Alcohol and drug counselors, along with other mental health
professionals, face a number of challenges and special issues
when working with people who have suffered abuse or neglect as
children. Like most people, counselors become upset or angry
when they hear about children getting hurt or being abused.
Some counselors are recovering from substance abuse disorders
and were themselves abused or neglected as children, and they
may find themselves in a professional situation where they have
to confront their own abuse experience and its impact on their
lives. As a consequence, counselors who were abused or who had
substance-abusing parents may experience feelings that interfere
with their efforts to work effectively with adult survivors.
For example, counselors may find it difficult to relate to clients
effectively and to reach a balance of providing enough--but not
too much--support and distance.
Survivors of abuse may pose many relational challenges to
the counselor. These clients are often mistrustful at the same
time that they need a trustworthy relationship, and a "push-pull"
dynamic may result. Counselors may find themselves overly fascinated
by and invested in a client's abuse history (sometimes to the
exclusion of other life and therapy issues), or they may want
to avoid discussion of the abuse for personal reasons. Counselors
must be mindful of these possible reactions and develop appropriate
strategies to ensure effective care of the client. Because child
abuse and neglect reflect the ultimate violation of trust, it
is critical that counselors maintain a professional relationship
with appropriate boundaries and limitations in place. The counselor
must be trustworthy and provide a safe relational context that--in
contrast to the client's past experience--presents a unique opportunity
for healing.
This chapter reviews some of the challenges posed by transference
and countertransference issues with this treatment population
and discusses possible secondary traumatization in counselors.
The Consensus Panel recommends that counselors establish and
maintain clear boundaries from the outset, as well as establishing
a "treatment frame." Some of the topics discussed below are
basic to good counseling and clinical practice, but it is helpful
to review them in the context of treating clients with histories
of child abuse or neglect.
The counselor-client relationship is a crucial component of
all therapy. Its importance is highlighted in work with abuse
survivors because of the nature of the injury caused by the abuse--it
was often caused by someone in close relationship to the client,
on whom she was dependent, and from whom she should have received
care and protection. The counseling relationship is therefore
instrumental in providing the client with the necessary support
to address and work through issues related to abuse (including
substance abuse) while modeling a healthy, nonexploitive relationship.
Transference generally refers to feelings and issues
from the past that clients transfer or project onto the counselor
in the current relationship. When clients interact with other
persons, they are likely to respond in ways that repeat old patterns
from their past. Clients bring the everyday responses and distortions
of life into the relationship with the counselor, who, as a professional,
can recognize these problems that are interfering with clients'
daily functioning (Kahn, 1991). These
transference reactions have specific implications for survivors
of childhood abuse, who may perceive the counselor as threatening
or abandoning in the same way as the perpetrator of the abuse.
Conversely, clients may idealize the counselor, seeing him as
the warm and loving parent they always wanted.
Clients' feelings about themselves might also affect the relationship.
Many survivors have enormous shame and low self-esteem and feel
responsible and guilt-ridden about the abuse. This may lead
to attempts to distract the counselor from abuse-related issues
so that they are not discussed or examined, or to respond to
the counselor in ways that replicate the past (e.g., as caretaker,
as self-sufficient and not expecting or deserving supportive
attention). The counselor must be aware of and prepared for
possible responses of this sort and must work to bring them to
clients, attention for discussion. The counselor must also avoid
replicating relational patterns from the past even if clients
expect them and act in ways to encourage them. For example,
the counselor should not allow clients to be overly caretaking
toward him, nor should he be so overinvolved with clients that
objectivity is lost. These issues are discussed in more detail
below in the section "Establishing the Treatment Frame and Special
Issues."
Countertransference refers to the range of reactions
and responses that the counselor has toward clients (including
the clients' transference reactions) based on the counselor's
own background and personal issues. Although countertransference
occurs in all therapy and can be a useful tool, an unhealthy
countertransference occurs when the counselor projects onto clients
her own unresolved feelings or issues that may be stirred up
in the course of working with the client. If the counselor's
own boundaries are not firm, she is more likely to have difficulty
remaining objective and may respond to a client's transference
reaction with countertransference. This is not the same thing
as the counselor's subjective feelings toward the client, which
may be positive (if the client is a friendly and attractive person)
or negative (if the client has an unpleasant appearance and temperament).
