Harris, D. L., & Winokuer, H. R. (2012). Caregiver issues for grief counsellors. In Principles and practice of grief counselling (pp. 195-206). Springer Publishing.
Every form of helping and caring is accompanied by its own unique emotional burden. For counselors, not only is caring a motivation or desire, but it is also a requirement in order to work effectively with clients. In essence, a counselor’s livelihood is dependent upon his or her ability to profoundly engage with this capacity for caring and empathy without losing these abilities along the way. Grief counselors are especially prone to the accumulation of occupational stress and subsequent loss of their caring capacity on account of continually witnessing people’s deep pain and despair, hearing clients’ stories that highlight the unfairness of life events, repeatedly being exposed to the traumatic images and material that clients share, and the needs of their clients to process intense images and emotions with them. An additional drawback to the counseling profession is isolation. Even though you may be seeing clients all day, there is often a sense of seclusion that counselors describe in their work, as contact with other clinicians and colleagues is often limited by differing work schedules and the fact that most of the work occurs behind a closed door in private with your clients.
To many counselors, the “work” of counseling is a natural extension of who they are. In addition to typically being highly empathic and caring, most grief counselors closely identify with the choice to work in such an intense field. People who are drawn to grief counseling are usually not foreigners to the experience of loss and personal pain, and their desire to do this type of work is often a result of experiencing their own personal losses. Thus, it may be impossible to separate the person who is the grief counselor from the profession of counseling. This unique blending of who you are with what you do can be incredibly rewarding. However, it can also have unique drawbacks, as being so highly identified with your work can lead to difficulties with boundaries, a strong need to be validated in your work in order to feel validated as a person, and difficulties with balance in other areas of life if those other parts of your life are not consciously cultivated. Implicit in this statement is that some counselors will attach great value to their caring role, and when this role is impaired by stress or when there is frustration with one’s work environment, significant damage can occur to the counselor’s self-esteem and sense of meaning in the world.
In a study by Osipow, Doty, and Spokane (1985), three different dimensions were identified in the occupational stress of those engaged in helping professions:
- internal stressors, including the internalized attitudes toward work and how problems are perceived and interpreted by the individual;
- external stressors, which include the individual’s perception and experience of stress in the work environment itself; and
- coping resources available to counter the effects of the occupational stresses, and the individual’s ability to draw upon these inner resources at various times.
Internal Stressors
Stresses that come from internalized sources may be the most difficult to identify, as they are often not readily apparent, are often not seen as problematic by the person, and the counselor may not necessarily be aware of their presence and influence upon his or her choices and experiences. Some of the more common internal stressors for counselors include having unrealistic expectations of themselves, or a need for this type of work to provide completion of unfinished business from the past. In grief counseling especially, a history of significant losses, personal death experiences, a high degree of emotional investment in clients without an opportunity to have time to pull back and be replenished, and feelings of powerlessness and lack of control in regard to life events can take a big toll over time. Caregivers also may struggle with self-induced stress, which can include tendencies toward perfectionism, fear of failure, and the need for approval. Counselors’ needs for success and approval in the client setting may interfere with their being totally present and attentive to the needs of their clients. These needs are often manifest in the counselor having difficulties with boundaries. Signs that the counselor’s needs are driving the process rather than the client’s may include some of the following examples:
- Excessive self-disclosure on the part of the professional caregiver, including detailed discussions of the counselor’s personal problems or aspects of intimate life.
- Beliefs in the indispensability of the counselor to the client that are perpetuated by the counselor.
- Encouraging personal communication and dependence by the client upon the counselor, including the counselor giving out personal information.
- Repeated or lengthy calls to clients outside of the session times.
- Giving preferential treatment to a client to the detriment of others.
- Buying gifts for or accepting gifts from clients that are more than token or symbolic gestures.
- Lending money or personal belongings to clients.
- Flirtatious behavior with a client or a member of the client’s family.
- Failure to seek supervision when a boundary has been crossed or is being “skirted” by the counselor (Sheets, 1999; Taylor, 1998; Wogrin, 2007).
It is these often unspoken, but very real issues that can cause the counselor to alienate himself or herself from others and not receive the needed peer support or supervision to ensure that the counselor’s needs do not usurp the needs of the client or take advantage of a client’s vulnerability.
