Download - Stress Management For Clients and Their Counselors

Stress Management For Clients and Their

Counselors

Michele D. Aluoch, PCCRiver 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)

• 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 Listening Listeners 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 Pitfalls Tuning Out or Halfheartedly Listening

Rehearsing Our Responses

Assuming Meanings From What the Speaker Says

Jumping to Conclusions

Four Listening Preferences

People- OrientedAction OrientedContent OrientedTime Oriented

People Oriented Listening

Other focusedDemonstrates caring and warmthNonjudgmentalClear verbal and nonverbalsRelates to where the other is coming from

Focuses on building relationshipsNotices changes in other’s moods & incongruencies in them quickly

People Oriented Listening

Problems• Becomes overinvolved in other’s feelings• Too empathic and may overlook faults• More prone to burnout because internalizes and

adopts other’s feelings• Sometimes considered overly expressive by

others• Nondiscriminating in relationships- nice to

everyone• Exs: counselors, service professionals, teachers• Tell stories, use illustrations.• Use “we” and focus on teamwork.• Be personal.

Action-Oriented Listeners

• Concentrate on the task at hand• Frustrated with disorganized people• Comes across as impatient to others• Focuses on expectations• Able to redirect others towards the

most important points of things• Identifies inconsistencies in

messages where things don’t add up

Action-Oriented Listeners

Problems• Impatient with people who talk too long• Jumps to conclusions quickly• Distracted by disorganization• Too blunt- pushes people too far too fast in

conversations• May ask blunt questions• Comes across as critical• Minimizes the importance of the emotional/feelings

in communication because they are too task and thing oriented

• Exs: Attorneys, financial analysts• Keep points to 3 or less• Be short and to the point.• Speak quickly.

Content-Oriented Listeners

• Evaluate every angle of things• Likes digging below the surface to

dissect problems• Value technical information• Wants people to back up what they

say with examples and supports• Values complexities

Content-Oriented Listeners

Problems• Overly detailed• May come across as intimidating because knows

so much• Asks pointed questions• Devalues info. from people who don’t know their

job• Takes time to make decisions after studying all

the angles of things• Exs: scientists, mathematicians, engineers• Provide the data.• Quote experts and statistics.• Use charts and graphs.

Time Oriented Listeners

• Sets time boundaries for conversations

• Gives guidelines for conversation• Does not want “wasted” time• Tells others when they are “wasting”

time

Time Oriented Listeners

Problems• Impatient with time wasters as he/she see

it• Interrupts others• Not good at concentrating and just hearing

others in the moment• Rushes others by watches and clocks• Squelches creativity because so focused

on time and clocks• Go 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 doesn’t matter as much as what you want

• Stopping 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 Listening• Body language= up to 93%• Words can hide secrets whereas body language gives

more clues• 1st 10 seconds= most important• Cautions: defining things by a single gesture alone

without context• Cultural background must be considered• First obtain baseline behavior• Factors to consider:• Status in society fashion subculture• The gaze of person- direction, length of gaze• What eyebrows do• Touch- spatial relations and how touch is used

Nonverbal Listening• Direct look• Lean slightly in• Smile gently• State the person’s name and shake

hand• Take turns communicating• Angling your body toward the

speaker• Use regular head nods• Reflect the speaker’s emotions

Issue #2- Client’s Expectations

• Advertisements/Marketing of Your practice• Insurance panels Bios.• Your website• What they thought they gave consent for• Their understanding of what therapy is/is not• What they think your title or credentials are or

mean• What they think your certifications, licenses or

certificates are for• How they perceive the environment physically• How they perceive you, office staff, colleagues,

other clients

Issue #3- Informed Consent

• Extent and nature of services• Pros and cons (counseling in general, electronic

counseling, phone counseling, techniques used, setting)• Limitations• In clear, understandable, non-technical language• Specified provider name• Therapist’s 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 behaviors• Risks/benefits of therapy• Qualifications of the therapist• Financial considerations and responsibilities

