Stress Management For Clients and Their Counselors

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Stress Management For Clients and Their Counselors Michele D. Aluoch, PCC River of Life Professional Counseling LLC c.2013
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Stress Management For Clients and Their Counselors. Michele D. Aluoch , PCC River of Life Professional Counseling LLC c.2013. The Client’s Stress. Area #1- Not Feeling Listened To. Three Common Assumptions about Listening (Barker, L., & Watson, K., 2000 ) - PowerPoint PPT Presentation

Transcript of Stress Management For Clients and Their Counselors

Stress Management For Clients and Their Counselors

Stress Management For Clients and Their CounselorsMichele D. Aluoch, PCCRiver of Life Professional Counseling LLCc.2013The Clients Stress

Area #1- Not Feeling Listened ToThree Common Assumptions about Listening(Barker, L., & Watson, K., 2000)

Speakers control communication more than listeners.We can wait to listen well when we really have to.When someone starts talking people automatically listen.

Realities of ListeningListeners control communication because they can open up communication by engaging or shut it down by tuning out.Listeners use their will to tune in or out to a person.The listener often is the one who puts his/her interpretation into things.Listeners evaluate whether messages are important and valuable or not.Listeners decide to follow through on what the speaker says or to not to that.Listening is not automatic. Rarely can listeners answer more than 4 details of a conversation correctly. Listening takes time and practice.Listeners only remember a small portion of what has been said- 50% immediately after talk, 10% after 1 day.

Listening PitfallsTuning Out or Halfheartedly Listening

Rehearsing Our Responses

Assuming Meanings From What the Speaker Says

Jumping to ConclusionsFour Listening Preferences People- Oriented

Action Oriented

Content Oriented

Time Oriented

People Oriented Listening Other focusedDemonstrates caring and warmthNonjudgmentalClear verbal and nonverbalsRelates to where the other is coming fromFocuses on building relationshipsNotices changes in others moods & incongruencies in them quicklyPeople Oriented Listening ProblemsBecomes overinvolved in others feelingsToo empathic and may overlook faultsMore prone to burnout because internalizes and adopts others feelingsSometimes considered overly expressive by othersNondiscriminating in relationships- nice to everyoneExs: counselors, service professionals, teachersTell stories, use illustrations.Use we and focus on teamwork.Be personal.Action-Oriented ListenersConcentrate on the task at handFrustrated with disorganized peopleComes across as impatient to othersFocuses on expectationsAble to redirect others towards the most important points of thingsIdentifies inconsistencies in messages where things dont add upAction-Oriented ListenersProblemsImpatient with people who talk too longJumps to conclusions quicklyDistracted by disorganizationToo blunt- pushes people too far too fast in conversationsMay ask blunt questionsComes across as criticalMinimizes the importance of the emotional/feelings in communication because they are too task and thing orientedExs: Attorneys, financial analystsKeep points to 3 or lessBe short and to the point.Speak quickly.Content-Oriented ListenersEvaluate every angle of thingsLikes digging below the surface to dissect problemsValue technical informationWants people to back up what they say with examples and supportsValues complexitiesContent-Oriented ListenersProblemsOverly detailedMay come across as intimidating because knows so muchAsks pointed questionsDevalues info. from people who dont know their jobTakes time to make decisions after studying all the angles of thingsExs: scientists, mathematicians, engineersProvide the data.Quote experts and statistics.Use charts and graphs.Time Oriented ListenersSets time boundaries for conversationsGives guidelines for conversationDoes not want wasted timeTells others when they are wasting time

Time Oriented ListenersProblemsImpatient with time wasters as he/she see itInterrupts othersNot good at concentrating and just hearing others in the momentRushes others by watches and clocksSquelches creativity because so focused on time and clocksGo under time limits if you can.Avoid unnecessary exs.Watch their impatience level.Top Ten Listening Hindrances(Barker, L. & Watson, K., 2000)Interrupting the speaker.Not looking at the person who is talking.Rushing the speaker and communicating thereby that his/her message is unimportant. Not letting the speaker tell the whole thing.Showing interest in things other than the conversation at hand.Getting head of the speaker and finishing or concluding what he/she is saying.Top Ten Listening Hindrances(Barker, L. & Watson, K., 2000)Not doing what the speaker requests.Saying, yes- BUT which shows that the speaker doesnt matter as much as what you wantStopping the speaker by relating things to yourself.Forgetting what the speaker talked about.Asking too many questions about details. Not doing what the speaker requests.

Nonverbal ListeningBody language= up to 93%Words can hide secrets whereas body language gives more clues1st 10 seconds= most importantCautions: defining things by a single gesture alone without contextCultural background must be consideredFirst obtain baseline behaviorFactors to consider:Status in society fashion subcultureThe gaze of person- direction, length of gazeWhat eyebrows doTouch- spatial relations and how touch is usedNonverbal ListeningDirect lookLean slightly inSmile gentlyState the persons name and shake handTake turns communicatingAngling your body toward the speakerUse regular head nodsReflect the speakers emotions Issue #2- Clients ExpectationsAdvertisements/Marketing of Your practiceInsurance panels Bios.Your websiteWhat they thought they gave consent forTheir understanding of what therapy is/is notWhat they think your title or credentials are or meanWhat they think your certifications, licenses or certificates are forHow they perceive the environment physicallyHow they perceive you, office staff, colleagues, other clientsIssue #3- Informed ConsentExtent and nature of servicesPros and cons (counseling in general, electronic counseling, phone counseling, techniques used, setting)LimitationsIn clear, understandable, non-technical languageSpecified provider nameTherapists responsibility to make sure the client understands (e.g. if cannot read, blind, etc.)Defines role of counselor (versus mediator, court guardian, expert witness)Expectations of both therapist and client behaviorsRisks/benefits of therapyQualifications of the therapistFinancial considerations and responsibilitiesIssue #4- Assessment/DiagnosisWhy we as the questions we doWhat the diagnosis meansWho knows whatUnethical- therapist as moral agent, client no longer autonomous person coming for helpEthical- based on observation of concrete, observable or clients self reported behaviors compared to norms and researched and studies standardswith respect to client perspectives and worldviewwith full information and informed consentunder a specific contract outlining terms of the clinical relationship

Issue #5- Treatment PlanningWhat goals the client will by intoClient desiresWhat client perceives to have worked/not worked so farHow involved client wants to get in the therapeutic processHow goals are measuredOperational definitions of measurable goalsHow achievable goals areCompeting demands therapists hopes, clients hopes. Referring agency, insurance company, family/friends, employers/schools/physiciansIssue #6- Clients Perceptions of your CompetencyHow the client defines competencyBoard requirements regarding licensure, certifications, and disclosure statements in officeClients assumptions about your title and ability to clarify or correct theseTechniques used

Issue #7- Readiness or ResistanceA) RESPONSE QUALITY RESISTANCESilenceMinimal talkIncessant talkB) RESPONSE CONTENT RESISTANCEIntellectualizing everything to avoid discussion of emotionsPreoccupation with symptomsSmall talkRhetorical questions bout the counselors decisions on hmwk, assumptions of Dx, etc.

