Tag Archives: workplace stress

When the caring is too much

By Christine Sacco-Bene and Fay Roseman January 13, 2020

With the proliferation of research and information focusing on human-animal interactions, counselors are more aware of opportunities to incorporate animal-assisted interventions as part of their clients’ treatment. However, there is a population of clients who have been overlooked in this equation until recently — veterinarians. In fact, the mental health of these professionals is an emerging area of research and mental health treatment. We (the authors of this article) have also seen the pressures of this field firsthand with our family members and friends who are veterinarians and veterinary students. The sheer level of stress and strain they experience on a day-to-day basis has a significant impact on their work and personal lives.

For that reason, this article focuses not on animal-assisted interventions or the benefit of animals in their humans’ lives but rather on the increasing need of mental health attention to the helpers who take care of our pets and service animals. Note that although the information presented here may be applicable to others who work to care for animals, we are focusing specifically on veterinarians and veterinary students in this article.

We depend on veterinarians to be kind, compassionate and attentive to their patients and their patients’ owners. Because of the multifaceted nature of veterinary service, the occupational stress of these interactions and the inherent professional isolation of the field can result in a number of mental health challenges, including compassion fatigue, burnout, depression and anxiety. Veterinarians face some of the same challenges that other health care professionals face, including working with a large number of stressed clients (people and animals), long hours, and limited financial resources. However, they also have the added pressures of meeting the difficult requests and expectations of pet owners, making the best decisions given difficult situations, and dealing with unwanted or sick animals.

In the Centers for Disease Control and Prevention report “Prevalence of Risk Factors for Suicide Among Veterinarians — United States, 2014,” Randall Nett and colleagues chronicled that veterinarians were found to experience serious psychological distress at a rate higher than the general U.S. adult population. Their survey of over 10,000 veterinarians in the United States further detailed that more than 1 in 6 veterinarians have experienced suicidal ideation. Belinda Platt and colleagues, in their study “Suicidal Behaviour and Psychosocial Problems in Veterinary Surgeons: A Systematic Review,” noted that these challenges have also contributed to the increasing rate of death by suicide among veterinarians. This information draws attention to the need for further consideration and development of support and assistance strategies for this community of helpers.

While neither of us has worked directly with this population, we do have a personal interest in this area. Christine has a close friend who is currently in her final year of veterinary medical training. The financial stress related to the cost of being in this professional program and uncertainty about how she will be able to pay off her college loans after graduation have caused her and her family significant worry. Even more startling are the stories about the strains the veterinary program puts on its students related to schedule, physical and mental demands, money, travel, etc. Christine’s friend has shared accounts of her peers breaking down in tears on a regular basis (sometimes several times a day), not sleeping or eating properly, pushing themselves to do more practice, and maintaining late night and early morning study times, sometimes alone and sometimes in groups, to prove themselves worthy to their faculty. The demands leave little (if any) time to engage in self-care, which seems to be affecting their current mental well-being and may be setting a precedent that will affect their mental health as they progress through their careers.

Fay’s daughter is a veterinarian who became interested in the high rate of suicide among veterinarians while she was in school for veterinary medicine. She explored the potential connection between compassion fatigue and suicidality and shared her work with Fay. After Fay’s daughter graduated and entered into veterinary work, she experienced the loss of colleagues to death by suicide. Our mutual concern about the high rate of death by suicide among veterinarians and the stigma felt by numerous veterinarians about seeking mental health counseling has prompted us to raise awareness of this issue with other counseling professionals. 

What veterinarians are saying about mental health

Some of the mental health issues that veterinarians face are similar to those faced by the general population. However, international studies, particularly in Europe and Australia, report more significant mental health concerns within the veterinary profession when compared with the general population or with other health care professionals. The 2012 article “Suicidality in the Veterinary Profession: Interview Study of Veterinarians With a History of Suicidal Ideation or Behavior,” by Platt and colleagues, indicates that specific challenges of workplace relationships, career concerns, patient issues, unreasonable work hours/work volume, and responsibilities related to clinical practice management are all contributing factors to veterinarians’ mental health issues. Research also notes that student debt and ethical dilemmas, most notably around issues of animal care and euthanasia, generate the highest levels of stress for this population. In a 2018 article for JAVMAnews (Journal of the American Veterinary Medical Association), R. Scott Nolen noted that veterinarians show a higher rate of psychological distress and have slightly lower degrees of well-being than does the general population. The seriousness of this dilemma is more significant when considering that 25% of veterinarians have considered suicide at some point in their lives and 1.6% have attempted suicide.

In their review of the practice of veterinary social work, Elizabeth Strand and colleagues found evidence suggesting that veterinarians may experience stress, anxiety and depression as early as their first year of study. High-achieving students are often drawn to veterinary medicine, and among this group, failure is not an option. Veterinary school is demanding and requires a great deal of time and energy from students, beginning with the acceptance process and continuing through clinical practical experiences. Rates of depression, self-harm, and suicidal ideation increase during the clinical year when students are completing medical rotations in various specialties of veterinary medicine. The rigor of each rotation and the requirement of completing multiple rotations, which can be located either near or far from home, present other challenges for managing stress and the life skills of students. Although the social support offered by family, friends, and veterinary faculty was found to be beneficial to these students, we believe the specialized training of mental health practitioners might improve outcomes for veterinary students during their course of study.

The debt acquired through the course of study can become a significant contributing factor to the stress levels experienced by veterinarians at the beginning of their careers. A review of the 2019 cost of veterinary medicine programs throughout the United States indicates that a four-year residential program can range from $168,000 to $329,000, whereas a nonresidential program can cost between $223,000 and $460,000. The median debt carried by veterinary school graduates ranges from $96,000 to $329,000. Given the significant cost of a four-year veterinary degree, it is easy to identify another reason for increased stress, anxiety and depression among this population.

The function of a veterinarian is not only to provide top-quality medical care to animals and to maintain a relationship with pet owners but also to do so in a compassionate manner, even when it creates significant stress for the veterinarian. Many veterinary professionals become overwhelmed when they need to offer emotional support and comfort to patients’ owners because they are not adequately equipped to handle the owners’ emotional responses. This is especially true when having to convey messages about a patient’s illness or death.

In her article “Moral Stress the Top Trigger in Veterinarians’ Compassion Fatigue,” Susan Kahler noted that giving bad news, managing adverse events, interacting with difficult clients, working in teams, and balancing work and home life create diminished levels of wellness for veterinarians. This work cannot be done in isolation, and the support staff in a veterinary hospital is a key component to the relationship between veterinarian, pet and pet owner. People trust that veterinarians will interact sympathetically with them, but managing these multiple relationships, in addition to providing ethical and professional care and respecting the dignity of the patient and patient’s owner, can be a challenge. This is especially relevant when considering that veterinarians encounter difficult issues — including cases of trauma, illness, abuse, terminal illness and death — on a regular, sometimes daily, basis.

Another identified contributing factor to the mental health issues of veterinarians is the ongoing pressure inherent in the daily operation of a clinical practice. In addition to the stress of managing the business side of the clinical practice (billing, inventory, equipment, payroll, legal, etc.), veterinarians are now dealing more frequently with “emotional blackmail,” which involves attempts to guilt these professionals for charging for their services. Just as we have seen in other industries, consumers of veterinary services are increasingly turning to social media to complain about products and service. In “Media’s Emotional Blackmail Is Killing Veterinarians,” Dr. Sarah Boston, a veterinary surgical oncologist, explained, “There are several results of this irresponsible reporting. The obvious one is the direct damage to the veterinary hospital and staff. There is also the widespread damage it does to all veterinary professionals when they receive the message that what we do is not valuable and should not cost money, and that we are terrible people who are only in it for the money.”

