Counselors have to receive and absorb their client's traumatic stories at the same time as being hopeful, supportive, and empathic, which often places considerable stress on their emotional health and psychological well-being. This is especially the case if the counselors do not have someone else with whom to share their thoughts and feelings and/or are having a difficult time in their own personal lives. Many mental healthcare workers gain much satisfaction from helping the survivors of traumatic events and feel privileged to help their clients gain strength and fortitude in the healing process (Kassam-Adams, 1995). On the other hand, many other counselors have a very difficult time overcoming traumatic events when they consist of serious injury or a threat to their client's physical well-being. Examples of traumatic events that clients face include physical or sexual assault, domestic violence, school- or work-related violence, natural disasters, and neighborhood or community violence.
The stress that counselors gain from helping traumatized individuals is positively associated with compassion fatigue, because they have the tendency to turn to their own internal store of personal characteristics to help others. According to Tedeschi and Calhoun (1998), the same personal traits that allow counselors to help clients alter negative responses to posttraumatic growth place professionals at risk of developing compassion fatigue. When practitioners focus on others without practicing their own self-care, negative behaviors can arise, such as lethargy, isolation, internalized anger and depression and substance abuse. Counselors have to be ever aware of this delicate balance between health and fatigue.
The traumas in the clients' lives often impact the counselors' emotional stability. The opposite is also true: The trauma in the counselors' lives can negatively impact their clients. Everall and Paulson (2004) explain how counselor burnout, which is similar to secondary traumatic stress (STS), has the ability to have a negative effect on the therapist's ability to deliver high-quality care. Although burnout and STS have different clinical definitions, they do have descriptive commonalities, similar symptoms, and shared themes, and the client may see the outcome of both of these illnesses in a similar fashion as presented in the counseling session. Both burnout and STS are often cumulative and may lead to the counselor suffering from depression, insomnia, or loss of intimacy with friends and family (Arvay & Uhlemann, 1996, as cited by Everall and Paulson). These effects of burnout and STS may result in a counseling session with lower levels of empathy, respect, and positive feelings for the client. In addition, depersonalization has the tendency to lead to negative counselor behavior, which may include making derogatory responses to the client, demining the client as a person, and not responding correctly to client needs. Counselors who ignore or do not properly respond to their feelings of STS or burnout have a greater chance of experiencing disruptive empathic abilities. They also have a greater likelihood of having problems maintaining a therapeutic attitude and holding to boundary violations (Everall and Paulson, 2004), which leads to crossing therapeutic barriers and, more commonly, providing incomplete treatments.
Everall and Paulson (2004) explain that counselors who are suffering from STS or burnout may not be able to act responsibly in counseling sessions, as well as with their regular job duties. They may not be able to communicate with or have a desire to interact in social and family circles, can be reluctant to check for messages or return calls, and may often be pleased when appointments are cancelled. These counselors may actually begin to agree with those clients who feel hopeless, frustrated, or pessimistic, as well as start doubting the effectiveness of their counseling work. Therapists who are burned out or troubled with STS often daydream or have escape fantasies and are very reluctant to start their day. Being cynical, losing spontaneity and a sense of enthusiasm, procrastinating, not sleeping, being physically and mentally exhausted, lacking social and family involvement and giving thought to quitting work all go hand in hand with depression, as well as being burned out and having STS.
When counselors reaches this point of burnout, it is important for them to ask, "Am I
doing my work as well as I might? Should I search for ways of becoming more effective?" (Pawlovich, 2000, p. 46). This is the main thrust of the part of the ACA Code of Ethics (2005) that deals impairment and incapacitation: These areas read:
Counselors 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 that 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. Counselors assist colleagues or supervisors in recognizing their own professional impairment and provide consultation and assistance when warranted with colleagues or supervisors showing signs of impairment and intervene as appropriate to prevent imminent harm to clients.
C.2.h. Counselor Incapacitation or Termination of Practice
When counselors leave a practice, they follow a prepared plan for transfer of clients and files. Counselors prepare and disseminate to an identified colleague or "records custodian" a plan for the transfer of clients and files in the case of their incapacitation, death, or termination of practice.
According to Everall and Paulson (2004), the counselor and/or supervisor needs to take preventative measures to counteract the negative impact of burnout or STS. As noted by the ACA Code of Ethics (2005), this is a matter of personal health and welfare, and it is an ethical duty to maintain the provision of service to clients to the highest quality possible. Counselors can take three levels of action. The first is self-regulation, the second is contacting a supervisor, and the third is having colleagues intervene. The client's needs are first and foremost in whatever approach is taken. Even before any problems with STS or burnout occur, it is essential for counselors to better understand how these health concerns can arise and what steps will be taken if and when they occur. Norcross (2000) turns to the Socratic philosophy and states that the concepts of "know thyself " and "heal thyself " should be closely adhered to by all practitioners; psychological principles, methodology, and academic studies should be considered by the counselors to know the best way to proceed. Mahoney (1997) agrees with Norcross, saying that it is an ethical necessity to protect both clients and therapists. Self-monitoring is an ethical task that all therapists need to perform on a regular basis.
Similarly, Pearlman and Saakvitne (1995) believe that the impact of being traumatized can be responded to and reduced if the counselor becomes aware of the situation and addresses it. Counselors have the responsibility of identifying and accepting signs of burnout and trauma in themselves as a normal response, so if problems occur they can more readily define strategies and find the necessary support to counteract negative effects. Norcross (2000) relates a study where both program directors and professional psychologists listed "self-awareness / self-monitoring" as the most important contributor to maximum functioning among mental health therapists. Because it is so difficult to determine and measure counseling competence, regular self-monitoring may be the most efficient way of ensuring that effective services are being provided. Mahoney (1997) reports that a considerable number of surveyed therapists (87.7%) have been in personal psychotherapy, in addition to participating in other self-care activities such as meditation or prayer, regular physical exercise, and reading, hobbies, and artistic enjoyments. Maintaining a fulfilling personal life helps to keep clear boundaries between in and outside of work.
Being supervised and maintaining a professional support system are additional components of ethical behavior by therapists (Norcross, 2000). Helping employees maintain emotional stability can include debriefing sessions, monitoring caseloads, and focusing on client resilience and strengths. In terms of prevention, these approaches can help counselors maintain their psychological and physical health and well-being at the same time as working with a caseload of highly stressful individuals. Establishing and retaining a strong network of people who can provide support and with whom trauma-related work can be discussed and shared can also act as preventative measures (Pearlman & Saakvitne, 1995).
In many cases, a double standard exists between the counselors and clients in terms of emotional well being. Individuals who heal others may be reluctant to recognize and admit that they may also need healing. This erroneous belief could very well hinder a counselor from seeking the help needed to cope with a stressful position and the burnout and secondary trauma that may ensue. It can also cause a counselor to provide less than adequate care to his or her clients and exacerbate an already difficult situation Adhering to the ACA Code of Ethics is essential for all counselors. Counselors in training need to be instructed that self-monitoring is essential, and options should be available if and when a therapist needs to…