, the meaning of his dad’s sickness and death was that he was losing his rock, and there would be no one there to give him guidance. His story changed to dad was sick and died through no fault of his own, nor by his father’s choice, and now he would have to find his own guidance. In changing the meaning of his story, his emotions changed, and his need to numb out his painful emotions with drugs gradually evaporated.

 

Being present

So, at the heart of my work is the aim of being present with another person so that they can learn to be emotionally present themselves. One of my favorite outcomes was when a patient told me about his 17-year-old daughter. She was the rock of their family, a straight-A student who was always reliable and dependable, emotionally calm and stable.

She came to visit her father a few weeks after he had entered recovery. He told me he could not believe what had happened. His strong, calm and rational daughter had broken down in tears in front of him. I said, “She was emotionally present with you.” After a moment, I asked, “Do you understand why?”

He looked baffled and said, “No.”

I said, “For the first time since she was a little girl, she could sense that you were emotionally present for her, no longer drunk or high, but really right there with her. She felt it, and so she, for the first time in years, was able to be emotionally present with you. That is why she cried.”

My final meeting with the young man whose father had died of diabetes was the night before he completed the program. He told me that he was planning to move back home where he could help his mother. He expected he would be able to go back to work at his job in a restaurant, and he planned to attend school in the fall. I asked what he would study, and he said he was interested in psychology. He said he was thinking of becoming a counselor, which would further motivate him to stay on his path of recovery.

I saw him again the night he finished the program. I was thinking of the years I had spent in grad school — the books I had read, the papers I had written, the checks I wrote and all the time I had invested. And in a moment, it was all worthwhile when he threw his arms around me and said, “Thank you.”

 

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James Rose, a national certified counselor and graduate professional counselor, is a recent graduate of Loyola University Maryland and works in addictions treatment at Ashley Addiction Services. Contact him at jrrose@loyola.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.

It’s not about ‘clean’: Dismantling the language of HIV stigma

By J. Richelle Joe and Sarah B. Parkin June 5, 2018

Words matter. The language we use when discussing sensitive, controversial or stigmatized topics reflects and shapes our attitudes and beliefs about those topics. Such is the case with HIV and AIDS. Since being widely identified in the 1980s, HIV and AIDS have been perceived negatively by the general public, resulting in the pervasive use of language that characterizes those living with the virus or the disease as undesirable and even dangerous.

The counseling context is not immune to such damaging language, and it is reasonable to infer that words have a powerful influence on mental health and counseling outcomes for people living with HIV. Counselors must beware of the power of language; outdated information about HIV and AIDS can intersect with the inadvertent use of stigmatizing language and undermine the ethical principles of nonmaleficence and beneficence that form the foundation of our profession. We also have a responsibility to actively oppose HIV- and AIDS-related bias and stigma by educating ourselves about HIV and AIDS and changing the language we use when discussing them.

Let’s start by offering a quick guide to HIV and AIDS terminology:

  • HIV: Human immunodeficiency virus; people can be diagnosed with HIV and not have an AIDS diagnosis
  • AIDS: Acquired immunodeficiency syndrome; caused by HIV
  • CD4 cells: Cells that are a part of the body’s immune system; also known as T cells
  • Viral load: The amount of HIV particles in the body
  • Opportunistic infections: Illnesses, including certain types of cancer, that occur more often when someone has a weakened immune system
  • ART: Antiretroviral therapy, a common treatment for HIV
  • PrEP: Pre-exposure prophylaxis, daily medication that can reduce one’s risk of contracting HIV
  • PEP: Post-exposure prophylaxis; prescribed use of ART within 72 hours of a possible exposure to HIV
  • Viral suppression: When the amount of HIV particles in an individual’s system decreases to the point that the virus is not detectable by current tests; occurs when an individual is adherent to treatment; also known as having an undetectable viral load

The changing face of HIV and AIDS

In the United States, AIDS was originally called GRID (gay-related immune deficiency), and the illness was most commonly associated with gay white males. Although the name of the illness changed as it became apparent that minority sexual orientation was not a determinant of HIV transmission, AIDS continued to be viewed as a “gay disease,” with multiple layers of associated stigma.

Although the stigma remains, the demographics of individuals living with HIV have shifted and increasingly include women and individuals of color. According to the Centers for Disease Control and Prevention (CDC), women account for approximately 20 percent of new HIV diagnoses, and among African American women, the estimated lifetime risk of an HIV diagnosis is 1 in 54 (compared with 1 in 941 for white women). African American and Latinx communities are disproportionately affected by HIV and AIDS. This is largely as a result of social determinants of health such as access to accurate information, preventive methods and health care, which are influenced by geographic location, cultural and social beliefs, socioeconomics, and stigma about sex and sexuality.

As the demographics related to HIV and AIDS have changed since the 1980s, so has the scientific knowledge, leading to key advancements in HIV prevention, diagnosis and treatment. Today, people with HIV can live long, healthy lives, provided that they adhere to treatment and monitor other aspects of their health.

Unfortunately, much of what is commonly known about HIV and AIDS is outdated and inaccurate. For instance, recent surveys conducted by the Kaiser Family Foundation indicated that some Americans still believe that HIV can be transmitted via mosquito bites, shared eating utensils and toilet seats. Many Americans also instinctively associate HIV with death, despite critical advancements in HIV care.

HIV is not a death sentence. For individuals living with HIV, the key to their health is the strength of their immune systems as measured by their CD4 cell count and viral load. Ideally, the goal for people living with HIV is to have a high CD4 cell count and a low viral load. Fortunately, as a result of significant medical advances over the past few decades, individuals with HIV who are consistent in their adherence to ART can have a viral load that is undetectable. Studies have shown, and the CDC has affirmed, that individual with undetectable viral loads have almost zero chance of transmitting HIV to another person even if other protective measures are not present. Never before in the history of HIV and AIDS has there been such hope for HIV prevention generally and people living with HIV specifically.