Suggestions for all helpers

Until recently, wellness and mental health self-care were not included in the curricula of veterinary training programs. Because veterinarians tend to be empathetic and nurturing, they focus their efforts on caring for and promoting the health and well-being of animals and routinely put the needs of patients and patients’ owners above their own. In her article on moral stress, Kahler explained that moral stress is unique in that the typical stress management techniques are useless and may even contribute further to mental health challenges. She encourages these professionals to redefine their work ethic to include self-care.

Self-care is really a moral imperative for all professionals in the helping fields, including veterinarians. Helping professionals have a moral obligation not just to facilitate patient care but also to take care of themselves. In collaboration with university training programs, mental health care professionals and counselor educators can help start this process by integrating self-care, stress management skills, and education about mental health issues and substance abuse into veterinary school courses. The College of Veterinary Medicine and the College of Social Work at the University of Tennessee created a collaborative partnership in which focus is given to animal-human interactions, including the issues of compassion fatigue and conflict management.

University counseling centers can also be invited to have greater presence during professional development seminars with veterinary students. This can help erode the stigma of students and professionals seeking mental health care when it is needed. The colleges of veterinary medicine at both Ohio State University and Colorado State University have taken proactive positions in providing resources and education to their students about mental health and self-care.

In addition to reaching out to veterinary programs to capture the attention of students, professional counselors might consider reaching out directly to veterinary professionals. The integration of tools to manage school-work-life balance should be incorporated at both the student and professional levels.

Moral stress and its associated challenges — compassion fatigue, burnout, depression and anxiety — can feel insurmountable to manage. Veterinarians are generally problem-solvers, analytical thinkers and high achievers. They tend to be task oriented and strive toward order. These characteristics certainly help veterinarians to be good at their jobs, but they do little to help these professionals remain good “in” their jobs. Although veterinarians are empathetic toward their patients, some may lean toward low self-awareness and struggle with understanding or dealing with their own emotions. Incorporating opportunities to promote emotional intelligence during veterinary programs and professional development trainings can help these professionals to become more aware of their emotions and the emotions of others, which in turn facilitates better management of themselves and their relationships with colleagues, staff members and patients’ owners.

Mental health professionals can assist veterinarians with increasing awareness of their emotional reactivity and help them take a more proactive approach to self-understanding and emotion regulation. Daniel Goleman popularized the psychological theory of emotional intelligence and its five components: self-awareness, self-regulation, internal motivation, empathy, and social skills. These components can easily be assimilated into training and wellness interventions. Emotional intelligence enhances the individual’s ability to reroute their thinking, allowing them to move away from their initial emotional response to situations (including avoidance) and toward more action-based reasoning.

Many times, veterinarians with a history of suicidal thoughts or behaviors do not talk about or share their experiences with anyone because they feel guilty or ashamed. Their silence may also be attributed to a fear that reaching out will affect their job, or simply to a feeling that they do not have time to seek help. Providing a space for group work, whether in person or virtually,  allows veterinarians to develop support networks. Kahler explains that group time presents veterinarians with a setting to talk about and debrief their experiences and memories together in an open, safe forum. When this group interaction occurs, the group members start making sense of their situations and learn that they are not isolated in their experiences.

One of the major stress factors for this group of professionals is their reported lack of time. Especially for those with busy schedules or those who work in rural areas, telemental health services may be a particularly attractive option.

In addition, bibliotherapy is a brief adjunct intervention that is helpful with a variety of psychological problems. It can be a resource for veterinary professionals with busy schedules or for those who work in locations far from traditional mental health offices. Bibliotherapy is used to increase clients’ understanding about what they are experiencing, and it promotes agency in their treatment. In their systematic review of the use of bibliotherapy in the treatment of depression, Maria Rosaria Gualano and colleagues explain that there is a self-help element to bibliotherapy. It teaches, through the reading of specific material, a number of strategies designed to regulate negative emotions and explains how to practice them in daily life. Bibliotherapy interventions are best used in conjunction with counseling. They can be used between counseling sessions to enhance clients’ commitment to working toward health and well-being.

Finally, mental health professionals can help by providing education, maintaining open opportunities for collaboration, and advocating with the veterinary field to promote well-being and reduce stigma around mental health issues and counseling.

Conclusions

The suicide rate among veterinary professionals is higher than that of other professional fields due to the unique responsibilities of veterinarians. Veterinarians, like other helping professionals, are at risk of giving too much of themselves to their patients and their patients’ families, their staffs, and their businesses and leaving little time for themselves because of their natural qualities of compassion, empathy and caring. A variety of stressors, starting during veterinarians’ programs of study, can lead to mental health issues over time.

On the basis of what we have learned, we believe that providing access to counselors and other mental health professionals could help veterinary students become more proactive in managing some of the emotional challenges they may face as they move through their programs of study. In addition, counselors working with veterinarians in the community can help these clients identify any unhealthy coping methods and provide opportunities for promoting resiliency and wellness. This may require offering strategies that extend beyond the counseling office because of the veterinary profession’s time demands.

Resources

Various resources are available to counselors working with these gifted healers and for veterinarians themselves.

The American Veterinary Medical Association (AVMA) lists several articles and resources for its members and for those who work as veterinarians. Among the areas highlighted under AVMA’s professional development dropdown menu at avma.org are well-being and peer assistance.

The University of Tennessee veterinary social work program provides referrals and resources to people in veterinary practice. The university’s S.A.V.E (Suicide Awareness in Veterinary Education) mental health education program, which was created to honor a colleague’s last wishes, has served as a model for mental health education in veterinary schools across the country (see vetsocialwork.utk.edu and vetmed.tennessee.edu/SAVE).

The National Suicide Hotline (suicidepreventionlifeline.org) provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, seven days a week.

 

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Christine Sacco-Bene is a licensed professional counselor and licensed mental health professional. She is an associate clinical professor in the Rehabilitation Counseling Department at the University of South Carolina. Over her 15 years as an educator, she has been an advocate for students and professionals in the field of counseling (and in all helping professions) to engage in self-care activities to support their mental well-being and professional growth. Contact her at christine.sacco-bene@uscmed.sc.edu.

Fay Roseman is an associate professor in the counseling program in the Adrian Dominican School of Education at Barry University in Florida, where she also served as the coordinator for practicum and internship. As a practitioner certified in the Myers-Briggs Type Indicator, she teaches career development and other courses in the master’s and doctoral programs. Contact her at froseman@barry.edu

 

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.

Generational divisions in the workplace: Where counselors come in

By Bethany Bray October 29, 2018

More than 1 in 3 American workers are part of the millennial generation, according to the Pew Research Center. This growing contingent of young professionals works alongside supervisors and co-workers who came of age when workplace dynamics were very different. These differences encompass everything from demographics to overall level of reliance on technology.

If left unaddressed, these dynamics can be a recipe for conflict and division, assert Carolyn Greer and Kimberly Key, who have co-presented on the topic of bridging the divisions in the modern workplace at ACA’s annual conference.

“The baton is not passing very well,” says Key, a licensed marriage and family therapist with a private practice in Austin, Texas. “It’s so systemic and vast and complex, with multiple factors that influence this [issue]. … There’s not just one factor.”

