Tag Archives: workplace stress

Putting first responders’ mental health on the front lines

By Lindsey Phillips July 6, 2020

A firefighter/emergency medical technician (EMT) in Maine answers an emergency call. He grabs his gear and performs a job he knows well. The next day, he discovers that the person he helped has tested positive for COVID-19. He immediately starts worrying not just about himself but about his wife and young child, who have respiratory issues.

Amy Davenport Dakin, a licensed clinical professional counselor in Maine and a licensed clinical mental health counselor in New Hampshire, has been working with this firefighter/EMT for several years now. Before this incident, he had struggled with anxiety, depression, suicidality and posttraumatic stress disorder (PTSD), but with Dakin’s help, had successfully worked through many of these issues. This latest experience of being exposed to the virus that causes COVID-19 adds another layer of stress and anxiety that could negate his previous progress, Dakin says.

As the name implies, first responders such as EMTs, police officers, firefighters, paramedics, dispatchers and others are trained professionals who are the first to respond in emergency situations. Unless people happen to be facing an emergency themselves, this service often gets taken for granted, and little thought is generally paid to the accumulating toll on first responders’ mental health.

That calls for a reality check. “Our worst day is first responders’ every day,” points out Drew Prochniak, a licensed professional counselor (LPC) and licensed mental health counselor (LMHC) in private practice in Portland, Oregon. “Their days are filled with accidents, pain, grief, loss and trauma.”

According to a 2018 supplemental research bulletin from the Substance Abuse and Mental Health Services Administration’s Disaster Technical Assistance Center, depression and PTSD affect approximately 30% of first responders. In addition, 37% of fire and emergency medical services professionals have contemplated suicide, which is nearly 10 times the rate of American adults in general. In fact, in the United States, more firefighters die from suicide than from fires, Dakin notes.

It is easy to surmise that this population could benefit from therapeutic interventions, yet its members are often the last to ask for help. By getting to know the first responder community and tailoring approaches to match this population, counselors can break down some of the barriers that prevent these heroes from prioritizing their mental health.

 

Getting to know the culture

Dakin, a member of the American Counseling Association, acknowledges that it can be difficult for counselors who do not have previous experience with first responders to get a foot in the door with the community. Someone initially referred a firefighter to Dakin for counseling services, and the experience piqued her interest in working more with first responders. But first she had to earn their trust.

For approximately seven years, she attended labor union meetings, conducted trainings and presentations, rode along with first responders on calls, and hung out at their stations. This exposure allowed her to build relationships and trust within the first responder community and helped her determine that it was a population with which she wanted to work full time. Today she owns New Perceptions Inc. in Kingston, New Hampshire, a private practice that focuses on trauma and mental help treatment for first responders.

Prochniak, a former search and rescue professional and author of the book Addiction & Recovery for First Responders, agrees that establishing a relationship with a first responder department or agency is an important step toward overcoming community members’ belief that clinicians don’t understand their culture. “There’s this mystique about clinicians that we only want to talk about emotions and get in people’s heads,” Prochniak says. Building relationships with first responders outside of counseling sessions will show them that therapists are just regular people too, he says.

Prochniak, who specializes in the education, training and treatment of first responders, says there is a personality type that goes along with being a clinician who works with this population. Counselors must be able to handle hearing about grotesque experiences and communicate respect for the work that first responders do, he explains. With clients in law enforcement, this often means that counselors must be comfortable with clients having guns in session, he adds.

Prochniak cautions counselors against asking first responders about the worst thing they have seen, what type of gun they carry or whether they have ever shot someone. Instead, counselors should be curious about them as people: How long have they done this work? What led them to get into this line of work? How does their work affect their family? What kind of social network do they have? Do they hang out only with people from the first responder community? What else do they do outside of work?

Counselors will also need to be able to tolerate a dark, almost morbid, sense of humor because first responders often use that as a coping mechanism. “One of the ways we cope with trauma is with humor. And it can be really upsetting for people who don’t experience [what first responders do],” notes Carrie Whittaker, an LPC and LMHC in New York and Connecticut.

Prochniak points out that counselors must also be savvy about managing dual relationships. In addition to being a clinician in private practice, he is also a trainer and educator. At the start of every new client relationship with a first responder, he prepares them for the possibility of also bumping into him at trainings, briefings, meetings or ride-alongs. He makes it clear to these clients that he will not initiate acknowledgment of them in such circumstances out of respect for their confidentiality. “One wrong slip in acknowledging that you see someone [in counseling] or that you know someone else could cost you a client,” he explains.

In addition, counselors have to be flexible when working with first responders because they have irregular schedules, Dakin says. This might mean needing to conduct telehealth sessions or meeting with these clients outside of the typical 9-to-5 workday. There will also be last-minute cancellations, she points out. Dakin typically has a 24-hour cancellation fee, but she waives it for first responders who are stuck at work or otherwise have a good reason for not making their appointments.

In many ways, counselors may need to be on call themselves when working with first responders, Dakin says. When there is an emergency such as a line-of-duty death or an explosion, Dakin has to be prepared to drop everything, including her current caseload for that day, to respond. And if a client who is a first responder has a bad call on a Sunday, then she is also working that Sunday. Although it has happened infrequently, she has even had the labor union or clients call her as late as 10 p.m. because of an emergency.

Prochniak and Dakin both emphasize the importance of being humble when working with this population. “Although you are the professional in mental health, you’re not the professional in their field,” Prochniak explains. “Just because you know trauma or just because you know stress doesn’t mean you know this population. It shows up very differently … because this is a unique culture. So, get to know the culture. Spend time with them.”

No shame in needing help

The biggest barrier to first responders seeking help is the attached stigma — a false belief that if they need counseling, it means they are weak or unfit to do the job, Dakin says.

People often assume that because first responders signed up for the job, it means they are prepared to handle the associated trauma. But that’s not how the brain works, Dakin stresses. “The brain can only handle so much exposure to traumatic images before it’s on overload,” she says.