Unfortunately, not all individuals living with HIV access care and have an undetectable viral load. According to the CDC, approximately 1.1 million Americans are currently living with HIV, with 85 percent of these individuals aware of their HIV status. However, only 62 percent of Americans living with HIV are engaged in care, and only 49 percent of individuals living with HIV have an undetectable viral load. Multiple factors, including public health policies and social determinants of health, contribute to these statistics.

Unaddressed mental health needs might also be at work. People living with HIV may experience adjustment difficulties, depression, anxiety and trauma — all of which can affect an individual’s willingness and ability to seek medical care and remain adherent to treatment. In the past, HIV care focused primarily on the medical needs of people living with HIV. Today, there is growing awareness of the need to address the psychological and emotional aspects of HIV and AIDS because those factors may affect overall wellness.

The power of language

Despite the hope that science has given us with respect to HIV prevention and treatment and the increased awareness of the need for mental health support for people living with HIV, the language frequently used to describe HIV and AIDS continues to bolster the stigma associated with the illness.

Whereas phrases such as “clean bill of health” are benign with respect to other illnesses, when used in connection with HIV and AIDS, they can have a much different connotation. For instance, use of the word “clean” to describe someone who does not have an HIV diagnosis can send the message that those who are HIV positive are somehow unclean and dirty, or even impure and sinful. But HIV is not about clean. Not having an HIV diagnosis is not a determinant of cleanliness or good moral character. Equally, having an HIV diagnosis has nothing to do with being dirty or having loose morals.

Similarly, referring to HIV “infections” rather than HIV diagnoses or transmissions conjures thoughts of contamination, impurity and even death. Simply put, the dichotomy of “clean” versus “infected” breeds stigma, negativity and hopelessness. These negative connotations make getting tested, disclosing one’s HIV status, discussing methods of protection, and accessing and staying in care more difficult.

When counselors inadvertently use stigmatizing language in reference to HIV and AIDS, they risk harming clients by perpetuating stigma and reinforcing barriers to both physical and mental health care. By reducing stigma through intentional language choices, counselors can better help individuals explore their options for entering care or identify potential barriers that may prevent them from staying in care in the future. Additionally, helping clients identify protective factors such as support systems, positive coping strategies and individual strengths can be beneficial to their growth and development.

Regardless of HIV status, and in the name of balance, it is also important for counselors to inquire about aspects of their clients’ sexual wellness when the topic arises. As previously mentioned, with clients who are living with HIV, counselors can discuss getting and staying in care. With clients who are not living with HIV, counselors can use psychoeducation to identify appropriate prevention methods, including PrEP, PEP and proper condom use.

 

 

Say this, not that

Recognizing the negative impact that stigmatizing language has on individuals is only the first step toward defusing the taboo of HIV and AIDS. The next step is to identify specific stigmatizing phrases and replace them with appropriate alternatives.

On a foundational level, counselors can make an easy change in their communication about HIV and AIDS simply by using person-first language. Saying “person living with HIV” rather than “AIDS patient” does several things. First, it builds the therapeutic relationship and helps to externalize the diagnosis rather than fusing it with the client’s identity. Second, person-first language decreases stigma by emphasizing the possibility of living, and living well, with HIV.

The use of “person living with HIV” rather than “AIDS patient” also reflects a more accurate understanding of the illness and its progression. Often, HIV and AIDS are used interchangeably, despite an important medical distinction between the two. For counselors, it is essential to accurately differentiate between an HIV diagnosis and an AIDS diagnosis.

An HIV diagnosis follows a reactive test for the HIV virus; however, a diagnosis of AIDS is given by a physician only if an individual’s CD4 cell count is below 200 or if the individual develops certain opportunistic infections. Given that effective treatment is available for individuals who have been diagnosed with HIV, it is likely that someone who is adherent to treatment will never receive an AIDS diagnosis. By ignoring the difference between these two diagnoses, a counselor might appear to be invalidating, deterministic and incompetent to a client who is living with HIV.

Additionally, the phrase “full-blown AIDS” needs to be retired from our collective vocabulary. This phrase — which bolsters fear, reinforces HIV stigma and conjures thoughts of death — is wholly inaccurate and is no longer used among medical professionals. Along the same lines, stating that someone “died from AIDS” is also unproductive and inaccurate. If HIV progresses to the point that an AIDS diagnosis is given, an individual is vulnerable to opportunistic infections, which could be fatal. Hence, an individual might die from an opportunistic infection or an AIDS-related illness but not from AIDS itself.

Accuracy in our language when discussing this particular illness is critical. Errors in our word choices can communicate misinformation and harm clients, adding to the barriers that often prevent clients with HIV from seeking medical and mental health care services.

Conclusion

Understandably, discussing HIV and AIDS can be awkward or uncomfortable for some individuals, including counselors. However, equipped with the right language, counselors can engage their clients in vital conversations about their sexual and mental health. By discussing HIV transmission rather than infection, we can destigmatize the illness and the conversation. We can disrupt the pervasive narrative that equates HIV and AIDS with death, uncleanliness and immorality. And most important, we can be bridges rather than barriers so that people living with HIV will feel encouraged and empowered to access care and live well.

 

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J. Richelle Joe is an assistant professor of counselor education at the University of Central Florida. Her work focuses on HIV prevention and culturally and ethically sound services for people affected by HIV or AIDS. Contact her at jacqueline.joe@ucf.edu.

Sarah B. Parkin is a master’s student in clinical mental health counseling at the University of Central Florida. Her research interests focus on intersectionality and marginalized communities.

Letters to the editor: ct@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, 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.