Issue #4- Assessment/Diagnosis

• Why we as the questions we do• What the diagnosis mean• s• Who knows what• Unethical- therapist as moral agent, client no longer

autonomous person coming for help• Ethical- based on observation of concrete, observable

or clients self reported behaviors compared to “norms” and researched and studies standards

• with respect to client perspectives and worldview• with full information and informed consent• under a specific “contract” outlining terms of the

clinical relationship

Issue #5- Treatment Planning

• What goals the client will by into• Client desires• What client perceives to have worked/not worked so

far• How involved client wants to get in the therapeutic

process• How goals are measured• Operational definitions of measurable goals• How achievable goals are• Competing demands therapist’s hopes, clients’ hopes.

Referring agency, insurance company, family/friends, employers/schools/physicians

Issue #6- Client’s Perceptions of your Competency

• How the client defines competency• Board requirements regarding licensure,

certifications, and disclosure statements in office

• Client’s assumptions about your title and ability to clarify or correct these

• Techniques used

Issue #7- Readiness or Resistance

A) RESPONSE QUALITY RESISTANCE• Silence• Minimal talk• Incessant talkB) RESPONSE CONTENT RESISTANCE• Intellectualizing everything to avoid

discussion of emotions• Preoccupation with symptoms• Small talk• Rhetorical questions bout the

counselors decisions on hmwk, assumptions of Dx, etc.

Issue #7- Readiness or Resistance

C) RESPONSE STYLE RESISTANCE• Discounting (yes BUT ____)• Limiting topics in session• Blaming others• Second guessing the counselor (“are you saying or

meaning ___?”)• Reporting only positives• Seductiveness• Forgetting supplies or materials• Disclosure at last minute• Habitually breaking promises

D) LOGISTIC MANAGEMENT RESISTANCE• Poor appointment keeping• Payment delay or refusal• Personal favor asking

Common Defense Mechanisms(Clark, A.J., 1991)

• Outside awareness initially• Habitual• Useful (in client’s perception)

Denial- rejecting responsibility• “I don’t have a problem.”• “Nobody ever told me.”• “I didn’t know.”

Displacement- shifting responsibility to a vulnerable substitute• “I couldn’t control my behavior because of that stupid

overbearing teacher.”• “A few drinks just cause me to do things I don’t expect.”

Identification- acting like someone he/she admires• “I have a good heart just like my brother.”• “My family may have it’s 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 opposite

• “I drank all weekend but when I came to my senses I realized this isn’t 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 vulnerable

• “Drinking 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 self

• “It seems like you don’t want this counseling to help me. You disagree with me.”

• “They said I didn’t perform on my job.”• “If that fool would have gotten out of the way I wouldn’t

have hit him in the drunk driving incident anyway.


(Clark, A.J., 1991)Rationalization-Justifying one’s behaviors• “Everyone lies to their parents.”• “All people steal some of the extra supplies on

the job that aren’t being used.”• “Most parents get frustrated with their kids and

lose control at times.”

Reaction formation- Exaggerating claims of highly moral actions and attitudes

• “I would never get tempted to do anything like that.”

• “I organized the community fair against that kind of behavior.”


(Clark, A.J., 1991)

Regression-returning to an earlier stage of maturation and development

• “I had these kids young. It is my time to live . What’s 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 topics

• “I don’t recall anything like that.”• “I don’t ever remember disobeying my parents.”

Dealing With Defense Mechanisms

Relationship stage• Identify specific defenses for that client• Generally will be the same ones they use with you• Use advanced empathy to understand and help them

understand why they habitually relied on them• Sentence completion exercises help

Integration stage• Distortions are confronted• Lack of congruency is brought to the client’s attention

Accomplishment stage• Productive actions and alternatives are highlighted• Client is encouraged to act differently as he or she

would like to be• Alternative behaviors are maintained• A strengths-based approach is used