Joel Smith, an LPC in private practice in Denver, concurs that as a society, we do relatively little to acknowledge vicarious trauma among first responders. Although these professionals do generally possess an enhanced skill set to cope with trauma, they are still vulnerable to burnout, he says. Smith tries to normalize this reality for clients who are first responders by asking, “Has your stress been building up for a while? Is it exploding? How are you handling your stress?”

Whittaker, an ACA member who has a private practice in Manhattan and Westchester, New York, puts this idea of “being tough enough to handle it” into context for her first responder clients. She explains that being tough doesn’t mean that they never get upset or that nothing bothers them. It means processing those feelings to help themselves do their job better.

“It’s important for counselors to remind them that being tough enough to handle it doesn’t have to mean being hardened to it. It doesn’t mean that you don’t break down and cry sometimes,” she says.

First responders also have a tendency to not want to burden others with what they have experienced. Some of Dakin’s clients have said to her, “It’s a really bad call, and I don’t know if I want to put those thoughts in your head.”

Clinicians have to reassure these clients that counseling is a safe space for them to talk about their issues and experiences. When hearing difficult stories, Dakin says, counselors should refrain from sounding alarmed and making statements such as, “I can’t believe that happened! That must have been horrible.”

“While [that statement] is validating and has the best of intentions, that’s not what these people want to hear,” Dakin says. “They basically want to talk. They want to tell their story.” Counselors can validate that the client’s experience was tough without being too reactionary, she says, and that largely involves listening carefully.

Counselors should also remain aware of their facial expressions, Whittaker adds. If counselors look shocked or terrified, these clients will notice and be more likely to shut down.   

Smith, a therapist at Jefferson Center (a community-focused mental health care and substance use services provider in Colorado) and an associate at Look Inside Counseling, finds motivational interviewing an effective technique when first responders are hesitant to accept help from others. For example, Smith says, counselors can ask these clients, “How can you receive help yourself?” or “How can you model receiving help?” The technique allows first responders to develop some healthy discomfort with the fact that they are simultaneously heroes who help others and people who need help with their own problems, Smith explains.

“One of the best ways they can help themselves is to feel like they have a role in helping someone else,” Smith continues. That’s one of the reasons he encourages first responders who have benefited from counseling to tell colleagues about how it has helped them.

These clients could share an effective coping skill they learned in counseling with the rest of their team, or they could model self-care at work. “If you see someone struggle, that’s one thing. But if you see them struggle and overcome it, it builds the idea that it’s possible [for you too],” Smith notes.

Tailoring counseling to fit first responders

Prochniak, the mental health professional for American Medical Response in the Portland/Vancouver metro areas, finds that mindfulness, focused breathing and meditation techniques all work well to reduce first responders’ anxiety and stress levels and build their stress resilience. Sometimes, however, these clients can be hesitant to try such techniques, either because they perceive some stigma attached to the techniques or because of the way that counselors present them.

One approach that can help break through this hesitation is finding concrete ways of translating clinical speech into first responders’ everyday language, Prochniak says. For example, if he’s working with a paramedic, he will discuss how mindfulness techniques strengthen the parasympathetic nervous system. If he’s working with a client in law enforcement, he will reference combat breathing, which is how these professionals already describe the use of deep breaths to calm down or reduce stress.

Dakin frequently convinces first responders to give mindfulness and yoga a try by explaining the science behind the exercises. She often compares how the brain processes trauma with what happens with diabetes: Just as elevated levels of glucose in the body worsen when the pancreas does not work correctly, experiencing too much trauma causes an overload of chemicals to be dumped into the brain. Then the brain responds by releasing cortisol. Breathing and mindfulness exercises help reduce that response and regulate chemical levels.

Similarly, the traditional way of presenting and explaining yoga doesn’t match with the culture of first responders, Dakin notes. When she first encourages these clients to try yoga, the response is typically along the lines of, “I’m not going into a studio wearing spandex and meditating.”

To counter this negative perception, Dakin recommends a yoga program designed specifically for first responders (yogaforfirstresponders.org). The program gears its language to fit the culture, she says. For example, it renames child’s pose as a warrior’s pose, which is a more strength-based term. Dakin now knows some first responders who practice yoga on the job to regulate their breathing and avoid going into fight-or-flight mode as quickly.

Smith has discovered that some of his clients find it helpful to conceptualize grounding techniques as a workout. They have a “grounding buddy,” and together they work on their awareness, he says.

Dakin also uses familiar language to help first responders get more comfortable with mindfulness. For example, rather than having firefighters use a numerical scale to describe how upset they are, she uses the fire danger warning scale, which estimates the existing and expected fire risk for an area. The scale is color-coded, moving from red (extreme danger) to green (low danger).

If a client says they are in the red, then Dakin has them breathe deeply while imagining their arrow moving into a safer level. She explains how each breath is calming their nervous system. This skill has become a special language that she shares with her clients. A client may start a session by saying, “I was in the red a couple of times this week, but I breathed and at least got myself into the yellow.”

Dakin also explains to clients that mindfulness doesn’t have to be limited to sitting still and taking deep breaths. It can take the form of something they normally enjoy doing, such as fishing, taking a walk, kayaking or hiking, as long as they are doing it mindfully.

Managing anxiety

First responders often get anxious anticipating what their day might hold. “Schedule and routine are the enemy of anxiety,” says Smith, who specializes in trauma, mood management, addiction, and LGBTQ-specific needs. First responders can incorporate comforting activities such as walking their dog or calling a family member at certain times throughout the day. “Having that kind of expectation in life leaves less room for anxiety to happen,” he explains.

He encourages his clients to make grounding a part of their daily routine. They can ground themselves when they wake up, when they shower or when they go to bed. They can also ground themselves on the way to work, Smith points out, taking a few minutes when they are at a red light and noticing what’s happening around them: “I’m stuck in traffic. A kid is riding a bike beside me. It’s raining. A song I like is playing on the radio.”

Smith advises clients to set phone reminders to ground themselves. Even if they can’t check their phones that minute, they will be reminded later. Then they can take two minutes before going back to work to breathe and be aware of the way their body feels, their surroundings and their emotions.

Grounding can also be a preventive measure, Smith adds. “If you walk into an emergency and you’re already grounded, then you’ll be better off on the back end of that emergency,” he says.

