Counselor Self-Care and Role of Clinical Supervision
A counselor is somebody who gives advice. But it is also the first person who gets affected on the patients experienced. It is the one who involves his feelings towards the patients and many times sacrifice self for the betterment of other. The feeling, the stress are being experienced by the counselor in sharing his life to the patients.
Vicarious Traumatization, is enduring psychological consequences for therapists of exposure to the traumatic experience of victim clients. Person who works with victims may experience profound psychological effects, effects that can be disruptive and painful for the helper and persist for months or years after work with traumatized persons. Vicarious traumatization is conceptualized as a special form of counter transference stimulated by exposure to the client’s traumatic material. (Courtois, 1993)
Compassion Fatigue is the emotional residue of exposure to working with the suffering, particularly those suffering from the consequences of traumatic events. Professionals who work with people, particularly people who are suffering, must contend with not only the normal stress or dissatisfaction of work, but also with the emotional and personal feelings for the suffering. (Ace-Network, 2006)
It is a one-way street, in which individuals are giving out a great deal of energy and compassion to others over a period of time, yet aren’t able to get enough back to reassure themselves that the world is a hopeful place.(Neurosy Network 2004)
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It is what we feel when we’ve cared for others more than ourselves, when our sense of responsibility to others has become exaggerated or out of balance (Wagner, 1985).
Burnout, a condition that evolves slowly over a period of prolonged stress, wearing down and wearing out of energy, exhaustion born of excessive demands which may be self-imposed or externally imposed by families, jobs, friends, value systems or society which depletes one’s energy, coping mechanism and internal resources. The feelings of state which is accompanied by an overload of stress which eventually impacts one’s motivation, attitudes and behaviors. (Stress Control Institute, 2006).
Secondary Traumatic Stress, a person who undergo psychological symptoms that treat victims of trauma, hear tales of extreme human suffering and observe the emotions of fear, helplessness and horror registered by survivors on a consistent basis.(Reagan et al, 2003).
Traumatic Counter transference is defined as redirection of a therapist’s feelings towards a client or more generally as a therapist’s emotional entanglement with a client. Some therapists become confused between clients and intimate partners if counter transference is not recognized and appropriately addressed by the therapist. (Wikipedia Encyclopedia)
The Impact on Counselor
The Vicarious Traumatization
Therapists can be directly impacted by the nature of the trauma itself and its unique dimensions and characteristics. The after effects, especially those indicating dramatic post-traumatic deterioration and acute repercussions, can be especially disturbing. The clients previous interactions with medical and mental health personnel can upset the
Clinician if PTSD went undiagnosed and untreated, causing compounded reactions and additional challenge for the victim.
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Counselors and EA professionals were affected vicariously by just hearing about it from those who were there. It’s hard not to come away affected in some way from one major event, regardless of whether it was experienced first- or secondhand, and regardless of whether you’re an experienced counselor or experienced firefighter trained to be detached. (Fischer, 2003).
Listening all day to people in pain depletes the therapist. At the end of the day the skillful listener may be exhausted. Home problems seem minor, dull, and insignificant compared to the horrendous stories patients have shared. Many therapists prefer to be left alone at home, while others see homecoming as their first opportunity of the day to unburden them selves and stop the flow of other people’s complaints. The burned-out therapist experiences low energy, reduced interest and satisfaction, and often dreads work. Burnout in beginning therapists is linked closely to emotional overload and a sense of inefficacy. (Zur, 2003).
Secondary Traumatic Stress
Stress is an alarm reaction to a stimulus the person appraises as emotionally charged or threatening. This state can range from exhilaration to mild or severe discomfort. It has also been called the fight-or-flight reaction; it produces hyper arousal, which is a normal and necessary response to threat. The fight-or-flight reaction prepares the body for defensive action through a cascade of sympathetic nervous system firings and the release of stress hormones, the most well known of which is epinephrine, or adrenaline.