 

Guiding lights

By Bethany Bray May 30, 2018

Counselor supervision is a rite of passage for professional counselors. Although supervision requirements vary from state to state, the crux of the experience — learning that is based in a relationship between a beginning counselor and an experienced practitioner — is universal. As is the case for any relationship to remain healthy and beneficial, the supervisor–supervisee pairing requires care, hard work, respect and trust from both parties.

Supervision is meant to be “the other half” of counselor education, bridging classroom learning and in-session counseling skills, says Summer Reiner, a licensed mental health counselor (LMHC), clinical supervisor and associate professor and school counseling coordinator at the College of Brockport, State University of New York. “There’s no way you can fully prepare the student in a classroom. Supervision is to fill out your education,” says Reiner, president of the Association for Counselor Education and Supervision, a division of the American Counseling Association.

Supervision begins “a lifelong process of always stepping back and looking at what went well and what didn’t,” she adds. “Supervision is training to be able to do that throughout your career, a constant of thinking what went well and what do I need to do differently? It’s a supervisor’s role to get that internal dialogue moving, by demonstrating it first and letting [supervisees] know that they will self-evaluate, in a healthy way, throughout their career.”

Balancing act

The supervisor–supervisee relationship is different from the therapeutic bond forged between counselor and client. However, many counseling skills come into play as supervisors support and foster growth in their supervisees. Although supervisors never shed their identity as counselors, they must learn to shift gears between working with clients and working with counselors-in-training or beginning professionals.

Supervisors must also achieve a balance between two primary roles that can, at times, feel like they are at odds with each other: fostering an open and honest dynamic with supervisees and evaluating supervisees. The best learning opportunities often arise when supervisees feel comfortable with and have enough trust in their supervisors to ask questions and admit when they are struggling.

“It’s a delicate balance,” says Kevin Doyle, a licensed professional counselor (LPC), clinical supervisor and adjunct instructor of counselor education at Virginia Tech. “The supervisor has the power, but it still needs to be an open relationship. … A supervisor should focus on creating a connection that is similar to counseling, with focus on the supervisee’s professional growth and development. Transparency is paramount, even though there’s a grade or evaluation piece to the situation.”

“It’s one of the biggest fissures in supervision: There’s this evaluative piece. It’s similar to a counseling relationship, but you also have the responsibility to assign grades or to be a reference for a future employer,” says Doyle, a member of ACA. “It’s not a counselor–client relationship, but it also shouldn’t be an inverted relationship” with a power imbalance.

Supervisors are a unique blend of teacher, counselor, evaluator and role model, and they need to be able to nimbly weave in and out of those roles as the moment demands, Reiner says. Throughout the process, counselor supervisors should remain very supportive of their supervisees while also offering honest feedback.

“Help them understand that we’re not evaluating them as a person, or as a counselor, but with each intervention they use with a client,” says Reiner, whose experience is with graduate student supervision as a counselor educator. “This isn’t me judging you; it’s me helping you see what was your intent in this process? What was the intended outcome? If that didn’t happen, what would you have changed?’”

“At the same time,” she continues, “it’s important not to be a cheerleader. Don’t let them feel like everything’s OK when it’s not. It’s this balancing act of having students hear critical feedback without personalizing it and [then] using it constructively.”

Stacey Brown, an LMHC and clinical supervisor in Fort Myers, Florida, stresses that the best supervision happens when the relationship is central to the experience, which transcends simply going through the motions of clocking the needed hours and ticking items off of a to-do list. “For me, it’s about becoming a counselor — beyond the techniques they learn in grad school,” says Brown, an ACA member. “It’s very easy to forget the human part of the equation, and our role as nurturer and encourager, as there are so many boxes to tick. Don’t make it so structured that [supervision] sessions are repetitive or predictable. Be open and allow flow to happen, like you would in a counseling session. You can still cover everything you need to cover, but be creative and open to what comes. Otherwise, you may lose out on [teaching] opportunities that pop up.”

For example, a supervisor might have a stack of case studies ready for review with a supervisee, but the beginning counselor walks into the room with tears in her eyes because of professional stress or something going on in her personal life. In that case, “You shouldn’t push forward with your case reviews,” Brown says. “You should take a step back, ask what’s going on and how can you [the supervisee] manage it? But if I have some kind of checklist to get through, I will miss out on opportunities to help her become a counselor. Teach [supervisees] flexibility, intuition, being present and learning that they have to deal with their own stuff and take care of themselves to be able to help other people. What better way to teach that than by doing it?”

Modeling and forging a bond

Doyle says the skills that supervisees gain through counselor supervision can be divided into two realms: everything that happens in the room with clients, and everything that happens outside of the counseling room.

The first part of the equation, the “nuts and bolts” of counseling, as Doyle calls it, is developed through case review and the one-on-one guidance that a supervisor provides. It involves real-time application of the knowledge base that counseling students were introduced to in graduate school.

The second part encompasses learning that can’t truly be acquired from textbooks. It involves preparation for the entirety of the job of being a professional counselor, Doyle says. Much of the knowledge acquired in this sphere is based on how supervisors model their own professional skills, both inside and outside of client sessions, in the presence of their supervisees. Supervisees watch and absorb not only their supervisors’ interactions with clients, but also the professional boundaries that supervisors set, how much they focus on self-care and how they manage time, professional ethics and other aspects of the job.

Supervisees “absorb so much from how we carry ourselves and what we do in supervision,” says Doyle, who wrote his doctoral dissertation on how supervisors can model wellness and how that influences supervisees’ wellness.

A little self-disclosure, when appropriate, on the part of supervisors can help keep the supervisor–supervisee relationship open and honest, says Kathryn Henderson, an LPC and an assistant professor at the University of Saint Joseph in West Hartford, Connecticut. When supervisors disclose, for example, that they sometimes struggle to prioritize self-care, it demonstrates not only that even supervisors are imperfect but also that wellness will need to be a career-long goal.

