When Helping You is Hurting Me: Counselor Care EthicsCOUNSELORS, THERAPISTS AND those in the helping professions are often thought of as being compassionate people. Indeed, many who feel called into the profession readily identify with the compassion of Christ as He related to people. Webster’s Collegiate Dictionary de- fines the term compassion as a “sympathetic consciousness of others’ distress, together with a desire to alleviate it.” For Frost (1999), it is a much broader concept than sympathy because it “entails and even inspires helpful and merciful action.” In South Africa, the word “ubuntu” is used, meaning humaneness or a sense of compassion combined with communality. Since most systematic studies underscore the critical importance of the therapeutic alliance between clinicians and clients, mental health providers are frequently in close proximity to the emotional suffering and trauma of those they treat. Although leading with grace may be a learned capability and most people probably have some potential in this area, liberating it is an entirely different matter. Perhaps it is the test of pressure or uncertain times that reveals the inner heart of a person. According to Dutton, et al. (2002), when the unexplainable, the unpredictable or traumatic event takes place, managerial rulebooks are inadequate when a response of compassion is required. The authors, conducting research at the Compassion Lab (University of Michigan and University of British Columbia), have found a link between a leader’s ability to foster a compassionate response with an organization’s ability to function at higher levels during difficult or stressful times. They further believe that compassion supersedes mere empathy and has the additive quality of public action, regardless of how small or insignificant it appears to be. This is because compassion, to be effective, must likewise be visible, or in essence “let the light shine in such a way that others may see good works and glorify God.” The challenge of the counseling profession is the simple reality that the concept of wellness is something counselors tend to focus on when it is related to their clients and not necessarily to themselves. This principle also has ethical implications that may impact the clinician’s competence and ability to maintain a “best practice” orientation. A consistent orientation toward compassion can tax the physical, mental, emotional, and spiritual old_resources of health care providers, often leading to a variety of lifestyle stress reactions. Some of the more common examples include such things as: • developing a preoccupation with stress-producing people or situations • over indulging in escape behaviors such as drugs, alcohol, pornography, etc. • avoiding intimacy in personal relationships and seeking fantasy over reality • attempting to control everything and everyone as a means of survival • justifying one’s actions by blaming other things and/or other people • choosing to simply leave the profession • compromising ethical and professional boundaries Dr. Hans Selye, the father of stress research, began to describe stress in terms of the “General Adaptation Syndrome” during the 1950’s. He broadly defined it as the, “nonspecific response of the body to any demand.” The term “compassion fatigue” has emerged more recently in literature and is sometimes referred to as “vicarious” or “secondary” traumatic stress associated with the “cause of caring.” While most anyone can be subject to workplace stress and burnout, compassion fatigue typically impacts those people in care giving professions such as nurses, physicians, rescue workers, counselors, social workers, clergy, etc. Left untreated, it may result in reduced job performance, a lowered self-concept, depression, and increased tension in other facets of life. Symptoms can also mimic those of post-traumatic stress disorder such as sleeplessness, irritability, anxiety, emotional withdrawal, avoidance of certain tasks, isolation, feelings of helplessness, and even flashbacks. High levels of stress usually result in the release of two key hormones into the bloodstream, adrenaline and cortisol. Both have the potential to produce harmful effects over time. These include an increase in the production of blood cholesterol; a narrowing of the capillaries and other blood vessels leading in and out of the heart; a decrease in the body’s ability to flush excessive cholesterol out of its system; and an increase in the depositing of plaque on the walls of the arteries. Like sleep loss, the effects of stress and compassion fatigue are accumulative. Sooner or later, one’s body will demand a payback and if the person cannot comply, it begins to shut down all of its systems in fairly rapid succession. Additionally, the “fight” or “flight” response tends to be instinctive but often compromises rational or calm thinking because adrenaline signals the body to move blood out of the brain and to the muscles where it may be needed more. Charles Figley, Ph.D., a Professor at Florida State’s Traumatology Institute, authored a book called “Compassion Fatigue: Coping With Secondary Traumatic Stress Disorder In Those Who Treat The Traumatized.” Along with B.D. Stamm, they have begun developing and norming a measure for this construct. Their research, as well as the instrument, can be accessed by logging onto the following websites: www.isu. edu/~bhstamm/tests.htm or www.acenetwork. com/cftest.htm. Figley believes compassion fatigue is closely linked to the cognitive schema of the therapist (social and interpersonal perceptions of morale), and like dysfunctional family dynamics, can easily be “spread” from contact with the traumatized person. There are two major categories of stress for counselors. One is the stress “of” the profession and the other is the stress that is “brought into” the profession. Counselors who successfully manage the second category of stress will usually handle the first category more effectively. As in sound treatment planning with clients, developing one’s own preventive stress management plan could be essential in helping to ensure longetivity. Most physicians will con- firm that one of the most prominent features of a heart attack is the denial that it could be happening in the first place. A few considerations in “taking one’s own pulse” include: • depersonalizing the process when it is appropriate by recognizing counter-transference reactions and the signs of secondary traumatic stress • learning the art of the 15-minute vacation and taking time to be silent and to be still every day • setting aside at least one two-four hour period of time each week for self-care, relaxation, play, exercise, and rest • triaging daily events and prioritizing tasks to avoid the tyranny of the urgent • having realistic expectations at both the personal and professional level and in terms of potential therapeutic outcomes with clients • resolving those things that can be attended to easily and quickly and focusing the majority of available old_resources in this direction • learning to manage the clock, the calendar and the appointment book by saying “no” and setting boundaries when necessary and without feeling guilty • delegating to others whenever, wherever, and however it is appropriate • scheduling a personal retreat at least once a year for a time of renewal, reflection, and refocusing • finding two or three key people in life as part of a personal support system and as accountability partners who have permission to offer objective feedback From a Biblical framework, it is essential to understand that God gives people permission to take care of themselves. Take help from internet counseing . Those who fail to realize this important truth continually run the risk of trying to minister to others out of their own provision as opposed to their overflow. What is it about the “ministry” that can compel a person to try to do more than Jesus did? In Luke 5:15-16, it says that Jesus would “often go to a quiet place to be alone with the Father.” Counselors are agents of change and change is a complex process that occurs over time. In order to “run the race with endurance,” the wise will be those who learn to “wait upon the Lord in order to renew their strength” so that they may “run and not grow tired, walk and not become weary” (Isaiah 40:31). b Eric T. Scalise, Ed.S., LPC, LMFT, is Associate Professor and Department Chair for Regent University’s School of Psychology and Counseling. He has over 25 years of clinical experience. Eric is the President of Beacon Counseling & Consulting and oversees the Counselor Care program for AACC. He also served for six years on the Virginia Board of Counseling. |