Tag Archives: Voice of Experience

Voice of Experience: Betrayal

By Gregory K. Moffatt December 20, 2021

Grouping symptoms and behaviors into categories can be very helpful. It gives us a starting place for treatment planning. By doing this, instead of mistakenly treating symptoms, we can more quickly get to the treatment of causes.

For example, those of you who work with addictions are undoubtedly aware of the underlying concept of entitlement that can lead to relapse. “I haven’t had a drink in over a year, and my brother is getting married. I’ve earned a sip of wine to celebrate with him.”

This isn’t an excuse or a rationalization so much as it is entitlement. By helping our clients see that their entitlement thinking can easily lead to relapse, we can help them avoid this pitfall and make better decisions.

In April 2020, I wrote a column for CT Online about grief. I argued that grief underlies many of our clients’ issues. They may be grieving the loss of childhood, the loss of dreams, the loss of a marriage, or strained relationships with their children, parents or other loved ones.

Again, if our clients can recognize that grief underlies some of what they are experiencing, we can help them work through it like we would any other client who is dealing with a more obvious loss.

It is this kind of thinking that leads me to consider another category — betrayal.

Just as we may tend to think of grief too narrowly — as if it applies only to those clients who have experienced the death of a loved one — we can do the same thing with betrayal. This word is most often applied in the case of infidelity in a relationship, but I’ve learned there are many other ways in which we feel betrayed.

Certainly anyone engaging in an emotional relationship outside of a committed relationship will create a sense of betrayal in their partner. But let’s broaden our thinking to all social relationships.

Any engagement with another person — a co-worker, a weekly tennis date, a parent, child or even neighbors — involves social contracts. These contracts sometimes involve written agreements. Job contracts, marriage contracts, and informed consent for counseling are all explicit social contracts with clear expectations for behavior.

But much of our existence in our social worlds is made up of unwritten social contracts. These are implicit promises to behave in a certain way. “We always meet for coffee on Friday mornings at 8 before work.” Nobody would write that down, have it notarized and have all parties sign it. But the unwritten contract can be just as powerful as a written one. When the agreement is broken, we feel betrayed.

I’ve spent many years consulting with businesses and evaluating employees who are presenting disruptive, concerning or dysfunctional behaviors in the workplace. Many of them have been able to function fairly well in other environments, but in the workplace, they have felt betrayed. Therefore, their dysfunctional behaviors seem rational to them.

Valentina Shilkina/Shutterstock.com

For example, we would have no trouble understanding a husband who loses his cool after finding out that his partner has had an affair. After all, he was betrayed. The same emotional response happens in the workplace when an employee believes they have worked hard and earned a raise or promotion yet have been passed over. The employee with weak coping skills or other compromising mental health issues might behave in seemingly inexplicable ways. But I can see what’s happening. Metaphorically, they’ve found their partner in bed with someone else.

In couples counseling, I see this happening over time. Even if there are no outside relationships compromising the marriage, a sense of betrayal can still exist. “I’ve stayed home, cleaned house, given up my career and done laundry for 15 years. All I ask is a little appreciation.”

“Ah … so what you’re telling me (in counselor terms) is that you had an unwritten social contract with your partner — an expectation that you would do X, Y and Z and, in return, you would receive A, B and C. The contract has been violated and you feel betrayed?”

Resolving that betrayal, along with whatever other systemic dynamics may be at play, is a critical step in healing resentments. The partner may be totally unaware of the unwritten expectations — the fine print in the social contract. Sometimes healing can begin by simply articulating those expectations, negotiating them and putting them into practice.

Just like the large categories of entitlement and grief, betrayal is not a universal emotion in all dysfunction, but it is so big that I always consider this in evaluation and treatment planning. This helps me be more efficient and can begin the healing process sooner.

 

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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.

Voice of Experience: Three rules for identifying abnormal child sexual behaviors

By Gregory K. Moffatt November 23, 2021

I explained my symptoms as the orthopedist looked at my knee, and he made a statement that I subsequently borrowed and have used many times in my work since then: “What you are experiencing isn’t normal, but it isn’t unusual.”

In other words, while my knee shouldn’t have been doing what it was, my symptoms were common and not necessarily a problem.

That line is applicable to many things we face as counselors. I have seen literally thousands of children in one forum or another throughout my long career, and I’ve talked to hundreds of worried parents.

“I found my child doing …” they often begin with awkward hesitation and then follow it with some behavior they observed that troubles them. Sometimes I am troubled too, but not always.