Issue #8- Perceptions of Process Variables

• Still critical foundations for success• Empathy• Non possessive warmth• Genuineness• Whose 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 function• EMPATHY/GENUINENESS- under control of the

therapist

Client’s Perceptions of What Predicts Therapeutic

Alliance

(Duff, C.T., & Bedi, R.P., 2010)• Therapeutic alliance=most robust predictor of outcome than

techniques• Three critical factors: making encouraging statements, making

positive comments about the client, greeting the client with a smile• Others listed:• Asked me questions• Identified and reflected back feelings• Was honest• Validated my experience• Made eye contact with me• Referred to details discussed in previous sessions• Sat still and did not fidget• Sat facing me• Told me about similar experiences he/she had• Let me decide what to talk about• Kept the administration outside of our sessions

Mattering To Others (Rayle, A.D., 2006)

• Internal need to feel significant:• A) general mattering• B) 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 Intervention

• Elements of Helpful Counseling Interventions(Miller, G., 1997)

• Promote empathy, encouragement, and positive approach to addressing problems

• Assist clients in attending to previous unattended areas

• Shifts clients from a problem focus to a solution focus

• Plants 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 solutions

• Reinforcing how the client manages to get by• Emphasis on increasing the frequency of healthy

behaviors

Issue #10- Confidentiality/Privacy

• Has 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 client• The frequency and intervals of appointments• Types of treatment or services received• Reasons for treatment• Specific words, behaviors or observations during

treatment• Client diagnosis• Course and prognosis of treatment• Summaries and recommendations

Confidentiality/Privacy• Requires informed consent- specifying what

consenting to, with discussion to client about advantages and disadvantages and potential limitations of disclosure

• Should be in your policies and procedures about confidentiality, possible breaks of confidentiality and how this is should be handled

• Should be in writing and signed by all parties

Confidentiality/Privacy• Information 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 others

• “When in doubt don’t give it out.”

Issue #11- Therapist Openness/Disclosure

Reasons to Disclose• Fostering therapeutic alliance• Modeling freedom for clients to disclose• Reducing client’s sense of being alone in his/her

problems• Increasing sense of realness in the counselor• Sidney Jourard’s 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 Disclosure• Shifting focus off the client• Using counseling time• Role confusion

Therapist Openness/Disclosure

What May Be Disclosed:• Professional identity/credentials• Educational background• Professional experiences• Professional Successes or failures• Counselor Cognitions and emotions related to the

client life Experiences• Personal Feelings• Personal Life Successes or Failures• Personal Values• Personal Beliefs• Personal Attitudes on Topics• To Be individualized to each client

Three Dimensions of Self Disclosure(Jeffrey, A., & Austin, T., 2007)

• The amount of disclosure• The intimacy of information shared• The duration of disclosure• Within 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 Disclosure

• Acceptance and Encouraging• Ensuring Attention• Body Language• Silence (Listening)• Open and Closed Ended Questions• Reflection of the Content of Sessions• Disclosure of Feelings• Reflection of Feelings• Self Disclosure• Confrontation• Key- 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-85• Encourage client and instill hope- 81

• Model coping strategies- 71• Build rapport and foster alliance-68

• Increase awareness of alternative views- 67• Provide reality testing-38• Decrease client anxiety-37

• Prevent client idealization of counselor-36• Increase self disclosure through modeling/reinforcement-31

• Increase counselor authenticity-29• Decrease client resistance-8

• Dilute transference near termination-7• Challenge the client-4

• Decrease general transference-3• Prevent transference with clients who have poor reality

testing-3• Provide counselor satisfaction-1• Decrease counselor anxiety-0

Frequency of Reasons Not to Self Disclose

(Simone, D.H., McCarthy, ., & Skay, C.L., 1998, p.179)• Avoid blurring boundaries- 107• Stay focused on the client-99• Prevent concern about counselor welfare-67• Prevent merging-54• Prevent premature closure-45• Avoid information overload and confusion-40• Prevent client feeling burdened by counselor problems-39• Avoid interfering with transference-28• Prevent client demoralization by counselor success/failure-