For example, if clients act seductively, the counselor may feel
uncomfortable or threatened. Counselors must pay close attention
to their own feelings to protect their clients and to learn more
about them. At the same time, the counselor should keep in mind
that the feelings clients evoke in a counselor are likely to
be feelings that clients are evoking in their daily interactions
with others.
Countertransference occurs when the counselor loses her objectivity
and becomes overwhelmed, angry, or bereft when hearing a client's
story. In such a situation, the counselor may push a client
to deal with childhood abuse or neglect issues before the client
is ready--out of the counselor's own emotional needs. For the
same reason, a counselor might discourage the client from talking
about abuse issues, saying it is not the right time. However,
it is very important to let the client determine when and at
what pace to work on the issues, especially when dealing with
child abuse and neglect. Effective treatment will be severely
diminished if the counselor is unaware of her countertransference
feelings toward a client. In these cases, the counselor should
be closely supervised, or the client may need to be referred
to another counselor.
Counselors must also be cautious not to see signs of childhood
abuse in every symptom. Because of the high incidence of childhood
abuse and neglect among clients in substance abuse treatment
and many counselors' earnest desire to help, there is a danger
of overinterpreting nonspecific sequelae. Not everyone in treatment
has been abused, and counselors should be aware of the possibility
of clients recovering nonexistent repressed memories, especially
from clients who are eager to please their counselor. (See also
the section below, "Avoiding the 'Rescuer' Role.")
It is important for counselors to have a general awareness
of these transference and countertransference issues and to be
as knowledgeable as possible about their own areas of emotional
vulnerability and unresolved emotional issues. This is especially
important for counselors who are themselves survivors of childhood
abuse or neglect.
Many counselors find the level of violence and cruelty they
are exposed to in working with adult survivors of abuse upsetting
and incomprehensible. The counselor who is repeatedly confronted
by disclosures of victimization and exploitation, especially
between parent and child, may experience symptoms of trauma,
such as disturbing dreams, free-floating anxiety, or increased
difficulties in personal relationships. He may also experience
anger or helplessness, which are detrimental to both the counselor
and the client. Or, after a day of dealing with intense material
in client sessions, a counselor may seem unaffected until strong
emotions emerge--seemingly out of nowhere. The stress and "burnout"
that may result from working with such clients can even produce
symptoms similar to those of posttraumatic stress disorder (PTSD)
(e.g. anhedonia, restricted range of affect, diminished interest,
irritability, difficulty concentrating, and insomnia). Counselors
can have these reactions even if they have no personal history
of childhood abuse.
Counselors experiencing these symptoms may lose perspective
and become either over- or underinvested in a client (Briere,
1989; Pearlman and Saakvitne, 1995).
Counselors who are underinvested may become numb to feelings
that would otherwise cause anxiety, anger, or depression. A
counselor may unintentionally, even unconsciously, dismiss, negate,
or minimize a client's history of abuse. This reaction represents
an attempt to avoid and distance oneself from the uncomfortable
issues raised by the abuse. He may respond to the client coldly
and clinically. Those counselors who overinvest, on the other
hand, become extremely involved with their clients, going beyond
the appropriate boundaries of the relationship. They may respond
by becoming parental and doing problematic things such as lending
their clients money, trying to solve their problems for them,
or seeing them too frequently. They may also fail to confront
clients when they behave inappropriately or destructively. When
working with a client who was abused as a child, an overinvested
counselor may have rescue fantasies or feel inappropriate anger
directed at former therapists, child protective services (CPS)
workers, and parents or caretakers. In extreme cases, the relationship
can cease to be beneficial as it becomes overly personal, with
the attendant loss of objectivity that is necessary in a professional
relationship (Briere, 1989).
As mentioned above, working with clients who have chronic
mental health disorders, severe substance abuse disorders, or
a history of childhood abuse and neglect can often lead to "burnout."
