Self-Care for Counselors

The other night in my practicum class, I had an informal discussion with some classmates about self-care. I said, “if I do one self-care activity, that should be it, right? I should be emotionally ready to move on with my life, even if it was a really intense day of counseling.” Unfortunately, self-care is not always something you can check off of a list – it may be more of a mindset, of being aware that you are more emotionally fragile while you are processing your counseling sessions. My friend Michael DeJesus said in response to my statement that we need we remember we are new at this and have not developed an understanding of our own emotional reactions yet. He said to think of it like a sore muscle; if you go for a long, hard run for the first time ever, you will be sore afterwards. You may not notice it until you go to walk up stairs, or go out for the second run, but you will be sore nonetheless. With more training, you will build up the strength and endurance. Similarly, with beginning counseling we may be emotionally sore to start.

Self-care may take a little time and a little patience, as well as a few good tools. For some counselors, this may mean singing loudly on the drive home, chatting with a friend on the phone, making a nice dinner, taking a walk or going for a run, or watching a mindless tv show. For counseling graduate students, it might mean taking some of that pressure off of yourself, even if it’s just for an evening.

One word of advice: if you are struggling to adjust emotionally to working in the baggage department of other people’s lives, let at least one of your social supports know. That way, at least if you end up crying in your kitchen because the coffee grounds spilled all over the floor while you were making dinner, your boyfriend (or girlfriend, spouse, parent, cat or roommate) will have some idea why!

Theory and Practice – Supervision Groups

At the beginning of this semester, I was hesitant to push the red “record” button on my videotape during my first session as a counselor, working with another student in my Theory and Practice I class (taught by Professor Doug Guiffrida). Not only was I counseling someone for the first real time, other people were going to watch me counseling someone. And even worse, I was going to have to watch myself. Now, at the end of the semester, I am not only comfortable sharing and watching my counseling tapes – I am excited to do more. I want to do more tapes, I want to counsel and be counseled, and I want to see how my group members progress with their clients.

Those “other people” who watched me counsel consist of three other students, members of my supervision group. Learning how to partake in a supervision group with them has been such a strength; it recognizes that we will not know all the answers, nor are we expected to know them all – but we are expected to support one another in finding them. I no longer feel like the world will end if I mess up a little bit in a session, because in the overall scheme of things I am still presumably helping someone and “messing up” is part of the process. Having the ability to address my own roadblocks and having people who are there to help me to do so makes me feel more capable.

Next semester we will be supervising one another as part of the second section of the class, without a professor or doctoral supervisor around to help us all the time. I think we’re ready, and I can’t wait to see what my group members do in their next counseling tapes with their student clients. I feel like I’m an avid fan of this “Camaraderie in Counseling” show and I can’t wait for the next episode.

Good job, HBO: Counseling in “In Treatment”

            After my post on the frustrating portrayal of an unethical therapist in the tv show “How I Met Your Mother,” several people have directed me to more accurate, appealing portrayals of counselors and therapists in current media.  While I have seen impressive feats of therapy in media in the past, I had not recently encountered effective therapy in the media – especially on tv – until I began watching the HBO show “In Treatment.”   

          At first, watching this show felt a bit like homework, since we spend a lot of time in class reviewing counseling tapes and the show generally follows a counseling session per show.  However, it was a bit different to be watching a seasoned therapist working in private practice with a variety of clients.  I quickly found myself drawn into this world of therapy with its genuine dialogue and exchanges, and the challenges and insights that come with Paul’s practice.  I wanted to watch more and I find myself pulled in to the narratives of the clients as well as wanting to learn about Paul as a therapist.  He’s a realistic, multi-dimensional character and I want to watch him at work, watch how he recovers from his mistakes (since he is realistic, I know there will be some!), and see the true benefits of counseling in action.