Millennials are “digital natives,” accustomed to internet connectivity and the flexibility afforded by the ability to video chat and send email at any time and to anywhere. The need for a 9-to-5 workday in which someone is physically in the office and at a desk can often seem needless or archaic to these younger professionals. Their older co-workers – baby boomers and members of Generation X – however, grew up in a world where the term “work-life balance” was nonexistent and many people stuck with one company or one career for their entire adult life.

“Not only was working from home not feasible a generation ago, it wouldn’t have been allowed. Expectations were very, very different,” says Greer, a retired licensed professional counselor, a longtime member of the American Counseling Association and a past president of the Texas Counseling Association. “That older worker, they set aside family and said, ‘It’s all about work.’ While millennials say, ‘It’s all about family, and work comes second.’ They opt to work from home and take personal time more often. There may be resentment from older co-workers, [who feel] ‘somebody has to hold down the fort!’ There are differences in expectations: What does it mean to go to work?”

Technology aside, modern workplaces look very different than they did a generation ago, in everything from dress code to the benchmarks used for promotion and advancement, notes Greer. At the same time, more and more women are attending college and joining the workforce, and the role of stay-at-home dad is not as unheard of as in decades past.

The Pew Research Center reports that the U.S. labor force is currently a varied mix of generations that even includes a small percentage of post-millennials, or those born after 1996. Baby boomers are slowly retiring, but a healthy share of the American workforce (25 percent in 2017) is still composed of those born during the post-World War II years (1946 to 1964). Roughly one-third of the labor force hails from Generation X, or those born after the baby boom but before the 1980s. Millennials, or those born between 1981 and 1997, have surpassed both generations in recent years to make up the largest percentage of American workers, according to Pew.

The divisions that can arise when generations with different expectations are working side by side is an issue that needs more attention and further discussion within the counseling profession, Key and Greer assert. The duo met through the National Employment Counseling Association, an ACA division in which they are both active. Key also offers training and consulting work on bridging family and work issues.

Key and Greer encourage counselor practitioners to seek professional development in this area, consult with colleagues and get involved in professional counseling organizations such as ACA and NECA. “This is a call to action: Take it to your local professionals, bring it up, talk about it, do research,” Key says.

 

Counselors as bridge builders

Counselors of all specialties – not just career counselors – should be aware of and sensitive to the generational divisions that can arise in today’s workplaces, say Key and Greer. Practitioners may see clients who present with anxiety and other issues related to generational breakdowns such as feeling overlooked, alienated or misunderstood.

There is potential for resentment to form when younger generations don’t follow “the old-school method of working hard and waiting to earn your promotion” that older workers may expect, Key explains. However, career planning and goal setting for younger generations is unlikely to follow the steady, stable and gradual trajectory toward retirement that older generations came to expect. Instead, they may change jobs and careers several times to fit their family and life choices.

“We’re not a one-career society anymore. Making room for other things is OK,” Key says. “It’s essential for counselors to know about these aspects to identify and treat the issue. … Meet [clients] where they are. Understand what is happening. Be open and tell them that this is a very far-reaching thing, a pervasive issue that can affect people both at work and at home. It’s a very real issue, and we have to work with them to find what our clients need.”

“This is all so complex and vast that people may not even realize they’re affected by it. Let them know that they’re not alone and that many people are going through this,” Key adds. “Address it, and recognize that we [counselors] have the tools to be peacemakers.”

Greer, an adjunct professor at Texas A&M University-Central Texas, says she talks about workplace issues in her introduction to family counseling classes. Just as there’s no one definition of “family” anymore, she tells her students, there’s also no one definition of “work.”

“There’s no more going to work and punching a clock for 40 hours. Now, maybe you work from home or do Skype meetings late at night with other time zones. The world has become so different,” Greer says. “We’re in this whole uncharted place. It’s not so simple anymore.”

 

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Related reading

On helping clients with workplace stress and conflict, from the Counseling Today archives:

 

ACA Divisions

  • The National Career Development Association (ncda.org)

 

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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.

 

Could toxic workplaces be killing your clients?

By Laurie Meyers September 27, 2018

Many American workers are overworked, exhausted and underpaid. Defying their biological clocks with shift work. Putting in 50-plus-hour workweeks and often juggling the work of two or more people — all under the eye of sometimes capricious management. Employees huddle together like Survivor contestants, hoping not to be voted off the island through layoffs, outsourcing or random termination. Employees also struggle to achieve work-life balance, hoping to leave work early enough to spend time with a spouse or partner, help their children with homework or take the dog for a walk. “Self-care” may consist of slumping on the couch, shades drawn, a six-pack or jumbo glass of wine at the ready, binging on Netflix. All while living paycheck to paycheck. And some experts say that it’s killing us.

The idea of work as a mortality risk may sound like an exaggeration, but research, particularly the work of Jeffrey Pfeffer, a professor of organizational behavior at Stanford University, suggests that the danger is all too real. His recently published book, Dying for a Paycheck, details his research on health effects often specific to work-related stressors such as unemployment and layoffs, the absence of health insurance, shift work, long working hours, job insecurity, work-family conflict, low job control, high job demands, low social support at work and low organizational fairness. Pfeffer’s conclusion: Stress caused by modern workplace conditions is sickening employees mentally and physically. Although the problem is global, Pfeffer’s research indicates that work is particularly toxic in the United States, where job stress costs employers more than $300 billion annually and may cause 120,000 deaths each year.

Pfeffer’s work is not the only research that reflects the unhealthiness of the American workplace. Mental Health America’s 2017 report “Mind the Workplace” detailed the results of the nonprofit’s Workplace Health Survey given to more than 17,000 employees across 19 industries in the United States. The survey showed that only 36 percent of employees felt that they could rely on supervisor support and only 34 percent felt supported by their colleagues. Respondents also felt underappreciated: 79 percent thought they were underpaid, and 44 percent reported that skilled employees were not given enough recognition. Survey participants cited this lack of support and appreciation for causing increased levels of employee disengagement and high rates of absenteeism (33 percent), work-family conflict (63 percent) and increased mental health and behavioral problems (63 percent).

The reality of the research is evident in the offices of many career and mental health counselors, where clients report struggling with heavy workloads, conflicts with managers and co-workers, poor work-life balance and general disengagement. Making the workplace less toxic will take systemic change, but in the meantime, counselors are helping their clients cope either by finding more compatible work environments or by better managing — or changing — their current positions. In addition, some counselors are helping employers build better, healthier workplaces.

Always working overtime

Over the course of her career, licensed professional counselor (LPC) Alicia Philipp, a former human resources professional who now specializes in career counseling, has seen a significant escalation in workplace stress. Overwork is one of the most common client complaints, she says. Not only are workplaces demanding more work from fewer staff, but many employees also are expected to respond to voicemail and email during off hours and on the weekend, says Philipp, whose practice is located in Atlanta.

“I think many consider the idea of using a time clock as confining, but sometimes I think we would all be better off if we could clock out from work daily and truly enjoy our free time,” she says.

In some workplaces, defining specific work hours — such as 9 to 6 — and not being available outside of those parameters is feasible, says Katie Playfair, an Oregon LPC who specializes in anxiety and career counseling. A set schedule works best if management and team members have similar schedules, she says. However, in an increasingly globalized marketplace, team members and contacts may be working on significantly different timelines.

Playfair, who also offers workplace consultations to employers, urges clients to set clear boundaries and to “talk process” with their employers. For example, an employee who was up until 1 a.m. working remotely with team members in Vietnam justifiably will not want to come into the office bright and early, but the employee cannot simply assume that it is OK to show up at noon without an explanation, she says.