Working with substance-abusing clients who have experienced
childhood maltreatment can further challenge a counselor's capacity
to remain focused in treatment. Burnout occurs when the pressures
of work erode a counselor's spirit and outlook and begin to interfere
with her personal life (De Bellis, 1997).
These secondary trauma responses have been called "compassion
fatigue" (Figley, 1995), referring to the
toll that helping sometimes has on the helper.
Burnout affects many counselors and can shorten their effective
professional life (Grosch and Olsen, 1994).
If the counselor sees a large number of clients (many with trauma
histories), does not get adequate support or supervision, does
not closely monitor her reactions to clients, and does not maintain
a healthy personal lifestyle, counseling work of this sort may
put her at personal risk (Courtois, 1988).
This situation is even more serious in the current financially
focused managed care atmosphere that requires health care workers
to assume larger and more complex caseloads. These complex cases
often involve previously traumatized clients who present the
counselor with many personal and treatment challenges (Grosch
and Olsen, 1994).
Counselors can minimize the likelihood of burnout. As much
as possible, they should not work in isolation and should seek
to treat a caseload of individuals with a variety of problems,
not only those who have experienced childhood trauma. Discussing
feelings and issues with others who are working with similar
clients can decrease isolation through a process of shared responsibility
(Briere, 1989).
Counselors also should try to keep a manageable caseload.
They should deliberately set aside time to rest and relax, keep
personal and professional time as separate as possible, take
regular vacations, develop and use a support network, and work
with a supervisor who can offer support and guidance. Some treatment
settings have established in-house support groups for counselors
who work with abuse and trauma survivors. By sharing graphic
descriptions of clients' experiences with a colleague, the counselor
can gain the crucial support and perspective to be able to continue
effective treatment. Working as part of a treatment team can
be a natural way to facilitate support and reduce stress.
In some cases, counselors may want to seek personal help through
therapy that will allow them to work more successfully with this
population. Among its other potential benefits, psychotherapy
can help counselors come to terms with their own limitations.
Counselors who are satisfied with their personal and professional
lives are less likely to experience secondary trauma symptoms.
Counselors should develop and maintain a treatment frame--those conditions necessary to support a professional relationship.
Setting and maintaining boundaries is especially critical in
treating survivors of childhood abuse and neglect. Several parameters
of the treatment frame are discussed below, as well as special
issues that may arise. Because childhood abuse is a profound
violation of personal boundaries, adult survivors of abuse or
neglect may never have developed healthy and appropriate boundaries,
either for themselves or in their expectations of others. They
often need a great deal of affection and approval, and counselors
must make clear that they are not responsible for directly meeting
all of those needs. Boundaries help the counselor as well as
the client because counselors tend to be nurturing healers, which
may lead them to fall unwittingly into inappropriate roles in
response to their clients' stories.
For example, a counselor may react to strong countertransference
feelings by trying to respond to a client's wishes and expectations.
The counselor should guide clients in doing difficult interpersonal
tasks themselves, not only to strengthen the clients' ability
to take responsibility for their lives but also to maintain important
adult boundaries. The counselor must maintain a calm, optimistic
interest in his clients, recognizing that getting overly involved
will rob clients of the opportunity to identify and build upon
their own inner resources.
Other parameters of the counseling relationship, or treatment
frame, set by many mental health professionals (Briere,
1989) include
Making regular appointment times, specified
in advance
Enforcing set starting and ending times for each session
Declining to give out a home phone number or address
Canceling sessions if the client arrives under the influence
of alcohol or psychoactive drugs
Not having contact outside the therapy session
Having no sexual contact or interactions that could reasonably
be interpreted as sexual
Terminating counseling if threats are made or acts of violence
are committed against the counselor
Establishing and enforcing a clear policy in regard to payment
These are general guidelines, and the specific arrangements
between a counselor and client will vary according to a number
of circumstances. For example, a client may arrive under the
influence of drugs or alcohol. Although the counselor will not
conduct therapy, he should make sure the client doesn't leave
the office and drive a motor vehicle. Also, for some clients,
telephone contact outside the therapy session is necessary and
fosters a working alliance between client and counselor. Some
clients may need ongoing support for dealing with difficulties
with their children or suicidal feelings. A rigid rule stating
no contact outside of therapy may be harmful for very needy clients.