         In the first episode, I encountered a stark contrast to the comedic “How I Met Your Mother;” both shows explored what happens when a client expresses feelings for her therapist (known as “erotic transference”).  In “How I Met Your Mother,” the therapist stops seeing his client due to his attraction and ends up dating her.  Paul of “In Treatment,” on the other hand, verbally establishes boundaries and continues on with the session in an empathic but structured manner.  While he may be surprised or confused at the information, he processes quietly and internally, not engaging himself personally as they continue on.  His sense of caring seems unwavering even as he clarifies the necessary structure of the relationship.  In addition, in a later episode he met with his own former supervisor in order to discuss how to handle the case.  While it was a tricky situation and not quickly or easily resolved (at least as far as I’ve watched so far!), the therapist handled it in a mature and professional manner.

            As a student I am finding this show to be incredibly interesting and useful as I note the aspects of the therapist’s practice that relate to in-class discussions of which I’ve been a part.  In the first few episodes of season one I have watched Paul demonstrate many of the skills we are learning about in class.  So far I’ve seen him establish expectations early on with his clients; work out the logistics of payment; work in a private practice out of his home; interview clients for the first time and continue work with established clients; and deal with the difficulties of countertransference (keeping his own reactions and emotions in check in order to not influence the client with them).  It’s a relief and a useful tool to know that there is such a show!

Garcia, Rodrigo.  Producer. (2008).  In Treatment (Television series). New York: Home Box Office.

Thomas, C. & Bays, C.  Producer. (Producers). (2005).  How I Met Your Mother (Television series).  Los Angeles: CBS Broadcasting, Inc.

A Closer Look at the Helping Professions

Over the years, several distinct helping professions have evolved around mental health care.  The main contenders today include psychiatry, clinical psychology, social work and counseling.  Each has its own history, theoretical approach, and licensure privileges.  In many ways they complement each other, especially when working in collaboration to provide a team of mental health professionals for those who need it.  Many clinics bring together various professions. One social worker commented on her clinic, Noyes Mental Health Services, “It’s really an asset having different backgrounds here – everyone brings a little different perspective to the table, and we often collaborate on cases. Sometimes I’ll have one of my patients see the art therapist to work on a specific issue and then return to me, or a patient might see one therapist for couples’ counseling and another for individual therapy.”  At this clinic, there are mental health counselors, family therapists, creative arts therapists, social workers, a psychiatrist and a psychiatric nurse practitioner who all work together to provide mental health services.

Each profession plays a different role in the care and advocacy for mental health, and have developed different licensure requirements and privileges that facilitate these roles.  It’s important to note that licensure privileges vary along state lines, and these professions may differ slightly in their capacity to practice depending on the state.  The descriptions below are specific to New York state licensure guidelines.

Psychiatry

Psychiatrists attend medical school and specialize in psychiatry in order to get a medical degree (MD) that enables them to work with patients, diagnose and prescribe medication.  Because of this background, they generally approach mental healthcare from a biomedical model perspective, treating mental illness with a similar approach to physical illness.  Psychiatrists tend to work with individuals dealing with major psychological disorders.

Clinical Psychology

Clinical psychologists attend a graduate program to earn a PhD, EdD, or PsyD and are licensed by the state.  These programs may be more research-focused than others, especially the PhD programs.  Many clinical psychologists are considered experts in psychological assessment and are also able to diagnose and treat individuals.

Social Work

Social workers are eligible to gain licensure after completing a master’s degree in social work (MSW) and an internship in a social agency setting.  Social workers help to improve social functioning for both individuals and groups, by working within social systems and advocating for change.  This can mean administering government programs or working in counseling, school, or medical and public health settings.  Generally, social workers come from a systemic approach, focusing on the individual in context of the environment.

Counseling

Counselors are eligible to gain licensure after completing a master’s degree in community mental health counseling and 3,000 supervised hours.  This enables them to diagnose and hold private practice, as well as practice in a clinic or agency setting.  Counselors come from a strength-based wellness approach and a biopsychosocial model.  This differs slightly from some other approaches in that it considers cultural context to be a priority as well as physical and mental development.