Herman (1992) discussed the problem of unrealistic expectations in counselors, calling them “narcissistic snares.” The most common snares include the aspiration and expectation of the counselor to heal all, to know all, and to love all. In addition, she discussed the concept of traumatic countertransference, where the counselor can become over-whelmed by bearing witness to the client’s intense emotional experiences. She stated that any person who thinks he or she can work with people who have undergone traumatic experiences without having a good support system and time for personal care is setting up a very unrealistic scenario for doing this type of work over the long term.
Counselor self-awareness is a key component of the work of grief counseling. In fact, we think self-awareness and self-care are profes-sional competencies that good counselors must cultivate and practice on a regular basis. Think about why you wanted to do this type of work. What draws you to this field? We mentioned earlier that the field of grief counseling tends to attract people with significant life losses and/or death experiences to enter into practice as the wounded healer, which can be a very powerful and effective place from which to work with the bereaved (Nouwen, 1996). However, it is important for counseling professionals to have examined the impact of the wounds from significant loss events and to experience a sense of healing from these wounds before attempting to participate in another individual’s healing process. We have all known individuals who mean well and who truly wish to help others in this field, but who would be more aptly described as the “walking wounded” because their wounds are still readily apparent and need focused attention. Others, who take on the identity of being “damaged goods” as a result of their wounds, may continue to need others to feel better about themselves because of the overlay of shame onto their experience(s). These latter scenarios have the potential to bring harm upon potential clients, as it would be impossible to completely focus on the client’s issues and experiences when wounds such as these in the counselor are still glaring and prominent (see Figure 12.1).
Figure 12.1 Differentiating How Personal Loss Experiences May Affect Counselors
- "Wounded Healer" - loss experiences deepen empathy and resilience.
- "Walking Wounded" - loss experiences are still raw and will seek attending.
- "Damaged Goods" - loss experiences are felt as shameful and a sign of weakness.
Worden (2009) stated that working with bereaved individuals may affect counselors by (a) making them more aware of their own losses, (b) causing them to be more “tuned in” to losses that they might fear (such as losing a child), and (c) heighten their awareness of personal mortality and existential anxiety. When working so closely with clients who are dealing with significant loss experiences, it is important for counselors to be very aware of their own loss history, and their attitudes about death and grief, and to be able to identify any topical areas that may present an especially difficult challenge because of personal experiences or vulnerabilities. This personal inventory for the counselor should also include whether the counselor can be fully present to the feelings of powerlessness, helplessness, and frustration that can arise in working with bereaved individuals, as we highlighted in an earlier chapter that you cannot take away the pain, you cannot bring back the loved one who died, and you cannot change what has happened. Counselors can be triggered into their personal pain when they witness the pain in their bereaved clients, and this discomfort can cause them to shut down emotionally, or, worse, attempt to shut the client down to stop this discomfort (Worden, 2009). Both Worden (2009) and Wogrin (2007) suggested that counselors complete a personal loss history (see Figure 12.2) and that they share this history with a friend or colleague to ensure that there are no “lurking shadows” that may impede their ability to work effectively with bereaved clients.
External Stresses
Sources of stress that are external to the counselor can have a very big impact upon the counselor’s effectiveness and ability to be fully present with clients. Some of the more common external stressors include the high demands placed upon individuals to see clients expeditiously even when their schedule is full, unrealistic expectations of the workload for counselors (especially when these counselors are in institutional and agency settings), limited or inadequate resources of clients to be able to afford counseling, and limited professional support and awareness of the intensity of the work by other professionals (Wogrin, 2007). On a more practical level, counselors in private practice often face the realities of the ebb and flow of people’s lives, schedules, and financial reserves, which can lead to a wide fluctuation in income from month to month, causing difficulties in budgeting time and resources consistently. Choosing to practice in an agency or institutional environment may offer greater financial stability, but with a trade-off of the ability to have control over your time, schedule, and workload.
Elements of a Personal Loss History
Ask yourself the following questions. Then take the time to review your responses with a trusted friend or colleague. Think about the ways that these losses and your responses to them might affect your interactions with bereaved clients or clients who are struggling with loss issues.
