I'll be documenting in video some of the questions that I receive in clinical supervision.
This week, one of the questions was about working with a patient that you might not care for personally.
Leave a comment or question and let us all know how you handle that situation!
All the world needs is a little more love, a little more caring about each other, right? While this rings of truth to most of us, you have to wonder, is it possible to care too much? In this world where balance exists on all things, whether gentle and sweet or violent and chaotic, you have to expect that there is a situation where someone might care too much. To quote Arthur Schopenhauer, “Almost all of our sorrows spring out of our relations with other people.” Caring for others does give us the greatest cause for gladness and distress.
Emotional stress is a sign that we may be in this state of too much caring. We display our best judgment when we have just the right measure of caring and detachment. In fact, when we are too emotionally attached to a situation, we are said to have lost objectivity. This causes us to make irrational decisions.
What are the signs that we care too much?
For starters, we feel emotionally upset by what is going on. It is a hard thing to stop this feeling. As a mother, I have been emotionally upset greatly by things that my children did or did not do. As a counselor, this scenario plays out
for me in my office many times a week. A child, for their own reasons, behaves in a way that a parent thinks is
not in their best interest. The parent and the child may let their emotions get the better of them. Once voices are raised, rationality has left the building!!
I have made it a practice and encourage others to do self examination whenever strong feelings of any type emerge.
What is underlying these feelings? Are you afraid that your child is engaging in things that are going to bring them harm? Are you feeling neglected by your spouse and therefore more sensitive to a comment? Teasing out these feelings and exposing them to the bright light of day often reduces their ability to impact a person.
If you feel you are forcing a thing, this might also be a sign that you’re caring too much. At times, we feel we see the most direct or best route to an end, and so we try to force the “how” of achieving it. The more you push, the less “flow” can occur. Who can argue that the universe has a serendipitous way of easily making things happen? Often in spite of our so called assistance!
Examine yourself. If you have areas in your life where you feel you are in a state of too much caring, give yourself direction to take a step back. Determine what thoughts or beliefs your fear is drawing you towards. Look around.
Aren’t there an infinite number of other possibilities?
As the time of the year changes, we experience different things, temperatures change, the time changes for most of us, activities change. It seems to drive some momentum, all this change.
I pondered the fresh perspective that I have when I wake up to a crisp autumn day and I consider that it is the “change” that gives me hope anew. Isn’t life like that?
Sometimes, we get shaken out of our current “status quo” by some change. It may be subtle, like the season’s change, or it might be violent, like a hurricane which we sometimes experience here in Florida.
Either way, change brings newness. This newness in itself forces us to go places that we haven’t gone before.
I wonder what would happen if we allowed change every day? Would we be afraid of the chaos of being out of routine?
Or would we reach heights we never dreamed of because of the momentum of sheer movement?
“I’ve crossed the line from forgiveness to stupidity”
Isn’t that a great insight? A friend said this to me as we processed an event that is unfolding in her life. It got me thinking about forgiveness and how we fallible human beings get all wound around the drama of forgiveness. We are afraid that by forgiving someone, we are condoning their actions that brought us pain.
According to Wikipedia: Forgiveness is typically defined as the process of concluding resentment, indignation or anger as a result of a perceived offense, difference or mistake, or ceasing to demand punishment or restitution.
While I can’t feign to be of the ultra-forgiving camp (those who know me can attest to this), this very definition implies judgment and a moralistic attitude. After all, how else can we determine that forgiveness is needed? Who are we to make the determination of what is right and what is wrong?
Certainly wrongs are done in this world, but most people behave in the way they do because they perceive it as the “right” thing for them to do in that moment. Looking at it from that perspective, you can almost always forgive most things.
Are you stuck on the issue of forgiveness? Either needing it or needing to give it? I certainly have a couple of pain points in my life right now.
So, where is the line between forgiveness and stupidity? Ultimately, the line is where you go from respecting yourself to feeling you let yourself down.
During times of limited resources for health care funding, it seems sights are always turned towards social funding including mental health services. It is hard to disagree that those with un-served mental health issues end up hospitalized, incarcerated or homeless when support is not there.
In Florida (where I live) government has cut Medicaid coverage for hospitals. They are pushing Medicaid out to for profit insurance companies based on a pilot project that has been widely criticized. In addition, they are passing on a premium to recipients. Aren’t those on Medicaid generally devoid of cash resources? All the ones I know are. Obviously, I am not a politician, nor do I have the answers, but this doesn’t seem right to me.
What is going on in your state? Are mental health services being restricted or is funding being slashed? Make it your business to know what is going on in your community and take action. Write your legislators and voice your opposition for this type of fiscal activity. Mental health issues need to be a budget priority for everyone’s well being.