Issue #7- Readiness or ResistanceC) RESPONSE STYLE RESISTANCEDiscounting (yes BUT ____)Limiting topics in sessionBlaming othersSecond guessing the counselor (are you saying or meaning ___?)Reporting only positivesSeductivenessForgetting supplies or materialsDisclosure at last minuteHabitually breaking promises

D) LOGISTIC MANAGEMENT RESISTANCEPoor appointment keepingPayment delay or refusalPersonal favor askingCommon Defense Mechanisms(Clark, A.J., 1991)Outside awareness initiallyHabitualUseful (in clients perception)

Denial- rejecting responsibilityI dont have a problem.Nobody ever told me.I didnt know.

Displacement- shifting responsibility to a vulnerable substituteI couldnt control my behavior because of that stupid overbearing teacher.A few drinks just cause me to do things I dont expect.

Identification- acting like someone he/she admiresI have a good heart just like my brother.My family may have its flaws but we all are hard working.I can be just as competitive as the next guy when things comes down to it.

Common Defense Mechanisms(Clark, A.J., 1991)Undoing- Trying to reverse an unhealthy behavior by doing something oppositeI drank all weekend but when I came to my senses I realized this isnt me so I threw all the liquor in the house down the drain.I know I mouth off and get out of control but I am the most gentle and apologetic person afterwards.Common Defense Mechanisms(Clark, A.J., 1991)Intellectualization- avoiding unpleasant feelings which are perceived as negative and make someone feel vulnerableDrinking on occasions is not like getting drunk, you know.I just have a different way of getting things done than what my boss wants.

Projection-attributing unacceptable behaviors to others that are really characteristic of selfIt seems like you dont want this counseling to help me. You disagree with me.They said I didnt perform on my job.If that fool would have gotten out of the way I wouldnt have hit him in the drunk driving incident anyway.

Common Defense Mechanisms(Clark, A.J., 1991)Rationalization-Justifying ones behaviorsEveryone lies to their parents.All people steal some of the extra supplies on the job that arent being used.Most parents get frustrated with their kids and lose control at times.

Reaction formation- Exaggerating claims of highly moral actions and attitudesI would never get tempted to do anything like that.I organized the community fair against that kind of behavior.

Common Defense Mechanisms(Clark, A.J., 1991)Regression-returning to an earlier stage of maturation and developmentI had these kids young. It is my time to live . Whats wrong with dressing in their clothes and going to clubs. I missed out.Repression-Resisting discussing or approaching topics or barring self or others from certain topicsI dont recall anything like that.I dont ever remember disobeying my parents.Dealing With Defense MechanismsRelationship stageIdentify specific defenses for that clientGenerally will be the same ones they use with youUse advanced empathy to understand and help them understand why they habitually relied on themSentence completion exercises help

Integration stageDistortions are confrontedLack of congruency is brought to the clients attention

Accomplishment stageProductive actions and alternatives are highlightedClient is encouraged to act differently as he or she would like to beAlternative behaviors are maintainedA strengths-based approach is used

Issue #8- Perceptions of Process VariablesStill critical foundations for successEmpathyNon possessive warmthGenuinenessWhose are these? (Counselor Versus Client?)Hypothesis #1: Good counselors enhance treatment when they have high levels of these variables.Hypothesis #2: Clients determine the levels of variables. Good clients elicit high variables but poor clients elicit low variables.NON-POSESSIVE WARMTH- mutual functionEMPATHY/GENUINENESS- under control of the therapist

Clients Perceptions of What Predicts Therapeutic Alliance (Duff, C.T., & Bedi, R.P., 2010)Therapeutic alliance=most robust predictor of outcome than techniquesThree critical factors: making encouraging statements, making positive comments about the client, greeting the client with a smileOthers listed:Asked me questionsIdentified and reflected back feelingsWas honestValidated my experienceMade eye contact with meReferred to details discussed in previous sessionsSat still and did not fidgetSat facing meTold me about similar experiences he/she hadLet me decide what to talk aboutKept the administration outside of our sessionsMattering To Others (Rayle, A.D., 2006)Internal need to feel significant:A) general matteringB) interpersonal mattering

Why do I exist? What difference do I make?Do others notice me?Are my interactions with others different because of me?Do I have the social supports I desire?

*** Counselors can have a significant role in shaping mattering.***

Issue #9- Successful InterventionElements of Helpful Counseling Interventions(Miller, G., 1997)Promote empathy, encouragement, and positive approach to addressing problemsAssist clients in attending to previous unattended areasShifts clients from a problem focus to a solution focusPlants the seed that there will be a time where the issue does not have to have a negative hold on the client (Getting the client to imagine not having the problem anymore)Shift from constructing problems/analysis to constructing solutionsReinforcing how the client manages to get byEmphasis on increasing the frequency of healthy behaviors

Issue #10- Confidentiality/PrivacyHas to do with private information being protected through reasonable expectation that it will not be further disclosed except for the purpose for which it was provided

Areas Protected:Whether or not a person has been a clientThe frequency and intervals of appointmentsTypes of treatment or services receivedReasons for treatmentSpecific words, behaviors or observations during treatmentClient diagnosisCourse and prognosis of treatmentSummaries and recommendations

Confidentiality/PrivacyRequires informed consent- specifying what consenting to, with discussion to client about advantages and disadvantages and potential limitations of disclosureShould be in your policies and procedures about confidentiality, possible breaks of confidentiality and how this is should be handledShould be in writing and signed by all partiesConfidentiality/PrivacyInformation cannot be disclosed in court proceedings unless both: 1) a subpeona has been issued 2) a court order has disclosure. Then court must find that the need for information outweighs the public policy for confidentiality (42 CFR 2.61-2.65 and 45 CFR 164,512 (e) (1) (ii)By law confidentiality continues even after the death of the patient, death of the therapist or sale of the practice to othersWhen in doubt dont give it out.

Issue #11- Therapist Openness/DisclosureReasons to DiscloseFostering therapeutic allianceModeling freedom for clients to discloseReducing clients sense of being alone in his/her problemsIncreasing sense of realness in the counselorSidney Jourards idea of dyadic effect: disclosure begets disclosure- people are more likely to be open with interviewers who themselves are open than with interviewers who express little or nothing of themselves

Reasons against DisclosureShifting focus off the clientUsing counseling timeRole confusionTherapist Openness/DisclosureWhat May Be Disclosed:Professional identity/credentialsEducational backgroundProfessional experiencesProfessional Successes or failuresCounselor Cognitions and emotions related to the client life ExperiencesPersonal FeelingsPersonal Life Successes or FailuresPersonal ValuesPersonal BeliefsPersonal Attitudes on TopicsTo Be individualized to each clientThree Dimensions of Self Disclosure(Jeffrey, A., & Austin, T., 2007)The amount of disclosureThe intimacy of information sharedThe duration of disclosureWithin each there are the issues of where the disclosure is positive or negative, personal or demographic, similar or dissimilar, past or present.