As clients progress with their grounding skills, Smith asks them to visualize grounding themselves during an emergency on the job. This involves visualizing the person in front of them who is having the emergency, as well as all the chaos and turmoil unfolding around them, while also being aware of their body and their role in the situation.

“It sounds counterintuitive to have them visualize chaos, but first responders are going to experience that during their day, and then they can ground themselves in the midst of this chaos,” Smith says. This is an advanced grounding skill and not appropriate for first responders who have just started therapy, he points out.

Processing the trauma

Trauma is no stranger to first responders. They see people die and watch people suffer, all while working long hours. And they often feel unable or powerless to help, Smith says.

Some first responders also wrestle with guilt over choices they made during an emergency. “When you have to make a decision in a split second, that’s something that can be really haunting. It might mean saving your life or saving someone else’s life but sacrificing something or someone else,” says Whittaker, who specializes in working with trauma.

“Trauma makes us think horrible things about ourselves and our own abilities,” Smith says. For example, a highly skilled emergency room nurse may suddenly doubt their skills if multiple people die during their shift one week. The nurse may suddenly feel out of control or useless.

Smith finds trauma-processing therapies such as eye movement desensitization and reprocessing (EMDR) and trauma-focused cognitive behavior therapy effective with the first responder population. These therapies help clients process their feelings about the trauma while learning to separate themselves from unhealthy thinking.

Because emergency situations are filled with chaos and unpredictability, it is often difficult for first responders to slow down and think about what they can realistically control, Smith says. He often has clients journal about what they can and can’t control.

“They can have control over their own beliefs about themselves and what their own purpose is. And that can be enormously helpful in a trauma environment,” Smith says. With EMDR, clients are able to look at a task that gives them anxiety, reduce that anxiety, and feel more confident to perform that task, he adds.

Behavior patterns can be telling

Dakin often detects PTSD and emotional problems by looking for behavioral shifts or irregular behavior patterns with first responders. For example, a first responder who has been working in the department for 20 years without any issues may suddenly start yelling at the fire chief and refusing to follow rules. When this happens, the labor union often asks Dakin to perform an evaluation to figure out what might be going on.

Counselors should also be aware of behavior patterns around substance use. “There’s a huge co-occurrence of substance abuse and trauma,” Smith says. “So, if you work in an environment where you’re going to see and experience trauma, then … you’re more likely to develop a substance abuse problem.”

First responders might not necessarily be battling a long-term addiction or engaging in binge drinking, Prochniak says. They might just be spending their days off work each week casually drinking because they find their home life less exciting than their work life, he observes.

Both Prochniak and Smith encourage counselors working with first responders to ask about their substance use, including amount, frequency and any changes over time. “If that problem exists, then it’s usually helpful to manage substance abuse habits before working on trauma,” Smith advises.

Prochniak also encourages clients to notice when they experience the itch to have a drink or use drugs and to think about what that itch (the substance use) is trying to scratch. Are they anxious, bored, unsettled? Together, they then figure out a plan to address the underlying issue. “Breaking it down into this smaller view of what’s behind the drinking [or substance use] can be helpful,” he notes.

Developing transition plans

All the stress and trauma of the job can spill into first responders’ personal relationships. “People who are going through trauma can be emotionally up and down, so a first responder may be angry or irritable, if not explosive, sometimes,” Smith says. “Maybe they will cry a lot or be super anxious and not be able to really be in a room with [family or friends] because they have pent-up energy.”

First responders often need help learning how to transition from work to home, where the rules may be different, Prochniak says. For example, if a firefighter works a 24-hour shift (followed by 48 hours off), their partner is in charge of the house for those 24 hours. When the firefighter returns home, they may be upset because they expect the house to be clean and organized like it is at work.

Prochniak and Smith help these clients develop transition plans to better manage the boundaries between work and home. Smith encourages his clients to perform self-checks before heading home from work. They can ask themselves, “Where am I right now? How am I feeling (angry, sad, anxious)? What do I need before I go home?” His clients often discover they need to take 30 minutes for themselves. They may go for a run, sit in the car and listen to music, read a book or grab a bite to eat before they are ready to take on the demands at home.

Prochniak recommends that first responders use the following transition strategies:

  • If they’ve had a rough day at work, text or call their partner to provide a heads-up.
  • Take 30 minutes to exercise either at a gym or on equipment they keep in their garage to process the cortisol and neurotransmitters that have accumulated over the course of their shift.
  • Change their clothes at work so that they don’t wear their uniform home. Prochniak often advises clients to look at the shoes they’re wearing. If they are wearing their duty or work boots, then they are at work. If not, then they are at home. This serves as a reminder of the role they are in and what their expectations should be.

Helping first responders support themselves

First responders operate in a close-knit community. “They protect each other, but they also don’t know what to do [to help one another],” Dakin says. She recalls a client who found his co-worker’s behavior troubling, but he wasn’t sure how to provide assistance because he didn’t want to get his friend in trouble or for his friend to get mad at him.

One of the best things counselors can do to support this population is to educate them on healthy ways to help one another. Dakin works with a program (offered by the International Association of Firefighters and the Professional Firefighters of Maine) that trains firefighters to look for warning signs that a co-worker may be struggling and to intervene before it turns into a mental health crisis.

According to Whittaker, peer support often works better than group therapy for this population. Group therapy places people who have been taught to swallow their feelings and just “deal with it” in a setting where they may fear what a therapist will push them to say and how their peers will react, she explains.

Peer support, on the other hand, “takes the therapist out of the room,” Whittaker says. “It is led by people who have been through it and people who can find that common ground. It feels less like therapy and more like people just hanging out and talking, which is a much safer experience for them.”

Dakin recently helped some firefighters/EMTs launch a peer support recovery group. Even if she is present in the group, she lets the first responders lead. She is there not as a counselor but as moral support, she says. If the group asks for her clinical advice, she provides a quick blurb on how the brain works or offers tips such as how to get better sleep. She then fades into the background and lets the group take control again. The goal, she says, is for the first responders to support one another.