The childhood sexual behaviors I see can be grouped into three categories: normal behaviors, behaviors that are not normal but not unusual, and behaviors that are abnormal.

Prior to age 2 or 3, children don’t have any concept of modesty and may disrobe in the middle of Walmart if they are uncomfortable. By age 5, most children are beginning to learn modesty but still might run through the house naked even if company is present. In a way, they think that if they run fast enough, it doesn’t count as being naked.

By prepubescence, nearly all children have learned the family and cultural rules of modesty.

Likewise, nearly all children exhibit sexual behaviors at one time or another. They may self-stimulate, explore their bodies, and if other children are in the home, they might notice, explore or tease about the other child’s body parts.

As with modesty, children must learn how to use their body parts, what parts they can show and what parts they cannot, and what parts on someone else they can touch and which ones are off-limits. Learning these rules takes time and experience.

Parents rarely call me about the normal exploration they see in their children. Most of them recognize common childhood behaviors. It’s more likely I’m called when behaviors fall into the second or third category.

“I saw my 6-year-old child and his same-aged cousin in the bedroom playing. They had taken off their pants and were waiving their penises at each other,” one troubled parent said.

While not normal (not all children do this), this behavior isn’t unusual and by itself isn’t necessarily cause for alarm.

“I came into the bathroom and caught my 8-year-old son holding down his 5-year-old sister and pulling her underwear down while she was yelling at him to stop,” said another parent. This behavior is definitely troubling and falls into the third category.

There are three basic rules for distinguishing between behaviors like the second and third examples above: forced, painful, invasive.

Rule No. 1: Normal sexual behaviors in children are never forced. The exploration is mutual. While one child likely had the idea first, both children must participate. This doesn’t mean that two children might agree to engage in abnormal sexual behaviors, however. Hence the next two rules.

Rule No. 2: Normal sexual behaviors in children are never painful. When children who usually behave normally realize they have caused pain, they stop.

Rule No. 3: Normal sexual behavior in children is never invasive. Normal childhood curiosity does not include inserting objects or one’s own body parts into the cavities of others — anus, vagina, mouth, etc.

There is one other important caveat. Most normal childhood behaviors occur between children of similar age. It is highly unusual for a young child to sexually engage with a teen without violating one of the three rules above. That behavior definitely calls for further investigation. And, certainly, any sexual interaction between an adult and a child is cause for mandated reporting.

Most of the sexual behaviors parents see in the first two categories — normal or not normal but not unusual — are not necessarily behaviors we condone. But just because one of these behaviors happens doesn’t mean there is trouble.

Sexual behaviors are laden with both cultural rules and religious meaning. As a counselor, I must be able to identify sexual behaviors that are common — as well as those that may not be normal but aren’t unusual either — and put a parent’s mind at ease while also respecting their culture and belief systems.

Most importantly, I must be able to identify symptoms of abuse and abnormal sexual development, and I must comply with mandated reporting laws within my state. It was a desire to prevent child abuse and intervene where I could that motivated me to begin my career as a child therapist in the first place.

Andrew Seaman/Unsplash.com

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Related reading, from the Counseling Today archives: “Addressing children’s curiosity of private parts

 

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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.

Voice of Experience: A not-so-simple question

By Gregory K. Moffatt October 21, 2021

I have a feeling some of you will stop reading after the next paragraph. You could be excused for thinking, “This is so basic.” But even if you are a seasoned professional, I ask you to hang with me for a bit. The question I pose might not be as basic as you think.

Here is the not-so-simple question: Should counselors contact their clients by email or text to confirm appointments?

It is common practice to send such messages, and perhaps they are even necessary. After all, for every no-show, we often lose money. And forgetfulness and disorganization are sometimes part of our clients’ dysfunction, so reminders might be in their best interest.

As subtle as it may seem, a reminder/confirmation message is a boundary crossing. There is nothing inherently wrong with a boundary crossing (as opposed to a boundary violation). Still, we should always carefully examine the possible ramifications of any boundary crossing.

Let’s ask another question: Should we call our clients on the phone to confirm their appointments? I suspect most of you reading this would say no.

And one more question: Should we drop by our clients’ homes or workplaces to remind them of their appointments? Surely no one would think this kind of boundary violation is ethical.

Brett Jordan/Unsplash.com

So, what is the difference between an email and dropping by someone’s home? Don’t get me wrong. By no means am I proposing that these three scenarios are the same, but I am suggesting that they have something in common. In all three cases, we are crossing a boundary. Even with a simple text or email, we are figuratively stepping into our clients’ private worlds, potentially without invitation (I’ll come back to this in a minute). In this way, a text message is similar to standing at your client’s front door.

