In this section you will learn about the following:
- Risks associated with crisis support
- Principles and practices of self-care
- The importance of supervision and debriefing.
Supplementary materials relevant to this section:
- Reading H: Self-Care
Working with clients who are at risk or in crisis can be quite challenging for counsellors. Counsellors must remember that it is not only the client who needs to receive appropriate support but the counsellor, too. As such, the final section of this module discusses the risks often associated with supporting clients in crisis and how counsellors can ensure that they engage in appropriate self-care strategies and receive appropriate support.
Because of the nature of our work, counsellors are subject to experiences of burnout, vicarious trauma, and compassion fatigue. All of these can impact upon a counsellor’s own wellbeing and professional capacity, and can also present a risk to client welfare.
Burnout
Burnout is a state of physical, mental, and emotional exhaustion caused by long-term involvement in emotionally demanding situations (James & Gilliland, 2017). Common signs of burnout may include (The Lookout, 2019):
- Physical and emotional stress
- Low job satisfaction
- Feeling frustrated by or judgmental of clients
- Feeling under pressure, powerless and overwhelmed
- Not taking breaks, eating on the run
- Unable to properly refuel and regenerate
- Frequent sick days or “mental health days”
- Irritability and anger
(The Lookout, 2019)
Vicarious trauma and compassion fatigue
Vicarious trauma and compassion fatigue can occur from one-off empathic engagement with clients, though more typically from an accumulation of experiences and traumatic imagery presented by clients (James & Gilliland, 2017).
Vicarious trauma
It is the consequence of being exposed indirectly to traumatic material in your professional work, that can lead to traumatic stress symptoms and altered views on self, others and the world (Louth, Mackay, Karpetis, & Goodwin-Smith, 2019).
Compassion fatigue
It is often characterised by experiences of ‘emotional burnout’ and the loss of the ability to feel compassion for others. The initial symptoms of vicarious trauma and compassion fatigue often overlap, as they typically involve detriments to a counsellor’s personal and professional functioning.
While the effects will vary from person to person, some common signs of vicarious trauma and compassion fatigue are included in the following table.
| Vicarious trauma | Compassion fatigue |
|---|---|
(The Lookout, 2019) |
(Adapted from Harris & Winokuer, 2016, p.221) |
When working with clients at risk or otherwise in crisis, there are also dangers relating to over-involvement. It can be very frustrating and emotionally draining when client outcomes turn out to be different from what the counsellor hopes. This is particularly true for beginner counsellors who often start their careers with idealised expectations. Counsellors need to develop realistic expectations of their own capacities and skills, as well as possible outcomes, and address issues of over-investment in clients in their own personal counselling or supervision. Failing to do this can lead to problems relating to mental health, work-life balance, the counsellor’s personal relationships, the sustainability of their work, service delivery, and client-counsellor relationships.
Counsellors need to be mindful of maintaining their own well-being and must have a range of self-care activities and resources. They must seek available support within their work and personal environments, both in general and in response to particular work challenges.
Check your understanding of the content so far!
To put simply, self-care is the conscious effort that workers take to look after themselves adequately. It is highly recommended that you develop a comprehensive self-care plan that consists of a range of effective strategies you can use to maintain your well-being and safety and make sure that it is being reviewed and updated on a regular basis. Ideally, your self-care plan should include strategies that you can implement at work as well as beyond work.
General self-care strategies that helping professionals employ may include strategies relating to the following areas:
- Recognising the symptoms
- Engaging in reflective practice
- Maintaining health and wellbeing
- Work-based self-care
- Promoting work-life balance
- Engaging in social and other activities outside of work.
Review the following tips for developing self-care.
Recognising the symptoms
Reflect on the signs of stress that you commonly observe in yourself and actively monitor for those signs. Research and educate yourself concerning symptoms of burnout and vicarious traumatisation. Develop a plan for recognising stress and determining your course of action when emotionally impacted. Be prepared and willing to seek additional support in areas of vulnerability.
Engaging in reflective practice
Regularly check in with yourself and engage in discussions with your supervisor to effectively monitor your well-being. Being honest and open in reflective processes allows you to gain insights into your areas of vulnerability, identify stressors impacting your personal and professional life, and assess your personal strengths and resources (or lack thereof) for coping with the demands of your work.