Clients may feel abandoned if a telephone call is not returned,
damaging the therapeutic alliance.
In smaller communities, a counselor may expect to encounter
clients in public places. It is wise to discuss in advance with
clients the confidentiality and boundary issues that could arise
in these situations. Clients may prefer that the counselor not
acknowledge them or may wish to be greeted with a simple hello.
Addressing such issues in advance ensures that the client will
understand the counselor's behaviors and will not feel ignored
or abandoned.
Building trust has been described as the earliest developmental
task and the foundation on which all others are built (Erikson,
1980). Establishing trust is broadly accepted as fundamental
to the development of a therapeutic relationship. However, because
adults who were abused or neglected by their parents have experienced
betrayal in their most significant relationships, they often
find it difficult to trust others. Clients who were not abused
by persons close to them also experience problems with trust,
but for those who have been betrayed by people on whom they were
dependent, issues of confidentiality and privacy are especially
critical. Trust makes an individual vulnerable to criticism,
abandonment, and rejection. Clients may therefore be mistrustful
and suspicious of the counselor, making the development of a
trusting relationship a potentially long and difficult task.
Reflecting the transference discussed above, they may fear the
counselor or see him as abusive, manipulative, or rejecting.
The counselor must not personalize these feelings but be consistent
and reassuring, never taking trust for granted (Courtois,
1988).
As clients deal with childhood abuse and neglect
issues, they may face a series of crises. These crises give
the counselor opportunities to build trust. In such situations,
the counselor can remain consistent and available, helping to
allay clients' fear of abandonment and rejection. Many tenets
of a good therapeutic relationship (unconditional positive regard,
a nonjudgmental attitude, and sincerity) are also essential for
establishing a foundation of trust.
Because of the difficulties many abused clients have with
intimacy, the new experience of having someone who listens and
whom they can trust can sometimes lead them to believe that they
are in love with the counselor. Sadly, many survivors of abuse
are so accustomed to negative feelings (shame, fear, guilt, anger)
that positive feelings (joy, trust, contentment, playfulness)
are unfamiliar to them. Such clients may not understand their
own feelings, and they may not have the skills to differentiate
them. In some cases, if a client has recently stopped abusing
drugs or alcohol, romantic obsession or sexual fantasies can
substitute for the substance addiction as a way of reducing tension.
Powerful romantic feelings may be directed toward the counselor,
threatening the therapeutic relationship.
The counselor may first become aware that a client is having
strong transference issues by subtle changes in the client's
demeanor or by more obvious signs, such as requests to see the
counselor in a nonprofessional setting. The counselor must,
above all, avoid transgressing the boundaries of the relationship
and continue to emphasize the guidelines discussed when the counselor
established the treatment frame. He should not consent to personal
requests, even if they seem innocent (e.g., having coffee or
going shopping together). Second, even if he only suspects a
client of harboring sexual feelings for him, he should immediately
bring the matter to the attention of a colleague. This consultation
will serve not only to protect himself, should legal complications
arise later, but can also help him work through the difficulty
in the therapeutic relationship itself.
If the counselor senses that a client is developing romantic
feelings for her, she can try to discuss the matter openly by
asking questions, such as "I sense that you are feeling very
strongly about something today. Is there something in particular
you want to talk about?" If a client eventually discloses romantic
or sexual feelings, the counselor must maintain a therapeutic
stance and uphold the boundaries of the client-counselor relationship.
Clients should be encouraged to examine the feelings rather
than act on them. The tension of this interaction can lead to
a "teachable moment" in which the client learns to better differentiate
his feelings. The counselor should remind the client repeatedly
of the purpose of their sessions, emphasizing what she and the
client will and will not do as part of the relationship. Clients
often substitute an attraction to the counselor for an attraction
to the abused substance as a way to avoid dealing with unresolved
feelings or emptiness.
