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?
Think of all the possibilities in the world. Isn’t it thrilling to know that if we let go of the thoughts that will hold us back, anything at
all is possible?
If you allow yourself to just imagine anything at
all, what would it be? Don’t your thoughts feel free?
Now start to notice those little niggling thoughts that pop up that would hold you back. Now ask yourself “is that the truth?” So many times, we just accept these limiting beliefs without questioning.
Just for a moment (because it can feel threatening and scary) let your imagination go to the places where you would love to go? Try to do this a
little every day. It’s good for your soul.
“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.
I just reinforced my decision to maintain what is essentially a news fast. I don’t read newspapers. I don’t watch the news. I get my news from CNN News Alerts on my phone and scanning various other email news alerts. I occasionally watch The Colbert Report also!
Someone gave me a copy of the Stars and Stripes which is the military newspaper. It was given to me because it had a story of a soldier’s suicide and the investigation that stemmed from the incident. The below summaries just have to do with “mental health” related stories:
One Army, Two Failures: The front page story outlining the bullying and maltreatment of two Army soldiers who ultimately committed suicide.
Sexual Assaults Reported at Veterans Affairs Facilities: A story of abuse of patients and staff of these facilities who were abused or committed abuse.
Weiner latest NY Official Caught in Scandal (tells you how old this paper is!): The story of Anthony Weiner’s poor choice in his pornographic Tweets and the history of several other NY politicians who have met with similar indescretions.
‘Hotness Delusion Syndrome’ Wields Power: An opinion column on why Anthony Weiner and others would perceive that young females would be interested in seeing pornographic pictures of him.
Series Shows NHL Still Struggling with Violence: A story of Nathan Horton’s injury during the Stanley Cup finals.
I’m sure that any other newspaper I chose to pick up would have a set of similar headlines. Now I understand that newspapers are desperate to sell. Maybe they have tested this out and these are the types of stories that get readers. It seems to me that we have our full quota of negative news every single day. I prefer to expose my brain to more uplifting extracurricular information.
What do you think? Do you feel the news impacts your outlook on life? Try doing without it for a while and see if anything changes in your life.
Earlier this week, SAMHSA released what is supposedly a unified definition of recovery. While I feel that attention to this topic is not futile, I also feel that recovery from mental illness or substance abuse is an inherently personal status. I liken this definition to how we feel about “freedom” or “love”, each person has their own unique perception.
The posting of this report sparked a lively discussion on a forum that I belong to. Below are some of the compelling comments posted by one of the members. With his permission, I have copied it here.
The phenomenon of our field struggling to define "recovery" is astonishing. The SAMHSA effort seems to be motivated around how to decide what resources to make available to efforts around addiction. That's a noble effort.
Some earlier work to define "recovery" got bogged down in other ways, like deciding if total abstinence was or was not an element of recovery and whether those treated with buprenorphine or other medications are in bona fide "recovery."
Deciding what resources are needed to address a problem is important and practical. Defining "recovery" for other people, however, is absurd.
Do we ever hear of endocrinologists convening a conference to define "recovery" from adult-onset diabetes? Or even psychiatrists arguing about how to define "recovery" in regards to bulimia or anorexia nervosa? Or even FEMA and Red Cross professionals arguing about how to define "recovery" from an earthquake?
"Recovery" from a disease, disorder, natural disaster, or personal crisis can only be defined by the individual who suffers. We only create confusion when we try to create an idiosyncratic vocabulary for the addiction field by enshrining the clinician's vision as the only way to justify a human being's goals.
Clinical professionals stick to a professional vocabulary when communicating with each other. That is, clinical professionals use words like:
The word "recovery" however, simply means (roughly) "the subjective experience of the individual struggling with a given problem."
For a group of professionals to try to define "recovery" for their clients is inherently paternalistic and condescending. It's a symptom of inappropriate boundaries by the professionals.
Steve Coulter, MD
What do you think? Should professionals define recovery for the people they serve?
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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The counseling environment is an important facet of the counseling experience. In this case, you often need to literally meet a patient where they are!
Most counseling practice cannot effectively occur in an environment outside of an office setting. It is just not efficient for a counselor to travel to see patients where they live. There are some models, such as home health, that use an “in home” approach, but the professionals rendering this service are reimbursed to a level which makes this feasible. For most of us, our patients have to come to us. This does not mean that you should ignore your environment with a take it or leave it mindset.
Those who have worked with me in the past know that I favor an “unoffice” type setting. I prefer my office to look like a living room, very cozy and comfortable. I currently have two offices where I see patients, one is more “officey” and one is cozier. Guess which one I usually see patients in? I have lamps vs. the harsh florescent lighting usually used in offices. I have fabric curtains that make the environment soothing. It makes me feel comfy just walking in.
Recently, I decided to use my less favorite office for a patient I was seeing and I thought it would make an interesting discussion. My patient has a long history of trauma and significant trust issues. I am humbled that they are working with me. The first time I met this person, we met in the “unfavorite” office. On our second visit, I considered moving to the other “favorite“ office, but did not because of several factors.
The first thing I thought of was that this would take the person aback. I wanted the setting to remain the same to give some stability to our brand new relationship. I am a believer that everything you do in counseling matters and so I like to stage the things I can. (Mind you, I’m not a control freak!) Coming to the same office and seeing things arranged in the same way lends a sense of stability to the counseling sessions. If you don’t believe me, the next time you see an anxious child, change something in your office between visits and see if they are not disturbed by it! An adult usually won’t even be conscious of something changed, but I feel that it impacts them.
The second thing that I thought of was trust. If you have ever done relaxation, meditation or hypnosis with someone, you know they have to have a certain level of trust before you can expect them to close their eyes and relax! For this reason, I felt that being in a room with bright lights would be more comfortable for this person.
Thirdly, because of the significant trust issues, I didn’t want to take them into a room that was more intimate. The seating is much closer together, it faces directly. I thought it would put this person a little on the defensive.
I have continued to see this person in counseling and I haven’t moved to the “favorite” office yet. I believe we are at a critical point and I don’t’ want to cause any disruption in the momentum if I can help it!!
Let me know if you have any thoughts about this topic. I’d love to hear what you think.
Licensed Mental Health Counselor
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