Maintaining health and wellbeing
Maintain a balanced diet, stay physically active, avoid substance abuse, and engage in spiritually oriented activities (e.g., meditation, mindfulness, joining a spiritual community, volunteer work) that foster a sense of meaning and purpose in life.
Work-based self-care
Take regular breaks; adhere to safe practices, and make sure there is always someone in the building whom you can seek support from. Always monitor your emotions and stress levels, and be prepared to seek additional support from your manager, supervisor and colleagues when necessary. If possible, vary professional activities to prevent isolation and burnout.
Promoting work-life balance
Limit work-related activities in non-work time. Monitor workload and review work arrangements. Be prepared to negotiate for flexible work arrangements when necessary.
Engaging in social and other activities outside of work
Stay connected in healthy and positive social relationships. Other strategies include developing a hobby or interest, taking vacations, listening to music, and spending time in nature.
Ultimately, every individual’s preferences and circumstances are different, and it is important that you select self-care strategies that are accessible, practicable, and effective for you.
Self Care Strategies in Trauma Work
This video depicts interviews with trauma counsellors offering self care advice to professionals.
Read
Reading H – Self-Care explores the topic of self-care for helping professionals who work in the context of crisis counselling and mental health care.
Reflect
Take a moment to reflect on your self-care strategies. How are you looking after yourself while studying for this diploma and fulfilling other responsibilities in life?
What signs do you typically notice when you are feeling stressed? How can you make sure that you can effectively monitor these signs when you are working as a counsellor?
Write down ten self-care strategies that you can apply when things get challenging at work, or generally in life. If you already have a self-care plan in place, review it and determine if it remains effective.
Don’t forget to draw upon your strengths and resources while planning for self-care. Think about experiences when you have overcome challenges in life; what has been helpful in those circumstances?
Developing resilience
Another important technique in minimising risks to self and promoting self-care involves developing resilience. Miller (2012) refers to the concept of resilience as being a component of effective stress management, which assists in coping with the difficulties and pressures of life. Psychological resilience is recognised as underpinning the ability to manage stress and maintain wellness, and is described as “the ability to live, succeed and develop in a positive way” (Howe, Smajdor & Stockl, 2012, p. 350). When considering the intensity of crisis situations, having and demonstrating resilience is a necessary attribute. It helps counsellors adapt and be able to restore positive functioning for both clients and them in situations of overwhelming stressors (Padesky & Mooney, 2012). Another element of resilience involves being able to find meaning and grow from significant, adverse or threatening psychological events. Fostering resilience can help protect counsellors from the psychological and physical health consequences of possible burnout.
Some positive strategies proposed by Howe, Smajdor and Stöckl (2012) to support the growth of resilience include:
- Using effective coping strategies
- Engaging in appropriate and sufficient social support
- Increasing one’s capacity to manage negative emotions
- Increasing one’s capacity for reflective learning.
Check your understanding of the content so far!
Reflect
Consider the elements of resilience described and reflect upon your own capacity for resilience. Which ‘resilient’ qualities do you currently possess, and which would you like to further develop?
Counsellors must remember that they are not alone. Whenever a counsellor requires support or advice they should seek out assistance to help promote their own self-care. Counsellors should also be aware of the importance of supervision and debriefing in caring for themselves.
Using 5 minutes of Self-Care to Survive Burnout
The presenter discusses tips on how to survive burnout.
Accessing professional support through supervision and debriefing is critical to your own well-being as a counsellor. Whenever a counsellor requires support or advice, they must seek out assistance in promoting both self-care and professional competence. This includes whenever counsellors observe any signs or symptoms of burnout or vicarious trauma, otherwise worsening mental health, problems in their day-to-day lives, and when dealing with particularly complex client issues.
Counselling exposes counsellors to situations that impose a great demand on practitioners' emotional and professional well-being. This demand can lead to becoming enmeshed and overinvolved leading to ineffective practice. Counsellors cannot in all cases be objective about their own abilities, agendas and practices. A supervisor can be objective and help the counsellor to grow and learn. The supervisor can ensure that the counsellor is meeting the needs of their clients and keeping to ethical and professional standards. Supervisors will also help counsellors relate practice to theory and vice-versa. Supervisors are most likely to identify potential mental health issues in the Supervisee before they become a problem.
