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SA 127 Chapter 2

by: Andolina Ziolkowski

SA 127 Chapter 2 SA 127-IC1

Andolina Ziolkowski
Erie Community College

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About this Document

This chapter covers issues in terms of ethical standards. The focuses in this chapter are transference, countertransference, client dependency, stress and therapist self-care.
Topics in Addiction
Tracey Taylor
Class Notes
ethics, Counseling, transference, countertransference, stress, self-care
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This 14 page Class Notes was uploaded by Andolina Ziolkowski on Tuesday September 20, 2016. The Class Notes belongs to SA 127-IC1 at Erie Community College taught by Tracey Taylor in Fall 2016. Since its upload, it has received 5 views. For similar materials see Topics in Addiction in Substance Abuse Counseling at Erie Community College.

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Date Created: 09/20/16
Chapter 2: The Counselor as a Person & As a  Professional Self­Awareness & the Influence of Therapist's Personality & Needs Mental health practitioners must be aware of their needs, problems, conflicts, defenses,  & vulnerability in order to be productive & act ethically. MOTIVATIONS FOR BECOMING A COUNSELOR Ask yourself:  What motivates me to be a counselor?  What are my rewards for counseling others? It is crucial to be aware of your motivations & to recognize that your way of coping with  life's challenges may not be appropriate for client's.  Personal needs cannot assume priority or get in the way of the client's growth. Therapeutic progress can be blocked if the therapist's use their clients, even  unconsciously, to fulfill their own needs.  Personal need fulfillment should be a by­product not an aim. Goals of therapy suffer when therapists with a strong need for approval try to win  acceptance, admiration, & aw of their clients.  Clients often feel a need to please their therapist, & thus are easily drawn into taking care of their therapist's psychological needs. Ask yourself:  How will I know when I'm working for my own benefit at the expense of the client's  benefit?  If I have personal experience with a problem a client is having, how can I work to be  objective enough to relate to this person professionally & ethically?  How much do I depend on being appreciated by others in my own life? Do I depend  primarily on sources outside of myself to confirm my worth?  Am I getting my needs for nurturance, recognition, & support met from those who  are significant in my life?  Do I feel inadequate when clients don't make progress? If so, how could my attitude  & feelings of inadequacy adversely affect my work with these clients?  Do I have healthy boundaries in place & set limits for myself both personally &  professionally? PERSONAL PROBLEMS & CONFLICTS Mental health practitioners should be aware of their unresolved problems & conflicts. It is not realistic to believe that such problems are ever fully resolved. The critical point is not whether you happen to be struggling with personal problems, but how you are dealing with them.  When in denial of your own problems, you are likely unable to pay attention to  the concerns of your clients, especially if their problem areas are similar to yours. 2 **Ask peers or colleagues for honest feedback on your strengths & weaknesses as a  person & professional.  Difficulty will arise if a client struggles in an area you are relucant or fearful to  look at in your own life. Recognize the topics that make you uncomfortable with clients and in your personal life. Personal Therapy for Counselors Recommended that you involve yourself in therapeutic experiences that increase your  availability to your clients. You can do this through:  Individual therapy  Group counseling  Consultation with trusted colleagues  Continuing education  Keeping a personal reading Pay attention to the areas & situations that make you feel uncomfortable. EXPERIENTIAL LEARNING TOWARD SELF­UNDERSTANDING Experiential learning – basic component of many counseling programs, providing  students with the opportunity to share their values, life experience, & personal concerns  in a peer group *students will benefit most if they are willing to focus on themselves personally & not  merely on their clients 3 By being personally invested in their own therapeutic process, students can use the  training program as an opportunity to expand their abilities to be helpful. PERSONAL THERAPY DURING TRAINING Studies on Personal Therapy for Trainees  Some contend that personal therapy should be mandated for any person in the  counseling profession. Grad clinicians who had personal therapy felt more confident in their role & delivered  treatments that were 2x as long as those without personal therapy. *These clinicians also developed strong agreement with their clients on the goals & tasks of treatment. Reasons for Participating in Personal Psychotherapy Your appreciation for the courage your clients will require in their therapeutic journey will be enhanced through your own experience as a client. One way to ensure clients will get the best help is to prep students both academically &  personally for the tasks they will face as practitioners. Working with clients can affect trainees in personal ways.  Both trainees & experienced therapists must recognize & deal effectively with  their countertransference which can be explored in personal therapy. **Some licensing boards will require therapy to recognize & monitor  countertransference when a violation occurs.