1. Stress Management For Clients and Their Counselors
Michele D. Aluoch, PCC
River of Life Professional Counseling LLC
c.2013

2. The Client’s Stress

3. 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.

4. 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.

5. Listening Pitfalls Tuning Out or Halfheartedly Listening
Rehearsing Our Responses
Assuming Meanings From What the Speaker Says
Jumping to Conclusions

6. Four Listening Preferences
People- Oriented
Action Oriented
Content Oriented
Time Oriented

7. People Oriented Listening
Other focused
Demonstrates caring and warmth
Nonjudgmental
Clear verbal and nonverbals
Relates to where the other is coming from
Focuses on building relationships
Notices changes in other’s moods & incongruencies in them quickly

8. 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.

9. 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

10. 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.

11. 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

12. 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.

13. Time Oriented Listeners
Sets time boundaries for conversations
Gives guidelines for conversation
Does not want “wasted” time
Tells others when they are “wasting” time

14. 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.

15. 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.

16. 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.

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. Issue #7- Readiness or Resistance
A) RESPONSE QUALITY RESISTANCE
Silence
Minimal talk
Incessant talk
B) 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.

25. 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

26. 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.”

27. 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.”

28. 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.

29. Common Defense Mechanisms (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.”

30. Common Defense Mechanisms (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.”

31. 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

32. 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

33. Client’s Perceptions of What Predicts Therapeutic Alliance (Duff, C. T
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

34. 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.***

35. 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

36. 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

37. 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

38. 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 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.”

39. 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

40. 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

41. 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.

42. 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

43. 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.

44. Frequency of Reasons to Self Disclose (Simone, D. H. , McCarthy, P
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

45. Frequency of Reasons Not to Self Disclose (Simone, D. H. , McCarthy,
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

46. 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

47. Self Disclosure With Children/Teens (Capobianco, J. , & Farber, B. A
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

48. 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)

49. 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”

50. Issue #12: Doing Confrontation
Open, Honest identification of self defeating thoughts or behaviors
identify the cycle
help client increase awareness of thoughts and behaviors which keep the unhealthy cycle going
Functions
bringing contradictions to light
helping develop congruency
admit personal needs
keys:
timing
genuineness and empathy of counselor
foundations of rapport and trust built

51. 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

52. The Therapist’s Stress

53. 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

54. The Interpersonal Cycle of Burnout ( Geurts, S. ,Schaufeli, W
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
EQUITY
EXPECTED CONTRIBUTIONS
EXPECTED BENEFITS
Sense of negative norms in the setting
Discrepancies between investments and outcomes
Availability of positive alternatives
Discrepancies between “shoulds” and actualities

55. 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

56. 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?

57. Issues in Burnout: Institutional Goals
Healthy Unhealthy Strong commitment of employees Weak commitment of counselors Strong availability/support from staff Isolation, weak involvement of staff Co-worker relationships- encouraged Minimal opportunities for rel. Support supervision Low collegial support Specific, concrete expectations Ambiguous/changing expectations Freedom for some autonomy Discouraging new ideas/creativity Reasonable deadlines Excessive unrealistic time pressure Some staff retention High turnover of staff Sense of purpose/fulfillment Doubt as to meaning/purpose Clients who want help Mandated clients Realistic specific goals Goals which cannot be achieved Solid clinical identity Need to be liked by clients Facilitator, counselor Responsible for change Separation self/client Self tied to client outcomes Setbacks are one part Setbacks as personal

58. 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

59. 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

60. 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.

61. 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.

62. Exercises: What’s Wrong With These Goals?
Poor Goals Improved Goals
To improve client’s
sense of self confidence.
To help the client have
greater self satisfaction.
To improve communication
skills.

63. Exercises: What’s Wrong With These Goals?
Poor Goals Improved Goals
For parent and child to
fight less.
To feel less depressed.
For things not to get to the
client as much as they do.

64. 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.”

65. 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.”

66. Factors in Burnout Cognitive Expectations: Self Setting Clients
Time spent in field
Types of cases
Personal “controllability” over caseload, scheduling, etc.
Degree of balance in life in general

67. 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.”

68. 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.

69. 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

70. 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?

71. Healthier Self Messages
I would like to do my best with this effort, but I do
not 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.