Responding during COVID-19

The “invisible threat” of COVID-19 currently looms over first responders, Prochniak says. When they pull up on scene or respond to a call, they no longer know what to expect. They have to assume that everyone is sick or symptomatic, so they wear protective gear and practice physical distancing as best they can while still performing their jobs.

Clients have told Prochniak that although the number of emergency calls has decreased, the overall intensity of those calls has increased. More calls have been made related to suicide and domestic violence.

Most first responders are anxious about what the future holds, Dakin says. They worry about the health of their families and co-workers and their own health. They are concerned about people in the community who often rely on their services and who aren’t calling right now. And they are anxious about the types of calls they will receive once call volumes return to normal.

Prochniak is helping his first responder clients manage their anxiety over the COVID-19 pandemic by having them focus on what is in their control. They may not be able to reduce their threat of being exposed to the virus, but they can develop a plan for what they would do should they be exposed. Would they live in the garage, in a tent in the backyard, in a hotel? How would they handle child care?

Whittaker admits that listening to first responders’ experiences can be difficult, but she also appreciates that they are willing to share something so personal with her. She makes a point of ending each session on an uplifting note. They might talk about how the client demonstrated bravery, how much the client has improved at using a particular counseling skill or how an experience worked out better than the client expected.

“When you see change in somebody’s life,” Whittaker says, “it’s easier to hear these difficult stories because you have a role in making it a little better for them.”

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

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

Help wanted: Managing work stress

By Bethany Bray February 28, 2020

In 21st century America, the adage that “all work and no play” makes a person dull should probably be amended to say that it makes a person stressed out.

Every job involves a certain amount of stress, and it’s normal for work demands and pressures to ebb and flow. When the tension rises above a normal level for a sustained period of time or becomes an ongoing reality, however, work-related stress can dramatically affect the individual’s personal life and mental, emotional and physical health. Trying to handle friction with a co-worker or supervisor, taking on an unwanted change in role or responsibilities, or being forced to navigate a toxic work environment, possibly including bullying or harassment from co-workers, can all result in stress setting up shop in a person’s life and remaining there, even after the workday (or workweek) is done. Today’s technology tools — wonderful as they can be — are another common contributor to ongoing work stress because they tend to encourage overwork and expectations of around-the-clock connectivity. Work emails don’t typically abide by a 9-to-5 schedule, and neither do smartphones, laptops and WiFi connections.

Professional clinical counselors, no matter their setting or specialty, may notice work stress manifesting in clients’ lives in a variety of ways. Some clients might complain about having trouble sleeping or experiencing physical aches and pains. Others might mention ruminating on work issues when they are off the clock, associating their self-worth with career achievements, feeling guilty when they take time off, fearing losing a job, or even feeling mentally or emotionally exhausted just thinking about their job responsibilities or work environment.

Work-related stress “can take away some of our joy,” says Michele Kielty, a licensed professional counselor (LPC) and licensed school counselor in Virginia. “We can be so overrun with responsibilities that we experience a lack of joy in things we have previously found joy in. … It’s carrying an ever-present, low-grade, oppressive stress with you all the time. It can take over your life more than you’d like for it to.”

Simply put, work stress keeps us from being the person we want to be, says Kielty, a professor of counseling and director of the school counseling program at James Madison University (JMU) in Harrisonburg, Virginia.

Complicating the issue further is that some clients who realize that work is the main cause of their stress feel embarrassed that a job can have that effect and level of control over them.

“The painful thing about this is that there can be a lot of regret, guilt and, occasionally, shame over loss of presence — not being able to be fully present when you’re home or around your children,” says A. Renée Staton, an LPC and professor in JMU’s counseling program. “Parents may report [in counseling] that their work stress might not feel like it’s on the forefront of their mind, but they’re finding they’re more reactive and impatient with their children. It might be harder to keep things in perspective, in context, when they’re responding to their children.”

A major source of stress

A majority of American adults (64%) cited work as a significant source of personal stress last year in the American Psychological Association’s annual Stress in America survey, which collected data from more than 3,000 adults between August and September 2019. Among Gen Xers, money and work were tied as the most frequently cited sources of stress (at 65% apiece). Among millennials, money (72%) barely edged out work (71%) as the most frequently cited stressor. Work was the second-most cited source of stress for baby boomers (preceded by health concerns), whereas Generation Z, or the post-millennial generation, reported work as its third-largest source of stress (behind money and health concerns).

The American Institute of Stress, a Texas-based nonprofit organization, notes that work and career are major sources of stress for Americans and can be linked to hypertension, increased risk of heart attack, and other medical concerns.

“Although the Institute is often asked to construct lists of the ‘most’ and ‘least’ stressful occupations, such rankings have little importance for several reasons,” the organization says on its website (stress.org). “It is not the job but the person-environment fit that matters. … Stress is a highly personalized phenomenon and can vary widely even in identical situations for different reasons. One survey showed that having to complete paperwork was more stressful for many police officers than the dangers associated with pursuing criminals. The severity of job stress depends on the magnitude of the demands that are being made and the individual’s sense of control or decision-making latitude he or she has in dealing with them. Scientific studies based on this model confirm that workers who perceive they are subjected to high demands but have little control are at increased risk for cardiovascular disease.”

Dissatisfied, disconnected, underappreciated

The term “work stress” can mean different things to each individual client, and a counselor’s response should be tailored to each client’s distinct situation. However, Sharon Givens, an LPC in private practice who specializes in career development and mental health, has found some common themes in her work with clients. She says that levels of dissatisfaction and stress can surge for individuals when they:

  • Are in a job or role that they find unfulfilling or don’t enjoy
  • Have issues with leadership (e.g., think that they have a bad boss, don’t feel respected or valued, have a personality or values conflict with a supervisor or company leadership)
  • Believe they are not being compensated properly financially
  • Are doing work that doesn’t meet their needs, such as personality style, passion or interests

This last bullet point can make all the difference, asserts Givens, president-elect-elect of the National Career Development Association, a division of the American Counseling Association. At the end of the day, a job will be a good fit only if what it offers matches what the individual needs. For example, a person who values teamwork and struggles to work independently will never thrive in a position in which they work alone from home full time, says Givens, whose practice has offices in Columbia, South Carolina, and Charlotte, North Carolina.