What Clients Said Was Helpful DisclosureAcceptance and EncouragingEnsuring AttentionBody LanguageSilence (Listening)Open and Closed Ended QuestionsReflection of the Content of SessionsDisclosure of FeelingsReflection of FeelingsSelf DisclosureConfrontationKey- developing an understanding of what each operationally means to a given client

How Clients Judged if Disclosure Was Helpful

It built my confidence.It helped me share more.I felt relieved afterward.I had more respect for the therapist and/or the clinical relationship.Frequency of Reasons to Self Disclose(Simone, D.H., McCarthy, P., & Skay, C.L., 1998, p.179)Promote feelings of universality-85Encourage client and instill hope- 81Model coping strategies- 71Build rapport and foster alliance-68Increase awareness of alternative views- 67Provide reality testing-38Decrease client anxiety-37Prevent client idealization of counselor-36Increase self disclosure through modeling/reinforcement-31Increase counselor authenticity-29Decrease client resistance-8Dilute transference near termination-7Challenge the client-4Decrease general transference-3Prevent transference with clients who have poor reality testing-3Provide counselor satisfaction-1Decrease counselor anxiety-0

Frequency of Reasons Not to Self Disclose(Simone, D.H., McCarthy, ., & Skay, C.L., 1998, p.179)Avoid blurring boundaries- 107Stay focused on the client-99Prevent concern about counselor welfare-67Prevent merging-54Prevent premature closure-45Avoid information overload and confusion-40Prevent client feeling burdened by counselor problems-39Avoid interfering with transference-28Prevent client demoralization by counselor success/failure-25Avoid giving client information to manipulate counselor-20Avoid counselor discomfort-14Prevent client questioning counselors ability to help-11Avoid questions about counselors mental helath-9Prevent client communicating information about counselor-4Avoid losing credibility as an expert-3Questions to Consider Regarding DisclosureHave I paused to evaluate this potential disclose beforehand?Why am I disclosing?How will this help the clients goals in counseling?Are there conditions which necessitate this disclosure? If so, what?Are there other ways of approaching the clients issue that may be as effective as disclosure?Is there any potential harm or danger to the client from this potential disclosure?Does the client have the ego strength for this disclosure?Will this disclosure blur professional boundaries?How will this disclosure help the client emotionally (instilling hope, moving toward counseling goals, feeling less alone)?Could the client end up feeling demoralized by my disclosure?Will this disclosure help with reality check?Possibly test out a lower level disclosure first (e.. an obvious topic the client may be wondering about) versus a more detailed deliberate disclosureSelf Disclosure With Children/Teens(Capobianco, J., & Farber, B.A., 2005 & Gaines, R., 2003)Children/teens require a higher degree of self disclosure.Children may elicit and require a higher level of therapist disclosureAll information on you is a type of disclosure for a child/adolescent (mannerisms, dress, dcor, word you use/dont allow, etc.)Children/teens generally less rigid than adults.Find the meaning for the child (what is the symbolism behind it?)Keep in mind age, maturity level, culture, an individual variables unique to this child/teen.Our reactions to the childs behaviors disclose something to (e.g. how we handle misbehaviors, how to set boundaries, how we handle parent/child interactions, play allowedIssue #11: Cultural SensitivityCounseling is culture infused so the working alliance must be culture infused when necessaryThe worldview, orientation, race, ethnicity, identity factors, abilities, religion, socioeconomic status, language, music, hobbies, traditions, beliefs, etc.Three areas of competency:Domain I: Self: active awareness of personal assumptions, values, and biasesDomain II: Cultural awareness: Other- Understanding the worldview of the clientDomain III: Culturally Sensitive Working Alliance: (respect, goal formation, collaboration throughout)

Discursive Empathy (Sinclair, S.L. & Monk, G., 2005)Also called discursive empathy

Not only 1) perceiving the clients viewOr 2) communicating this to the clientBut also 3). incorporating the culture framework and backdrop4). while keeping our separatenessInvolves deconstruction- exploring assumptions and what they are made up of to reinforce or challenge them

What this achieves:1. clarifies the clients position and values2. helps the clients become more reflexiveIncreases clients ability for choice, freedom and self-development

no study found that showed that empathy is harmful

Issue #12: Doing ConfrontationOpen, Honest identification of self defeating thoughts or behaviorsidentify the cyclehelp client increase awareness of thoughts and behaviors which keep the unhealthy cycle goingFunctionsbringing contradictions to lighthelping develop congruencyadmit personal needskeys:timinggenuineness and empathy of counselorfoundations of rapport and trust built

Issue #12: Doing ConfrontationTypes of Confrontationbody language and words do not match uptwo verbal comments do not match upwords and long term behaviors are incongruentone persons behaviors influence the system negatively

The Therapists Stress

Issue #1: Therapist ExpectationsWhat I Expect of The Mental Health Field

What I Believe Is Expected of Me In My Job Setting

My Company ShouldMy Company Actually

The Interpersonal Cycle of Burnout( Geurts, S.,Schaufeli, W., & DeJonge, J., 1998)Cognitive thoughts regarding injustice

Social comparison

Communication with colleagues

Reactions to ambiguous criteria for successEQUITYEXPECTED CONTRIBUTIONSEXPECTED BENEFITS

Sense of negative norms in the setting

Discrepancies between investments and outcomes

Availability of positive alternatives

Discrepancies between shoulds and actualitiesIssues In Job SatisfactionGraduate School Instruction/ExpectationsClient loads

Ability to help others

Ability to have freedom to schedule and build practice in own personal style

Time frame for building a caseload

Role models witnessed- grad school, practicum, internship, mentors, TV, coursework, volunteering, etc.

Dealing with uncontrollable variables

The practice versus the business

Enthusiasm to help versus practical mgmt. of tasks involved

The many facets of counseling: Community, private practice, teaching, administration, assessment, crisis work, consultation

Issues in Burnout: Institutional GoalsQUESTION: DOES EVERYONE EXPERIENCE IT?

10 year life span

60%-90% depression rates in mental health professionals

Is the pay worth the emotional cost?

Mission of the organization versus personal mission- partnership?

Administrative tasks, counseling tasks, associated tasks

Proportion of job/home/personal life expected from this setting

How is this job affecting my home? Interpersonal? Other life?

Issues in Burnout: Institutional GoalsHealthyUnhealthyStrong commitment of employeesWeak commitment of counselorsStrong availability/support from staff Isolation, weak involvement of staffCo-worker relationships- encouragedMinimal opportunities for rel.Support supervisionLow collegial supportSpecific, concrete expectationsAmbiguous/changing expectationsFreedom for some autonomyDiscouraging new ideas/creativityReasonable deadlinesExcessive unrealistic time pressureSome staff retentionHigh turnover of staffSense of purpose/fulfillmentDoubt as to meaning/purposeClients who want helpMandated clientsRealistic specific goalsGoals which cannot be achievedSolid clinical identityNeed to be liked by clientsFacilitator, counselorResponsible for changeSeparation self/clientSelf tied to client outcomesSetbacks are one partSetbacks as personalWhat Agencies Can Do to Support WellnessEducate your staff and supervisors on the concepts of impairment, vicarious traumatization, compassion fatigue and wellness.