Another, less confrontational way to deal with this type of
situation is to maintain the boundaries of the client-counselor
relationship but to use clients' feelings to help them discover
solid but non-sexual relationships with people who listen. The
client can be assisted to differentiate feeling good from feeling
sexual desire. The counselor can explain that the "attractive"
aspects of their relationship, such as trust and feeling safe,
are qualities that clients will want to look for in their personal
relationships.
Similar problems of inappropriate attachments and boundary
issues can occur in group therapy, and counselors (whether as
group leaders or in separate individual counseling) must be prepared
to work with their clients on this dynamic. Here, too, a treatment
frame should be established at the outset that addresses interactions
between group members and between the group leader and members.
Clients should avoid letting any of these relationships become
too personal and should be made to understand why, in this setting,
developing sexual relationships would be counterproductive.
Counselors, in turn, must understand and support the bonding
that occurs when clients make disclosures in a safe and sympathetic
environment--and the confusion group members may have about their
feelings of dependence on or responsibility for other group members
(Valentine and Smith, in press). These are therapeutic issues
to be addressed in the group that can contribute to the clients'
healing from the effects of abuse (Briere,
1989; Courtois, 1988).
Because of low self-esteem, incest survivors (or other survivors
of abuse) may feel that the only way they deserve a relationship
with another person is if they offer sexual involvement (Courtois,
1988). If a victim of sexual abuse acts seductively toward
the counselor, the counselor should understand that transference
issues are in operation and that the victim is trying to sexualize
the relationship. Unfortunately, some counselors do become sexually
involved with their clients, thus exploiting the counseling relationship
and violating the trust the client has placed in them. Such
behavior is unethical, unprofessional, and in some States, illegal.
Counselors who become sexually involved with clients may be
reenacting the role of victimizing caretaker. Most treatment
programs have policies prohibiting such behavior and will fire
staff members who violate these policies. In addition, they
are likely to register a complaint with the State licensing agency;
professional associations will censure or expel members who have
sexual contact with clients. In some States, sexual contact
with clients is illegal, and counselors will be prosecuted.
Some in the treatment field believe that males should not
treat female survivors of male sexual abuse. Although some women
may feel safe only with a female counselor, many male counselors
can provide effective treatment if they give adequate attention
to abuse issues and their own reactions to clients. Furthermore,
sensitive handling of the case by a male who does not exploit
the client can provide a new, positive male role model. Whenever
possible, the client's preference regarding the counselor's gender
should be respected; unfortunately, many facilities do not have
adequate staffing to allow choice. In such situations, it is
important to openly acknowledge the client's feelings and validate
them as understandable reactions. This can reduce feelings of
helplessness and help prevent the client from leaving treatment
prematurely.
Clients in treatment for substance abuse may act rebelliously
or violently, a situation that can be exacerbated by an undisclosed
history of child abuse. Counselors working with this population
have sometimes been victims of physical assault or other violence
by clients. It is the program's responsibility to be aware of
and inform counselors of any client's history of violence (which
may be more common among adolescents in substance abuse treatment).
Counselors should have a personal safety plan, and policies
should be in place that require them to call law enforcement
and press charges if they are threatened.
As well as taking steps to ensure their own safety, it is
the responsibility of counselors to create and maintain a safe
environment in which clients can explore and address issues.
It is the client's responsibility to behave in ways that do
not threaten others either physically or emotionally. Early
in treatment--at the very outset, if it is a group setting--counselors
should communicate and enforce ground rules about how clients
can safely and appropriately deal with anger and other feelings
of discomfort. Knowing what is expected of them and the other
group members contributes toward their experiencing the group
as a safe place to share and be heard. Ground rules should include
maintaining members' confidentiality and not sharing any information
outside the group, no threats or acts of violence, no verbal
abuse, no interrupting other members, and no disruptive behavior.
Counselors can help clients learn how to express their feelings
constructively by validating their affect but not their
expression (if it is abusive or violent).
Abuse survivors commonly are concerned about their safety--or
their potential reactions to others--while reliving painful events.