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Some helpers experience intrusive imagery of the traumatized person’s experience. For instance, a helper may have a nightmare that has elements of a client’s experience in it. On the other hand, some helpers are plagued by emotional numbing. They suddenly feel hollow, empty, dull, and unable to feel anything about anything or anyone. They close up shop, as it were, not just on the job, but in all parts of their lives. In addition, they may find that they shy away or avoid any reminders of their clients’ experience. (Weingarten, 2001)
Traumatic counter Transference
A typical counter-transference might occur when a therapist starts feeling angry with a patient who describes doing something that is similar to something that previously harmed (or would harm) the therapist or someone the therapist cares about. A therapist I’m friendly with recently described a situation where a patient was talking about feeling good about not being expected by his elderly parent to take care of that parent. The parent in this case preferred the patient’s brother to provide care, and the patient enjoyed the freedom of being the ‘less responsible child’. The therapist found herself suddenly angry with her patient because she was herself a ‘responsible child’ with an irresponsible brother and she felt herself to be unfairly burdened with elder care responsibilities. It wasn’t exactly fair for her to get pissed at her patient, and she didn’t show it or let the anger feeling interfere with her duties, but she did feel it, and it was there because of counter-transference. (Dombeck 2006)
Strategies for Managing
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In handling Burnout, Recognize the symptoms of burnout. Learn to ask for help. Be aware of the limitations of your family, your job, and yourself. Maintain discipline in daily responsibilities and duties. Take “time out” during the day. Diversify responsibilities; put more variety in both your job and your home life. Take short vacations at least twice a year. Try to change little things that gnaw at you and accommodate to those you can’t change. Organize your time so you can concentrate on vital tasks. Admit burnout is a real problem for you; don’t try to cover it up. Distinguish between stressful aspects of your job or home life that you can change, and those you can’t change. if too much time is being taken away from the satisfying aspects of your life by unimportant, trivial duties, establish a set of priorities for yourself. Discuss your priorities with your boss and your family members. Make a list of the things you hate most on the job or at home. Dispense with or delegate all you can. Alternate major tasks in which results won’t be seen for awhile with those that will have immediate productive and gratifying results. Reach an awareness of your motivation in dealing with your family or in entering your specific career field. (Messina 2006)
Coping with the feelings and reactions to the clients’ trauma is the next step in addressing vicarious trauma. They mange to cope in many ways. In general, people deal with crises and trauma in different ways as do the persons in the helping profession. Some of the ways we get through the experience are health and productive, such as having peer consultation about a difficult case. (Courtois, C., 1993).
Strategies of Counselor
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The counselor has to be continually practice good emotional health maintenance along the way and maintain some sort of balance in your life. There has to be a portion of your life inn which you need to take, rather than give. Beyond practicing fundamental self-care skills, you need to put yourself in situations in which you see the positives in life, for example, attending a field trip with your child where you’re truly enjoying the experience, or volunteering where you’re able to give and receive. Sometimes, you can’t prevent compassion fatigue from
occurring. We see this lot with individuals working in professions with a high degree of human interaction and human service. However, practicing some of these techniques can restore your ability to feel compassion for and sensitivity to the troubles and difficulties of others. (Neurosy Network)
The counselor, maintain personal growth both at home and on the job. Seek out helpful supervision for your work both at home and on the job. Develop an active outside life with a variety of interests. Personalize your work and home environment with meaningful pictures, objects, colors, etc. Feel comfortable with yourself, set limits for yourself, and know how far to become involved with family and colleagues. Encourage and practice good communication skills. Provide for flexible working conditions. Seek out encouragement for trying new ideas. Find your own “decompression techniques” such as activities like meditation or exercise that relieve tension and put you into a more relaxed state. Build a support system for yourself with those who can discuss your problems and help look for solutions. Don’t just air gripes, but look for solutions.(Messina 2006)
Prevention is important and includes interventions before and after the professional’s involvement. Some studies show regular consultation while working with victims or survivors to process the painful client material, personal emotions, or cognition is important in preventing (Judy Regan and et al),
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Role for Clinical Supervisor
The approaches in helping helpers in order to protect themselves (Mooli Lahad).
B Belief – belief system, hope, self-esteem, locus of control
A Affect – direct or indirect emotional expression
S Social – friends, role, family
I Imagination, creativity
C Cognition, logic, realism and cognitive techniques
Ph Physical – physical activity, relaxation and activity
Affect refers here to encouraging speaking, ventilation, and legitimization of direct and indirect emotional expression after the event. The social aspect includes social support, taking a role, belonging to the organization. Emphasize one particular role and that is the role of the team leader as manager of the event, the one responsible for emotional health and physical needs of the team. The person responsible for work schedules referrals for rest, the organization of talks, provision of official recognition of the effort and helping create distance. Imagination refers to the use of creativity, acting, guided imagery, relief, and distraction. The cognitive aspect refers to preparation of the staff in advance for what may happen, updating them in the course of the process, guidance and problem solving, use of prepared programs and the CISD. In the physical aspect, the focus is on physical activity as a stress reliever, resting, sleeping, and using relaxation and proper diet (Mooli Lahad).
Mooli Lahad also suggested to use multidimensional BASIC Ph model to classify the methods that have been found effective in helping care givers to reduce compassion fatigue and demonstrated it with an example of group supervision. Naturally, these are only initial suggestions, and as far as I know, the first attempt to use creative methods in supervising crisis intervention teams and to use a drama therapy approach in this context. These ideas need to be followed up and further researched. However they do provide insights that I believe give us a direction for understanding and coping with the incidence of compassion fatigue.