“I stress that we’re in this together,” says Henderson, an ACA member. Supervisors share “our knowledge and experience, but we’re learning from [our supervisees] and growing ourselves. We’re learning just as much from them as they are from us. It’s mutually enriching.”

Brown says she is upfront with her supervisees that counselors are no different from the general population in that they sometimes have trauma in their past, struggle with an inner critic or anxiety, or face other challenges. “Part of being a good counselor is being comfortable with yourself and coming to terms with your own issues. I can’t be [my supervisees’] therapist, but as a supervisor, [I] can recommend they see a therapist,” Brown says. “I tell people right off the bat, there’s no reason to hide who you are.”

Brown also thinks that supervisor self-disclosure, within ethical boundaries, can strengthen the relationship with supervisees and help them realize that being honest about their struggles won’t sabotage their evaluation. Brown recalls one supervisee who had an infant at home. When Brown would check in with her about her stress level and self-care routine, the supervisee would insist she was fine. In truth, she was struggling with breastfeeding and a severe lack of sleep. The supervisee opened up only after being shown photos of Brown’s children and having Brown share a few of her own struggles during motherhood.

“My job, as I see it, is not to be rigid or pretentious at all, but to be real,” Brown says. “Being a real person who can share my experiences, my missteps, my learning, my boundary conflicts, my wellness efforts, etc., helps supervisees to be willing to be real with me. Then I
can see who they are and can offer suggestions that can help them personally and professionally.”

“The relationship is the most important part of the supervision,” she continues. “Elements of trust, mentoring, nurturing, directing, humor, compassion and tutoring are all there, just as in the counseling relationship. The difference is that in supervision, the supervisee will one day be completely equal or surpass me in credentials and expertise. I treat them as colleagues while still offering the nurturing and guidance and respect they need and deserve.”

Henderson agrees that trust is paramount in creating a good supervision experience. For supervisors, this includes trusting their supervisees enough to give them room to find their own way professionally. For supervisees, this means trusting the relationship enough to be able to share — and, in turn, work on — their weaknesses and areas of struggle.

“You can’t give someone insight; [a supervisee] needs to find that on their own. But we can create that opportunity in supervision,” says Henderson, co-editor with Alicia M. Homrich of Gatekeeping in the Mental Health Professions, published by ACA in May. “Supervision is their first time working with real clients in a real-world setting and applying what they’ve spent so many hours learning. That can be scary and overwhelming — there’s a fear of inadequacy. … The crux of supervision is that you’re not alone in that. This is exactly where you go to talk about those concerns and get the support and help that you need to grow in your own self-awareness and confidence in your skills.

“Supervisors are the ones to build that support [by offering] encouragement and validation. All of that helps create an environment where I [the supervisee] can come and bring my greatest concerns and failures, be vulnerable and not be afraid of being judged or of negative outcomes or consequences. Trust is so needed to create that environment.”

It takes two

What does it take to establish a healthy and beneficial supervision experience? In part, both parties must contribute by being flexible and practicing open and honest communication.

Suggestions for supervisees

Shop around to find the best fit. Look for a supervisor with whom you click, both professionally and personally. Alicia Simmons, a counselor intern working toward counselor licensure in Florida, found her supervisor, Stacey Brown (quoted in this article), by searching online and talking with friends from graduate school. She called and spoke with Brown before meeting her in person to test the waters of what would become a very positive supervision relationship. Simmons and Brown co-presented a session, “Intuitive Clinical Supervision: Creative Solutions for Helping New Counselors,” at the ACA 2018 Conference & Expo in Atlanta this past April.

“Look for someone who is going to walk beside you for … however long it takes,” says Simmons, a clinician and play therapist at an agency that serves children removed from their homes due to trauma or neglect. “Don’t be afraid to ask questions before you begin. You want to know you’re in the right fit. Don’t be afraid to try more than one supervisor. … Look for someone who is going to be flexible and work with you in the way you need to work. If you don’t know what that is, work with someone who will help you figure that out.”

Speak up. If you have a need that is not being met through the supervision experience, talk to your supervisor in a tactful but honest way. Doyle acknowledges that this can be a tall order because supervisors are seen as authority figures. At the same time, identifying any area where you might be struggling in the relationship will actually help your supervisor, he says. Counselors who provide supervision have so much to focus on — including client needs, scheduling, paperwork and so on — that they may not notice everything going on with their supervisees.

“Advocate for your needs [even though] that’s a lot to ask at the outset,” says Doyle, who will be starting a new job as assistant professor of mental health counseling at the University of Tennessee at Chattanooga this fall. “Speak up when you need support. Realize that the supervisor will rely on that. … When you come to see your supervisor as a safe person, you will really connect with them and [that will] make it easy to disclose your struggles.”

Respect the process. Keep in mind that your supervisor likely took on this extra responsibility because he or she wanted to “pay it forward” to the profession, Reiner says. Yes, supervisees have needs that should be met through the supervision experience, but at the same time, they must remember that a counselor’s first priority will always be client care.

“Step one is being appreciative that someone was willing to take you on as a supervisee and has trust in you that you will be able to serve clients well,” says Reiner, an ACA member. “Keep in mind that you are practicing under the license of someone else. If the [supervisee] does something really inappropriate, it can open the supervisor up to a lawsuit. They are taking on a personal risk as well as an additional workload. … Recognize that the supervisor is investing in the future of the profession and has no obligation to do that. Realize that they care about your future and the clients you are going to work with.”

Be authentic and drop preconceived expectations. Bring your true self into supervision. Don’t act one way with clients and another way with your supervisor. There should be “a thread of authenticity” throughout your work in supervision, Simmons says. “Counseling is basically holding up a mirror and showing somebody what’s there. Supervision I think ideally would be the same way.” Authenticity, both on the part of the supervisee and the supervisor, builds trust, she asserts.