- Complete a loss line of all the losses that you have had in your life (death and non-death related).
- What are the most significant losses that you have experienced? How are these losses more significant to you?
- How did you react to these losses? Do you tend to have similar reactions to loss experiences?
- How did the people around you react to these losses and to you during these times?
- What have you learned about death, grief, and life from your experiences?
- What are your religious or spiritual beliefs about death? How about life events?
- What are your cultural beliefs and assumptions about the expressions of grief, especially in regard to feelings and social obligations?
- Based upon your own experiences, what do you believe people typically need from others as they attempt to cope with grief and loss?
In her study of palliative care staff, Vachon (2004) found that the main sources of stress for caregivers were unrealistic workloads, low consideration of the input of caregivers in decision making, and little time for staff to offer support to each other. Previously, Vachon (1987) noted that much of the stress experienced by caregivers who worked with this population was related to their work environments and the unrealistic occupational expectations they felt from supervisors and administration rather than their work with individuals and family members who were terminally ill or bereaved.
Working environments that create a sense of depersonalization, demoralization, and moral distress can deeply challenge the assumptive world of those who work in such an atmosphere. In essence, work situations where there are unrealistic demands and expectations such as these can lead counselors to question the reasons why they entered this profession, whether the work they do really has any meaning or purpose, and whether they really do help others or not. It is almost impossible to be person-centered in your counseling practice if you, the counselor, are being objectified in the environment where you practice.
Coping and Internal Resources
The concept of coping implies some attempt at adaptation, either by the ability to reappraise stressful or negative experiences in some way or by reintroducing aspects of benevolence, meaning, and self-worth into situations that may otherwise challenge the existence of these values to an individual. Corr (2002) emphasized that coping is seen as a process of attempting to deal with challenges to one’s assumptive world and situations that are perceived by the individual as stressful or even threatening, although coping strategies may or may not be successful. Perhaps the most important point to make about coping strategies in stressful work environments is the ability of the counselor to (a) identify the source of the stress, (b) explore if there is anything that can be done to either eliminate the stress or to change one’s relationship to the stress, and (c) know when a situation has reached “critical mass,” where ongoing attempts to grapple with a situation that is draining precious internal resources will eventually deplete the counselor of his or her ability to work competently and with a sense of integrity.
The ability to clarify how to respond to a stressful work environment requires the counselor to be comfortable recognizing when personal limits can be pushed and expanded, yet to also be realistic in regard to personal limits that should not be compromised. The difficulty here is that the longer you are exposed to ongoing stress and pressure in a situation, the more exhaustion you will experience, and this exhaustion can have a profound impact upon your ability to decide how you need to respond to the ongoing and significant stress in the work environment. Thus, a vicious cycle can be set up where you are chronically exposed to stress and become so depleted that you lose your ability to see yourself and the situation clearly, lessening your ability to know how to respond in a way that is congruent with your original intentions and values. Losing yourself in this way only adds more suffering to a stressful situation; thus, it is important to know yourself, that you are able to discuss issues and concerns with colleagues who are not in the same environment, and that you maintain a healthy and realistic view of your expectations of yourself and your workplace.
Many counselors enter the field with very good, but idealistic hopes about helping others and being successful in their chosen profession. Very few would probably even consider the possibility that they could experience negative repercussions from doing work that they have envisioned as highly rewarding. In fact, many individuals consider their profession of counseling as something akin to a “calling,” which implies that a high degree of investment and sacrifice are expected as part of being a good counselor (Yalom, 2003). This desire to help others and to be so highly identified with the profession is both laudable and concerning, as a high degree of commitment and a deep capacity for empathy usually allow the counselor to be effective with clients, but these same attributes can set up the counselor for unique forms of personal harm that are insidious in nature. In this section, we will explore how exposure to certain stressful situations in counseling can deeply affect the assumptive world of the counselor, with the potential to harm the counselor personally and professionally. We will specifically discuss burnout and secondary traumatization (some-times referred to as compassion fatigue).