72. 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

73. 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

74. 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

75. Issue #7: Maintaining Counselor Wellness
Defining Counselor Wellness Both an outcome and a process Involves several dimensions

76. 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)

77. 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

78. 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

79. Includes Life Tasks Of Wellness (Myers, J. E, Sweeney, T. J
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

80. 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

81. Work and Leisure
satisfaction at challenges of task completion and quality of work
a sense of competency
balancing work and relaxation (doing versus being)

82. 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

83. 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

84. Friendship relational connection with others
asking for help when needed
extending outreach to others

85. 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

86. Concept of Counselor Stamina (Osborn, C., 2004)
Stamina- strength to withstand and hold up under pressure
Seven Principles of Counselor Stamina:
Selectivity- intentional choosing what one will and will not do
tasks
populations served
number of cases
limiting “specialty” areas
reasonable goals/objectives

87. Concept of Counselor Stamina (Osborn, C., 2004)
2.Temporal selectivity- time consciousness
sessions
planning days
juggling tasks
work/personal
spacing of sessions

88. Concept of Counselor Stamina (Osborn, C., 2004)
3. Accountability- partnering with credible colleagues
Standard of care
Ethics
Current practice
4. Measurement/management- conserving and budgeting resources
Role clarifications
Supportive, positive capable personnel choices

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

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

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

92. 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

93. Resilience Models Dispositional/Trait Models Protective Factors
Risk Factors
Protective and Risk Factors combined

94. 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

95. Dispositional Resilience (Rossi, N. E. , Bisconti, T. L
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)

96. Hope Theory (Grewal, P.K., & Porter, J.E., 2007)
Two components:
1) Agency- belief that goals can be met, goals are manageable and achievable
2) Pathways- Actual behavioral plans of implementing goals
May need to be taught:
Recalling past successes
Naming and reconceptualizing goals
Accountability for actions and follow through

97. Approach goals- moving toward a desired outcome
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

98. Reasonable Hope Weingarten, K., 2010
1. Relational- community of others
2. A Practice- not in isolation, not just one goal
3. Maintains that the future is open, uncertain, and influenceable- realistic but full of possibilities
4. Seeks Goals and Pathways to Achieving Them- willing to do trial and error and modify as needed
5. Accomodates doubt, contradictions, and despair- life can be messy
Can also be vicarious

99. 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 growth
Broadening of focus
Finding resources
Defending against the effects of stress
Can co-exist with negative emotions but act as diversion and balance

100. 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

101. 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

102. 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

103. 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

104. Empathy Without Loss of Self
The Most Important Factor: Social Support Systems
Personal life/family/friends
Community involvement
Colleagues
What social supports do that helps:
Facilitating compassion
Focusing on similar elements among all people-
normalizing feelings
Reducing self blame
Facilitating realistic self acceptance

105. EXERCISE: PLANNING FOR WELLNESS
Word Associations:
Health-
Healing-
Replenish/renewal-
Escape-
Coping-
Fulfillment-
Satisfaction-

106. 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.

107. Issue #10: What Cases You Can/Can’t Handle
Effects of Traumatic Cases
Negative
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

108. What Cases You Can/Can’t Handle
Effects of Traumatic Cases
Does 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

109. 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

110. Compassion Fatigue Examples: Dreaming the client’s dreams
Experiencing intrusive thoughts and images
Hyperarousal
Sleep problems
Difficulty concentrating
Being easily startled
Sense that no one understands my distress
NOTE: May also extend to family of the counselor and support systems of the counselor

111. 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 cases
Examples:
Child abuse, terrorism victims, physical or emotional abuse victims, natural disaster victims, violent crime victims, people with sudden violent deaths

112. 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”

113. Those Most Prone To Burnout
Issue #11: My Identity
Those 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

114. 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

115. Behaviors Which Indicate Burnout
lack of assertiveness
struggles dealing with ambiguity
chronic clock watching
interpersonal difficulties
more debates and struggles with colleagues

116. 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.

117. 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.

118. 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.

119. What I Can/Can’t Control
Serenity Prayer Exercise:
Goals for myself What I can’t control What I can control
I want to be helpful
to people who have
limited life skills or
resources.
I want to make a
change in other’s lives.

120. Cognitive-behavioral Technique: Watch where you put your BUTS
Feelings BUT Positive self statement Concerns Strengths based Questions affirmation Stresses

121. 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?

122. 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.

123. How Personal Therapy May Help
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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