In many ways, the counseling supervision relationship mirrors the counseling experience. I recently had to say goodbye to one of the students that I had been supervising for close to a year. Although I’ve supervised numerous beginning counselors, this student was special.
She was bright and had a very intuitive sense of the people that she worked with. It was refreshing to hear her perspective on things that occurred in the counseling sessions. She was a model student, considering everything that she learned from me, her instructors, and the other clinicians she worked with.
Saying goodbye to her reminded me of the difficult experience which counseling termination can be. It can be very frightening for you and the person being served. As professionals, we have to recognize when termination is the appropriate course of action and when to allow the relationship to continue.
In my experience, people that I work with either agree with the timing of termination, or they have anxiety that comes up for them when it is discussed. When this occurs, we can then process the feelings of anxiety and develop a plan for whatever comes up.
Often, the anxiety about termination will cause a setback that is crisis oriented. If you suspect that this may occur, you can raise that possibility with the person. Usually, once the issue has been discussed in the light of day, the person recognizes that tendency and will avoid it.
If a setback does occur, it deserves a fair amount of attention. This indicates the person you are working with has a lack of confidence in their own ability to work things through. In this case, you are responsible to assist them in building that up rather than allowing them to be dependent on you.
We all like to feel valued and needed, but we have to sort out our own needs about keeping people in counseling beyond their maximum benefit. To do this, we have to recognize it in ourselves first!
So, as I said goodbye to my student, I was sad, but I also knew that she had a better chance of growing further without me. I can’t tell you how satisfying that realization was!
If you can relate to this experience, leave me a comment. I’d love to hear how you handle termination in counseling.
During my non-violent techniques class a couple of weeks ago, the instructor shared this poem. I thought it was excellent for a counselor's consideration. Consider the following:
When I ask you to listen to me and
You start giving me advice, you have not done what I have asked
When I ask you to listen to me and
You begin to tell me why I shouldn’t feel that way.
You are trampling on my feelings.
When I ask you to listen to me and
You feel you have to do something
To solve my problem,
You have failed me. Strange as that may seem.
Listen: all that I ask you to do is listen.
Not talk or do—just hear me.
When you do something for me
That I can and need to do for myself
You contribute to my fear and inadequacy.
But when you accept as a simple fact
That I feel what I feel, no matter how irrational
Then I can quit trying to convince you
And get about this business of understanding what’s behind them.
So please listen and just hear me.
And, if you want to talk, wait a minute for your turn.
And I’ll listen to you.
Body language is a vital component of communication. A counselor must demonstrate to the speaker that they are listening. Communication can be negatively impacted negatively by our body language if we do not work to control it. As a helping professional, you must be attuned to your body language and practice positive body language. Non-verbal communication is a vital skill development area for therapists. Below is a brief discussion of some aspects of body language.
1. Eye Contact-Maintaining good eye contact is a great method of becoming engaged with the speaker. It demonstrates focus and attentiveness to what is being spoken. There are some cultural implications with direct eye contact (and you should always have awareness of these), but for most people looking into the eyes of another person most of the time is essential to making them feel heard.
2. Smiling-In most cultures, a smile is a gesture of welcome and approval. Smiling encourages the speaker to continue speaking (good goal!). Conversely, frowning implies disapproval and should be avoided unless you are using this to accentuate a point. For instance, a counseling patient might provide conflicting information. Displaying a frown while asking about this incongruence can accentuate the question about clarification.
3. Gestures-A lot of people “speak with their hands”. While this can be habitual, like saying umm, it is worthwhile to try to tone down this particular habit. It can be extremely distracting to the speaker. Not to mention, some gesturing may be perceived as threatening.
4. Proxemics-Everyone has a different comfort level with how close you get to each other. A good rule of thumb is at least 3 feet in distance. You both should be able to reach out and grasp hands for a handshake comfortably. When you sit with a patient, you should be close enough so that their normal voice tone is easily heard. Be mindful that different cultures have different concepts of appropriate proxemics.
5. Touch-Handshakes at first meeting may be the only touch that is needed with a counseling patient. You may at some point find it appropriate to touch someone’s hand in a session. There are times when I have given a friendly or encouraging hug to a patient as they are leaving my office. I personally always ask for permission before I give a hug, but touching someone’s hand would probably be a spontaneous gesture. Bear in mind that many times counseling patients have histories of trauma and we do not want to contribute to any re-traumatization. You should never “grab” a patient or intentionally startle them with your touch.
As with everything, examine your own personal biases with these points. We all have work to do on ourselves so that we can best help others!
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Licensed Mental Health Counselor
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