Develop or sponsor wellness programs (such as in-service trainings and day-long staff retreats)

Provide clinical supervision (not just task supervision)

Encourage peer supervision

Maintain manageable caseloads

Encourage/require vacations

Do not reward "workaholism"

Encourage diversity of tasks and new areas of interest/practice

Establish and encourage EAPs

Issue #2- Time ScheduleBalancing counseling tasks with non-counseling tasks (setting, time mgmt., how this fits in with initial goals for entering field

ProposalsBlocking time for tasksScheduling certain days for certain functions

Exercise:Ordering the clients in your schedule- cards

Issue #3- Client Vs. Therapist GoalsSpecific

Measureable

Achievable

Broken down into manageable parts

Concrete, behavioral

Evidence based

Tailored to the specific client

Try camera check method to make goals concrete and behavioral. Tends to help produce operational definitions.

Client Vs. Therapist GoalsProblems are rarely so well defined and linear: if only ___, then ___.

Many interactional variables occur at the same time.

Any given person only has a portion of the information.

Sometimes the most important variables are not always revealed.

Timing of decisions may be as important as the rightness or wrongness of decisions.

Decisions are interdependent- one decision affects others.

Goals in decision making may sometimes be contradictory.

Plan for correction and modification.

Exercises: Whats Wrong With These Goals?Poor GoalsImproved Goals

To improve clientssense of self confidence.

To help the client havegreater self satisfaction.

To improve communicationskills.

Exercises: Whats Wrong With These Goals?Poor GoalsImproved Goals For parent and child tofight less.

To feel less depressed.

For things not to get to theclient as much as they do.

Issue #4- Not Paying Attention To Stress/Burnout As It OccursEmotional Exhaustion

I feel drained by this work.

I feel used up by the end of the workday.

I am fatigued when I get up in the morning and have to face another day on the job.

Working with people all day drains me.

I feel like Im at the end of my rope.

I have no energy left after I counseling people.

Not Paying Attention To Stress/Burnout As It OccursSense that one can no longer give as much of oneself to clients professionallyI feel like this job takes too much out of me.This job is more tiring and less pleasurable than it used to be.

Increasingly cynical attitudes about the counseling fieldI can see why my clients are fed up with the system.

Negative/critical self evaluationsI dont feel like I am making as much of a difference in peoples lives as I should be or I would like to be making.

Factors in BurnoutCognitive Expectations:SelfSettingClients

Time spent in field

Types of cases

Personal controllability over caseload, scheduling, etc.

Degree of balance in life in general

Irrational Beliefs of Burnout Prone Therapists(Deutsch, 1984)I should always work at my peak level of enthusiasm and competence.

I should be able to cope with any client emergency.

I should be able to help every client.

Client lack of progress is my fault.

I should always be available when clients need me.

I should be able to work with all types of clients.

I should be on call always.

Irrational Beliefs of Burnout Prone Therapists(Deutsch, 1984)Client needs come before my own needs.

I am responsible for my clients behaviors.

I have power to help, control, or fix a client.

Its selfish to put myself first.

Theres no time for self care.

I cant do this on my own.

The Cognitive- Behavioral Cycle FeelingsThoughts/BeliefsIntensified FeelingsGoalsBehaviors/ActionsNOTE: personal patterns as a therapist of these

Toxic ThoughtsSHOULDSIF ONLY _____ THEN _____ABSOLUTES: ALWAYS/NEVERSTRONG/WEAKGOOD/BADHAVE TO GOAL OF DOING ENOUGH

Toxic ActionsJust keep trying harder/doing moreGive up/withdraw

Cognitive Debating StrategiesIs this a fact or just an opinion?

Is there any other way of looking at this?

According to whom?

Is this belief life giving or death producing?

If this belief is not helpful to me how can I continue telling myself this?

Healthier Self MessagesI would like to do my best with this effort, but I donot have to be perfect.I'm still a good person even when I make a mistake.I can do something well and appreciate it, without it being perfect.I will be happier and perform better if I try to work at a realistic level, rather than demanding perfection of myself.It is impossible for anyone to function perfectly all the time.Signs of burnout are not my fault as a weak person.

Issue #5: Balancing Competing ResponsibilitiesTo assess clientsTo diagnose clientsTo provide relevant treatment for DSM IV disordersTo do insurance paperworkBillingCase notesUp to date education/CEUsConsultation with colleaguesAwareness of and adherence to agency policies

Issue #6: Dealing With Problem SpotsStruggles of CounselorsAdmitting that they have any problemsAdmitting that they need outside helpSetting boundaries regarding time in session and feesMarketing for servicesKnowledge of and skill development in business relationsNegotiating on clients behalf

Caseload Versus WorkloadCaseload= highly related to burnoutHighly intense clientsMandatory referred clientsTypes of clientsVariations of diagnosesWorkload- the actual amount of time spent in client contact and work related functionsMediator variablesSupport systems(e.g. community mental health center example)Self perception of level of effectiveness

Issue #7: Maintaining Counselor WellnessDefining Counselor WellnessBoth an outcome and a processInvolves several dimensionsPhysicalSleepingEating healthyAlertness/being aware and attentive to clientsAbility to physically accomplish the tasks of counselingRegular schedule of mealsSufficient liquid intakeAwareness of hunger and thirstLimiting sugar intakeRoutine physical examsSelf monitoring personal physical needsCreating a warm environment: music, flowers, picturesBreaks (with non-counseling content)

EmotionalSkills in helping clients identify and process their feelings and issuesBalancing insight, awareness and actionAllowing for balance between social time and time aloneProfessional training/competencyCaseload evaluationVacations/breaksDaily recognition of small victories in spite of challengeFlexible thinkingRevisiting successful client filesRe-evaluating personal growth throughout time in practiceJournal of successes and victoriesAccountability with colleagues- to help affirm strengthsInvolvement in interests or projects outside themselvesLimited the number of one way relationships

Behaviors of Healthy Self CareLook at own unresolved issues with clients or supervisees clients Have a network of other supervising counselors to speak withSet aside time for healthy lifestyle behaviors: eating, sleeping, exercisingAllow space from the clinical setting Permit self to not be a caretaker and caregiver for everyone (e.g. see Letting Go Poem)Take time off when necessaryReconceptualize being a supervisor not as one with all the answers (promotes burnout) but a more experienced facilitatorKeep a clear contract (modify if necessary) in writing what job roles and tasks areCharge an appropriate feeKeep your own professional development up to dateKeep an idea about expectations ahead of time so there is some structure for supervision sessions Have an idea ahead of time about how you will let go of stress at the end of the work day