In addition, it might be best for supervisees to leave behind their ideas of what supervision should look like. The important thing is for the supervisor and supervisee to be working toward the same goals. “What I had heard about clinical supervision was mostly [about] case review and going over the work with clients — very textbook and academic,” says Simmons, an ACA member. “What I’ve learned is that it can be much more fluid than that. All the in-between stuff is what has stuck with me and helped me develop my own style and confidence in my abilities. It’s about more than just the logistics of what’s going on in each [client] case.”

Remain open to feedback. Having a relationship built on trust makes it easier for supervisees to remember that any critical feedback they receive from their supervisor is meant to help them and that they are both working toward the same goal: the supervisee’s growth and development as a counselor. “It’s the same as the counseling relationship — you have to have that rapport,” Simmons says.

Regardless, being critiqued can prove challenging. “As a supervisee, it’s our responsibility to be able to receive feedback,” Simmons says. “If there’s something that’s getting in the way, perhaps that’s something [we] need to work through. We may need to seek therapy ourselves to work on it. Check yourself: Is it something related to the supervisor, or is it something unrelated that you need to work on?”

Think for yourself. At the same time, do not accept feedback blindly. Think it through and talk through any areas you have questions about with your supervisor, Reiner advises. But first, take a step back and consider whether you have received similar feedback from others in the past.

“Critically examine any feedback that you are receiving and be open to being the one who needs to grow and change. Or simply say ‘thank you for that feedback’ and ‘I’ll be mindful of that in the future,’” Reiner says. “I don’t think that supervisees know that supervisors are sometimes uncomfortable sharing critical feedback. They have probably thought it through [before telling supervisees] and were anxious about it themselves.”

Suggestions for supervisors

Temper criticism. Set realistic expectations and frame criticism in a way that lets supervisees know you’re focused on their growth, Doyle says.

In Reiner’s work supervising graduate students, she assures them that she won’t start evaluating them for a grade until halfway through the semester, once they have settled into the experience. It is important to stress that feedback is never personal but rather focused on supervisees’ development, Reiner says.

“There’s also an element of modeling for your supervisees — ‘This is how you have hard conversations with people.’ [They] will need to do that as a counselor,” Reiner says.

Debunk myths of perfection and the existence of one right way. Henderson shares an important lesson with her supervisees that she learned through her own supervision: There is no such thing as a perfect counseling session. Supervisees often put enormous pressure on themselves to find the “right” way to do something, she says. The truth is, clinicians can work with the same client in multiple ways and take different therapeutic directions and still arrive at a positive outcome, Henderson says.

Prioritize fostering growth. Might your supervisees end up working for a local competitor or leave your agency and move on once they’re licensed? Be supportive and invested in their growth, even if it won’t benefit you in the long run, Doyle urges. “Don’t think of [supervision] as just one more thing to get through. Don’t think of it as a task but as a relationship to foster,” he says.

One mark of a good supervision relationship is when a supervisor is comfortable enough to allow — or even to encourage — a supervisee to seek additional skills elsewhere, Simmons says. For example, if supervisees use different therapeutic modalities than their supervisors do, they might want to look for workshops or online training while
in supervision.

Help supervisees embrace their counselor identity. Supervisors can help prepare supervisees for work environments in which they may be the only counselor. “Once people get into a work environment, there becomes a lot of pressure to do things not in the way a counselor is trained to do. Part of a supervisor’s job is to train a supervisee not to lose their identity as a counselor,” Reiner says. “Sometimes you might get the message, ‘We know that’s what you learned in college, but that’s not how we do it.’ Be mindful of teaching them to be a team player yet [also] an advocate for counselors and counseling.”

For example, a counselor in a school setting may be the only person in the building with a counseling background, and he or she may repeatedly be asked to spend time as a test proctor or hall monitor or to perform other noncounseling duties. “How do you politely tell your principal that counselors are not lunch monitors?” Reiner asks. “Instead, explain that your approach will be different. ‘I will do it, but I’ll do it within my counselor identity. Instead of being a disciplinarian, I will use it as an opportunity to talk to students.’”

Lift supervisees up. Supervisees should leave the supervision experience even more energized about the counseling profession than when they began, Brown says. “The way I see it, our job is to lift them up. To help them see that they are more capable than they think they are. To teach, to offer guidance and education, and to model how we do what we do. … Yes, there are techniques and ethics and strategies, but there is also joy in the giving. Graduate students don’t often pick up on that part in grad school. I believe that is the key element we, as supervisors, need to be offering to new counselors. This will help keep integrity in the profession and prevent burnout [by] shining a light on the ability to truly offer healing to clients.”

Navigating the ups and downs

Because supervision is an experience that involves two human beings, it is only natural that not every experience will be positive. Frustration, awkwardness and other negative feelings may surface.

Conflict can arise easily in supervision relationships in which expectations are unclear, Henderson notes. To decrease the likelihood of that happening, she recommends that supervisors document their expectations thoroughly before supervision begins, regardless of whether that process is mandated by the state in which the supervisor practices.

Among the details that should be included:

  • How the supervisee will be evaluated
  • How often the supervisor plans to meet with the supervisee
  • The cancellation policy should a supervisee need to miss a meeting
  • The length of the supervision or how many hours are expected
  • How much the supervisee will pay the supervisor (if applicable)

These details should be talked through with supervisees before they agree to sign the document.

This is also a good time to map out wellness goals, says Doyle, who has supervisees include self-care in the learning contract they create at the beginning of supervision.

“In many ways, it’s on the supervisor to try and develop a welcoming, supportive, yet honest and challenging relationship with their supervisee,” Reiner says. “That starts out with being very direct and forward with your supervisee about what is expected and how they will be evaluated.”