“I would encourage them to email their boss at 1:15 a.m.: ‘The team in Hanoi was stuck on problem X until just now. I will be coming in around noon tomorrow. Also, I’ve asked them to communicate with me earlier on issues like this so that I’m not missing our 10 a.m. team meeting regularly,’” she says. “This message communicates: 1) I am not going to stay up until 1 a.m. working and come into the office at a regular time. 2) I understand I’m going to miss a meeting because of this decision. 3) I’ve attempted to prevent a situation like this from happening in the future.”

Playfair also encourages clients to set boundaries by letting their bosses and colleagues know how best to reach them after hours. For example, employees can let everyone know that after 6 p.m., they will be with their family and unavailable via email but will respond to a text or phone call in an emergency. A similar method can be used for weekends and vacations, she says. If employees intend to truly be unreachable, in addition to informing their colleagues, they should indicate their “away” status on voicemail and via email auto-respond messages.

In some cases, the pressure to overwork is indirect. Employees might overwork because that is how they achieved career advancement in the past, Philipp says. In other cases, bosses overwork, creating the perception (whether intentionally or unintentionally) that not staying late is a sign of slacking off or not doing a sufficient job, says American Counseling Association member Susan Grosoff-Feinblatt, an LPC who specializes in career counseling.

Overworking can also be a coping mechanism, she notes. By staying busy at work, clients can sufficiently distract themselves from job dissatisfaction or personal issues.

Restless and disengaged

Another common complaint from clients is a sense of disengagement. A variety of factors contribute to workplace dissatisfaction, but Philipp thinks that loss of control is the most significant cause. “Having a say in what and how things get done for the greater good of whatever purpose their work serves helps to make one’s work meaningful,” she says.

This lack of meaning and sense of powerlessness is happening in many professions, but over the past five years, a number of school teachers in particular have come to Philipp seeking help with feeling disengaged. “They want to teach, and many of them who have taught for years have seen huge changes in what is expected of them. It has taken them away from what they see as their role — engaging young minds in learning,” she says.

Some of the discouraged educators have left teaching altogether, whereas others found that changing schools allowed them to regain their sense of purpose. A few of the clients moved from teaching to administrative roles in hopes of making changes on a larger scale, Philipp says.

Grosoff-Feinblatt also works with clients whose jobs have undergone an uncomfortable change. For these employees, a promotion or shifting role responsibilities have left them feeling that they lack the skills and knowledge needed to perform their duties.

This skill misalignment can sometimes be solved by seeking another position, but technology is increasingly changing how specific jobs are performed. Employees who want to remain competitive in the workplace have to seek additional training, which is a daunting prospect for many. Grosoff-Feinblatt says that clients sometimes see any new technology as part of some vast, unknowable, futuristic landscape. Helping clients let go of that notion and instead focus on what they actually need to learn for their position can greatly reduce their anxiety, she says.

Seeking new opportunities

Personal conflict is another frequent cause of work dissatisfaction. Negative workplaces abound and, sometimes, changing jobs is the only answer, but Philipp believes that counselors should also help clients identify what exactly went wrong. Not only does this examination help clients process how the experience affected them, but it also helps them consider their response to the situation — and hopefully avoid replicating it.

“In changing jobs, they may be getting away from a bad situation, but it could be something they see again at a new employer, and recognizing the earlier problems and getting a grasp on a solution earlier can be helpful,” Philipp says.

Philipp teaches clients to use the interview process to better determine whether a different prospective work environment might be a good fit. “So many people go into an interview anxious about how to answer the interviewer’s questions, but to be really prepared for the interview, a candidate should have some of their own questions to ask to help them assess if the company is a good fit,” she says.

For example, if a counseling client left a previous job because co-workers were uncooperative or even engaged in workplace bullying, the person should ask the prospective employer about the team and work environment there. Is the work done in a collaborative environment or more independently? What is the turnover rate for the department? What is the team’s biggest challenge?

As clients examine what they didn’t like about a former workplace, they may also find that they could have reacted to the conflict more effectively, Philipp says. Counselors can help these clients work on developing better resolution skills so that they can respond differently in the future.

Philipp also uses career assessments for clients who are fleeing negative workplaces. The assessments can help determine whether their interests, personalities, values and abilities are in line with the type of work they have been doing. In some cases, the client might want to consider a different career. Career assessments can also help determine what kind of work environment is best for the client. 

Whether her clients are searching for a new career or just a new position, Philipp encourages them to become more involved with other people working in the field by expanding their networks through professional associations and LinkedIn. This enables clients to learn more about what is going on within their industry, including the kinds of workplace environments that different employers offer.

Building a better workplace

Playfair says that creating a healthy workplace is complicated and involves multiple factors. However, she has some definite ideas about how employers should start the process.

“It includes paying people enough so that they can meet their basic needs and not have to worry about food or shelter, minimally,” she says. “Offering benefits is wonderful, but know the limitations of your benefits packages. Having an EAP [employee assistance program] doesn’t mean it’s usable. Having ‘good’ health insurance on the medical side doesn’t mean your employees have access to a good network of mental health providers.”

Human resource professionals have to fully understand the benefits that a company offers and be proactive about helping employees take full advantage of those benefits, she continues. Ideally, employers should also allow flexible work schedules so that employees can access services that are available only during business hours.

“Above all, organizations need to be less conflict averse,” Playfair emphasizes. “They need to address abusive behavior, implement good, evidence-based management practices, broadcast compelling and cohesive visions for employees to rally around, and have real dialogues with their employees about how to achieve those visions. This means making it safe for employees to communicate their needs and for them to receive honest feedback from the employer about the feasibility of implementing their ideas and where their idea ranks [among] company priorities.”

Philipp is less convinced that better benefits are the answer, but she agrees that enfranchising employees is critical. “Many employers have made some great improvements to provide benefits to employees to help deal with stress by way of health and wellness programs,” she says. “While there are known benefits to employees participating in those, the better approach, I think, is for employers to make sure their employees’ work environment is optimal to avoiding stress to begin with. Open and regular communication, allowing employees to have a voice and see that their efforts are helping in some fashion, is essential to a healthy workplace. Some employers talk of doing this but don’t really follow through with that idea. Being given lots of free benefits may be nice, but at the heart of why we work [is that] we want our efforts to matter.”

 

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Additional resources

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

Counseling Today (ct.counseling.org)

Books (counseling.org/publications/bookstore)

  • A Counselors Guide to Career Assessment Instruments, sixth edition, edited by Chris Wood and Danica G. Hays
  • Postmodern Career Counseling: A Handbook of Culture, Context and Cases, edited by Louis A. Busacca and Mark C. Rehfuss
  • Career Counseling: Holism, Diversity and Strengths, fourth edition, by Norman C. Gysbers, Mary J. Heppner and Joseph A. Johnston

Podcasts (aca.digitellinc.com/aca/store/5#cat14)

  • “Career Errors” presented by Frank Burtnett (ACA261)

ACA Divisions

  • National Career Development Association (ncda.org)

NCDA provides professional development, publications, standards and advocacy to practitioners and educators who inspire and empower individuals to achieve their career and life goals.

NECA was founded in 1966 to implement solid and practical interventions to enhance employability and long-term employment.

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@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.

