The Professional helper

Counsellors Self-awareness
Professionals who work immediately with others, have a responsibility to be aware of their own life issues. In understanding your needs and their possible influence on work, ask yourself the following questions (Corey page 40). How will I know when I am working for the clients benefit or working for my own benefit? Even though I have personal experiences with a problem a client is having, can I be objective enough to relate to this person professionally and ethically?

 How much do I depend on being appreciated by others in my own life. Am I able to appreciate myself, or do I depend primarily

on sources outside of myself to confirm my worth? Am I getting my need for nurturance, recognition and support met from those who are significant in my life

Stress in the Counselling Profession The Hazards of Helping

Helping professionals engage in work that can be demanding, challenging, and emotionally taxing. Mental health practitioners are typically not given sufficient warning about the hazards of the profession they are about to enter. Many counsellors in training look forward to a profession in which they can help others and, in return, feel a deep sense of self-satisfaction. They may not be told about commitment to self-

exploration.

Stress Caused by Being Overly Responsible

When therapists assume full responsibility for their clients lack of progress, they are not helping clients to be responsible for

their own therapy. Practitioners who have a tendency to accept too much responsibility for their clients sometimes experience their clients stress as their own. It is important to recognize when this is happening.

Signs of Stress
Signs to look for are irritability and 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 behaviour, and feedback from friends or partners.

 Stress is an event or a series of events that leads to strain, which often results in physical and psychological health

problems. To assess the impact of stress on you both personally and 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? Do you listen to your family, friends, and colleagues when they tell you that they are seeing signs of severe stress? Are you willing to ask for help?

Counsellor Burnout and Impairment

Stress, burnout, and vicarious traumatisation are ongoing challenges associated with the work of helping professionals (Smith & Moss, 2009). Therapists are vulnerable to the effects of stress; if stress is not adequately addressed, it can result in impaired professional competence.

Clinicians who do not engage in self-care practices are at great risk of not being able to carry out their professional duties (Barnett, 2008).

 Unmanaged stress is a major cause of burnout

and eventual impairment. Burnout is a state of physical, emotional, intellectual, and spiritual depletion characterized by feelings of helplessness and hopelessness. Maslach (2003) identifies burnout as a type of job stress that results in a condition characterized by physical and emotional exhaustion, depersonalization, and a reduction of personal accomplishments.

 Baker (2003) refers to burnout as the terminal

phase of therapist distress (p. 21). Jenaro, Flores, and Arias (2007) describe burnout as an answer to chronic labour stress that is composed of negative attitudes and feelings toward co-workers and ones job role, as well as feelings of emotional exhaustion (p. 80). Long work hours, heavy involvement in administrative duties, and the perception of having little control over work activities can place practitioners at high risk for emotional exhaustion (Stevanovic & Rupert, 2009

 Burnout comes at the end of a long process of what we refer to as therapist decay. Based on our observations over the years,

we have identified the following signs of therapist decay:

 An absence of boundaries with clients Excessive preoccupation with money and being

successful Taking on clients that exceed ones level of professional competence Poor health habits in the areas of nutrition and exercise The absence of camaraderie with friends and colleagues Living in isolated ways, both personally and professionally Failing to recognize the personal impact of clients struggles Resisting personal therapy when experiencing personal distress

Maintaining Vitality Through Self-Care

Sustaining the personal self can be a serious ethical obligation. To work in a competent and ethical manner, clinicians

need to acquire and regularly practice selfcare and wellness strategies. Self-care is not an indulgence, It is necessary to prevent distress, burnout, impairment, and to maintain a level of psychological and physical wellness.

 Professionals who work intimately with others

have a personal responsibility to be aware of their own life issues. Without self awareness, the counsellor is likely to obstruct the progress of their clients as the focus of the therapy shifts from meeting the needs of the client to meeting the needs of the therapist.

 Their own needs, areas of unfinished business, personal conflicts, defences and vulnerabilities can interfere with their

therapeutic work. Therapists however do have their own personal needs but these needs should not get in the way of clients growth or assume priority over clients needs Motivations for becoming a counsellor (page 39-41)

Motivations for Becoming a Counsellor

Questions to ask: What are my motivations for becoming a counsellor? What are my rewards for counselling others?

As a way of understanding your needs ask yourself the following questions:

How will I know when I am working for the clients benefit or working for my own benefit?

Even though I have personal experience with a problem the counsellee is having, can I be objective enough to relate to this person ethically and professionally?
How much do I depend on being appreciated by others in my own life? Am I able to appreciate myself or do I depend primarily on sources outside of myself to confirm my worth?

 Am I getting my needs for nurturance, recognition and support met from those who are significant in my life? Do I feel inadequate when clients dont make progress? If so how could my attitude and feelings of inadequacy adversely affect my

work with these clients?