The importance of being direct also extends to addressing any differences between supervisors and supervisees, from level of expertise to gender identity to spirituality, Reiner says. She recommends asking supervisees upfront, “How are you feeling about these elements of who you are and who I am and how that comes together in our space together?” In addition, she says, supervisors can offer assurances to ease supervisees’ concerns about those differences: “If there’s ever a time when I’m not hearing you or not understanding you, please tell me. I want to hear it because it will only help our relationship.”

When tough conversations arise or when things aren’t going well in supervision, it is helpful to keep the discussions focused on growth opportunities. In her role as a counselor educator, Reiner sometimes has to mediate meetings between supervisors and supervisees who aren’t seeing eye to eye. She begins by asking both, individually, what is going well, what can be improved on and what they would like to do or see in supervision that hasn’t happened yet. Reiner tries to frame the conversation so that both parties are able to take personal ownership of what has transpired without placing blame. That way, they are able to share and focus on what they want from the experience that they haven’t yet received.

Clear and open communication is essential when the supervision relationship is having its ups and downs, agrees Henderson, and that is when a supervisor’s counseling skills especially come into play. Supervisors should focus on concrete expectations that aren’t being met rather than vague or arbitrary attributes that they may not like, such as a supervisee’s personality or professional style. If necessary, supervisors can also refer to the contract put in writing at the beginning of the relationship, she adds.

“Many times, we talk around things without talking about the process that’s going on in the room, that here-and-now experience,” says Henderson, who presented on supervision and ethics at the ACA 2018 Conference & Expo in Atlanta. “Oftentimes we need to go to that level of metacommunication, to use counselor lingo, to address the dynamics that are happening between us and what’s contributing to it. That can be a very difficult conversation to have, especially considering the power differential. I like to make it as concrete as possible. Having clear expectations and a contract helps focus on competencies and what’s not being met.”

“[Sometimes] it’s these unexpected lessons that find us, that we’re not looking for, that can be the most difficult but that lead to the most growth,” she adds. “When we are having these conversations, keep in mind our mutual goals. What’s our purpose? The supervisee’s growth as well as client welfare. Monitor both.”

Keep it going

Peer support and feedback, mentorship and case review with colleagues can play a vital role throughout a counselor’s career, long after formal supervision leading up to licensure has ended. Doyle recommends that counselors engage in lifelong supervision, whether in an informal or formal capacity, to continue learning and to find support.

“It’s extremely rewarding work that we do, but it’s extremely taxing too. Peer support becomes that much more important after formal supervision ends,” he says. “It’s hard to describe the grind you go through daily as a counselor and the emotional toll it takes. Connect with people who can understand that. Connect with peers across the profession, whether that’s within a professional organization or the practitioner in the office next to you. Make sure you have a support network, wherever you are.”

Henderson says one of the things that stuck with her most from Irvin Yalom’s keynote at the ACA 2017 Conference & Expo in San Francisco was that he — a noted psychiatrist, author and scholar — had sought support from peer groups throughout his storied career. “Even though he’s a giant in the field, he continues to work on his own development,” she says.

“The message that we want to send is that the journey doesn’t end when you get that license or degree,” Henderson adds. “The journey is ongoing, and we don’t want to be alone in that journey.”

 

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Related reading: Counselor supervision: Reflections and lessons learned,” an online-exclusive companion piece to this article: wp.me/p2BxKN-58U

 

Additional resources:

From the Counseling Today archives:

 

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Bethany Bray is a staff 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.

Counselor supervision: Reflections and lessons learned

Compiled by Bethany Bray May 25, 2018

[EDITOR’s NOTE: This is an online-only companion article to “Guiding lights,” a feature on the ins and outs of the counselor supervision process appearing in the June issue of Counseling Today.]

 

Counselor supervision can have quite a steep learning curve — one that often comes with several ups and downs for beginning counselors.

Counseling Today recently asked several American Counseling Association members about their experience navigating the supervision learning curve. They share their thoughts here so that others can learn from their journeys along the sometimes-bumpy road into professional practice.

 

Fill in the blank: I wish I had known ________ when I was in my supervision.

 

“I wish I had known that it was OK to think outside of the box. I am a naturally creative and intuitive person, but I tried to reel all of that in during supervision. My supervisor was very structured. I still learned a lot, but it took me many years of practicing as a counselor before integrating who I am into my work as a counselor.

Be open to your supervisees interests — you can miss out on opportunities for them to grow, otherwise.”

Stacey Brown, a licensed mental health counselor (LMHC) and clinical supervisor in Fort Myers, Florida

 

” [In supervision,] I felt that I couldn’t make a mistake because it would be evidence that I’m not a good counselor. I felt scared, instead of realizing that my supervisor was interested in knowing me as a person and interested in my development. [My supervisor] wasn’t looking for me to be a fully-formed counselor, they were expecting me to be a novice, and expecting to provide modeling and encouragement for improvement.

Now, I remind my students: If you’re scared and hiding [things from your supervisor], those are the students who don’t do as well, as opposed to those who are open and seeking growth. Be honest about your weaknesses instead of not acknowledging them.”

Summer Reiner, LMHC, clinical supervisor and associate professor and school counseling coordinator at the College of Brockport, State University of New York and president of the Association for Counselor Education and Supervision

 

“One of the hardest lessons for me in supervision was [learning] the boundary of my own responsibility with my client. I was always wanting more [for them], feeling like I was responsible for more of their change and their experience. [Feeling that] it was somehow my fault or responsibility that they weren’t making progress in a way we wanted to see.

It took some very strong and honest supervisors [for me to learn not to feel that way]. That’s a level of insight, something you can’t give anybody. They helped me find my way.

One supervisor challenged me with ‘where does Kathryn end and where does your client begin?’ At first, I didn’t know that that meant. But it has really stuck with me.