25• Avoid giving client information to manipulate counselor-20• Avoid counselor discomfort-14• Prevent client questioning counselor’s ability to help-11• Avoid questions about counselor’s mental helath-9• Prevent client communicating information about counselor-4• Avoid losing credibility as an expert-3

Questions to Consider Regarding Disclosure

• Have I paused to evaluate this potential disclose beforehand?• Why am I disclosing?• How will this help the client’s goals in counseling?• Are there conditions which necessitate this disclosure? If so, what?• Are there other ways of approaching the client’s 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 disclosure

Self 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 disclosure• All information on you is a type of disclosure for a

child/adolescent (mannerisms, dress, décor, word you use/don’t 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 child’s behaviors disclose

something to (e.g. how we handle misbehaviors, how to set boundaries, how we handle parent/child interactions, play allowed

Issue #11: Cultural Sensitivity

• Counseling is culture infused so the working alliance must be culture infused when necessary

• The 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 biases• Domain II: Cultural awareness: Other-

Understanding the worldview of the client• Domain 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 client’s view• Or 2) communicating this to the client• But also … 3). incorporating the culture framework and backdrop• 4). while keeping our separateness• Involves “deconstruction”- exploring assumptions and what they

are made up of to reinforce or challenge them

What this achieves:• 1. clarifies the client’s position and values• 2. helps the clients become more reflexive• Increases client’s ability for choice, freedom and self-

development

• “no study found that showed that empathy is harmful”

Issue #12: Doing Confrontation

• Open, Honest identification of self defeating thoughts or behaviors

o identify the cycleo help client increase awareness of thoughts and behaviors

which keep the unhealthy cycle goingFunctions• bringing contradictions to light• helping develop congruency• admit personal needs• keys:• timing• genuineness and empathy of counselor• foundations of rapport and trust built

Issue #12: Doing Confrontation

Types of Confrontation• body language and words do not

match up• two verbal comments do not match up• words and long term behaviors are

incongruent• one person’s behaviors influence the

system negatively

The Therapist’s

Stress

Issue #1: Therapist Expectations

What I Expect of The Mental Health Field

What I Believe Is Expected of Me In My Job Setting

My Company Should My 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 success

EQUITYEXPECTED CONTRIBUTIONSEXPECTED BENEFITS

• Sense of negative norms in the setting• Discrepancies between investments and outcomes• Availability of positive alternatives• Discrepancies between “shoulds” and actualities

Issues In Job Satisfaction

Graduate School Instruction/Expectations• Client 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 Goals

• QUESTION: 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 Goals

Healthy UnhealthyStrong commitment of employees Weak commitment of

counselorsStrong availability/support from staff Isolation, weak involvement of

staffCo-worker relationships- encouraged Minimal opportunities for rel.Support supervision Low collegial supportSpecific, concrete expectations Ambiguous/changing expectationsFreedom for some autonomy Discouraging new ideas/creativityReasonable deadlines Excessive unrealistic time pressureSome staff retentionHigh turnover of staffSense of purpose/fulfillment Doubt as to meaning/purposeClients who want help Mandated clientsRealistic specific goals Goals which cannot be achievedSolid clinical identity Need to be liked by clientsFacilitator, counselor Responsible for changeSeparation self/client Self tied to client outcomesSetbacks are one part Setbacks as personal

What Agencies Can Do to Support

Wellness• Educate 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 Schedule

• Balancing counseling tasks with non-counseling tasks (setting, time mgmt., how this fits in with initial goals for entering field

Proposals• Blocking time for tasks• Scheduling certain days for certain functions

Exercise:• Ordering the clients in your schedule- cards

Issue #3- Client Vs. Therapist Goals

• Specific• 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 Goals

• Problems 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: What’s Wrong With These

Goals?Poor Goals Improved Goals

To improve client’ssense of self confidence.

To help the client havegreater self satisfaction.

To improve communicationskills.

Exercises: What’s Wrong With These

Goals?Poor Goals Improved 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 Occurs

Emotional 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 I’m at the end of my rope.”• “I have no energy left after I counseling people.”