Research indicates that many workers leave jobs on the basis of whether they connect with their co-workers. Stress and unhappiness will naturally swell if an employee doesn’t enjoy the work or the people with whom they work — even if the employee is well-compensated, Givens adds.

Jennifer Linnekaste, an LPC with a practice in Oslo, Norway, specializes in career counseling and helping clients with work-related trauma. She says counselor practitioners should probe with further questions when clients, regardless of their presenting issue, spend a majority of sessions discussing or complaining about negative issues at work. Practitioners can get a fuller picture by asking clients when they began feeling overly stressed and whether that coincided with a change in leadership or supervision at work, a new job role or new work responsibilities, a traumatic incident in the workplace, or some other work-related circumstance.

Work stress occurs on a continuum, and “whether or not someone can handle that stress is totally within the perception of the client,” adds Linnekaste, who is writing a book on work trauma to be published by ACA.

Possible indicators

When work stress bubbles over, personal relationships commonly suffer the effects. That’s because work stress often robs individuals of their ability to engage with and be fully available to the people they love, Kielty says.

Givens, an ACA member, has seen work stress put so much strain on clients’ marital relationships that they end up on the verge of divorce. Carrying around constant feelings of stress can make the person become less patient, more irritable, and more likely to be snappy with or lash out at their significant other and other loved ones, generating relationship conflict as a result. Or, a couple can become distant if one person, feeling overwhelmed by work, shuts down and doesn’t want to communicate their needs and stressors to a partner, Givens points out.

In addition to staying alert to possible red flags in clients’ personal relationships, counselors should listen for other clues that work stress may be manifesting in clients’ lives, Givens says, including:

  • Displaying anxious behavior, including feeling paranoid that they are going to be fired
  • Spending a large amount of time talking about financial worries
  • Expressing a lack of commitment to their work, desiring to take excessive amounts of time off, or doing the bare minimum to get by
  • Expressing a lack of fulfillment or using language that indicates they simply tolerate their work
  • Expressing that they feel stuck, are too old or too entrenched to try something new, or are thinking about premature retirement
  • Saying that they do not enjoy, engage with or trust their co-workers
  • Feeling a lack of control or power over their work situation, feeling like a victim or feeling overlooked in company decision-making

Work stress may also be to blame if clients talk about physical symptoms such as headaches, high blood pressure, gaining or losing a significant amount of weight, or having trouble sleeping.

Fatigue can be another indicator that work pressures are overwhelming a client, says Quentin Hunter, an LPC associate in Kentucky who co-authored the September 2019 Journal of Counseling & Development (JCD) article “Assessing Life Balance and Work Addiction in High‐Pressure, High-Demand Careers.” When clients talk about chronic tiredness, feeling totally spent once they get home, not being able to turn off their “work brain,” or ruminating about work tasks when watching television or eating dinner with their family, counselors should probe with questions to learn more. “People often come in knowing that they’re exhausted by their job and that it’s affecting them, but not that it’s inappropriate,” notes Hunter, who works in a group private practice in a rural setting.

Amanda M. Evans, an LPC and co-author of a 2013 JCD article titled “Work-life Balance for Men: Counseling Implications,” notes that work stress can manifest in ways that chip away at clients’ overall wellness, including decreases in marital satisfaction and sexual activity or an inability to fully relax and engage in activities and hobbies that they previously enjoyed.

“For me, it would be concerning if a client says things like, ‘I just need to push through’ or ‘If I put my head down [and work hard], it will get better,’” says Evans, an assistant professor in JMU’s graduate psychology department and director of the university’s clinical mental health counseling program. “A counselor can be a reminder that it’s not a requirement [to be unhappy at work], and that’s not how we have to live our lives.”

Evans, Kielty and Staton have discovered that work stress often emerges as an issue that connects to other mental health topics that they collaborate on as colleagues at JMU, including most recently in their research on bicultural identity, which the trio presented at the Let the Voices Be Heard! conference in Belfast, Northern Ireland, this past October. (The conference, billed as “an international conversation on counselling, psychotherapy and social justice,” was jointly planned by ACA, the British Association for Counselling and Psychotherapy, and the Irish Association for Counselling and Psychotherapy.) Evans and Staton will also discuss work stress as part of a poster session on institutional discrimination at the ACA 2020 Conference & Expo in San Diego in April.

Recognizing counseling’s roots

Counselors may see clients who name work stress as their presenting issue. This is often the case for Givens, who receives many of her clients through referrals from employee assistance programs. But other clients may show up to counseling for help with a troubled marriage or help dealing with depression without realizing that work stress is inextricably linked to their presenting issue, Givens says.

“Work is such a large domain of our life, and it plays such an integral part in impacting our mental health,” Givens explains. “You can’t address one without the other.”

In other situations, Kielty points out, clients may come to counseling for work stress because it feels like a “safer,” less stigmatized or less embarrassing issue than what may be lying underneath, such as marriage trouble or intimate partner violence. In other words, for certain clients, work stress may represent a more acceptable way of entering the counseling relationship.

Givens says career counselors and mental health counselors shouldn’t hesitate to refer clients to one another or to co-treat clients who need to focus on both realms of life.

Many of the counselors interviewed for this article pointed out that the counseling profession’s foundations are in career counseling and say that professional clinical counselors shouldn’t hesitate to lean into the profession’s vocational roots.

“Remember that work and career are a key part of almost everyone’s life, so we need to spend some time exploring them,” says Hunter, an ACA member and assistant professor at Lindsey Wilson College in Columbia, Kentucky. “If you ask, ‘How’s your job?’ and they answer, ‘Great,’ don’t just accept that and move on. … A client might not necessarily say, ‘I know that work is stressing me out’ or ‘I hate my job,’ but it’s still sucking up a lot of their energy, and they’re not feeling effective in the domain they came to you for.”