Counselors can help clients face these feelings by reinforcing
the present safety of the counseling environment. In a calm
voice, the counselor should ask clients to explore rather than
act out anger or disruptive behavior. The goal is to emphasize
to disruptive clients that their feelings are acceptable as long
as their behavior remains appropriate. Clients are allowed to
have angry feelings--and verbally express them--but they are
not allowed to hit anyone, to throw things, or be otherwise violent
or disruptive. In this way, clients can be helped to separate
their feelings from their actions. The counselor may find that
some individuals become caught in obsessive loops, unable to
let go of the precipitating issue or to stop being angry. In
some cases, this can indicate hidden problems that may need to
be explored further (i.e., for possible referral to a qualified
medical or mental health professional), such as obsessive-compulsive
disorder, PTSD, or bipolar disorder. Constant rage can be a
symptom of manic depression or bipolar disorder.
Counselors can help create a safe atmosphere for clients and
reduce acting out by practicing "grounding" techniques such as
the following:
Anchoring/grounding: Have the client
sit in a relaxed posture in a chair with eyes closed (or open,
if he is uncomfortable closing them), focusing on his breathing.
Ask him to concentrate on feeling the chair supporting his weight
and the floor underneath his feet. Have the client recognize
how grounded he is in the present. No matter how anxious he
may become reliving moments from his past, he is still safe and
grounded in the present. (The counselor should be aware of the
hypervigilance characteristic of abused clients and not make
any sudden moves, or get up out of a chair while the client has
his eyes closed; the issue of personal safety is paramount for
most of these clients.)
Mirroring: Practice breathing techniques with the
client, having her synchronize her breathing with yours. These
techniques will relax the client. (This exercise may have intimate
overtones that could confuse clients with transference issues,
and counselors should be selective in its use.)
Timeout: To stop the current action or behavior pattern,
allow the disruptive client to leave the room for a few minutes.
The counselor must take care to avoid joining in the client's
disruptive behavior in any way. Disruptive behavior can best
be contained if the counselor stays in his role, maintaining
calm, comforting, reinforcing behavior that is appropriate for
the approach and setting. However, it is appropriate to use
authority and security personnel when physical harm is threatened.
Because of strong countertransference reactions, coupled with
a desire to meet clients' needs, the counselor may want to defend
or "rescue" clients. He may offer too much advice or even concrete
assistance, viewing clients too narrowly only as victims of mistreatment.
A counselor who is not self-aware or does not hold himself accountable
for his own personal emotional health may feel that he is the
only one who really knows or understands his clients. He attends
too many meetings, provides sponsorship, helps clients with child
care, lends them money, or dismisses fees.
Counselors must deal with their own strong feelings in an
environment separate from the client-counselor relationship so
that they do not confuse their own issues with the clients'.
If the counselor notices that she is being placed in the "rescuer"
role, it is recommended that this be directly addressed with
the client. A client may in fact be comfortable in the victim's
role and try to manipulate the counselor to intervene and rescue
her in a variety of situations.
If the counselor does take on the rescuer role, clients do
not learn about personal responsibility and how to deal with
resolving conflict and issues on their own (see Whitfield,
1993). Furthermore, clients may become angry when a misguided
counselor crosses the line without the clients' permission by
intervening in family relationships in an attempt to rescue or
defend them. When this happens, the counselor not only has lost
the ability to help his clients but also is likely to cause additional
harm. Rescuing may give the counselor a temporary relief from
her own feelings of helplessness and anger, but it does not lead
to positive outcomes for the clients. Clients will best be served
by facilitating the development of empowerment. This may mean
that the counselor allows clients to flounder at times.
Clients may sometimes report becoming involved in relationships
that are clearly dangerous from the counselor's perspective.
This often reflects the tendency for abuse survivors to be assaulted
or abused again after the initial incident or period of abuse.
Although the counselor may be tempted to directly advise a client
against such a relationship, it is far more useful to work with
the client to explore any propensity to excessive risks or self-endangerment.