(Australian Counselling Association, 2018, p. 5)
When working with situations of risk and crisis, supervision and debriefing not only helps counsellors ensure that they are meeting legal, ethical, and organisational requirements in supporting clients but also provides an opportunity for discussion of the counsellor’s own reactions to cases.
We have repeatedly referred to the importance of consulting with your manager and supervisor throughout this module. This can take the form of a ‘debrief’ session after contact with a client or a reflective discussion during regular supervision. In crisis or risk situations, you will also need to consult with your manager/supervisor to check the most appropriate responses during or immediately after client contact, particularly when the decisions you need to make are not ‘clear-cut’ or where there are risks to the client or another person. In some cases, you may need to get another worker or your manager/supervisor to attend in person for additional support. For instance, if a client is at high risk of suicide but reluctant to get help, it is important that you do not leave the client alone but seek help from others to contact emergency services while attending to the client.
In addition, where reporting to an authority may be necessary, it is important to seek advice from your supervisor/manager to ensure that your actions are lawful, compliant with organisational legal and ethical protocols, and meet your duty of care obligations. Remember, whenever in doubt, you should seek out appropriate advice and assistance.
Reflect
Some people have difficulty admitting when they need help or support. Take a moment now to reflect on your own feelings about admitting that you do not know all the answers and requesting help from others.
Supervision is also important for reviewing your professional practice and identifying areas that require professional development. For instance, to develop your capacity to work with clients at risk, you may discuss with your supervisor:
- Fears relating to working with clients at risk
- Strategies to work effectively under the high stress of a crisis situation
- Skills and knowledge required to work effectively with particular risk issues, such as suicide, DFV, child safety risks, and so on.
As stated previously, counsellors may be affected themselves when they work with people who are experiencing a crisis. As a counsellor, don’t forget your own needs. After counselling someone in a crisis, talk to your supervisor or another counsellor about your own experience of the counselling process and the emotional feelings generated within you. Such talking through, or debriefing, as it is called, needs to be accepted as necessary and normal after any crisis intervention work. It certainly is not a sign of weakness to engage in such debriefing. On the contrary, it is a sign of maturity, good sense and personal strength.
(Geldard, Geldard, & Yin Foo, 2017, p. 267)
Self-Care in Private Practice | Work Life Balance for Counsellors
The presenter shares tips on how to prioritise self-care in private practice.
In this final section of the module, you have learned about some of the risks associated with supporting at-risk clients. It is important for all counsellors to be aware of the risks of burnout, compassion fatigue, and vicarious traumatisation and develop their own self-care strategies to help counter potential issues. It is also important for all counsellors to utilise appropriate supervision and debriefing processes whenever issues arise.
Australian Counselling Association. (2018). ACA supervision policy. Retrieved from
https://www.theaca.net.au/documents/ACA%20Supervision%20Policy.pdf
Geldard, D., Geldard, K., & Yin Foo, R. (2017) Basic personal counselling (8th ed.) South Melbourne, VIC: Cengage Learning Australia.
Harris, D. L., & Winokuer, H. R. (2016). Principles and practice of grief counseling. (2nd ed.). New York, NY: Springer Publishing Company.
Howe, A., Smajdor, A. and Stöckl, A. (2012). Towards an understanding of resilience and its relevance to medical training. Medical Education, 46: 349–356.
James, R. K., & Gilliland, B. E. (2017). Crisis intervention strategies (8th ed.). Boston, MA: Cengage Learning.
Louth, J., Mackay, T., Karpetis, G., & Goodwin-Smith, I. (2019). Understanding vicarious trauma: Exploring cumulative stress, fatigue and trauma in a frontline community services setting. https://centacare.org.au/wp-content/uploads/corporate/VicariousTraumaReport.pdf
Miller, G. (2012). Fundamentals of crisis counseling. Hoboken, NJ: John Wiley & Sons
The Lookout. (2019). Vicarious trauma & burnout. https://www.thelookout.org.au/family-violence-workers/self-care-family-violence-workers/vicarious-trauma-burnout
Padesky, C.A. & Mooney, K.A. (2012). Strengths-based cognitive–behavioural therapy: a four-step model to build resilience. Clinical Psychology- Psychotherapy. 19: 283–290.