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Different degrees aren’t necessarily “better” or “worse” than any others; it is more a matter of goodness of fit for the individual entering the helping profession.  The question is which program and which degree will enable you to practice (or not) with a specific population of people, in the right setting and using the right set of tools for your own personal interests and motivation.

Gladding, S. & Newsome, J. (2010). Clinical Mental Health Counseling in Community and Agency Settings  (3rd ed.).  Upper Saddle River, NJ: Prentice Hall.

Therapy in “How I Met Your Mother”

“How I Met Your Mother” is one of my favorite tv shows.  That being said, a recent couple of episodes had me cringing and shouting at the tv the majority of the time.  I felt a little bit like my mother, who often gets frustrated with exciting hospital tv shows.  She was trained and worked for many years as a nurse in the emergency room, and readily picks up on the reality (or lack thereof) of the situations portrayed in television hospitals.  As a budding counselor, I felt a similar frustration with this portrayal of a therapist.


This particular set of episodes of “How I Met Your Mother” involved one of the characters, Robin, seeing a therapist for a court-mandated session after assaulting a woman on the street.  The show unfolds through Robin’s telling of the scenario in a therapy session and frequent quips by the therapist (or psychiatrist or counselor, it is unclear) to hurry up her story (“Can we just get to the assault?”).  Throughout the show he also breaks confidentiality on several counts by describing his other clients (in one case, he describes how one of his other patients – mostly “disturbed felons” – sent him a bag of his own feces for the therapist’s birthday).  In the following episode, the therapist actually starts to date Robin.  Ted tells his friend Robin, “Robin, if you asked a hundred people who is the worst person you could possibly date, they’d all say your therapist.”  What the show fails to regard is the fact that therapists, and in fact, the American Counseling Association (ACA), agree with Ted and those hundred people he mentioned.  Dating a former client is prohibited for counselors for 5 years after the cessation of treatment, according to the ACA’s Code of Ethics.  While the tv therapist acknowledged that he was not supposed to date Robin, he continued on to do so without much apparent concern for this violation of ethics.


I found the portrayal to be unprofessional and, while the therapist’s humor aided the ridiculous nature of Robin’s story, it was not so over-the-top as to be a satirical portrayal of a therapist.  In addition, this character only seemed to care for Robin’s well-being after he established a personal romantic interest in her; there was no demonstration of professional (and ethical) empathy.  While it may not be as interesting, humorous or contextually appropriate to have a caring and empathetic counselor in this situation, it is a shame that a counselor or therapist may be portrayed without ideal qualities (or even, some could argue, decent ones).  Unfortunately, for many who have never participated in a counseling session, watching this stereotype on television may be the closest they get to counseling.


American Counseling Association. (2005). Code of Ethics. Alexandria, VA: Author.


Thomas, C. & Bays, C.  Producer. (Producers). (2005).  How I Met Your Mother (Television series).  Los Angeles: CBS Broadcasting, Inc.

Online Counseling

Upon the death of Steve Jobs, a friend of mine* posted on Facebook, “Three apples changed the world: the one that Eve ate, the one that hit Newton on the head, and the one Steve Jobs offered us all.”  Jobs, the founder of Apple, certainly changed the way we use technology today.  It is more accessible, and constant, and personal. But how has Jobs (and his technology) impacted the world of counseling?

Well, in the trend of online counseling, he has enabled clients to literally keep their counselor in the palm of their hand.  Some counselors offer services via Skype or other live internet communication; clients can be in touch on their iphone or ipad while maintaining physical distance.  Some counselors also offer email communication (known as asynchronous communication, where the interaction does not occur in real time).  Clients also have access to lots of information about mental health, both accurate and inaccurate, through the web (Gladding & Newsome, 2010).