Burnout occurs as a result of cumulative and ongoing emotional drain, trauma, and disappointments associated with an imbalance between the counselor’s resources and the demands (both internal and external) placed upon him or her. It is seen as an evolutionary, cumulative process that starts with this imbalance and progresses to chronic emotional strain and exhaustion, depersonalization, and a sense of reduced personal accomplishment and satisfaction. The counselor who experiences burnout typically begins to cope with the emotional overload by distancing himself or herself from those who need help in order to feel more protected emotionally. What eventually happens is that the counselor can end up being and doing the very opposite of his or her primary motivation for entering the profession in the first place, and a devastating form of indifference and loss of human warmth begins to preside where there used to be compassion and concern. In addition, there is often personal shame and fear of others’ judgment for this change in attitude to have occurred, which may prevent the counselor from being able to reach out and get the support and care that he or she needs from others. An unrelenting cycle can become established where the needs and expectations that the counselor has for himself or herself are added upon by the needs and demands of clients and/or the work environment, within a vacuum of resources for the counselor’s renewal and energy, triggering the counselor to “try harder” to overcome the obstacles alone, but this effort only results in further, deeper depletion of the limited resources that are present.
Burnout is a state of physical, emotional, and mental exhaustion. The symptoms are caused by the stress that caring professionals experience in their careers, which is cumulative and often predictable (Maslach, 1982). It tends to be high when professionals experience a low level of control over decisions regarding how they will provide care, whether it is because of autocratic/ bureaucratic factors, lack of input into how their workload and responsibilities are assigned, or being given more responsibility or a higher work volume than a person feels is possible to handle (Maslach, 1982). Recognizing and addressing burnout may involve looking at both internal and external factors. Professionals who are passionately devoted to their work often have a strong desire to be successful, and feelings of repeated disappointment or inadequacy may foster high stress and burnout. What is more common is an interaction between these factors, especially when high workload demands are in conflict with the time requirements and needs of people who are in emotional pain and crisis (Wogrin, 2007).
Secondary traumatization (also sometimes referred to as vicarious traumatization or compassion fatigue) refers to a state of tension and preoccupation with the individual or cumulative trauma of clients (Figley, 1995). Ironically, it is those counselors who have the greatest capacity for feeling and expressing empathy who tend to be at highest risk for compassion fatigue. Professional work that is focused on the emotional suffering of clients can include the counselor being exposed to information that is deeply troubling, which can also include absorbing suffering (Figley, 1995). In addition, the “work” of counseling involves the opening of one’s self to another, which could increase the level of vulnerability of the counselor as he or she opens to the pain and suffering of others (Johnson, 1992).
The variety of symptoms associated with compassion fatigue include reexperiencing the client’s story in a way that is intrusive, personally traumatizing, or overwhelming, a feeling of dread when faced with working with certain people, difficulty separating work from personal life, and guilt for being free of pain or suffering. Secondary traumatization implies a physical, emotional, and spiritual exhaustion with a decline in the ability to experience joy as the body becomes exhausted. Those who experience secondary traumatization may experience hopelessness, blame, anger, physical fatigue, and drug abuse. They may feel irritable and have great difficulty with sleep. Lack of sleep, along with the other symptoms, may put not only their job but also their client’s well-being in jeopardy. Counselors who experience secondary traumatization are at a higher risk for depression, anxiety disorders, avoidance, and leaving the profession (Figley, 1999).
The type of stress encountered with secondary traumatization is different from what is experienced in burnout in that it is a result of vicariously experiencing the pain and trauma that your clients may share with you. Although secondary traumatization is detrimental to personal and professional functioning, it is preventable. If the counselor is highly selfaware, he or she will know when a client has shared something that is personally challenging or that leads to feelings of helplessness, hopelessness, and/ or powerlessness. At these times, if the counselor readily addresses what has been taken in from the client and can process the material expeditiously with a supervisor or a trusted peer, the traumatic overlay is much less likely to occur.
As our most important asset as counselors is our ability to care and to share in human compassion, it is of vital importance that these aspects of ourselves be nurtured, guarded, and protected so they will be available when we want and need them in our lives, both professionally and personally. We write this chapter with the assumption that in order for self-care to have any benefit, it must be recognized as a professional competency for effective counseling practice. It is not an option or something that you do when you have time. In the helping professions, there is always the need to establish a functional balance between taking care of others and taking care of self. Others’ needs tend be apparent, insistent, and pressing and can easily overshadow the needs of the self. Rigorous self-awareness practices encourage the balance to remain level and may prevent the onset of burnout, secondary traumatization, and/or debilitating numbing/ flooding (Pomeroy & Garcia, 2009).