** 4 Therapists should seek personal therapy before distressing life situations lead to  impairment & harm to clients. ONGOING THERAPY FOR PRACTITIONERS  Personal therapy among therapists is a common practice & that it is considered  beneficial. *Some of the lessons learned are:  The centrality of warmth, empathy, & the personal relationship  Having a sense of what it's like to be a therapy client  The need for patience & tolerance in psychotherapy  Learning how to deal with transference & countertransference Transference & Countertransference  Refer to the client's general reactions to the therapist & to the therapist's  reactions in response o How practitioners handle both their own feelings & their client's feelings  will have a direct bearing on therapeutic outcomes TRANSFERENCE: THE "UNREAL" RELATIONSHIP IN THERAPY 5 Transference – process whereby clients project onto their therapist past feelings or  attitudes they had toward their caregivers or significant people in their lives  Client's feelings are rooted in past relationships, but are now felt & directed  toward the therapist o Pattern causes a distortion in the way client's perceive & react to the  therapist *Allow the client to become aware of how past relationships resulted in unresolved  conflicts that affect present relationships.  Certain feelings may or may not be transference; therapist must take time & care  to adequately assess the feelings. COUNTERTRANSFERENCE: ETHICAL IMPLICATIONS  Counselors also have emotional reactions to their clients, some of which may  involve their own projections Countertransference – any projections by therapists that distort the way they perceive & react to a client  Therapist's reaction to the client is intensified by the therapist's own experience Manifestations of Countertransference Can show itself in many ways: 1. Being overprotective with a client a. Unresolved conflicts can lead him/her to steer a client away from those  areas that open up the therapist's own pain. 2. Treating clients in benign ways a. Creates a bland counseling atmosphere 3. Rejecting a client a. Therapist's perception of the client as needy & dependent b. Remains cool & aloof & does not let the client get to close 4. Needing constant reinforcement & approval a. May have an inordinate need to be reassured of their effectiveness 6 5. Seeing yourself in your clients a. You could be more invested in the client than they are in themselves 6. Developing sexual or romantic feelings a. The possibility that therapist's sexual feelings might interfere with their  work is one important reason therapists should experience their own  therapy when starting to practice & should consult other professionals  when they encounter difficulty due to their feelings toward certain clients 7. Giving advice a. Excessive self­disclosure, especially by telling their clients how they have  solved a particular problem for themselves 8. Developing a social relationship with clients a. Mixing personal & professional relationships can destroy the therapeutic  relationship & lead to a lawsuit Effective Management of Countertransference Reactions  Countertransference can be constructive or destructive in the therapeutic  relationship o Can illuminate the significant dynamics of the client The fact that the client may have stimulated the countertransference does not make it  the client's problem; the key is how the therapist responds. Guidelines for working effectively with countertransference:  Can greatly benefit the therapeutic work if clinicians monitor their feelings & use  their responses as a source for understanding clients & helping clients  understand themselves  The ability of therapists to gain self­understanding & establish appropriate  boundaries with clients is fundamental to managing & effectively using their  countertransference reactions 7  Personal therapy & clinical supervision can be especially helpful to therapists in  understanding how their internal reactions influence the therapy process & how  to use these countertransference reactions to assist clients COUNTERTRANSFERENCE: CLINICAL IMPLICATIONS  Becomes problematic when it is not recognized, monitored, & managed. Destructive or harmful countertransference occurs when a counselors own needs or  unresolved personal conflicts become entangled in the therapeutic relationship,  obstructing or destroying a sense of objectivity Client Dependence  Many clients experience a period of dependence on counseling or on their  counselor. *Clients can begin to view their counselors as having great wisdom  Therapist's who have a need to be seen this way collude with their clients in  keeping them dependent. **Whether therapists are encouraging dependence in clients is often not clear­cut. DELAYING TERMINATION AS A FORM OF DEPENDENCE  Most professional codes have guidelines that call for termination whenever  further therapy will not bring significant gains.. 8 Therapists who become angry with clients when they express a desire to terminate  therapy are showing signs of problematic countertransference. Termination of a professional relationship can be a complex process & it is critical to  anticipate & avoid problems that commonly occur during termination.  Open­ended txs occur over a long period of time without clear & identifiable goals are especially difficult to end o Clients are likely to experience termination as a personal rejection by the  therapist The ultimate sign of an effective therapist is the ability to help clients reach a stage of  self­determination wherein they no longer need a therapist. Stress in the Counseling Profession THE HAZARDS OF HELPING **The counselor can become deeply affected by the client's pain. If you find yourself struggling, seek consultation to ensure that the client's best interests  are in the forefront & that your practice is ethically sound.  