Spurring self-reflection

Discovering to what degree work stress is affecting a client’s mental health can be eye-opening for both counselor and client. Hunter says he often begins by asking clients to reflect on where a majority of their energy is going. “We only have so much personal energy each day,” he explains to clients. “How much of it is going into your work domain, family domain and individual domain, and where are the deficits? Where have you seen this affect you? … Work can impact all of the domains of wellness, [including] sleep disturbances, spirituality, intimacy with a partner, energy levels. How much of your life is wrapped up in work?”

Hunter often directs clients to think of their day as a pie, with each slice indicating a domain where they invest their energy. He then asks them to consider how this looks and feels. Is work the biggest slice? The entire pie? Are they OK with the way their pie is divvied up? Is it causing them stress?

Another exercise Hunter finds helpful is to have clients create a prioritized list of their values and the things they find important in life. Most clients place family and relationships at or near the top of their list and relegate work to further down. From there, Hunter spends time talking with clients about the priority they assign to different aspects of their life and where things may be out of alignment related to where they spend most of their energy. For instance, if work is No. 5 on their list of things they value, does that correspond with how much energy they are dedicating to it? If their marriage or their relationship with their children is the first thing on their list, is that part of their life truly receiving the most of their attention and energy?

Staton agrees that values exploration can be an important part of counseling with clients who are struggling with work stress. Counselors can help clients realize when their work does not align with their personal values, determine what is essential for them to “feel fulfilled without overdoing,” and learn when to say no and make changes when their situation doesn’t match with “what they truly want in their heart,” Staton says.

Kielty, a past president of the Association for Spiritual, Ethical and Religious Values in Counseling, a division of ACA, suggests that counselors guide clients in making a list of values and creating goals based on the top values they identify. For example, for clients who value autonomy, an appropriate goal might be to uninstall work email apps from their smartphones so that they can’t be contacted — and aren’t tempted to engage with work — when they’re supposed to be off the clock. Clients who value flexibility might consider requesting a change in their work schedule to do four 10-hour shifts per week so that one weekday is left free to go on field trips with their child’s school, grocery shop or focus on self-care, Kielty suggests.

These counseling exercises are all done with an eye toward building self-evaluation and self-reflection skills in clients, Hunter notes. One of the most important things counselors can help clients do when their work stress spikes is to take a step back to assess what they want their life to look like versus what it looks like in reality, he says.

Any type of contemplative practice — such as journaling or mindfulness — can help clients reflect, hone self-awareness and be honest with themselves, Hunter says. These skills are also important to instill in clients so that they can fall back on them outside of counseling sessions, he adds.

“[Creating] that space to listen to yourself and have self-evaluation is a hard habit to build but so powerful,” Hunter says. “Eventually, they will leave therapy and have to self-prescribe their own goals. They need to be able to assess their energy levels and where [in which domains of life] they are placing importance.”

Supporting clients if and when they decide to leave a job and transition to a new role is important, but a counselor’s guidance shouldn’t end there, Givens says. “In many cases, work stress can be the symptom of something greater, and it’s our responsibility to research and make sure we understand the root cause to help the person holistically, instead of just from a career or mental health perspective,” she explains.

Givens recalls a client who initially came to her for career guidance. He expressed feeling unhappy and “maxed out” in his role as an executive vice president. As Givens’ work with the client progressed, he also disclosed that he had become distant from his wife. The couple wasn’t communicating well, and their sex life was “nonexistent,” according to the client.

Further assessment and exploration revealed that the client wasn’t clicking with a new boss who had recently started working at the client’s company, leaving the client feeling undervalued. On top of everything else, Givens found that the client had never processed his parents’ deaths (his mother had been dead for eight years and his father for 26) and was beginning to show signs of depression.

At that point, “the work stuff became secondary,” Givens remembers. She introduced grief work and self-esteem techniques into their sessions, as well as cognitive behavior therapy. She worked with the client for roughly a year and a half, and during that time his self-esteem and marital relationship began to strengthen and rebound.

Roughly a year into their therapy relationship, the client made the decision to leave his company and find a new position. He received three desirable offers and ultimately accepted a position as a CEO — a life goal he had always wanted to achieve, Givens recalls.

Guiding influences

When considering changes to a work situation or pursuing work-life balance, it is often clients who have the answers themselves, Givens says. A counselor’s role is to guide and support clients as they take a step back, tap into the answers they already have within, and make decisions.

Givens had a client who came to her for career counseling. The client was well-paid, but she was also responsible for three different roles at her company: payroll, accounting and human resources. “When we talked it through, she realized it wasn’t fair to get one salary for three jobs,” Givens says. “She didn’t see it until she took a step back [in counseling] and realized, ‘I could get paid the same amount for doing just one of these jobs!’ Eventually, she made the choice to leave.”

Givens has a number of worksheets, questionnaires and other tools she uses in sessions with clients who are struggling with work stress to spark self-reflection and engage in goal setting. One of these tools is a puzzle with blank pieces that can be written on with a special marker and wiped clean for reuse. Clients label the puzzle pieces with various aspects of their lives, including work, and then fit the pieces together in two different ways: as their “ideal” life puzzle and as what their life looks like in actuality. After talking things through with her clients, Givens asks them what they would need to change — which puzzle pieces they would need to shift or remove altogether — to make the two puzzles be in better alignment.

In a similar vein, Givens uses a “life wheel” illustration (below) with clients so they can rate different areas of their lives (finances, career, relationships, relaxation, etc.) on a scale from 1 to 10. This exercise provides both the counselor and clients a better understanding of how clients see themselves and where they are — and aren’t — finding fulfillment.

Image courtesy of Sharon Givens

Givens also created and uses a flowchart-type document that she refers to as a “gap analysis.” The chart has two boxes with a gap in the middle. She asks clients to write a description of what their life looks like now in the first box and ideas about the life they would like to have in the second box. Clients’ challenges and missing pieces are written in the gap between the two boxes. These challenges and missing pieces might include getting a professional certification, partaking in additional training, or pursuing additional education to get into a desired career, she notes. In each session, Givens works with the client to set goals, address the challenges listed in the gap on the flowchart, and check in about progress.

“It could be that [a client] wants to be a plumber, but they need the proper training. I would help them connect to that,” Givens says. “Ultimately, that’s what we’re trying to do: get the client to where they want to be and get over what’s getting in the way.”