Identifying colors to create a rainbow of cohesion in the workplace for helping professionals

By Jetaun Bailey and Bryan Gere September 7, 2018

The idea for this piece came about when I (Jetaun Bailey) was pursuing my master’s degree in counseling. I recall my professor stating clearly that burnout occurs often among helping professionals and that the average stay for a counselor employed at a mental health facility is two years.

As one of my assignments, I completed and presented a paper on ways for helping professionals to avoid burnout. However, not once in my presentation did I illustrate ways that the workplace could employ preventive services to combat burnout. At the time, my focus was on using self-care and, ultimately, I received a grade of 100 on that project. However, in reflecting on my counseling career, I realized that workplace training programs overlook helping professionals by not addressing topics related to the complex workplace dynamics that may contribute to burnout, which is likely to increase, because the demands in the counseling profession can be overwhelming.

According to Amanda Stemen’s 2014 article, “Burnout: Who’s taking care of the care takers?” management in the helping professions focuses more on clients than on employees. Many factors are related to burnout. Low salaries are one contributing factor but not the most significant. Many of us who enter the helping professions, counseling in particular, understand that we are not pursuing a lucrative career. However, lack of managerial support is believed to be a significant factor in burnout. This lack of support isn’t necessarily intentional; it is thought that many in management believe that helping professionals have innate abilities to solve their work-related problems. However, in many cases, counselors work in isolation, without support from management and peers, and know its effects.

Thus, management’s support is critical in reducing burnout among helping professionals. In speaking with Terra Griffin, a manager at an acute behavioral hospital unit for children and adolescents, she revealed that the turnover in the unit was among the highest in the hospital. Such high employee turnover costs organizations time and productivity. One of the staff’s chief complaints was management’s failure to provide them with relevant training to meet the demands of the job and promote workplace cohesion, which had led to many problems within the teams.

Stemen’s article suggested the need for professional development in addressing burnout. She reports that providing professional development opportunities customized to employees’ interests encourages growth that benefits both the individual employee and the organization.

 

Mind-mapping

One professional development approach is to employ mind-mapping concepts. This is accomplished by creating a specific topic or question so that each person in the training session can see other points of view rather than just his or her own. This nonintrusive approach facilitates group cohesion. Researcher Tony Buzan, the author of Use Your Head, developed the mind-mapping concept in the 1970s. It is designed to facilitate the sharing of ideas and concepts to solve problems.

Through observation, Griffin employed this concept in a series of training sessions simply by asking employees in a unit where turnover had been problematic a simple question: “What is your favorite color?” Initially, the employees did not seem eager to participate in the training session. Remarkably, however, when Griffin focused the initial session on that single question, changes in body language occurred among the staff immediately, as if thinking about their favorite colors had some sort of healing effect. Afterward, they were eager to share their favorite colors and the ways they identified with those colors personally.

Interestingly, although employees weren’t given information about the psychological meaning of each color ahead of time, they ended up describing them similarly to how they were presented on Griffin’s color chart. Furthermore, they could identify their similarities and differences in relation to their multiple colors. This helped shed light on some of the difficulties the employees faced in creating a more cohesive work environment.

Three therapeutic teams were present at each training session, each of which was composed of two therapists, one psychiatrist, several nurses and several behavioral specialists. During their self-exploration of the colors, Team 2 realized that many of its members shared the same favorite color, red, while the two therapists identified with blue. Incidentally, of the three groups, Team 2 was confronting the most difficulties. Many of the team members who identified with red were having difficulties sharing leadership responsibilities and were disregarding the leadership authority of the two therapists who identified, unconsciously, with blue. Once members of Team 2 were able to understand their difficulties, they began to discuss ways that their team could work more cohesively. As a result, Team 2 set team goals, with respecting one another identified as the top priority.

Instead of asking employees direct questions about their workplace problems, this exercise of looking at their favorite colors appeared to be a nonintrusive method that encouraged employees to share their differences. Griffin’s simple question elicited many answers with respect to therapeutic problems occurring in this workplace of helping professionals, and thus promoted resolutions to some stressful issues.

 

The psychology of color

Intrigued with the feedback from the staff during these sessions as they compared their favorite colors to their personalities with respect to their workplace relationships, we set forth to emulate this training. Ultimately, we implemented a similar version in a group of training sessions for graduate students who would be entering the helping profession as practicum and internship students. Their feedback and interactions were outstanding. We learned much about our students that we had not known, and this helped us revamp our practicum and internship training program for students and site supervisors.

As a result, we set out to explore how many nonintrusive, evidence-based training programs of this nature were available. We conducted a content analysis of evidence-based studies on the psychology of color. We also sought to determine the extent to which such training materials are designed to facilitate workplace cohesion among helping professionals.

Using the American Psychological Association (APA) database and electronic resources, we searched APA PsycNET, PsycINFO and PsycARTICLES from their inception through 2018. Furthermore, we used the Google Scholar search engine. The search phrases we used were “evidence-based practices on color psychology” and “training curriculum on color psychology.” The criterion for inclusion for review was that the title contained the search phrase; studies that did not meet the criterion were excluded.

After completing the content analysis, we could not find a single evidence-based study on color psychology or training curriculum related to the topic. We also were unable to determine the extent to which such training curricula facilitated workplace cohesion among helping professionals. There appears to be a significant gap in the literature pertaining to the actual use of color psychology in the facilitation of workplace cohesion in human services or among helping professionals. We did not find any specific evidence-based studies that provided empirical information on training materials on the subject that lead to workplace cohesion. The absence of this information reflects the extent to which the topic is largely unexplored and illustrates what little recognition it is accorded.

In “Colors and trust: The influence of user interface design on trust and reciprocity,” Florian Hawlitschek and colleagues indicate that the literature available on the psychology of color suggests that color preferences associated with personality influence interaction patterns in the employment setting. This illustrates that understanding the role that color preferences play in group behaviors and settings is critical to interprofessional collaborations, especially among helping professionals. Furthermore, other literature has suggested that colors have individual meanings based on a person’s cultural background or racial and ethnic group. Therefore, the influences of color should be interpreted with caution.

However, what made this training so unique is that Griffin did not use any assessment tools to determine anyone’s colors. Instead, she asked each person his or her favorite color and thus gave life to their individuality based on their cultural or racial and ethnic backgrounds without probing for any specific details (colors hold a universal meaning of harmony in many cultures). This mind-mapping technique seemed beneficial. Griffin’s leadership played an important role in helping the employees navigate through their favorite colors by connecting to their personalities and the way they fit within the scheme of their work productivity to create or disrupt cohesion.

 

Conclusion

As the dynamism within health and human service delivery creates more interdependencies, there is a growing need for professionals to collaborate to achieve better client outcomes. However, there is little information on the role that the characteristics of interdisciplinary teams play in promoting synergy that influences such outcomes.

Shared values, mutual respect for colleagues’ expertise, and patient-oriented goals and outcomes are reflections not only of the diverse interests and asymmetry of power of the various partners in care, but also differences in their personalities and preferences. Therefore, fostering workplace cooperation and cohesion is essential for effective, competent, cost-effective, culturally responsive and comprehensive service delivery.

Creating mind-mapping trainings designed to honor individual uniqueness, such as the identification of favorite colors, can help us achieve such cohesion. These trainings draw us into companionship where we can evaluate our similarities and differences through our individual uniqueness, thus creating a meaningful and purposeful work environment for helping professionals and the clients they serve.

 

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Jetaun Bailey is an assistant professor at Alabama A&M University, where she serves as director of clinical training. Contact Jetaun at jetaun.bailey@aamu.edu or baileyjetaun@hotmail.com.