It’s a very common, normal part of development as clinician [feeling responsible for client change]. We can have a parallel process of that, as supervisors — feeling responsible for the growth of supervisees: Where do they begin and we end?

It’s really about being the best that we can for our clients, and supervisees, and acknowledging that we don’t have all the answers.”

Kathryn Henderson, a licensed professional counselor (LPC) and assistant professor at the University of Saint Joseph in West Hartford, Connecticut

 

“I wish I knew how to advocate for myself within supervision. A lot of times, I didn’t speak up when I was in situations I didn’t feel comfortable in. I wish I had known how to advocate within supervision and how to broach [tough] conversations. But more importantly, knowing how to spot a supervisor who would be willing to broach [those conversations] and model wellness.

I wish I knew [then] how to spot a strong supervision relationship from a weak relationship because ultimately that’s how we benefit.”

Kevin Doyle, an LPC and counselor educator who begins a position as assistant professor of mental health counseling at the University of Tennessee at Chattanooga this fall

 

I wish I had known:

  • How to navigate cultural barriers in the supervisee/supervisor process
  • How to advocate for quality over quantity for clients (providing quality clinical services to the client while meeting the agencies financial demands)
  • How to obtain clarity of expectations for my role in practicum/internship
  • That the process would be arduous at times

Kerri Legette McCullough, an LPC, licensed clinical professional counselor (LCPC), doctoral candidate at Argosy University and a mental health therapist at Hillcrest Children and Family Center in Washington, D.C.

 

 

“I had learned that in clinical supervision, I would learn how to function in the role of a counselor. Here’s what I didn’t know: I did not know that it was okay to not know things — that actually, it was pretty much expected that I wouldn’t.

I was unaware that clinical supervision could be an intuitive process — or that I would learn so much just within the context of the supervisory relationship. I was unaware of the full potential and was not expecting it to be as transformative as it has been for me, in both professional and personal ways.  I think that if I had known this in the beginning, I definitely would have had a lot less anxiety about the process. But experiencing it in real time has been a valuable part of becoming a counselor.  I wouldn’t change it.”

Alicia Simmons, a counselor intern working toward counselor licensure in Florida and a clinician and play therapist at an agency that serves children removed from their homes due to trauma or neglect

 

 

 

 

 

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Bethany Bray is a staff 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.

 

 

Past trauma in counselors-in-training: Help or hindrance?

By Bethany Bray May 20, 2018

Counselors are not immune to trauma — in fact, far from it. Many practitioners say that personal or familial experience with trauma or mental illness actually spurred them to become professional counselors.

The connection between personal experience and the pull to become a counselor is something that is hard to quantify, but “in my personal experience, I encounter it pretty frequently,” says Allison Pow, a licensed professional counselor in North Carolina and adjunct professor at both Wake Forest University and the University of North Carolina at Greensboro. “For a lot of people, past experience draws them into the counseling field, and trauma can play such a pivotal part in someone’s life. It’s a common thing that we see as supervisors and counselor educators.”

Past trauma can be either an impairment or a kind of “benefit” for counselors-in-training, depending on how much the person has worked through and processed the effects of trauma, say Pow and Amber Pope, a licensed mental health counselor and program chair of the clinical mental health counseling program at Hodges University in Fort Myers, Florida.

Counselor educators and other professionals in the field who have close contact with counselors-in-training should keep an eye out for red flags that may indicate that a person’s past trauma is interfering with their growth as a counselor or, in a worst-case scenario, has the potential to cause harm to clients.

“Just because you’ve been through trauma doesn’t mean you can’t become a counselor. You can become a great counselor if [your trauma] is processed correctly,” Pope says.

Pow and Pope co-presented a session, “Wounded healers: How to support counselors-in-training who have experienced trauma,” at the 2017 ACA Conference & Expo in San Francisco. The term “trauma” can encompass a wide variety of experiences, from an acute event to yearslong, developmental trauma, Pow explains.

People who have processed the effects of past trauma — often with the help of a therapist of their own — can become excellent counselors, Pow says. Posttraumatic growth and healing from the experience can foster empathy and strengthen coping skills.

“Going through trauma is a very unique experience [through which] you understand the way your brain works and your body reacts. That is hard for someone to understand who hasn’t gone through that,” Pow explains. “I have had some students who were very resilient because they have been forced to cope [in traumatic situations] in the past.”

“The reason a lot of people become very, very good counselors is their life experience,” Pow adds.

However, people who haven’t fully processed the trauma in their backgrounds can run into trouble as professional counselors. For example, in client sessions, they risk becoming triggered by topics that clients bring up and may be unable to regulate their own emotions or other behaviors in response. These reactions can harm the delicate balance of trust between practitioner and client.

“They may unwittingly be using their role as a counselor to work through their own unprocessed material or to recapitulate an unhealthy power dynamic to feel that they’re in control,” Pow says. “Control is often something that people seek after going through trauma. It may come from a lack of self-awareness.”

 

Red flags

Interactions with classmates and colleagues might be one of the best indicators of whether counselors-in-training have a trauma history that still needs to be worked through. During moments of vulnerability, do they become aggressive or reactive or express other strong emotions? In general, a lack of self-awareness, such as oversharing in class or being unaware of how the people around them are feeling, can be an indicator of unprocessed trauma, says Pow, who has a private practice in Greensboro, North Carolina.

Also watch for attachment issues or signs of avoidance, such as skipping classes or evading one-on-one contact with a professor or authority figures, Pow says. It can also be indicative of a trauma background if students do not generally have themselves together, including missing assignments or being late to class repeatedly, Pope says.