Includes Life Tasks Of Wellness(Myers, J.E, Sweeney, T.J., & Witmer, J.M., 2000)Spiritualitya sense of where I am in the universepersonal and private beliefs about self, others, and the worldhope and optimisma sense of meaning and purpose

Self Directionmindfulness and intentionality toward achieving personal goalshigher levels of perceived self controlacceptance of the whole self (shortcomings and strengths)realistic beliefs- reduction in irrational thoughts, absolutes, and polarized thinking, or magnifying one aspect of situations emotional awareness and regulationdeveloping creative problem solving goal setting and plans for a personal and cultural identity

Work and Leisuresatisfaction at challenges of task completion and quality of worka sense of competencybalancing work and relaxation (doing versus being)

Work and LeisureLeisure (Iwasaki, Y., 2003)2 Coping Models:The Deterioration Model- the presence of stressors reduces levels of resources that could have a negative effect on well being, all about conserving resources and protecting their loss

The Counteractive Model- Stressors elevate proactive resources which enhance well being

Leisure(Kleiber, D.A., Hutchinson, S.L., & Williams, R., 2002)Four Functions of Leisure1) Serves as a distraction away from negative life events- temporary suspension from them (Pallative coping & Leisure mood enhancement)

2) Generating optimism about the future- cognitive reappraisal, consideration of possible perspectives

3) Reconstruction of ones life story- back to normal

4) To assist with personal transformation- writing the story and planning for different endings

Friendship

relational connection with othersasking for help when neededextending outreach to others

Love

building trust in ability to give and receive from othersstability in close relationshipsknowing someone really cares for youGoal of Counseling= to develop a personal wellness plan

Concept of Counselor Stamina(Osborn, C., 2004)Stamina- strength to withstand and hold up under pressureSeven Principles of Counselor Stamina:Selectivity- intentional choosing what one will and will not dotaskspopulations servednumber of caseslimiting specialty areasreasonable goals/objectives

Concept of Counselor Stamina(Osborn, C., 2004)2.Temporal selectivity- time consciousness sessionsplanning daysjuggling taskswork/personalspacing of sessions

Concept of Counselor Stamina(Osborn, C., 2004)3. Accountability- partnering with credible colleaguesStandard of careEthicsCurrent practice4. Measurement/management- conserving and budgeting resourcesRole clarificationsSupportive, positive capable personnel choices

Concept of Counselor Stamina(Osborn, C., 2004)5. Inquisitiveness- fascination with people and their journey in lifemutual puzzlingDesire for ongoing learning

6. Negotiation-flexibilityDiagnosis within contextCultural and personal sensitivityRe-evaluation of counselor as expert

Concept of Counselor Stamina(Osborn, C., 2004)7. Acknowledgement of agencyFocus on personally meaningful goals

ResiliencyResiliencyHardiness- mediates effects of stressFeeling in controlCommitment to the workChange is a challenge

ResiliencyMore than education, more than experience, more than training, a persons resilience will determine who succeeds and who fails.

Adaptation under adversityThe ability to recover from psychological harmNot being defined by earlier negative experienceTo jump, to spring back, to reboundSurvival, adaptation, recovery, risk assessment

Resilience ModelsDispositional/Trait ModelsProtective FactorsRisk FactorsProtective and Risk Factors combinedPersonality Qualities of Resilient PeopleAcceptance of realityStrongly held valuesSense that life is meaningfulOptimism without distortion HopeThe ability to make do with whatever is set before themCognitive flexibilityBalance between expressing and concealing emotion and between positive and negative emotion

Dispositional Resilience(Rossi, N.E., Bisconti, T.L., & Bergeman, C.S., 2007)Is resilience a personality trait?1)Commitment (involvement with people)2) Control (influence over outcomes rather than powerlessness)3) Challenge (learning from experience)

Those who support this view claim that virtues can be cultivated if innate inclination: self discipline, compassion, friendship, work, perseverance, honesty, loyalty, truth, selflessness (Hall, S.E., 2006)

Stress cultivates dispositional resilience (more effective coping strategies, support seeking)Hope Theory (Grewal, P.K., & Porter, J.E., 2007)Two components:1) Agency- belief that goals can be met, goals are manageable and achievable2) Pathways- Actual behavioral plans of implementing goals

May need to be taught:Recalling past successesNaming and reconceptualizing goalsAccountability for actions and follow through

Four Categories of Hopeful Goals(Cheavens, J.S., Feldman, D.B., Woodward, J.T., Snyder, C.R., 2006)Approach goals- moving toward a desired outcomeForstalling negative outcomes- deterring unwanted consequencesMaintenance goals- sustaining the status quoEnhancement goals- augmenting positive outcomesReasonable HopeWeingarten, K., 20101. Relational- community of others2. A Practice- not in isolation, not just one goal3. Maintains that the future is open, uncertain, and influenceable- realistic but full of possibilities4. Seeks Goals and Pathways to Achieving Them- willing to do trial and error and modify as needed5. Accomodates doubt, contradictions, and despair- life can be messy

Can also be vicariousPost Traumatic Growth(Rolli, L., Savicki, V., Spain, E., 2010)Emotions, Mood, and AffectEmotions- short-term focused, intense, adaptiveMood- long term pervasive, less intense, and continuousAffect- involves both emotion and moods

Cultivating positive affect in the face of trauma is an essential ingredient for posttraumatic growthBroadening of focusFinding resourcesDefending against the effects of stressCan co-exist with negative emotions but act as diversion and balance

Narratives Of Resilience Hauser, S.T., & Allen, J.P.Reconstructing the story as able to be modifiedPromote internal locus of control and manageable client goalsSeeing things working outEnvisioning the stress and trauma being disruptedCreating a long term visionProtective FactorsPersonal- intelligence, emotion regulation, temperament, coping strategies, locus of control, attention, genetic influences, absence of antisocial behaviors, history of academic success, help skills, ego control, flexible, positive appraisalsFamily-stable caregivers, basic needs met, atmosphere of love and nurturance, security, positive parenting strategies, parental monitoringCommunity-neighborhood quality, community organizations, quality schools and businesses

Risk FactorsPersonal- disabilities, emotional instability, mental health diagnosis (self or close love one), uneven temperament, poor or no coping strategies, avoidance, withdrawal, external locus of control, family history of negative genetic influences, antisocial behaviors, academic challenges, low self efficacy, inflexible, negative appraisalsFamily-unstable caregivers, basic needs unmet, atmosphere of inconsistency, harsh or negative parenting strategies, parental monitoringCommunity-dangerous or unsafe neighborhood quality, no or few community organizations, poor schools and businesses, limited resources

Issue #8: Empathy Without Loss of SelfHearing the clients account without putting self into itFeeling parallel emotions but actively reminding self that in a session and someone elses storyHelping the client going through the issue(s)Can share with client in words the client relates to the feeling elicited by the incident but in such a way that it does not become the clinicians storyAwareness of signs of overload- muscle tension, fatigue, which clients you cant handle at a certain tie, lack of boundaries, poor eating/sleeping habits, disorganizationBalance between relating to what the client reports yet being detached enough