When that text or email goes through, we don’t know who might have access to it besides our clients. We don’t know what potential problems that might cause or what potential embarrassment or intrusion our clients might feel.

Would they feel obligated to explain who you are as a counselor? What if there are difficult relationships, jealously, distrust or other powerful and emotional dysfunctions in operation? Or what if our clients simply choose not to make others aware that they are seeing a counselor? This is why the question isn’t so simple.

When anyone — another professional, another client, a friend, a relative — comments about one of my clients, my response is always the same: “Who my clients are or are not is no one’s business but theirs.” This simple piece of information should be guarded as carefully as any secret our clients choose to share with us.

I’ve often thought about past clients and clients who dropped out of therapy without closure. I’ve wondered whether I should reach out to check on them or to ask if they would like to reschedule. But I never do, even when the urge to follow up is powerful.

If I reached out to them, a host of things could happen. They might feel obligated to come see me. As in the scenarios mentioned earlier, I might complicate their lives or embarrass them. Maybe they didn’t like me as a counselor but didn’t want to confront me by saying, “You haven’t really helped.” We protect all of that by not intruding into our clients’ lives.

But this doesn’t mean that we can’t send reminders or follow-ups. The easiest way to manage this is to include this information in your informed consent. At the end of my informed consent is a section where clients can check off the ways they approve for me to communicate with them. These options include phone (landline or cell), email, video (Zoom), chat and text. I note which options are HIPAA compliant and which are not.

I also include a section regarding clients’ preferences for receiving session reminders and messages about missed appointments. “None” is an option. This section of my informed consent is where clients extend me the “invitation” that I referred to earlier.

Thus, I’m not suggesting that we never send follow-ups or reminders. It is a reasonable and commonly used business practice that is not inherently unethical. But it would be very easy to never even ask the question regarding its effects because it seems so innocent.

If you decide to use these tools, keep three quick rules in mind.

  • Rule No. 1: Keep it short.
  • Rule No. 2: Keep it professional.
  • Rule No. 3: Keep it vague so that your client will know who you are, but it won’t be so obvious to others. For example, “Reminder of our meeting, Wed., Oct. 10, 3 p.m.”

In this way, we can protect our clients.

 

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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.

Voice of Experience: Three pieces of anger

By Gregory K. Moffatt September 23, 2021

He was court mandated, and to stay out of jail, he was required to engage in several months of anger management counseling, among other things. I was his choice as a counselor.

An incident of road rage had resulted in this outcome. The other driver had recklessly cut my client off on the interstate. His temper flared, and he pursued the other driver, eventually bumping her car and nearly causing an accident. The other driver was a young mother on her way to work with two children in car seats in the rear of the van. She called the police, who pulled my client over and arrested him.

My client didn’t have a single mark on his police record prior to this incident and said he had never done anything else like it in his 38 years of life. In our early sessions together, he was as befuddled by his behavior as the frightened young mother must have been on the highway.

Leremy/Shutterstock.com

Anger is a fascinating emotion. It is completely visceral. You can’t “decide” to be angry any more than you can decide to fall in love with someone. Instead, in a way, anger attacks us out of the blue, as it had done to my client.

People express anger differently depending on a variety of factors, including personality, coping skills, history and context. Regardless, we are all its victims at one time or another, and sometimes this emotion deceives us. In fact, anger can be much “safer” for us to express than other emotions. A counselor once told me that depression is really hidden anger, and while that may often be true, I believe the opposite is also true. It is sometimes easier to be self-righteous and angry than it is to admit that your heart is hurting.

I’ve had clients who have threatened others with weapons, engaged in violent road rage, and even some who have killed their workmates. Very few of these people planned their behaviors ahead of time. They acted spontaneously in the heat of passion (pardon the cliché).

I have witnessed anger many times in my clients, and I’ve recognized some things that help me manage it. Early in my career, “anger management” involved a set of techniques such as deep breathing and the development of varied coping skills. While those are certainly important areas on which to focus, I was missing a piece of the puzzle at the time that is also critical in managing anger.

Anger has three common components or pieces, and if we help our clients address these three issues, they will have new tools for coping in a variety of situations.

The first component is loss of control. When all of our tools for coping are expended, we are reduced to primitive behaviors. Think about how illogical (yet common) it is to push an elevator button repeatedly. In the midst of our frustration, we push the button again and again, even though we know it won’t help. This is where the use of deep breathing (or another relaxation technique) is very helpful.

