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Hazards of Practice

Challenges to Counselor Wellness

There are many challenges to maintaining counselor wellness, and many of these stem from the nature of the work itself. Thomas Skovholt, author of The Resilient Practitioner, describes the “Caring Cycle” in which counselors repeatedly connect to clients through empathy, become actively involved with them, and then ultimately disengage as clients leave therapy (after the work is done and also when counseling work ends prematurely for a variety of reasons). Over the course of months, years, and a career, this caring cycle can take a toll an emotional toll on counselors.  Empathy is the foundation for and an absolutely critical component of all effective counseling work. It is also the conduit through which the pain of the client impacts the self of the counselor.  While vital, being emotionally attuned and available to clients increases our vulnerability in the work. And, yet, we cannot be effective in our work if we are not emotionally attuned and available. Within the counseling relationship and within the moment-by-moment interplay of each session, this is the ultimate balancing act – finding ways to stay attuned to clients while maintaining a strong and deep connection with our own experience.

It is important for counselors to understand that there are risk factors inherent in the work and that noticing signs of stress or distress is a sign of health not impairment. None of us are immune to the effects of the work. When counselors can view their emotional responses to their work as an expected part of empathic engagement (rather than something they are doing wrong), they are more likely to seek support, talk about stress with colleagues, and engage in self-care practices to support their overall wellness.

Defining Key Terms: Compassion Fatigue, Vicarious Trauma, Burnout, and Impairment

Compassion Fatigue

Charles Figley originally coined the term “Compassion Fatigue,” an experience in which exposure to the suffering of clients coupled with an inability to rescue them from this suffering results in feelings of depletion, anxiety, depression, resentment, and/or emotional withdrawal.  Counselors experiencing compassion fatigue may deny client’s traumatic experiences, over-diagnose and pathologize clients, and become increasingly less attuned and empathic.  The ProQOL, a very useful and easy-to-score assessment tool, was developed by B. Hudnall Stamm and is available online at http://www.proqol.org/ .   This instrument includes measures for compassion fatigue/trauma, compassion satisfaction, and burnout.

Vicarious Traumatization

Vicarious trauma, a concept described thoroughly in the book by Pearlman and Saakvitne (1995) entitled Trauma and the Therapist, describes a process of personal change in counselors whose work involves empathic connection with traumatized clients. In this process, counselors can be secondarily impacted by the clients’ traumatic re-experiencing in similar ways to how clients themselves are impacted. Vicarious trauma is a concept that explains the influence of client’s trauma on the counselors who care about them as a natural consequence of empathic attunement.  When our work involves empathically engaging with people who have experienced traumatic events and wanting to help alleviate that pain, vicarious trauma (VT) is inevitable. VT is cumulative and modifiable and unique to each person, as every counselor has his or her own areas of vulnerability. I appreciate the breadth and depth of understanding offered by the concept of VT and its focus on normalizing and validating this experience rather than pathologizing counselors’ reactions to the work.

While the concept of VT was originally developed for trauma therapists, I continue to find this model extremely helpful for all counselors, regardless of client population or presenting concern. I believe that unresolved trauma underlies and drives most of the concerns people bring to counseling, and, as a result, a model that understands the impact of empathic engagement with the traumatized is incredibly supportive. Even when clients present with anger, depression, relationship concerns, anxiety, feeling stuck, or parenting worries, so often unhealed wounds from earlier life are creating or exacerbating their difficulties. Those who are wounded may challenge or mistrust therapists, have defensive personalities that interfere with healthy attachment, or unconsciously assume roles as victim or aggressor or both. Counselors need support as they enter into these complex therapeutic relationships, and they need to know that feelings that may surface as a result of the work are a sign of being human and not of failure or weakness.

It is important for counselors to understand that there are risk factors inherent in the work and that noticing signs of stress or distress is a sign of health not impairment. None of us are immune to the effects of the work. When counselors can view their emotional responses to their work as an expected part of empathic engagement (rather than something they are doing wrong), they are more likely to seek support, talk about stress with colleagues, and engage in self-care practices to support their overall wellness.

Burnout

Burnout can be viewed as a potential long-term consequence of unaddressed VT or compassion fatigue – and can also stem from working in a highly stressful organization. While both unaddressed vicarious trauma and compassion fatigue can lead to burnout, I view burnout as the accumulation of work-related stress that results in feelings of hopelessness and helplessness. It is typically created or exacerbated by the nature of the work and workplace, and, as a result, a change in work environment can dramatically improve one’s experience of burnout. Environmental stressors that contribute to burnout include: working long hours, large workloads with minimal supports, emotionally intense clientele, isolation and disconnection from colleagues, and absent, poor, or critical supervision. Counselors experiencing burnout tend to be emotionally numb, detached, and cynical about clients and the work. Many counselors experiencing burnout can regain their energy and passion for helping once they leave a toxic workplace and devote time to nurturing themselves.

Impairment

The ACA Task Force on Counselor Wellness and Impairment, which worked together from 2003 through 2007, developed the following definition of impairment – published in VISTAS: Compelling perspectives on counseling 2005:

Therapeutic impairment occurs when there is a significant negative impact on a counselor’s professional functioning which compromises client care or   poses the potential for harm to the client. Impairment may be due to

  • substance abuse or chemical dependency;
  • mental illness;
  • personal crises (traumatic events or vicarious trauma, burnout, life crisis); and
  • physical illness or debilitation.

Impairment in and of itself does not imply unethical behavior. Such behavior may occur as a symptom of impairment, or may occur in counselors who are not impaired. Counselors who are impaired are distinguished from stressed or distressed counselors who are experiencing significant stressors, but whose work is not significantly impacted. Similarly, it is assumed that an impaired counselor has at some point had a sufficient level of clinical competence, which has become diminished as described above. (Lawson & Venart, 2005, p.243).

 

Copyright 2010 Elizabeth Venart, Licensed Professional Counselor in the Philadelphia Vicinity.
602 S. Bethlehem Pike, Ambler, PA 19002 • Phone 215.542.5004 • Email evenart@comcast.net
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