When clients are feeling overwhelmed by work stress, counselors can help them break up what seems like an insurmountable challenge into smaller pieces, says Evans, a member of ACA. She suggests that practitioners equip clients with coping mechanisms, including psychoeducation on self-care, boundary setting and thought-stopping techniques, to navigate the here and now before tackling bigger decisions such as whether to leave a job or change career paths entirely.

Kielty notes that lessons on mindfulness and body scanning can provide clients with helpful tools for managing their emotions at work when stress begins to overwhelm them. “Identify what sets you off and how you can create healthy spaces for yourself. Create some healthy space between you and your work,” she advises.

Kielty, a member of ACA, often introduces the concept of “mindfulness moments” when she does workplace trainings. Taking time to reset, even if it’s just for a minute or two, can be a tremendous coping mechanism for handling work stress, she says. Resetting might include closing the door to one’s office and taking deep breaths, going for a brisk walk, doing a quick body scan or taking inventory of one’s senses of sight, smell, hearing, taste and touch. Mindfulness helps regulate stress hormones and heart rate, improves concentration and increases self-compassion, says Kielty, who adds that mindfulness is an evidence-based way to “help build inner resources.”

Being able to pause, even for just a moment, gives a person choice, agency and some options for dealing with stress rather than allowing it to control them, adds Staton, an ACA member.

Hunter sometimes equips individuals who are having trouble separating their work and home lives with a mantra they can repeat to themselves each day as they’re leaving work: “I’m finished with work today. I’m leaving work here in the parking lot. Anything that needs to be done at work can be done tomorrow (or the next time I return).” This simple exercise can help clients reinforce the idea that they are not their jobs and that work is only part of who they are, he says.

Counselors should be aware that some clients who struggle with work stress may also have a work addiction, Hunter points out. As is the case with any process or behavioral addiction (e.g., gambling, gaming, shopping), work can become an activity that provides a person with a temporary “high” and serves as an escape to avoid other issues. Professional clinical counselors should listen closely for hints that clients are practicing avoidance behaviors — such as throwing themselves into work to avoid dealing with relationship problems or mental health issues — or using language that may indicate work addiction, such as “I only feel good when I’m at work,” Hunter advises.

Although goal setting can be a helpful part of supporting clients through work stress, Hunter cautions that counselors must be sensitive to the individual client’s needs and personality before using the approach because it may not be a good fit for everyone. Setting benchmarks — such as leaving work by 5:30 each day, having dinner with the family every evening and making time to read a book for pleasure — can be helpful for clients who are interested in order and objective tasks, he says, but it can feed into anxiety for other clients.

“Goal setting can be a good place to start, until [finding work-life balance] becomes more natural,” Hunter says. “But when we set expectations, we have to realize that they can be anxiety-provoking. A client can throw themselves more into work because they don’t feel like they’ll meet their goals or have anxiety over meeting goals. The bigger goal should be knowing when work-life balance is off-kilter and needs to be shifted.”

Flipping perspective

One major factor that can contribute to clients’ hesitancy to push back against unrealistic workloads or to experience guilt over taking time off is cultural messaging, Hunter says. Clients may struggle to equate work stress with its harmful effects (physical and mental) because American culture emphasizes that working and supporting yourself is a highly valued quality.

“When I grew up, being a workaholic was a compliment,” Hunter says. “Counselors can be advocates [for the idea] that work is not the be-all, end-all, and there can be rewards in other domains of life. We can be the ones to push and question that as a culture. … While it’s good for people to have direction in a career and feel valued, it’s important to balance that with family and life outside of work.”

Counselors can be agents of change in this regard, Hunter insists, and help clients make a cognitive shift: Work is not intrinsically bad, but it can become a problem when it negatively affects an individual’s mental health and spills over into their personal life. This is especially true, Hunter says, when working with clients who struggle with work addiction, who express feeling like everything rests on their shoulders, or who voice sentiments such as “If I don’t do this work, who will?”

“When it comes to work-life balance, it’s such a challenge in 2020 America to think of work as a problem. It’s hard to argue that working hard and supporting your family is wrong,” Hunter observes. “A client may say, ‘I’m doing everything right. I’m doing what I should to build a career and support myself and my family.’ When in actuality, overwork is the issue, and feeling obligated to a career and sacrificing other aspects of life.”

“Oftentimes, a career will take as much as you will give,” Hunter continues. “We live in a capitalist society, and even a well-meaning organization will accept all the work you will put into it, and it’s up to the individual to say when it’s enough. The organization never will.”

 

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Contact the counselors interviewed for this article:

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Want to learn more?

Sharon Givens will present the session “Career development and mental health strategies” at the ACA 2020 Conference & Expo in San Diego in April. Find out more about Givens’ presentation and numerous other sessions on career-related topics at counseling.org/conference.

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Additional resources

Take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

Books (counseling.org/publications/bookstore)

  • Coping Skills for a Stressful World by Michelle Muratori and Robert Haynes
  • 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

ACA divisions

 

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Should I stay or should I go now?

What should a counselor’s role be when a client who is overwhelmed by work stress wants to throw in the towel and leave a job? Explore this issue in an online exclusive article at CT Online: https://wp.me/p2BxKN-5SZ

 

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

Letters to the editor: ct@counseling.org

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

Should I stay or should I go now?

By Bethany Bray February 26, 2020

When work stress becomes overwhelming, a knee-jerk reaction may be to dust off your resume and search for a new job. You may even fantasize about walking out and throwing in the towel to rid yourself of a micromanaging boss, an abrasive co-worker or an unrealistic workload.

But will leaving a stressful work situation solve the problem?

Not always. Professional counselors say that leaving a job without considering the full picture of what is stressing you out – both at work and in your personal life – may not eliminate all of your discomfort.

Stress can quickly resurface if a person switches jobs to a position that isn’t a good fit for them or doesn’t address underlying issues that are affecting their mental health, such as unprocessed grief or past trauma, says Sharon Givens, a licensed professional counselor (LPC) who specializes in career development and mental health.