Not Paying Attention To Stress/Burnout As It Occurs

Sense that one can no longer give as much of oneself to clients professionally

“I 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 field

“I can see why my clients are fed up with the system.”

Negative/critical self evaluations“I don’t feel like I am making as much of a difference in

people’s lives as I ‘should’ be or I would like to be making.”

Factors in Burnout• Cognitive 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 client’s behaviors.”

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

• It’s selfish to put myself first.

• There’s no time for self care.

• I can’t do this on my own.

The Cognitive- Behavioral Cycle

• Feelings• Thoughts/Beliefs• Intensified Feelings• Goals• Behaviors/Actions• NOTE: personal patterns as a therapist of these

Toxic Thoughts• SHOULDS• IF ONLY _____ THEN _____• ABSOLUTES: ALWAYS/NEVER

• STRONG/WEAK• GOOD/BAD

• HAVE TO • GOAL OF DOING “ENOUGH”

Toxic Actions• Just keep trying harder/doing more• Give up/withdraw

Cognitive Debating Strategies

• Is 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 Messages

I 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 Responsibilities

• To assess clients• To diagnose clients• To provide relevant treatment for DSM IV

disorders• To do insurance paperwork• Billing• Case notes• Up to date education/CEUs• Consultation with colleagues• Awareness of and adherence to agency policies

Issue #6: Dealing With Problem Spots

Struggles of Counselors• Admitting that they have any problems• Admitting that they need outside help

• Setting boundaries regarding time in session and fees

• Marketing for services• Knowledge of and skill development in business

relations• Negotiating on client’s behalf

Caseload Versus Workload

Caseload= highly related to burnout• Highly intense clients• Mandatory referred clients• Types of clients• Variations of diagnoses

Workload- the actual amount of time spent in client contact and work related functions

Mediator variables• Support systems• (e.g. community mental health center example)• Self perception of level of effectiveness

Issue #7: Maintaining Counselor Wellness

Defining Counselor WellnessBoth an outcome and a process

Involves several dimensions

Physical• Sleeping• Eating healthy• Alertness/being aware and attentive to clients• Ability to physically accomplish the tasks of counseling• Regular schedule of meals• Sufficient liquid intake• Awareness of hunger and thirst• Limiting sugar intake• Routine physical exams• Self monitoring personal physical needs• Creating a warm environment: music, flowers, pictures• Breaks (with non-counseling content)

Emotional• Skills in helping clients identify and process their feelings and

issues• Balancing insight, awareness and action• Allowing for balance between social time and time alone• Professional training/competency• Caseload evaluation• Vacations/breaks• Daily recognition of small victories in spite of challenge• Flexible thinking• Revisiting successful client files• Re-evaluating personal growth throughout time in practice• Journal of successes and victories• Accountability with colleagues- to help affirm strengths• Involvement in interests or projects outside themselves• Limited the number of one way relationships

Behaviors of Healthy Self Care

• Look at own unresolved issues with clients or supervisee’s clients • Have a network of other supervising counselors to speak with• Set aside time for healthy lifestyle behaviors: eating, sleeping,

exercising• Allow 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 necessary• Reconceptualize being a supervisor not as one with all the

answers (promotes burnout) but a more experienced facilitator• Keep a clear contract (modify if necessary) in writing what job

roles and tasks are• Charge an appropriate fee• Keep your own professional development up to date• Keep 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)Spirituality

• a sense of where I am in the universe• personal and private beliefs about self, others,

and the world• hope and optimism

• a sense of meaning and purpose

Self Direction• mindfulness and intentionality toward achieving

personal goals• higher levels of perceived self control

• acceptance 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 regulation• developing creative problem solving

• goal setting and plans for a personal and cultural identity

Work and Leisure• satisfaction at challenges of task completion and

quality of work• a sense of competency

• balancing work and relaxation (doing versus being)

Work and Leisure• Leisure (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 Leisure