 Am I getting my needs for nurturance, recognition and support met from those who are significant in my life? Do I feel inadequate when clients dont make progress? If so how could my attitude and feelings of inadequacy adversely affect my

work with these clients?

Personal Therapy for counsellors Reasons for participating in personal psychotherapy First it is important to know what the experience of being a client is like. Therapy can help you to take an honest look at your motivations for becoming a helper. Through therapy you can explore how your own needs influence your actions, how you use power in your life, what your values are and whether you have a need to tell others what to do.

Transference and Counter transference

Transference is the process by which clients project onto their therapist past attitudes or feeling they have had towards significant

people in their life

Counter transference can be considered as

any projection by therapist that distort the way they perceive and react to client

Counter transference; Ethical Implications

Being over protective with a client-A

counsellors unresolved issues can lead him/her to steer clients away from those areas that open up the counsellors own pain. Treating clients in benign ways-This may come as a result of a counsellors fear of his/ her anger. To guard this anger, the counsellor may create a bland counselling atmosphere and this can result in exchanges which are superficial.

 Rejecting a client-This may come as a result of

the counsellor perceiving the client to be dependent or needy. Instead of moving to protect client therefore, the counsellor may remain aloof. Needing constant reinforcement and approval-Counsellor may have the need to be assured of their effectiveness. When they do not see immediate results, they become discouraged and anxious

 Seeing yourself in your clients- Counsellors can

feel so close to their clients that they begin to identify with the clients problems to the point where they lose their objectivity and are unable to distinguish between their feelings and that of the client. Developing sexual or romantic feelings towards clients- this can exploit the vulnerable position of a client. Seductive behaviour on the part of the client can lead to therapist adopting a seductive style, especially if therapist is unaware of his/her own dynamics and motivations.

 Giving advice- This can easily happen with clients who seek immediate answers. The opportunity to give advise places counsellor in a superior position and they might fool themselves that they have the answers for their clients Developing a social relationship with clients-

This may stem from counter transference, especially if it is acted out while therapy is taking place. Clients often express the desire to to have a closer relationship with therapist. Mixing personal and professional relationship often destroys the relationship and could lead to law suit

Client Dependence
Clients frequently experience a period of dependence on counselling or on the counsellor. Dealing with dependence is not always clear cut (page 55 Corey)
Delaying termination is a form of client

dependence

Termination
Most professional codes of ethics require termination when it is evident that further counselling will not bring significant gain

Professional Impairment
American Association For marriage and family therapy(2001)

Marriage and family therapists seek appropriate professional assistance for their personal problems or conflicts that may impair work performance or clinical judgement (3.3)

National Association of Social Workers

Social workers whose personal problems, psychological distress, legal problems, substance abuse or mental health difficulties interfere with their professional judgement and performance should immediately seek consultation and take immediate remedial action by seeking professional help, making adjustments in work load, terminating practice, or taking any other steps necessary to protect clients and others (4.05.b)

American Psychological Association (2002)

When psychologists become aware of personal problems that may interfere with their performing work-related duties

adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties. (2.06.b.)

American Counseling Association (2005)

Counsellors are alert to the signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing

professional services when such impairment is likely to harm a client or others. They seek assistance for problems which reach the level of professional impairment and, if necessary, they limit, suspend or terminate their professional responsibilities, until such time it is determined that they may safely resume their work. (C.2.g.)

Ethical Issues in end of Life Decisions

Physicians/therapists have recognized the right of the patient/client to participate in medical decision making for the last 25 years.

The principle of autonomy, or the right to make choices about one's own life, has now become the centerpiece of modern American ethics

 The available data suggest that patients with terminal cancer are more likely to receive end of life care that is consistent with their

preferences when they have had the opportunity to discuss their wishes with their physician .

 Unfortunately, close to 50 percent of

individuals over age 85 have dementia, which usually precludes their understanding many of the issues involved in choosing among treatment alternatives . In addition, many cognitively intact elderly are delirious during an acute illness and are incapable of complex discussions about their care when important decisions must be made. In these situations, a surrogate must be identified to speak on behalf of the older patient

 Some have cautioned that excessive deference to patient autonomy has the potential to place unwanted and

unreasonable responsibility for technical medical decisions on patients or their surrogate decision makers

 Given the array of treatments now available for advanced and chronic illness, it is difficult, and at times nearly impossible, for patients or

their surrogates to fully comprehend the burdens and benefits of the available options. It remains the responsibility of the therapist to solicit and understand the patients goals and values, and then guide and facilitate medical decisions so that the treatments that are provided are consistent with these goals and values.

Assessing decision making capacity

The therapist must assess the patient's

decision making capacity before concluding that a given individual cannot speak for himself or herself. Mildly demented patients, for example, may understand the issues involved in amputation of a gangrenous foot well enough to allow them to choose or decline surgery, even if they no longer have the ability to balance their checkbook or live independently. Conversely, superficially intact patients may be unable to understand the pros and cons of a proposed intervention.