 

Bryan Gere is an assistant professor at Alabama A&M University, where he serves as coordinator of clinical training in rehabilitation counseling. Contact Bryan at bryan.gere@aamu.edu.

 

Terra Griffin, a licensed professional counselor supervisor with more than 15 years of experience in counseling management, supervision and training, contributed to this article.

 

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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.

Living with anxiety

By Bethany Bray May 24, 2017

Anxiety disorders are the most common mental illness in the United States, affecting 18 percent of the adult population, or more than 40 million people, according to the National Institutes of Health. Among adolescents the prevalence is even higher: 25 percent of youth ages 13 to 18 live with some type of anxiety disorder.

Anxiety disorders are often coupled with sleeplessness, depression, panic attacks, racing thoughts, headaches or other physical issues. Anxiety can run in families and be a lifelong challenge that spills over into all facets of life, from relationships and parenting to the workplace.

The good news is that anxiety disorders are manageable, and counselors have a plethora of tools to help clients lessen the impact of anxiety. Caitlyn McKinzie Bennett, a licensed mental health counselor, says she regularly talks this through with her clients at her private practice in Orlando, Florida. She often uses an analogy of ocean waves with clients: Anxiety comes in waves, and managing the disorder means learning coping tools and strategies to help surf those waves rather than expecting the waves to disappear entirely.

“Anxiety can be a long-term thing,” says Bennett, who is also a doctoral student in counselor education at the University of Central Florida. “With clients, I try and explain that [anxiety] is the body’s response that something’s not right — based off of what’s happened to you [such as past trauma] or what’s happening currently. Then we can work to accept it, cope and be happier in your life. Some things you can’t necessarily get rid of in their entirety, and that’s OK. It’s learning to be you and have a fulfilling life with anxiety, where you’re able to feel anxious and [still] be productive and be a mother, a student, a partner. I try and normalize that [anxiety is] going to come and go. It’s OK, and it’s human.”

Anxiety doesn’t happen in isolation

Everyone experiences anxiety from time to time, such as worry over an upcoming work responsibility, school exam or first date. Anxiety disorders, however, are marked by worry and racing thoughts that become debilitating and interfere with everyday functioning.

“It’s a normal part of life to experience occasional anxiety,” writes the Anxiety and Depression Association of America on its website (ADAA.org). “But you may experience anxiety that is persistent, seemingly uncontrollable and overwhelming. If it’s an excessive, irrational dread of everyday situations, it can be disabling. When anxiety interferes with daily activities, you may have an anxiety disorder.”

A number of related issues fall under the heading of anxiety disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), including specific phobia, panic disorder, separation anxiety disorder, social anxiety disorder, generalized anxiety disorder and others. According to the DSM-5, anxiety disorders “include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat.”

Racing thoughts, rumination and overthinking possibilities — from social interactions to decision-making — are central to anxiety. In addition, people with anxiety often struggle with insomnia or sleeplessness and physical symptoms such as a racing heart, sweaty palms and headaches, says Bennett, an American Counseling Association member who is currently leading a study for her doctoral dissertation on the effects of neurofeedback training on college students with anxiety. Adolescents sometimes turn to self-harming behaviors such as cutting or hair pulling to cope with anxiety. In adults and adolescents, anxiety can manifest in physiological issues such as stomachaches or irritable bowel syndrome. Although adults may channel their anxiety into physical problems, they’re also generally much more capable than adolescents and children of identifying and articulating the anxious thoughts, ruminations and social struggles that they’re facing, Bennett says.

Bennett worked with a 14-year-old female client whose anxiety had manifested as the behaviors of obsessive-compulsive disorder (OCD), including avoiding the number six, leaving her closet door open a certain way and struggling with crossing thresholds. Bennett worked with the client to identify her triggers and find coping mechanisms, such as connecting with friends and her Christian faith.

“A big part of her improvement was creating the awareness of what was happening,” Bennett says. “Typically there’s a large, irrational fear. With her, she was afraid that her mom was going to die. She would focus on it so much that it would cause her to start the [OCD] behavior. … For her, it felt so real. It was so scary for her that she felt compelled to do these behaviors to keep her mom alive, so to speak.”

Bennett worked with the young client to confront her fears in small doses through exposure therapy, such as listening to a song at volume level six and talking through how she felt afterward. This method allowed Bennett to first address the client’s OCD behaviors and then — once trust was built and the client had progressed — move on to work through the bigger, deeper issue of her fear of her mother’s death.

“It helped her to feel safe enough and have the confidence to work through some smaller things and move on to work on bigger things,” Bennett says. “For her it was talking it out, normalizing that for her and drawing attention to [her anxious behaviors].”

Christopher Pisarik is an associate professor in the Division of Academic Enhancement at the University of Georgia and a licensed professional counselor (LPC) who works with students in need of academic support. He says that stress and irregular sleep and eating patterns — which are often ubiquitous parts of college life — can go hand in hand with anxiety.

“Sleep is a big one — if they’re just not sleeping, or sleeping too much,” says Pisarik, who also treats many college-age clients at his private practice in Athens, Georgia. “This is really, really common — clients who can’t get to bed until 4 a.m., and then they can’t get to class, and it snowballs. Their thoughts just race with worry. … Sleep seems to be a big diagnostic indicator [for anxiety], and not being able to go to bed. [I ask clients,] ‘What are you thinking about, and can you stop thinking about this? Is that what’s keeping you from getting back to sleep?’ They get tired and fatigued, and it’s perpetuated.”

In addition, anxiety is often coupled with — or is an outgrowth of — other mental illnesses, most commonly depression. Counselors will need to treat a client’s anxiety alongside other diagnoses, Bennett says. For example, a client with schizophrenia will have hallucinations that provoke extreme anxiety. If the counselor doesn’t address the client’s anxiety, those symptoms will get worse, explains Bennett.

“Depression and anxiety are like brother and sister,” she adds. “They play off of each other and exacerbate the symptoms. You need to work through both. I don’t think I’ve ever worked with anyone who solely experienced anxiety.”

Stephanie Kuhn, an ACA member and LPC at the Anxiety Treatment Center of Greater Chicago, agrees. She regularly sees client anxiety paired with other issues such as specific phobias, insomnia, chronic pain issues, depression, panic disorders and OCD.

“It’s never really one thing,” Kuhn says. “It’s never just anxiety.”

Pumping the brakes on racing thoughts

The first step for many people who struggle with anxiety is to create awareness of their thoughts and then learn to manage those thoughts with a counselor’s help. Although the strategy of identifying negative self-talk and addressing one’s thoughts is old hat to most counselors, it may be an entirely new concept for some people, especially younger clients, says Pisarik, an ACA member who uses cognitive behavior therapy (CBT) in his private practice. Clients with anxiety often polarize, exaggerate or catastrophize details in their minds as they ruminate over them, he explains.

“Even being able to identify anxious thoughts is big,” Pisarik says. “They just assume it’s normal to walk around [feeling] anxious because of these thoughts. … It gives them a language and a real usable and rudimentary skill they can use in the moment when they’re walking in [to a stressful exam]. They can identify that their inner narrative isn’t healthy.”

For example, a college student might come to a counselor expressing worry about an upcoming exam in a class that he or she needs to pass for a major in pre-med. The student might have allowed negative and catastrophic thoughts to snowball: “If I get a C on this test, I will never get into medical school, which will derail my entire career plan and make my parents angry and disappointed.”