1) 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 one’s life story- back to “normal”

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

Friendship

• relational connection with others• asking for help when needed• extending outreach to others

Love

• building trust in ability to give and receive from others

• stability in close relationships• knowing someone really cares

for you• Goal of Counseling= to develop a

personal wellness plan

Concept of Counselor Stamina(Osborn, C., 2004)

Stamina- strength to withstand and hold up under pressure

Seven Principles of Counselor Stamina:1. Selectivity- intentional choosing what

one will and will not do1. tasks2. populations served3. number of cases4. limiting “specialty” areas5. reasonable goals/objectives


2.Temporal selectivity- time consciousness o sessionso planning dayso juggling taskso work/personalo spacing of sessions


3. Accountability- partnering with credible colleagues

• Standard of care• Ethics• Current practice4. Measurement/management-

conserving and budgeting resourceso Role clarificationso Supportive, positive capable

personnel choices


5. Inquisitiveness- fascination with people and their journey in life

• “mutual puzzling”• Desire for ongoing learning

6. Negotiation-flexibility• Diagnosis within context• Cultural and personal sensitivity• Re-evaluation of “counselor as expert”


7. Acknowledgement of agency• Focus on personally meaningful goals

ResiliencyResiliency

Hardiness- mediates effects of stress• Feeling in control• Commitment to the work• Change is a challenge

Resiliency• “More than education, more than experience, more than training, a

person’s resilience will determine who succeeds and who fails.”

• Adaptation under adversity• The ability to recover from psychological harm• Not being defined by earlier negative experience• To jump, to spring back, to rebound• Survival, adaptation, recovery, risk assessment

Resilience Models• Dispositional/Trait Models• Protective Factors• Risk Factors• Protective and Risk Factors

combined

Personality Qualities of Resilient People

• Acceptance of reality• Strongly held values• Sense that life is meaningful• Optimism without distortion • Hope• The ability to make do with whatever is set before

them• Cognitive flexibility• Balance 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:

o Recalling past successeso Naming and reconceptualizing goalso Accountability 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 outcome

• Forstalling negative outcomes- deterring unwanted consequences

• Maintenance goals- sustaining the status quo

• Enhancement goals- augmenting positive outcomes

Reasonable HopeWeingarten, K., 2010

1. 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 vicarious

Post Traumatic Growth(Rolli, L., Savicki, V., Spain, E., 2010)

Emotions, Mood, and Affect• Emotions- short-term focused, intense, adaptive• Mood- long term pervasive, less intense, and

continuous• Affect- involves both emotion and moods

• Cultivating positive affect in the face of trauma is an essential ingredient for posttraumatic growtho Broadening of focuso Finding resourceso Defending against the effects of stresso Can 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 modified• Promote internal locus of control and manageable

client goals• Seeing things working out• Envisioning the stress and trauma being

disrupted• Creating a long term vision

Protective Factors• Personal- 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 appraisals

• Family-stable caregivers, basic needs met, atmosphere of love and nurturance, security, positive parenting strategies, parental monitoring

• Community-neighborhood quality, community organizations, quality schools and businesses

Risk Factors• Personal- 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 appraisals

• Family-unstable caregivers, basic needs unmet, atmosphere of inconsistency, harsh or negative parenting strategies, parental monitoring

• Community-dangerous or unsafe neighborhood quality, no or few community organizations, poor schools and businesses, limited resources

Issue #8: Empathy Without Loss of Self

• Hearing the client’s account without putting self into it

• Feeling parallel emotions but actively reminding self that in a session and someone else’s story

• Helping 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 clinician’s story

• Awareness of signs of overload- muscle tension, fatigue, which clients you can’t handle at a certain tie, lack of boundaries, poor eating/sleeping habits, disorganization

• Balance between relating to what the client reports yet being detached enough

Empathy Without Loss of Self

The Most Important Factor: Social Support Systems

Personal life/family/friendsCommunity involvement

ColleaguesWhat social supports do that helps:

Facilitating compassionFocusing on similar elements among all people-

normalizing feelingsReducing self blame

Facilitating realistic self acceptance

EXERCISE: PLANNING FOR

WELLNESSWord Associations:

• Health-• Healing-• Replenish/renewal-• Escape-• Coping-• Fulfillment-• Satisfaction-

Issue#9: Developing a Balanced Life

Leisure• Leisure directly related to ability to cope

• True leisure related to sense of self spiritually• True leisure related to healthy connectedness

• True 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/Can’t Handle

Effects of Traumatic CasesNegative

• Personal trauma history• Female versus male

• Overidentification with traumatic elements• Extremely in depth detailed trauma work

• Long term trauma work• Trauma cases with little sense of justice and closure

• First responders- anxiety, substance abuse, burnout, PTSD risk

• Sleep interruptions• Chronic fatigue

• Milder versions of the victims symptomology

What Cases You Can/Can’t Handle

Effects of Traumatic CasesDoes this effect or influence counselor burnout?

Positive• 33% actually felt more positive- made a difference- involvement in disaster or trauma• Personally helpful to some degree if help

counselor reaffirm resilience about their own life stressors

• Sense of coherence- all humans go through some traumatic things to some degree

• Willingness to get therapy personally if indicated• Ongoing involvement in supervision

• Post traumatic growth• Witnessing the resiliency of others

What Cases You Can/Can’t Handle

Mixed Results• Length of years as a therapist

• Level of compassion• Depends on degree of previously unresolved

things

Compassion FatigueExamples:• Dreaming the client’s dreams• Experiencing intrusive thoughts and images• Hyperarousal• Sleep problems• Difficulty concentrating• Being easily startled• Sense that no one understands my distressNOTE: May also extend to family of the counselor

and support systems of the counselor

Vicarious Traumatization

Vicarious Traumatization• Reactions to cases of those abused or in trauma• not a pathological reaction• based on empathic reactions to trauma survivors triggered by

our own application of our counseling skills• “empathy 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 Cases

• Key how the clinician processes the inner experience of the traumatic material

• How personally they take their ability to control or fix things around them

• How much they have worked on their journey toward a professional identity to this point

• How well they can compartmentalize life between professional and personal

• What meaning the clinician assigns to the event (assumptive worldview)

• Access and willingness to use resources for self care• Balancing all aspects of personhood• Regular consultation and supervision• Resisting “savior syndrome”

Issue #11: My IdentityThose Most Prone To Burnout

• Those who desire excellence• Those who pride themselves on

“really caring”• Those who were “on fire” before• Those whose life meanings are

intricately tied to others’ reactions

Behaviors Which Indicate Burnout

• drag yourself into work most days• find yourself repeating the same things• give advice as a shortcut rather than helping clients learn

and grow• begin sessions late and/or end early• doze off or space out during sessions• experience a noticeable decline in empathy• do things that seem ethically questionable• push your theory, technique or agenda rather than

listening and adjusting• feel relieved when clients cancel• self disclose in ways that don't help the client• do things more for your purposes than for the client• defining clients in dehumanizing ways• loss of/significant change in faith/meaning in life• general pessimism• greater struggles with self/professional identity

Behaviors Which Indicate Burnout

• lack of assertiveness• struggles dealing with ambiguity• chronic clock watching• interpersonal difficulties• more debates and struggles with colleagues

Burnout Beliefs• I 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 Beliefs• Due 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 Beliefs• I 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/Can’t Control

Serenity Prayer Exercise:Goals for myself What I can’t control What I

can controlI want to be helpfulto people who havelimited life skills orresources.

I want to make achange in other’s lives.

Cognitive-behavioral Technique: Watch where you

put your BUTS

Feelings BUT Positive self statementConcerns Strengths based Questions affirmationStresses

Exercise: 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 Pledge

• Balance of time.• Responding to client demands• Setting 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 Help

1. Increased empathy for what others, especially clients go through.

2. Ability to catch and challenge triggers so they don’t 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.

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