Empathy Without Loss of SelfThe Most Important Factor: Social Support SystemsPersonal life/family/friendsCommunity involvementColleaguesWhat social supports do that helps:Facilitating compassionFocusing on similar elements among all people- normalizing feelingsReducing self blameFacilitating realistic self acceptance

EXERCISE: PLANNING FOR WELLNESSWord Associations:Health-Healing-Replenish/renewal-Escape-Coping-Fulfillment-Satisfaction-

Issue#9: Developing a Balanced LifeLeisureLeisure directly related to ability to copeTrue leisure related to sense of self spirituallyTrue leisure related to healthy connectednessTrue leisure promotes balance

I can let things happen in the moment.I try to see the beauty in everything.Playfulness is not necessarily unproductive or wasteful.I can periodically revisit how I am feeling and what I need.Meanings of my personal and career goals are allowed to change with age and life stage.Examples:Arts, cooking, music, meditation, physical activity, walking, physical labor, prayer, hobbies, et.

Issue #10: What Cases You Can/Cant HandleEffects of Traumatic CasesNegativePersonal trauma historyFemale versus maleOveridentification with traumatic elementsExtremely in depth detailed trauma workLong term trauma workTrauma cases with little sense of justice and closureFirst responders- anxiety, substance abuse, burnout, PTSD riskSleep interruptionsChronic fatigueMilder versions of the victims symptomology

What Cases You Can/Cant HandleEffects of Traumatic CasesDoes this effect or influence counselor burnout?

Positive33% actually felt more positive- made a difference- involvement in disaster or traumaPersonally helpful to some degree if help counselor reaffirm resilience about their own life stressorsSense of coherence- all humans go through some traumatic things to some degreeWillingness to get therapy personally if indicatedOngoing involvement in supervisionPost traumatic growthWitnessing the resiliency of others

What Cases You Can/Cant HandleMixed ResultsLength of years as a therapistLevel of compassionDepends on degree of previously unresolved things

Compassion FatigueExamples:Dreaming the clients dreamsExperiencing intrusive thoughts and imagesHyperarousalSleep problemsDifficulty concentratingBeing easily startledSense that no one understands my distressNOTE: May also extend to family of the counselor and support systems of the counselor

Vicarious TraumatizationVicarious TraumatizationReactions to cases of those abused or in traumanot a pathological reactionbased on empathic reactions to trauma survivors triggered by our own application of our counseling skillsempathy at full throttle, exaggerated empathy (Rothchild, B., 2002)Less than 10% in most casesExamples: Child abuse, terrorism victims, physical or emotional abuse victims, natural disaster victims, violent crime victims, people with sudden violent deaths

Critical Factors For Processing Traumatic CasesKey how the clinician processes the inner experience of the traumatic materialHow personally they take their ability to control or fix things around themHow much they have worked on their journey toward a professional identity to this pointHow well they can compartmentalize life between professional and personalWhat meaning the clinician assigns to the event (assumptive worldview)Access and willingness to use resources for self careBalancing all aspects of personhoodRegular consultation and supervisionResisting savior syndrome

Issue #11: My IdentityThose Most Prone To BurnoutThose who desire excellenceThose who pride themselves on really caringThose who were on fire beforeThose whose life meanings are intricately tied to others reactions

Behaviors Which Indicate Burnoutdrag yourself into work most daysfind yourself repeating the same thingsgive advice as a shortcut rather than helping clients learn and growbegin sessions late and/or end earlydoze off or space out during sessionsexperience a noticeable decline in empathydo things that seem ethically questionablepush your theory, technique or agenda rather than listening and adjustingfeel relieved when clients cancelself disclose in ways that don't help the clientdo things more for your purposes than for the clientdefining clients in dehumanizing waysloss of/significant change in faith/meaning in lifegeneral pessimismgreater struggles with self/professional identity

Behaviors Which Indicate Burnoutlack of assertivenessstruggles dealing with ambiguitychronic clock watchinginterpersonal difficultiesmore debates and struggles with colleaguesBurnout BeliefsI feel I am an incompetent counselor,I am not confident in my counseling skills.I feel frustrated by my effectiveness as a counselor.I do not feel like I am making a change in my clients.The quality of my counseling is lower than I would like.I am not a good counselor.I feel ineffective as a counselor.It is hard to establish rapport with my clients.I feel like I have a poor professional identity as a counselor.I am not connected to my clients.

Burnout BeliefsDue to my job as a counselor, I become physically ill.I feel like I need a vacation.I feel drained after sessions.I have a chronic feeling of general fatigue.My job as a counselor makes me feel depressed.I feel stressed by the size of my caseload.I feel bogged down by the system in my workplace.I am treated unfairly in my workplace,I feel negative energy from my supervisor.I feel frustrated with the system in my workplace.I feel negative energy from my coworkers.I often feel irritated in my workplace.I feel that there is too much emphasis on paperwork in my workplace.Burnout BeliefsI have Iittle empathy for my clients.I have become callous toward clients.I am no longer concerned about the welfare of my clients.I am not interested in my clients and their problems.I am relieved when clients do not show up for sessions.I have become inattentive in sessions.

What I Can/Cant ControlSerenity Prayer Exercise:Goals for myself What I cant control What I can controlI want to be helpfulto people who havelimited life skills orresources.

I want to make achange in others lives.

Cognitive-behavioral Technique: Watch where you put your BUTS Feelings BUT Positive self statementConcerns Strengths based QuestionsaffirmationStressesExercise: What Do I Want To Be Remembered For?Plan a eulogy for yourself. Write at least 3-5 important variables that you want memorialized about yourself.What are you doing to pursue these now?

Exercise: Create a Self PledgeBalance of time.Responding to client demandsSetting boundaries professionally and personally.Re-assessing my goals.Doing one thing just for myself.Allowing leisure for some time every day.

How Personal Therapy May HelpIncreased empathy for what others, especially clients go through.2. Ability to catch and challenge triggers so they dont repeat themselves.3. Personal issues are caught before they spill over into client relationships.4. There is less risk of an ethical violation or losing your practice.5. Burnout may be thwarted.6. Options of actions can be considered.

BibliographyAckerman, S.J., & Hilsenroth, M.J. (2003). A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review, 38, 171-185.Ackerman, S.J., & Hilsenroth, M.J. (2001). A review of therapist characteristics and techniques negatively impacting the therapeutic alliance. Psychotherapy, 38, 171-185.Angus, L.E., & Kagan, F. (2009). Therapist empathy and client anxiety reduction in motivational interviewing: She carries with me the experience. Journal of Clinical Psychology in Session, 65(11), 1156-1167.Bachelor, A., & Salame, R. (2000). Participants perceptions of dimensions of the therapeutic alliance over the course of therapy. Journal of Psychotherapy Practice and Research, 9, 39-53.