“We need to make sure we understand the root of a client’s stress. Look at the long term and not just the transition of leaving a toxic situation,” says Givens, whose private practice has offices in Columbia, South Carolina, and Charlotte, North Carolina. “They need to transition to somewhere they can sustain and not just make a move.”

A counselor’s role should never be to suggest that a client leave or stay at a particular job. However, a counselor can be a guide and support as a client steps back to assess what is out of balance in their life and creates goals to move toward the life they want to live, says Givens, president-elect-elect of the National Career Development Association, a division of the American Counseling Association.

“We can evaluate what this job means for this person [the client] and evaluate what this job is to this person,” agrees Quentin Hunter, a licensed professional counselor associate who counsels clients in a rural area of Kentucky. “What is the job like, and what does it demand? Is their stress unusual, constant or changing – and can they make changes?”

Hunter acknowledges that some clients may not have the option to leave a position if job options are scarce in their area, especially if their financial situation wouldn’t be able to sustain the transition until paychecks begin to come from a new employer. Counselors can help these clients make healthier choices about staying, Hunter says. “They can stay because they have reasons and not just stay without intention.”

For some clients who come to counseling for help dealing with work-related stress, “work may simply be non-negotiable,” adds A. Renée Staton, an LPC and professor in the counseling program at James Madison University in Harrisonburg, Virginia. “There may be no way out because it’s the only opportunity, the only game in town. It’s important to acknowledge that it’s a reality for many of our clients.”

Counselors can give clients “the space to acknowledge that this [work situation] is difficult … and normalize that [stressful] feelings come and go, and we deserve our own self-care and respect as we encounter these challenges,” Staton says.

In sessions with clients, Givens relies on an array of counseling tools to help clients identify the ways their job is affecting them and to arrive at the best decision for them based on facts rather than emotion.

“We take a step back and look at the variables of what they can change and can’t change. After mapping it out, I will ask, ‘What do you think is the best for you?’” she says. “I put the question back on them so they can ultimately make the decision. It needs to be based on symptoms and facts versus ‘I feel like.’ [We look at] what is actually happening, what are the symptoms and, then, what are your options?”

 

Finding solutions

Jennifer Linnekaste, an LPC who specializes in career counseling and helping clients with work-related trauma at her practice in Oslo, Norway, recalls one client who worked in an engineering firm and came to her because he felt he was stagnant in the position he had held for 15 years. “Tom” (not his real name) felt like he had no energy. He had come to dread the thought of being assigned new projects at work and “a never-ending string of meetings that felt pointless in nature to him,” says Linnekaste, an adjunct professor (teaching online) for Regent University in Virginia Beach and Old Dominion University in Norfolk, Virginia.

Conversations in counseling sessions revealed that Tom went into engineering as a career because he was drawn to the field’s focus on design and creativity. However, his job role had evolved away from the more creative, collaborative aspects that he enjoyed when he first began working for the firm. Roughly five years prior, new management had taken over and introduced new technology that allowed employees to work online and connect remotely.

“At first, Tom said he was checking email occasionally in the evening after [his] kids were settled or in bed. Then, the expectations began to increase,” Linnekaste recalls. “There was far more documentation, and he was moved into a task that involved more quality control – checking to make sure the people under him had done their jobs. He said he hated that. Soon, he found himself in middle management and was responsible for making sure others were meeting their deadlines. As someone who self-professed to be a perfectionist, Tom felt anxious about whether his team members would deliver. It began to consume him, worrying about whether the project would get done because he was the one who was responsible. His supervisor was a positive yet hands-off type of leader. As a result, Tom didn’t feel that he had the tools to manage things well. He also struggled with trying to communicate with those below and above him.”

After one particularly stressful meeting with his supervisor, Tom reported feeling completely overwhelmed and inept in his job. After the meeting, he told Linnekaste, he had “just wanted to walk out the door and never work there again. When I asked how he has persevered to this point, he said sheer willpower and a fear of not having a job. It was clear to me that he was surviving rather than thriving.”

“He came to me because he was wondering whether he should just leave and start somewhere new, but he had several concerns: 1) He actually liked the company and the people he worked with for the most part; 2) He was paid well; 3) He was unsure whether the ‘grass was greener on the other side’; and 4) He was uncertain whether he would be happy if he made a change,” Linnekaste says. “In order to help him make a decision, I felt he needed to have a good conceptualization of the problem and more information to move forward. We agreed on one thing: keeping the status quo was not sustainable [for] his mental health.”

From there, Linnekaste dove into a full assessment with Tom in counseling sessions, asking about his personal and family life, values and role models. The more they talked, the more it became clear that Tom was unhappy because he had lost the ability to be creative – one of his most valued attributes – at work.

Using this as a guide, Linnekaste helped Tom come up with a plan to seek creative work. The first step was to approach his supervisor and explain that his talents were best suited for creative work, not managing others. He planned to ask if there were different roles or tasks he could transition to within the company that would allow for creativity and design work. If his company wouldn’t allow him to change his role, then Tom would begin to search and apply for new jobs that offered creativity.

When Tom returned to counseling after approaching his supervisor, Linnekaste remembers that he smiled as he talked about how well the conversation had gone. His supervisor had been understanding and mentioned a new contract that was coming in that involved designing a new product.

“Tom told his supervisor that he was struggling with the management piece but didn’t want to be demoted. So, the supervisor stated that he was going to enroll him in a management course, as well as assign him a deputy manager that would handle the tasks related to quality assurance and benchmarks. Tom appeared energized and excited,” Linnekaste recalls. “He said, ‘You know, I had forgotten how much cooking was a passion for me. This past week, feeling better about the job front, I enrolled in a cooking class. I also told my wife I would like to have friends over once a month for dinner. We could have themed dinners where I try out different main dishes and they can provide the side dishes.’ When I asked about emails after work, etc., he said that they [didn’t] feel as overwhelming now to answer. He said he [was] going to put a hard boundary on not doing work on weekends, but he [felt] energized about being able to take on his new project.”

 

 

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Related reading

For more on helping clients with work stress, see Counseling Today’s March cover article “Help wanted: Managing work stress.”

 

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Bethany Bray is a senior writer 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.

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.