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The impact of terrorism, natural disasters or criminal acts is widespread and, to varying degrees, affects victims, responders and the community at large. Studies indicate that mental health professionals involved in the treatment of these victims can suffer from different stress stated above.
Being a counselor, it is easy to say that they can manage in preventing the consequences of being involve my feelings towards the experienced of my patients. But in actual situation they cannot avoid imparting their feelings and sentiments to the patients especially if the patients are victims of rape or tortured. They cannot avoid putting themselves in the foot of the patients.
Listening to the different experienced everyday and seeing the patients daily and hearing their cry every hour. It impossible for a counselor not to react and listen and even cried to what the patient sad experienced. Looking at the wounds the patients had is like having a wound in itself. What do expect for a counselor on this situation being just normal?
The tremendous experienced made a reaction to the emotional demands on these professionals and from exposure to trauma survivors who experienced terrifying, horrifying, and intrusive traumatic memories of the patients making the counselor one of the victims. It is conceptualized as a reaction to the emotional demands on these professionals and from exposure to trauma survivors who experienced terrifying, horrifying, and intrusive traumatic memories
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The counselor who will give an advice now will be given help and seek help from other people and most especially from the supervisor who can monitor them. As a supervisor understanding the experience of the victim and the helper and the fantasy of omnipotence related to the ‘magic touch’ of parenting evoked by the interrelationship of helper – parent; victim – child. Understanding experience of the encounter with the ‘darkness in the face of deep hole help to explain the powerful psychological effect on the helper once they get in contact with the deep hole and the dark. This in turn may be a partial explanation of compassion fatigue.
Nevertheless, the supervisor can help brilliant tool and technique for most all therapists to know about and use appropriately to the benefit of patients. It is a major contribution of the psychodynamic approach to the universe of psychotherapy techniques. Otherwise failure in helping the counselor made them face the trauma in an unhealthy and unproductive such as seeing all men as potential child molesters.
Finally, as counselor point of view to handle all the negative consequence is to think that you have your family that needs and loves you so much. I am educated and will not let transference ruin my life, I have the ability to be self-aware about it shouldn’t be taken as the norm. Learn to cultivate methods of personal renewal, self-awareness, and connection with others, and don’t be afraid to acknowledge your own needs and to find ways to get your needs met. Think of your personal energy in terms of not only energy expenditure, but also energy renewal, and focus on creating a balance in your life. To enjoy a healthy, sustainable life, let your mind, body, and spirit be continuously renewed.
Compassion Fatigue. (2006). The Neurosy Network . November 15, 2006, from http:// www.neurosy.org /caregiving/thecaregiver/compassion.shtml
Compassion Fatigue. (2006).What is Compassion Fatigue? November 15, 2006, from http://www.ace-network.com/cfspotlight.htm
Courtois, C, (1993). Vicarious traumatization of the therapist. NCP Clinical Newsletter, Spring, 1993
Courtois, Christine. (1993). Vicarious Traumatization of the Therapist. November 15, 2006, from http://www.ncptsd.va.gov/publications/cq/v3/n2/courtois.html
Dombeck, Mark (2006). Transference. November 15, 2006, from http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=8253
Fischer, Richard. (2003). EAP Digest, Spring 2003. November 15, 2006, from http://www.prponline.net/Work/EAP/Articles/compassion_fatigue.htm
Messina, James (2006). Belief contributes to Burnout. November 15, 2006, from http://www.coping.org/growth/burnout.htm#beliefs
Mooli Lahad (2006). Supervising crisis intervention teams following disaster. November 15, 2006, from National Association of Social Workers.
Reagan, Judy & et al. (2003). Journal Mental Health Series. November 15, 2006, from http://www.state.tn.us/mental/omd/STSinMHP.pdf#search=’secondary%20traumatic%20stress’
Wagner, Teresa. (1985). Compassion Fatigue. November 15, 2006, from http://www.animalliberationfront.com/Practical/Shop–ToDo/Activism/CompassionFatigue.htm
Weingarten, Kaethe. (2001). Counselor the Magazine for Addictions Professionals November 15, 2006, from http://www.counselormagazine.com/display_article.asp?aid=feb04Commonshock.htm
What is Burnout? (2006). Stress Control Institute. November 15, 2006, from http://www.mindspring.com/~wholistic/burnout.html
Zur, Ofer. (2003). Taking Care Of The Caretaker: How To Avoid Psychotherapists’ Burnout. November 15, 2006, from http://www.drzur.com/burnout.html