My client had been feeling a loss of control at work and a loss of control at home. When the other driver’s behavior caused him to feel a similar loss of control that day in heavy traffic, he tried to retake control by “punishing” her for her reckless driving.

A second component of anger is that the precipitating event is perceived as personal. My client perceived that the other driver was doing something deliberately to him (as if she had planned specifically to make him angry) when, in fact, she was simply in a hurry and wasn’t thinking. The irony in road rage is that we depersonalize the other driver and at the same time perceive their behavior to be a personal and intentional attack on us.

Finally, the third component is a belief that one has been wronged — that life isn’t fair. My client believed that “other drivers shouldn’t be so careless.” In a way, he was trying to make the world fair by righting a wrong. That thinking is quite illogical but very common in road rage incidents.

The rage my client experienced had occurred partially because his defenses were down. He had just wrapped up a very bad day at work, his home life was at a low point, and in the safety of his car — his own domain — he let his normal coping skills fly out the window.

After weeks of counseling work, my client went on about his life a much healthier person. By looking at these three pieces of anger, he was able to learn to recognize cues and apply anger management techniques. I hope he’ll never see the back seat of a police car again.

 

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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.

Voice of Experience: The ughly child

By Gregory K. Moffatt August 23, 2021

I was an ughly child, but I doubt that you would think that by looking at my grade school pictures. For the most part, I suppose I looked like any other kid. Nothing about me was exceptional in either direction. I wasn’t exceedingly attractive nor was I noticeably unfortunate looking.

But ughly children know who they are. They are the children teachers prefer not to see on their class rosters at the beginning of the fall semester and the ones who cause parents to grimace when they realize “that child” will be attending a birthday party. Even most therapists don’t like seeing these children’s names on their agenda for the day.

Ughly children demand others’ energy. They break things. They often rub people — including their peers — the wrong way. That is what makes them “ughly” — they cause us to go “ugh.”

Consequently, they are never the first ones chosen for games, and often their comments and thoughts go unnoticed, as if they weren’t there at all. Over time, they learn that they are irrelevant, sometimes even at home.

I run a camp for grieving children every summer. We always have a few children who demand far more of our time than do others. Some require a dedicated staff person 24/7. They force us to use all of our skills and, often, all of our energy.

Zdan Ivan/Shutterstock.com

It would be far easier if all of my campers were cute, cooperative and fun to work with. But ughly children are my favorites. I would be lying if I said that I looked forward to the hard work these children require of me. Camp is exhausting enough given the outdoor conditions, poor sleep and, of course, the energy required to help children through their grief. I would also be lying if I said that I haven’t sometimes thought “ugh” upon seeing certain names on my own therapy agenda.

I realized long ago, however, that these children are accustomed to the exasperated inflection in the voices of those who speak to them. The world these children live in is full of adults and kids alike who give clear indication that life would be much easier if ughly children weren’t in it. Mostly, that message is unintended, but it is the message these children receive nonetheless.

I work hard to communicate a very different message. I make sure to pick them first, to listen carefully to their stories, and to show patience that they sometimes don’t know what to do with. It is amazing how quickly I build rapport with these children and, consequently, how hard they will work to please me. That makes behavior modification much easier.

So, whether it is for a few days at camp or throughout months of therapy, I commit to acting like I might be the only person that day (or maybe ever) who makes these children feel that I am glad to see them rather than perturbed that they need something from me.

It would be a mistake to think that ughliness is limited to children. It isn’t. Adults can be ughly too and, like the children I’ve described, they know who they are. Their lives have been replete with rejection, and that is often at the core of some of their troubles.

Many years ago, a client of mine was an ughly child. I know because he told me so. “My teachers don’t like me,” he said on the first day we met. He wasn’t complaining. Just stating the facts. This young boy had endured several major life events that would have challenged any adult.

He was rambunctious and broke something nearly every time he came into my office. Upon his departure each day, the sand from my sand tray was always all over the floor and most of the toys were off the shelves. He was hard work, but I loved that child. I was his lifeline to a more peaceful future. We worked together for several years as he weathered many storms.

Today he is approaching 30, and I occasionally see him in the community. He is 6-and-a-half-feet tall and outweighs me by at least 50 pounds. Yet each time I see this very successful young man, he hugs me with the deepest affection. I’ll always be his “Dr. Gregory.”

Anybody can work with easy children. Professionals take on the challenge of the hard ones, and that is why ughly children are my favorites. Maybe they can become your favorites too.

 

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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.