BibliographyBaer, R.A., Smith, G.T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods toexplore facets of mindfulness. Assessment, 13, 27-45.Barber, J.P., Connolly, M.B., Critis- Cristoph, P., Gladis, L., & Siqueland, L. (2000). Alliance predicts patients outcome beyond in-treatment change in symptoms. Journal of Consulting and Clinical Psychology, 68, 1027-1032.Barker, L. & Watson, K. (2000). Listen up: How to improve relationships, reduce stress, and be more productive using the power of listening. St. Martins Press: New York: New York.Beck, M., Friedlander, M. L. &Escudero, V. (2006). Three perspectives on clients experiences of the therapeutic alliance: A discovery-oriented investigation. Journal of Marital and Family Therapy, 32(3), 355-368.BibliographyBedi, R.P. (2006). Concept mapping the clients perspective on counseling alliance formation. Journal of Counseling Psychology, 53, 26-35.Bedi, R.P., Davis, M.D., & Williams, M. (2005). Critical incidents in the formation of the therapeutic alliance from the clients perspective. Psychotherapy: Theory, Research,Practice,Training, 42, 311-323.Berger, C., Angera, J.J., Rawls, D.T., Rapaport, R.J., Bartels, E., & Black, R.J. (2002). College counseling centers with counselors in private practice: Guidelines to negotiate ethical challenges. Journal of College Counseling, 5, 99-104.Bobevski, I., & McLennan. J. (1998). The telephone counseling interview as a complex,dynamic, decision process: A self-regulation model of counselor effectiveness. The Journal of Psychology, 132(1), 47-60.BibliographyBreda, C. S., & Bickman, L. (1997). Termination of mental health services for children. Journal of Child and Family Studies, 6(1), 69-87.Brehmer, B. (1992). Dynamic decision making: Human control of complex systems. Acta Pschologein, 81, 211-241.Burwell-Pender, L., Halinski, K.H. (Winter 2008). Enhanced awareness of countertransference. Journal of Professional Counseling: Practice, Theory, and Research, 36(2), 33-51.Carney, J.S., & Granato, L.A. (2000). The business of counseling: Planning and establishing a private practice. Counseling and Human Development, 32(5), 1-11.Cheavens, J.S., Feldman, D.B., Wodward, J.T., & Snyder, C.R. (2006). Hope in cognitive psychotherapies. On working with client strengths, Journal of Cognitive Psychotherapy: An International Quarterly, 20(2), 135-145.BibliographyClark, A.J. (Summer 2010). Empathy: An integral model in the counseling process. Journal of Counseling & Development, 88, 348-356.Clark, A.J. (April 2010). Empathy and sympathy: therapeutic distinctions on counseling. Journal of Mental Health Counseling, 32(2), 95-101.Clark, A.J. (2004). Empathy: Implications of the three ways of knowing in counseling. Journal of Humanistic Counseling, Education, and Development, 43, 141-151.Clemence, A.J., Hilsenroth, M.J., Ackerman, S.J., Strassle, C.G., & Handler, L. (2005). Facets of the therapeutic alliance and perceived progress in psychotherapy: Relationship between patient and therapist perspectives. Clinical Psychology and Psychotherapy, 12, 443-454.Collins, S., & Arthur, N. (June 2010).Culture-infused counselling: A fresh look at a classic framework of multicultural counseling competencies. Counselling Psychology Quarterly, 23(2), 203-216.

BibliographyConstantine, M.G., & Gainor, K.A. (2001). Emotional intelligence and empathy: Their relation to multicultural counseling knowledge ad awareness. Professional School Counseling, 5(2), 131-137.Cook, J.E., & Doyle, C. (2002). Working alliance in online therapy as compared to face-to-face therapy: Preliminary results. Cyber Psychology & Behavior, 5, 95-105.Daniel, T., & McCleod, J. (2006). Weighing up the evidence: A qualitative analysis of how person-centered counselors evaluate the effectiveness of their practice. Counseling and Psychotherapy Research, 6(4), 244-249.Dixon Rayle, A. , & Myers, J.E. (2004). Wellness in adolescence: The roles of ethnic identity, acculturation, and mattering. Professional School Counseling, 8, 81-90.Dixon Rayle, A. (Fall 2006). Mattering to others: Implications for the counseling relationship. Journal of Counseling & Development, 84, 483-487.BibliographyDuff, C.T., & Bedi, R.P. (March 2010). Counsellor behaviours that predict therapeutic alliance: From the clients perspective. Counseling Psychology Quarterly, 23(1), 91-110.Elliott, G.C., Kao, S., & Grant, A.M. (2004). Mattering: Empirical validation of a social-psychological construct. Self and Identity, 3, 339-354.Feller, C.P., Cottone, R.R. (2003). The importance of empathy in the therapeutic alliance. Journal of Humanistic Counseling, Education, and Development, 42, 53-61.Feng, B., & Lee, K.J. (April-June 2010). The influence of thinking styles on responses to supportive messages. Communication Studies, 61(2), 224-238.Fernald, P.s. (2000). Carl Rogers: Body-centered counselor. Journal of Counseling & Development, 78, 172-179.Fitzpatrick, M.R., & Irannejad, S. (Fall 20008). Adolescent readiness for change and the working alliance in counseling. Journal of Counseling & Development, 86, 438-445.BibliographyFitzpatrick, M.R., Kovalak, A.L., & Weaver, A. (June 2010). How trainees develop an initial theory of practice: A process model of tentative identifications. Counselling and Psychotherapy Research, 10(2), 93-102.Gellhaus Thomas, S.E., Werner-Wilson, R.J., & Murphy, M.J. (March 2005). Influences of therapist and client behaviors on therapy alliance. Contemporary Family Therapy, 27(1), 19-35.Gibson, D.M., Dollarhide, C.T., & Moss, J.M. (2010. Professional identity development: A grounded theory of transformational tasks of new counselors. Counselor Education & Supervision, 50, 21-37.Gold, J.M. (2008). Rethinking client resistance: a narrative approach to integrating resistance into the relationship-building stage of counseling. Journal of Humanistic Counseling, Education, and Development, 47, 56-70.Greason, P.B., & Cashwell, C.S. (2009). Mindfulness and counseling self-efficacy: The mediating role of attention and empathy. Counselor Education & Supervision, 49, 2-18.BibliographyHamilton, B., & Roper, C. (2006). Troubling insight: power and possibilities in mental health care. Journal of Psychiatric and Mental Health Nursing, 13, 416-422.Handley, T. (August 2009). The working alliance in online therapy with young people: Preliminary findings. British Journal of Guidance & Counseling, 37(3), 257-269.Harmon, C., Hawkins, E.J., Lambert, M.J., Slade, K., & Whipple, J.L. (2005). Improving outcomes for poorly responding clients: The use of clinical support tools and feedback to clients. JCLP, 61(2), 175-185.Hartley, G.D. (1995). Empathy in the counseling process: The role of counselor understanding in client change. Journal of Humanistic Education & Development, 34, 13-23.Hathaway, S.R. (200). Some considerations relative to nondirective counseling as therapy. Journal of Clinical Psychology, 56(7), 853-859.Hersoug, A. G., Hoglend, P., Havik, O., Von Der Lippe, A., & Monsen, J. (2009). Therapist characteristicsinfluencing the quality of alliance in long-term psychotherapy. Clinical Psychology and Psychotherapy, 16, 100-110.