Other indicators can include:

  • Poor boundary keeping: This may manifest as oversharing, attention-seeking or disruptive behavior in the classroom, or an unhealthy preoccupation with relationships with classmates or colleagues.
  • Low self-confidence: Students with unresolved trauma may demonstrate low belief in themselves regardless of past successes. They may feel like they can “never do enough,” Pope explains. These students may lack motivation or even self-sabotage, such as missing a deadline even though they are capable of meeting it.
  • Rigidity in thinking: If students aren’t open to receiving feedback and unwilling to take constructive criticism, it can be a major indicator of past trauma that hasn’t been resolved. This attitude can stem from a black-and-white way of thinking in which the student categorizes things as “all good” or “all bad” with no in between, Pope says.

Everyone has bad days now and then that can set them off. However, if a student is repeatedly unable to regulate their emotions, such as becoming reactive or upset in class, it is a red flag, Pope says.

“When a student is so set in their values or way of thinking that they try and impose it on others, that can stem from trauma. If they can’t become more flexible in their thinking process or relationships with others, then they’re going to have a difficult time with clients,” she explains.

 

When it’s time to intervene

It is beneficial, for any number of reasons, for counselor educators to get to know and connect with the students in their program, Pope says. If a particular student seems to be struggling with challenges that could keep them from becoming a proficient counselor — such as issues related to unresolved trauma — it is better to intervene sooner rather than later.

Be prevention-focused instead of reactionary, Pope suggests. The longer a student continues in a graduate counseling program, the harder it will be to check their behavior or make decisions about their future.

“Don’t let students waste time and money if they’re not going to be a good fit,” she says.

Counselor educators who identify students raising red flags should pull them aside after class or ask them to stop by the counselor educator’s office, Pope advises. The first interaction with the student should be kept informal and light. Let them know that you have noticed some patterns and indicators in their behavior that require some attention, and ask them what supports they need to help them make improvements, she says. If appropriate, other professors or colleagues who know the student can sit in on this initial informal meeting to offer support, Pope says.

Check in with the student frequently during class breaks, supervision meetings and other opportunities. Ask how the student is doing and how they are practicing self-care. This conveys to the student that the professor wants them to succeed and grow, Pope says.

Pope emphasizes that this method should be applied only to counseling students who haven’t committed an egregious offense or intentionally gone against the ACA Code of Ethics. In those cases, a swifter and more formal response is necessary.

If a student does not begin to change their behavior after a first informal meeting, consider meeting with the counselor-in-training again to create a formal written behavior agreement. Spell out which behaviors aren’t acceptable, why those behaviors aren’t acceptable and what they need to do to continue in the counseling program. Be specific and include a timeline of when the expectations must be met, Pope advises.

If the student meets the requirements in the behavior agreement, they should be allowed to continue on with graduate school. If not, suggest that they take a semester or other time off to get the help they need, or leave the program entirely.

“When a student is given feedback and continues in their behavior patterns and doesn’t make any changes, that’s showing me that the student isn’t ready to change or do what they need to do to grow professionally,” Pope says.

Throughout the process, Pope says, she would recommend that the student attend counseling. There is some debate within counselor education as to whether it is ethical to require students to attend personal counseling . In the case of recommending a student to personal counseling, a counselor educator can request the student to provide proof, in the form of written letters from a provider, that they are attending therapy sessions and making progress to demonstrate their willingness to comply with their professors’ recommendation.

“We’re very open, telling students that we [their professors] have all attended or are attending counseling, and that it’s important to be as healthy as you can be, [to] take care of yourself mentally and emotionally,” Pope says.

Although sometimes uncomfortable, this process is also an opportunity for counselor educators to model what a healthy professional relationship should look like, Pope notes. It shows students that you can give critical feedback while caring and maintaining empathy.

“You can give suggestions and guidance while keeping professional boundaries. They may not have had that [example] in their life before,” Pope says.

“In my classes, I make a point of being very transparent with my expectations and predictable. I have a standard of which behaviors I respond to and which I don’t,” Pow agrees. “For a student who has gone through trauma, it’s not our job to be their counselor. But a lot of times their lives haven’t been predictable, and they haven’t had a safe base. We can be that predictable, safe base. We can talk openly about their struggles, getting help and that it’s not a bad thing that you’ve had some challenges in your life.”

 

Gatekeepers and guides

Counselor educators must strike a fine balance between acting as gatekeepers for the profession and serving as mentors and guides for those who need extra support, Pope says.

“When it comes to student trauma and challenges, for me, an ideal situation is when I can have enough conversations with a student so they can come to their own conclusions on whether the field is right for them or not,” Pow says. “Part of effective trauma treatment is creating choice and putting decision-making back into the person’s hands. That may be the choice to take some time off and return to the program. Emphasize where they have agency in things.”

It’s OK for a student to come into a graduate counseling program with unresolved trauma issues. They just have to be willing to work on it, self-process and accept help, Pow says. Students who are open to self-reflection and constructive feedback can experience a tremendous amount of growth, she says. “It’s unreasonable for us to expect, as educators, that people are going to come into these [graduate] programs having processed everything that has happened to them and be completely self-aware,” she affirms.

Processing and rising above trauma builds skills that are the hallmarks of a good counselor, including a strong sense of self-awareness, empathy and sensitivity. Counselors who have successfully processed their past trauma can become models for clients struggling with similar issues, Pope says.

“If you heal from a trauma, you really have to engage with the most vulnerable parts of yourself. It’s a depth that people who haven’t been through trauma may not fully understand,” Pope says. “That’s what creates really great counselors — [to be able to] engage with others at that level of vulnerability and intimacy. Knowing that going through something so challenging, you can become more whole, and in turn become a safe place for others. As a counselor, you’re better able to serve your clients.”

 

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Related reading

  • For more on supporting counselors-in-training through the supervision process, see the feature “Guiding lights” in the June issue of Counseling Today.

 

 

Suggested resources

Want to learn more on this topic? Pow and Pope suggest these titles:

 

 

 

 

 

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

 

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

 

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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.