“For … a student who is 20 years old and [still] learning to think critically, it would be easy to blow everything out of proportion and catastrophize everything,” Pisarik says. “I am really big on helping them understand negative thinking and false cognitions, and getting them to self-monitor and renarrate [their unhealthy thoughts].”

Following the CBT approach, Pisarik says he would talk such clients through their thought patterns to identify and restructure their negative thoughts about the exam. He would also suggest that they focus on and remind themselves of prior successes, such as other exams or classes in which they earned A’s and B’s.

“I would try and systematically educate the client [about] what type of thinking that is,” Pisarik continues. “There are many doctors out there who got C’s and got into medical school, and probably [who] got C’s in medical school. I will explain that they are catastrophizing this … [and] try and get them to think about it in a different way, evaluate it carefully and create a different narrative about it. Are there people who have gotten C’s and gotten into medical school? If it stops you from getting into medical school, would that be the worst thing in the world?”

“It takes a consistent effort to practice and challenge one’s thinking,” adds Pisarik, who co-authored the article “A Phenomenological Study of Career Anxiety Among College Students.” The article will be published in the December issue of The Career Development Quarterly, the journal of the National Career Development Association, a division of ACA.

CBT works well for anxiety because “it lets people see that their own thinking and their behaviors are not productive for the way they want to live or the life they’re living right now,” says Kuhn, who uses both CBT and exposure therapy with her clients at the Anxiety Treatment Center of Greater Chicago. “It’s giving people an outside perspective — getting them to look at their own thoughts and behaviors objectively rather than letting those anxious thoughts take over everything, making it harder to function.”

One way Kuhn works with clients on challenging their unhealthy thoughts is by asking them to identify the best, worst and most likely outcomes of situations they are ruminating over. “I ask, ‘Would [the outcome] matter in a week, a month or a year from now?’ Typically the answer is no,” Kuhn says. “After we go through that, we reframe the original thought [and] transform it into something more rational, more realistic.”

Both Pisarik and Kuhn encourage their clients to keep thought logs to track anxious thoughts and the situations that triggered them. This exercise increases self-awareness, helps identify triggers and creates an opportunity to discuss how the client might change the negative narrative.

“Writing helps a lot because it slows people’s minds down, and they can go back and read about it,” Kuhn says. “Creating that awareness is the only way to understand yourself, understand what you’re worried about and be able to accept it and push it away.”

In addition to using thought logs, Pisarik gives his clients a list of automatic negative thoughts, or ANTs, to check themselves against. The collection lists the most common types of unhealthy, anxious thoughts and types of thinking, including catastrophizing and either-or thinking (polarizing).

Kuhn has a particular phrase that she often repeats with clients: “Handle it.” She acknowledges that it’s not the most empathic of mantras, but it does help to focus on the manageability of anxiety. With clients, she works toward a goal of “being able to sit with the uncomfortableness [of anxious thoughts] and tolerate the stress.”

Kuhn says her style when working with clients matches her personality: “Let’s go forward and hit our fears hard instead of tiptoeing around them.”

Exposure therapy, which introduces things in small, controlled increments in session that make a client anxious, is another good way to focus on handling anxiety, Kuhn adds. Whether the scenario is a fear of speaking up in class or a fear of being rejected by a loved one, exposure therapy can help clients learn to live with the issue and the anxious feelings that come with it.

“When I talk to people about ‘handling it,’ it’s creating that awareness and understanding [of] themselves that they’re able to manage or take on more than they think they can,” Kuhn says. “Anxiety a lot of the time makes us believe that we can’t handle the tiniest things. That’s why our body has created or learned how to respond to things in an overactive or hypersensitive way.” This is most commonly experienced in our fight-or-flight response, she says.

Managing worry and taming anxiety

From CBT and mindfulness to a focus on wellness and coping strategies, professional counselors have a wide range of tools to help clients who struggle with anxiety. Here are some ideas and techniques that can be particularly useful.

> Controlling the controllables. Kuhn says it can be helpful for clients to talk through and identify what is out of their control during situations that make them anxious. “A lot of times, anxious clients want control over everything, and that’s just not realistic,” Kuhn says. “It’s important to go over what’s controllable and what’s not. That creates awareness and a pathway to reevaluate [their] own thinking and behavior. I like to call it ‘controlling the controllables.’ I talk with clients about this a lot.”

Kuhn often uses an exercise with clients in which she draws a target with concentric circles. Things that clients can control, such as their own thoughts and behaviors, go in the center circle. Things that they partially control, such as their emotions or what they focus on sometimes, go in the middle ring. Things that are out of their control, such as what other people think or do, go in the outside circle. In a simpler alternative, Kuhn draws a center line down a piece of paper and works with clients to list what is and isn’t in their control in situations that make them anxious.

> Creating common ground. Kuhn says she also talks openly with clients about how common anxiety is, alerting them that they are among literally millions of Americans who are battling the same challenge. “I let them know they are not alone. It creates a universality,” Kuhn says. “To let people know that they’re not the only ones suffering like this can help. … It does create a common ground for people not to feel ashamed of [their anxiety] or feel like they can’t talk to someone about it. Just creating that education typically makes people feel a ton better.”

> Acknowledging and naming worry. Journaling and making lists to document anxious thoughts can help clients address and reframe the everyday rumination that accompanies anxiety. Kuhn offers two variations on this intervention: worry time and the worry tree.

With “worry time,” clients set aside a dedicated amount of time (Kuhn suggests 30 minutes) every day to write down any anxious thoughts that are troubling them. Clients don’t need to engage in long-form writing to complete this exercise, Kuhn says. Making a bulleted list or jotting thoughts down on sticky notes will work just as well. When the designated time is up, clients put all the notes in a box or container that they have set aside for this purpose. This action signifies that they are leaving those thoughts behind and can move on with the day.

“They have to leave those thoughts or sticky notes there and be done with them,” she says. “Obviously more [anxious] thoughts will come, but you have to remind yourself to leave them behind.”

With Kuhn’s “worry tree” intervention, clients create a flowchart of their anxious thoughts. With each item, clients ask themselves whether their worry is productive or unproductive (see image, below). “Is it something that you can actually do something about?” Kuhn asks. “If it’s unproductive, then you need to just let it go. Do something you enjoy or focus on something else to reset [your mind].”

 

> Mind-body focus and exercise. Mindfulness, meditation and other calming interventions can be particularly helpful for clients with anxiety. Kuhn recommends the smartphone app Pacifica, which prompts users with breathing, relaxation and mindfulness exercises, for both practitioners and clients. Kuhn, who has a background in sports counseling, and Pisarik, who is a runner himself, also prescribe exercise to anxious clients. Exercise boosts serotonin, a neurotransmitter connected to feelings of well-being, and comes with a host of other wellness benefits. In addition, exercise allows a person to get outdoors or disengage from work and home activities and other people for a brief period to “have time to hear your thoughts and challenge them,” Pisarik says. “You have to hear your thoughts if you’re going to challenge them.”

> The butterfly hug. Beth Patterson, an ACA member and LPC with a private practice in Denver, teaches deep breathing exercises to anxious clients to help them become grounded, focusing on the flow of energy through the body. She also recommends the “butterfly hug” technique. With this technique, clients cross their arms across their chests, just below the collarbone, with both feet planted firmly on the floor.