BibliographyJohnston, P.J. (1988). Changing the image of a counseling center: Strategies for inexpensive advertising.Journal of Counseling and Development, 66, 250.Josefowitz, N., & Myran, D. (December 2005). Towards a person-centered cognitive behavior therapy. Counselling Psychology Quarterly, 18(4), 329-336.Karver, M., Shirk, S., handleman, J.B., Fields, S., Crisp, H., Gudmundsen, G., & McMakin, D. (March 2008). Relationship processes in youth psychotherapy. Journal of Emotional and Behavioral Disorders, 6(1), 15-28.Kensit, D.A. (2000). Rogerian theory:A critique of the effectiveness of pure client-centered therapy. Counselling Psychology Quarterly, 13, 345-351.Knapp, S., & VandeCreek, L. (2008). The ethics of advertising, billing, and finances in psychotherapy. Journal of Psychology: In Session, 64(5), 613-625.Liebert, T., Archer, J., Munson, J., & York, G. (Janury 2006). An exploratory study of client perceptions of internet counseling and the therapeutic alliance. Journal of Mental Health Counseling, 28(1), 69-83.BibliographyLyubomirsky, S., King, L., & Diener, E. (2005). The benefits of frequent positive affect: Does happiness lead to success? Psychological Bulletin, 131(6), 803-855.Mason, M. J. (Summer 2009). Rogers redux: Relevance and outcomes of motivational interviewing across behavioral problems. Journal of Counseling & Development, 87, 357-362.McLaughlin, J.E., & Boettcher, K. (2009). Counselor identity: Conformity or distinction? Journal of Humanistic Counseling, Education, and Development, 48, 132-143.Meier, P.S., Barrowclough, C., & Donmall, M.C. (2005). The role of the therapeutic alliance in the treatment of substance misuse: A critical review of the literature. Addiction, 100, 304-316.Meissner, W.W. (2006). The therapeutic alliance- a proteus in disguise. [Electronic version]. Psychotherapy: Theory, Research, Practice, Training, 43(3), 264-270.Mellin, E.A., Hunt, B., & Nichols, L.M. (Spring 2011). Counselor professional identity: Findings and implications for counseling and interprofessional collaboration. Journal of Counseling & Development, 89, 140-147.BibliographyMiville, M.L., Carlozzi, A.F., Gushue, G.V., Schara, S.L., & Ueda, M. (April 2006). Mental health counselor qualitiesfor a diverse clientele: Linking empathy, universal-diverse orientation, and emotional intelligence. Journal of Mental Health Counseling, 28(2), 151-165.Munder, T., Wilmers, F., Leonhart, R., Linster, H.W., & Barth, J. (2009). Working allianceinventory- short revised: Psychometric properties in outpatients and in patients. Clinical Psychology & Psychotherapy, 17, 231-239.Nolan, S. (December 2008). The experiencing of experience: A pragmatic reassessment of Rogerian phenomenology. European Journal of Psychotherapy and Counselling, 10(4), 323-339.Otani, A. (1989). Client resistance in counseling: Its theoretical rationale and taxonomic classification. Journal of Counseling and Development, 67, 458-460.Pearson, Q.M. (1999). Integrative empathy: Training counselors to listen with a theoretical ear. Journal of Humanistic Counseling, Education, and Development, 38, 13-18.Pembroke, N. (2005). A trinitarian perspective on the counseling alliance in narrative therapy. Journal of Psychology and Christianity, 24(1), 13-20.

BibliographyQuilliam, S. (2004). Body language: Learn to read and use the bodys secret signals. Firefly: Buffalo, NY.Reeves, M., & Deimer, M. (July-August 2011). Adaptability: The new competitive advantage. Harvard Business Review, 135-141.Restifo, S. (June 2010) Patients performance anxiety and related aspects as factors in resistance to change. Australian Psychiatry, 18(3), 226-229.Richards, K.C., Campenni, C.E., Muse-Burke, J.L. Self-care and well-being in mental health professionals: The mediating effects of self-awareness and mindfulness. Journal of Mental Health Counseling, 32(3), 247-264.Roberts, F.M. (1997). The therapy sourcebook. Contemporary Books, Chicago, IL.Rochlen, A,B., Rude, S.S., & Baron, A. (Spring 2005). The relationship of client stages of change to working alliance and outcome in short term counseling. Journal of College Counseling, 8, 52-64.Rothaupt, J.W., & Morgan, M.M. (October 2007) Counselors and counselor educators practice of mindfulness: A qualitative inquiry. Counseling and Values, 52, 40-54.

BibliographySchubert, J. (Winter 2007). Engaging youth with the power of listening. Reclaiming Children and Youth, 15(4), 227-228.Sinclair, S.L., & Monk, G. (August 2005). Discursive empathy: A new foundation for therapeutic practice. British Journal of Guidance and Counselling, 33(3), 332-349.Stevens, C.L., Muran, J.C., Sfran, J.D., Gorman, B.S., & Winston, A. (2007). Levels and patterns of the therapeutic alliance in brief psychotherapy. American Journal of Psychotherapy, 61(2), 109-129.Stoltz, K.B., & Kern, R.M. (2007). Integrating lifestyle, the therapeutic process, and the stages of change. The Journal of Individual Psychology, 63(1), 32-47.Tambling, R.B., & Johnson, L.N. (2008). The relationship between stages of change and outcome in couples therapy. The American Journal of Family Therapy, 36, 229-241.Tannen, T., & Daniels, M.H. (February 2010). Counsellor presence: Bridging the gap between wisdom and new knowledge. British Journal of Guidance & Counselling, 38(1), 1-15.BibliographyTentoni, S.C. (1997). A marketing technique to increase visability and use of health center counseling services. Journal of American College Health, 46(2), 93-95.Thompson, S.J., Bender, K., Lantry, J., & Flynn, P.M. (2007). Treatment engagement: Building therapeutic alliance in home-based treatment with adolescents and their families. Contemporary Family Therapy, 29, 39-55.Tursi, M.M., & Cochran, J.L. (Fall 2006). Cognitive-behavioral tasks accomplished in a Person-centered relational framework. Journal of Counseling & development, 84, 387-396.Vanaerschot, G. (2007). Empathic resonance and differential experiential processing: An experiential process-directive approach. American Journal of Psychotherapy, 61(3), 313-331.Watson, J.C., & Greenberg, L.S. (2000). Alliance ruptures and repairs in experiential therapy. Psychotherapy in Practice, 58(2), 175-186.Yalom, I.D. (1998). Inside therapy: Illuminating writings about therapists, patients, and psychotherapy. St. Martins Press: New York: New York.