Learning to deal with stress to prevent burnout & compassion fatigue is a critical  aspect of professional development. STRESS CAUSED BY BEING OVERLY RESPONSIBLE 9 Practitioners who accept too much responsibility sometimes experience their client's  stress as their own. Signs to look for:  Irritability & emotional exhaustion  Feelings of isolation  Abuse of alcohol or drugs  Having a relapse from recovery  Reduced personal effectiveness  Indecisiveness  Compulsive work patterns  Drastic changes in behavior  Feedback from friends or partners To assess the impact of stress on you both personally & professionally, reflect on these  questions:  To what degree are you able to recognize your problems?  What steps do you take in dealing with your problems?  Do you practice strategies for managing your stress?  To what degree are you taking care of your personal needs in daily life? 10  Do you listen to your family, friends, & colleagues when they tell you that they are seeing signs of severe stress?  Are you willing to ask for help? SOURCES OF STRESS Empathy fatigue – shares some similarities with other fatigue syndromes such as  compassion fatigue, secondary traumatic stress, vicarious traumatization, & burnout  Stress generated by listening to multiple stories of trauma saturated with themes  of grief, loss, anxiety, depression, & traumatic stress Human service professionals who experience & demonstrate empathy toward their  clients are at greater risk for compassion fatigue. Counselors need to learn to be both present & separate & also to be able to  strategically attach, detach, & reattach. Empathy balance – being able to enter the client's world without getting lost in that world Other sources of stress are associated with working in managed care & educational  systems.  Managed care o Pressures involve getting a client's tx approved, justifying needed tx,  quickly alleviating a client's problem, dealing with paperwork, & the anxiety of being put in an ethical dilemma when clients are denied further clinically necessary tx *For school counselors, in addition to the expectation that they can immediately solve  the behavioral problems of children, there is the added stress of dealing with the  frustrations of parents, teachers, & the administration in the school system. 11 Therapists who work with violent & suicidal clients are particularly vulnerable to stress. **Higher organizational stress is associated with lower client engagement. Counselor Burnout & Impairment *Unmanaged stress is a major cause of burnout & eventual impairement. Burnout – state of physical, emotional, intellectual, & spiritual depletion characterized by feelings of helplessness & hopelessness Top Ingredients That Lead to Burnout  Emotional depletion  A constant state of worry  Cumulative effects from work with trauma survivors  Loss of a sense of perspective   Helplessness & a sense of inefficiency  Inability to leave client's concerns at the office Difficulties that led to burnout among addiction & mental health counselors:  Funding cuts  Restrictions on the delivery of services  Changing certifications & licensing standards  Mandated clients  Special needs clients  Low salaries 12  Staff turnover  Agency upheaval  Limited career opportunities CBI (Counselor Burnout Inventory) ­ identifies three counselor types 1. Well­adjusted counselors (WAC) ­ low on all burnout subscales 2. Disconnected counselors (DC) ­ relatively high on incompetence & devaluing  client subscales 3. Persevering counselors (PC) ­ scored highest on the exhaustion, negative work  environment & deterioration in personal life subscales Signs of "therapist decay":  An absence of boundaries with clients  Excessive preoccupation with money & being successful  Taking on client's that exceed one's level of professional competence  Poor health habits in the areas of nutrition & exercise  Living in isolated ways, both personally & professionally  Failing to recognize the personal impact of client's struggles  Resisting personal therapy when experiencing personal distress Impairment – presence of a chronic illness or severe psychological depletion that is  likely to prevent a professional from being able to deliver effective services & results in  consistently functioning below acceptable practice standards  Unable to effectively cope with stressful events & are unable to adequately carry  out their professional duties Being a psychotherapist has both advantages & liabilities for one's family life. **It is essential for therapists to let go of their professional role when they are at home.** 13 Strategies to reduce burnout among psychologists must extend beyond the work setting to consider the quality of family life & the integration of work & family. Strategies for Self­Care:  Put yourself in your schedule book.  Make time to be with family & friends.  Consult with colleagues & seek peer support.  Avoid making your work the center of your life.  Maintain a balance between work & leisure.  Balance other­care with self­care. Maintaining Vitality Through Self­Care Competence is an ethical obligation & provides a major link between ethics & self­care. If counselors do not practice self­care, eventually they will not have the stamina  required to be present with their clients. Mindfulness, acceptance, & commitment therapy & positive psychology all stress  positive principles & practices for self­care. Mindfulness – a way of being aware of our thoughts, emotions, & sensations as they  arise in us; reduces reactivity to distressing emotions & thoughts Self­compassion – involves developing attitudes of caring, being nonjudgmental, being  accepting, & being kinds to ourselves; can enhance counselor well­being, counselor  effectiveness in the workplace, & therapeutic relationships with clients; enables us to  see ourselves clearly & make changes that lead to fulfillment; leads to healthier, more  productive lives than those who self­critical 14


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