Clients tap themselves gently, alternating between their right and left hands. This motion introduces bilateral stimulation, the rhythmic left-right patterns that are used in eye movement desensitization and reprocessing. “It’s phenomenally self-soothing,” Patterson says. “Doing that with deep breathing really helps with anxiety. I love the idea that you’re hugging yourself. Even just doing that helps.”

> Walk it out. Along with deep breathing and grounding, Patterson also recommends walking and movement for clients who are feeling anxious. She instructs clients to focus on the feeling of each foot hitting the ground instead of their anxious thoughts. As with the butterfly hug, this action creates bilateral stimulation, Patterson notes.

Bennett also uses walking as a way to help clients refocus their thoughts. She will take clients out of the office during a session for a “mindful walk” up and down the block. During the walk, they talk about what they’re sensing, from the sunshine to the breeze to the smell of flowers. Bennett says this allows her to work with clients “in the moment,” recognizing and refocusing anxious thoughts as they come. Afterward, they process and talk through the experience back in the office.

“It’s a lesson that [anxious] thoughts are going to come up for you, and you can refocus on your sense of touch or hearing,” Bennett says. “Thoughts will come up, and it’s really easy to attach to those thoughts and become anxious, but we can acknowledge the thought, be accepting of it in the moment and refocus. Change and connection can come that way.”

> This is not that. Clients commonly transfer anxiety-provoking personal issues onto relationships or situations in other facets of life, including the workplace, Patterson says. For example, Patterson worked with a client who had a very domineering, controlling mother, and this client felt triggered by a female boss in her workplace. Patterson introduced the client to the mantra “this is not that,” and they worked on reframing the anxiety the client experienced when she felt her boss was being controlling.

“She had to work through it in a beneficial and compassionate way for herself and really remember ‘this is not that,’” Patterson says. “Our minds are brilliant, but they’re binary computers. When something happens, it will immediately associate it with something else it knows. If a co-worker is being overly competitive, it might trigger feelings about sibling rivalry. This [mantra] offers a great opportunity to work through family-of-origin issues [with clients] when you see them replicated in the workplace.”

> Abstain from negativity. Another empowering tool clients can use is to become conscious of and then avoid unhealthy or toxic situations and people who trigger their anxiety, Pisarik says. He advises clients to “stay away from groups of people or individuals who they know will engage in negative self-talk or negativity. If you’re feeling anxious already, the last thing you want to do is to go and talk to that toxic person.”

Similarly, he commonly advises anxious students to avoid waiting outside the room where they’re about to take a big exam, surrounded by 30 classmates who might be saying that they are going to fail, they didn’t study enough, they don’t feel prepared and so on. Counselors can coach anxious clients to think ahead and prepare ways to remove themselves from these types of situations, regroup and redirect their thinking, Pisarik says.

> Lifestyle choices. Counselors can also educate clients on the connection between anxiety and lifestyle choices such as sleep patterns, exercise and diet, Pisarik says. For young clients especially, this also includes social media use, he notes.

Pisarik says he frequently talks with his college-age clients about their alcohol consumption, drug use, irregular diet and other aspects of the modern university experience. “The lifestyle of a college student is absolutely conducive to generating anxiety,” he says. “While they are college students, I get that — their job is to have fun and sleep whenever [they] want. But building some sort of healthy routine is important, [including] getting enough sleep and making sure they eat well. I tell them to try and maintain the diet they had at home. … If you’re struggling with anxiety to begin with, any one of those [elements] can add to it, and those are really easy fixes.”

For Bennett, conversations with clients about lifestyle also include questions about smoking and caffeine use. Both tobacco and caffeine can make a person shaky or make his or her heart and mind race, which can trigger or exacerbate anxiety, she points out.

In addition to social media use, Pisarik also asks clients about their social engagement, such as participating in sports or other hobbies. Clients who struggle with anxiety often isolate themselves, he notes, so he works with them to identify social outlets, from volunteering to joining a school club. This sense of connection can reduce anxiety, he says.

> Narrative therapy and externalization. Patterson finds narrative therapy helpful when working with clients with anxiety because it allows them to externalize what they’re feeling. When clients uses phrases such as “I am worried” or “I am anxious,” Patterson will gently redirect them by saying, “No, you’re Susan, and you have a problem called worry.”

“Externalize the problem,” Patterson explains to clients. “Externalize it and dis-identify it. See it outside of yourself. … ‘I can deal with that because it’s not who I am.’ … If you’re carrying it around as if it’s you, you can’t do anything about it. The truth of the matter is, it’s not you.”

Counselors can also help clients with anxiety to focus on a time in their lives when they faced a similar challenge and got through it, Patterson says. She asks clients questions to help them probe deeper. For example: How did you handle that challenge? What worked, and what didn’t work?

 

Working with clients on medication

Anti-anxiety medications are commonly prescribed in the United States. Their prevalence means that counselors are likely to encounter clients who are taking medication to control their anxiety symptoms.

Regardless of their feelings about the use of psychotropic medications, practitioners must treat and support clients who are taking such medications the same as they would any other client, Kuhn says. “I never treat someone differently based on their medication. They get the same CBT therapy that anyone else would get,” she says, adding that the most important thing is to ensure that clients don’t feel judged by the counselor.

Kuhn has seen anti-anxiety medications work well for some clients. “It can take that little edge off that they need to get through the day and be able to function,” she says. At the same time, she also has clients who express a desire to be able to stop taking their medication eventually.

Pisarik notes that for anti-anxiety medication to work well, clients must remember to take it faithfully, keep track of how it makes them feel and schedule the repeated appointments needed to monitor and adjust dosage levels. Each of these elements can pose a challenge to college-age clients. “It’s a lot of work, and [college students] often lack the discipline and time to get it right,” Pisarik says.

Bennett agrees, suggesting that even though professional counselors are not the ones prescribing medications, they still need to discuss and explore medication use with their clients. She also stresses that practitioners should be knowledgeable about the different kinds of medications that clients may be taking and their possible side effects.

Bennett sometimes conducts conference calls with her clients and the medical professionals who are prescribing them medications so that she can help clients ask questions and otherwise be a support to them. “We [counselors] don’t prescribe, but at the same time it’s very important to collaborate with whoever is prescribing the [client’s] medication,” she says. “Be supportive and involve the client in conversations: How long have you taken it? Have you noticed any side effects? Has it been helping? Talk about how often they’re supposed to take it and if they’re adhering to that. There can be stigma about taking medications, so it’s important to normalize it. … It’s comforting too for the client to know that you’re on their side, and part of that is collaboration [about medication].”

 

See the person, not the anxiety

Given how common anxiety disorders are, it’s likely that any counselor’s caseload will be filled with clients presenting with symptoms of anxiety. It is important, however, for counselors to treat each client as an individual and to tailor the therapeutic approach to meet that client’s unique needs, Bennett emphasizes.

Building trust and a healthy therapeutic relationship are key in treating anxiety because clients can feel very vulnerable as they talk about what makes them anxious, Bennett points out. That is why it is critical to get to know these clients as individuals rather than through the lens of their anxiety.

“Don’t assume that because they’re anxious, they’re going to think and behave like other people with anxiety,” Bennett says. “Meet them where they are and find out what’s most effective for them based off of their interests. It can be empowering for clients to integrate their own interests and life experiences into the therapeutic process. Not only does this create buy-in for the client, but it can also help in creating a safe space to begin exploring the vulnerabilities that come along with anxiety. … Hear their story, find their strengths and give them a voice in the process. It’s important to honor them as individuals.”

 

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To contact the counselors interviewed for this article, email:

 

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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.