Self-care for counselors and the regular seeking of peer support are imperative when your everyday practice involves an intense profession. Helping others to help them-selves requires that the counselor accept his or her own needs as well as the needs of others. The greatest resource a counselor has is the ability to relate on a human level with his or her clients. In order to do this, the counselor must be comfortable with his or her own “humanness,” which includes having needs and recognizing limitations. In fact, many counselors would say that the degree to which we take care of ourselves often reflects directly on our ability to foster the well-being of our clients. Preventing burnout requires that the counselor is self-aware of his or her own needs and is proactive in taking care of these needs in a healthy and constructive way. Unrealistic expectations, unmet needs, unfinished business, and the “need to be needed” must be addressed in an accepting and open way that allows the caregiver a chance to explore his or her own motivations and wounding in order to come to a place of healing and balance. Counselors need to cultivate a personal philosophy that will allow empathetic involvement with others while maintaining individuality and clear boundaries between the needs of self and the needs of others.
Professional peer support groups are an excellent resource for helping professionals to provide a place for the development of self-awareness, self-care, and interactions with others who are like-minded and share similar values. In one study of counselors, those who reported high occupational stress had lower levels of self-care and peer support than those who reported lower levels of stress (Sowa, May, & Miles, 1994). Being engaged in peer support with other clinicians counteracts the isolation and alienation that can occur from providing care to clients, and it also provides a place to receive much needed support and validation. Our society values the highly individualistic, self-sufficient “superman/superwoman” image. However, this image is completely unrealistic and denies our human need to both give and receive from others. Counselors must be able to see that being able to find support and receive it from others is in itself a strength that can be cultivated in the presence of a supportive network. Counselors also need to be able to find supportive persons in their lives who will allow them to ventilate feelings, share frustrations, find successful coping strategies, and observe positive role models in order to become empowered providers. The following are guidelines for counselors to assist them in engaging in reflective practice with necessary support and self-care strategies:
- Recognize and honor your limitations; you are a human being whose capacity to care for others hinges upon your ability to care for yourself.
- Have a place to go for support and debriefing that will respect the confidentiality of you and your clients.
- Have regular supervision with someone who is experienced in this type of work.
- Cultivate self-awareness of your issues, feelings, and values so that you will be able to separate them from those of clients.
- Take advantage of professional development opportunities, such as workshops, courses, reading journals, and new materials.
- Align yourself with a professional code of ethics and standards of practice within a counseling-related field.
- Monitor your own health and well-being. Develop your private world in a way that is nurturing to you.
- Give yourself permission to not always work well with everyone.
- Monitor your working hours and time spent focused on client related topics.
- Recognize your own philosophy of life and how that impacts your work as a counselor.
- Be aware of the unique signals from your body that may indicate you need to attend to work-related stress, such as disturbed sleeping patterns, changes in eating patterns, bodily aches and pains, and frequent illnesses that may indicate your immune system is being challenged.
Counselors are professionals who are also human beings. The profession of counseling relies upon the ability of the individual counselor to nurture and cultivate a capacity to care and connect with clients empathically. Counselors who work primarily with individuals who have faced painful losses, traumatic events, and the death of loved ones will be exposed to levels of human suffering and pain that can profoundly affect them at a personal level. Professionalism in counseling does not mean that the counselor will not be touched by this suffering; rather, being a professional in this field means that you have developed effective ways to take care of yourself and to find necessary support to explore your responses to clients’ pain. Self-awareness is a key component of being able to identify when you need to attend to your personal feelings so that these responses do not interfere with your clients’ process. Protecting your capacity to care may also involve an honest appraisal of your professional working environment and its impact upon your ability to be fully present to yourself and your clients. Having proficiency with the body of knowledge and completing a rigorous training program in this field are both very important. However, these factors will be of benefit to the client only if the counselor is able to connect with the client in a meaningful way. The relationship that forms between the counselor and the client is often stated to be the most important aspect of this work. Thus, attending to the personal aspects of the counselor is of paramount importance to maintain competency in this profession.