With email, counselors and clients can keep in touch conveniently and work with a flexible schedule, in a way that may even out the spread of power between client and counselor (each can communicate with a home court advantage).  However, email shares many risks with other internet counseling methods; namely crises in which the counselor is not present, issues of confidentiality and protecting privacy in a secure manner, as well as third-party payments (Gladding & Newsome, 2010).  In addition, there is a greater chance of miscommunication when technology is involved.  When videochatting, there is the potential for the connection to break up at a key moment.  In email, a sarcastic phrase may be taken as fact or adolescent slang may be difficult to decode.

In a recent New York Times article, one psychologist (Elaine Ducharme) discusses her long-distance practice. Ducharme uses Skype to videoconference with patients from her former practice, and is licensed to practice both in the state in which she counsels online and the one in which she lives.  She will only videoconference with a patient she has already met, and periodically returns to have face-to-face appointments.  “‘There is definitely something important about bearing witness,’ she said. ‘There is so much that happens in a room that I can’t see on Skype’” (Hoffman, 2011).  The article continues on to address the pitfalls and benefits of online counseling.

The National Board of Certified Counselors (NBCC) began putting together a task force to address technology-assisted counseling in 1995, an endeavor that tackles ethical and practical issues and led to today’s Standards for the Practice of Internet Counseling (Gladding and Newsome, 2010).  With the massive presence of the Internet in our lives, it is necessary to set these guidelines and enforce a standard in order to protect the professional integrity of counselors, both online and off.

As a beginning student, I see myself working in a more traditional face-to-face practice, as opposed to using Skype or email as a central mode of communication.  There are already so many concerns in the practice of counseling as to how to best work with a client and act in their best interest, without worrying about a dropped videocall or a crisis thousands of miles away.  I recently read what constitutes malpractice, and sat staring wide-eyed at the textbook for a good five minutes, contemplating all the ways I could screw up.  I don’t feel I need to add any additional potential for disaster to the list.  I appreciate the momentous contributions of Steve Jobs and the impact of the growth of technology on my daily and professional life, but as a starting counselor I think I may check the technology at the door.  I’ve been spending a lot of time lately learning how to be with someone, how to listen and share time and space in a therapeutic manner, and I plan to put those skills to use by counseling face to face.  As I learned in my orientation, the only real technology you need in a counseling session is a box of tissues and a clock.

Gladding, S. & Newsome, J. (2010). Clinical Mental Health Counseling in Community and Agency Settings  (3rd ed.).  Upper Saddle River, NJ: Prentice Hall.

Hoffman, J.  (2011, 23 September). When Your Therapist is Only a Click Away. New York Times, pp. ST1.

*Thanks to Michael Fleischmann for sharing this popular post.

Emotion as an agent of change

A primary goal in psychotherapy is to facilitate change in an individual.  Whether a person wants to change the way they interact with others, the way they view the world, or the way they eat, our objective as therapists is to help others make that change.  The natural question that follows is: how?  How do we facilitate change?Happy baby

In Counseling Theory and Practice II, I’ve learned a major way to help people change is, not surprisingly, through their affect and emotions.  Affect is simply emotion manifested through facial expression or body language.  For example, a person who is feeling deep sadness might have a sullen or blank affect.

Emotions are not just feelings.  They have a biological function.  Emotions direct our focus to that which needs our immediate attention.  For example, consider a graduate student who is feeling anxious about an upcoming exam.  That anxiety might help the student take action, such as studying (or a less desirable action, procrastination).  Emotions also help us understand what we like and do not like.  We feel happy when something good happens to us; we often feel sad when something of value is taken from us.  Emotion is not our enemy.  Rather, it is that which gives the most meaning to life.

We can help people make a change in their life by helping them recognize their emotions and the true meaning behind them.  For example, consider someone who has come to therapy for anxiety issues.  They feel on-edge all the time and they do not know why.  A good therapist would notice their tense affect and might even point it out to the individual.  The therapist would ask the individual to explore the way they are feeling at the moment.  It is this type of questioning and exploration that leads to the deeper issues behind the emotions.  Once the deeper issues are uncovered in therapy, the individual can begin the healing process.