The counselor's role is to help clients understand their vulnerability
to revictimization and to empower clients by helping them recognize
that they have the ability to set boundaries with others and
no longer have to remain victims. Rescuing clients will not
serve the longer term purpose of helping clients develop personal
respect and safe boundaries free from abuse and violence. (See
TIP 25, Substance Abuse Treatment and Domestic Violence
[CSAT, 1997b].)
The counselor must recognize when she is unable to work with
a specific client. She cannot benefit clients who are abuse survivors
if their issues cause her personal difficulties to the point
where her own effectiveness is compromised. Any counselor working
with adult survivors should seek support and some form of supervision
to review her feelings about the issues brought up by her clients.
At the same time, it is the agency's responsibility to ensure
that clients are receiving adequate, professional care. From
an ethical standpoint, it is better for counselors not to work
with abuse survivors at all than for them to take on such challenges
if they are not yet equipped to deal with these issues.
If a counselor cannot work with a particular client, he should
refer the client to a counselor who is better suited to that
individual's needs. Such transfer must be done after discussion
with the client, and any issues that arise as a result of the
transfer (such as the client's possible feelings of rejection)
should be addressed in therapy, both before and after the move.
It may be advisable to get an understanding in writing that
states that the client knows that treatment with that counselor
has ended, at least for the time being. This closes the contract,
may lessen abandonment issues, and can help protect the counselor
if the client later claims abandonment.
Alcohol and drug counselors are often subject to great stress.
They can be expected to function well and provide effective
treatment only if their agency's leadership gives them the appropriate
support. Such support includes recognition for and appreciation
of the role of the counselor and the stresses it entails. As
noted throughout this chapter, this is especially important when
counselors are treating clients or families who have a history
of child abuse or neglect, because the complexity and number
of issues increase, as does the number of systems that must be
dealt with. The agency's leadership should strive to impart
a sense of vision to staff members that communicates how important
their work is as part of the larger effort to break the cycle
of abuse and neglect and their impact on society.
The Consensus Panel makes the following recommendations about
how the agency can support the counselor:
Provide a sense of mission.
Provide (or facilitate) ongoing clinical supervision--if
possible, by someone with a specialty in the area of child abuse
and neglect.
Provide trauma training to the counselors that standardizes
the procedures for handling trauma cases.
Empower staff members by encouraging them to share their
ideas on improving the program and incorporating, as appropriate,
those ideas that enhance the stated mission of the agency.
Support staff members in their efforts to stay within the
limitations of their roles so that they do not take on responsibilities
likely to lead to burnout.
Support staff members in their efforts to keep caseloads
at manageable levels and, at the same time, work to educate managed
care about the drawback of limiting the length or intensity of
services.
Model the supportive role that the agency wants the counselors
to have with their clients.
Allow counselors unstructured time to talk to each other
to give and receive support.
Train staff on such topics as new assessment tools, research
findings, suicide intervention, crisis and nonviolent management
of assaultive behavior, and liability issues related to abuse
and false memory accusations.
Bring in an outside professional occasionally to hold a group
session with the staff (this can encourage staff members who
have been holding in or minimizing the impact of their work on
themselves to open up).
Recognize and reward the work of the staff on a regular basis
(e.g., award ceremonies to recognize ongoing and special contributions).
Hold regular social events (e.g., picnics, softball games).
If staff members are given opportunities to grow, they will
stay motivated and will be less likely to burn out. The agency
can provide ongoing training to increase counselors' expertise
in specific areas, such as preventing relapse and dealing with
stress. It is important to solicit input from staff members
on what issues are compelling to them--asking, for example, what
they perceive to be the sources of their burnout, then get their
recommendations regarding how to address it most effectively;
they are often the best resources in this situation. Administrators
also need to be familiar with managed care guidelines and other
funding streams to ensure adequate income for the agency to support
the treatment staff and the services it provides. The process
of involving staff members in resolving the problem may help
to empower them--which, in and of itself, can be a corrective
measure. A flexible organizational structure that encourages
an atmosphere of mutual purpose can help reduce turnover rates,
increase staff morale, and contribute to a program's total effectiveness.