Setting Ethical Limits: For Caring and Competent Professionals ______________________________________
One study investigated how the use of dialectical behavioral therapy (DBT) in working with young, self-harming women with borderline personality disorder affected the occupational stress and levels of burnout among psychiatric professionals [40]. DBT was stressful in terms of learning demands, but it decreased the experience of stress in actual treatment of clients. Participants felt that mindfulness training, which was one aspect of DBT, improved their handling of work stressors not related to DBT [40]. Counselors were better able to accept feelings of frustration, cope with stress, and be more patient and relaxed [40]. Mindfulness has been found to decrease stress, increase concentration, and increase the counselor’s ability to detach from the client’s material. It also assists a counselor’s empathy and boundary setting [41]. Mindfulness, attention, empathy, and counseling self-efficacy have been found to be significantly related to one another [41]. One study explored the impact of Buddhist mindfulness (meditation) practice on the attitude, work, and lived experience of counselors and their self-reported experiences of working with clients [42]. Findings suggest that a long- term mindfulness meditation practice can positively impact counselors’ ability to distinguish their own experiences from their clients’ experiences, can enrich clarity in their work with clients and may help them develop self-insight [42]. Mindfulness may also help to increase patience, intentionality, gratitude, and body awareness [43]. It is an excellent tool for caring, compassionate professionals to use to maintain their own energies and support their clients’ growth. Expand Your Professional World Symptoms of burnout or compassion fatigue can be signs of a need to grow professionally. This might mean branching out from individual therapy sessions to include group therapy, teaching at local colleges, supervising other professionals, developing continuing education units, or providing consultations. In some instances, it might mean changing careers or exploring other ways to use your licensure and experience.
• Have a procedure for after-hours emergency calls. For example, many counselors instruct clients to call the nearest hospital or go to the local emergency room. Other offices may have an on-call clinician dedicated to responding to emergency calls. The important thing is that there be a clear policy in place for after-hours calls and that clients are aware of and understand the policy. • Do not skip meals to see an extra client. Include regularly scheduled breaks as part of each work day. • Schedule and take vacations. Do not check your messages while on vacation. Ask another counselor to see clients in cases of emergency. Most clients can tolerate their counselor’s absence for a week or two. • Live a well-rounded life beyond the office. Make time for friends and family and engage in interests that renew you. • Educate yourself about trauma and its effects. If you are a supervisor, consider using instruments that measure stress with supervisees. The Maslach Burnout Inventory (MBI) and the Professional Quality of Life (ProQOL) scale should be administered on a regular basis to assess both organizational and individual risk of burnout and trauma-related conditions in high-risk settings. • Increase your capacity for awareness, containment, presence, and integration. Awareness can be encouraged through meditation, visualization, yoga, journal keeping, art, other creative activities, and personal psychotherapy. Containment abilities can be built through self-care efforts and a balanced life that includes time spent in activities unrelated to work. Mental health professionals should strive to maintain a balance between giving and getting, between stress and calm, and between work and home. These stand in clear contrast to the overload, understaffing, over-commitment, and other imbalances of burnout. To give and give until there is nothing left to give means that the professional has failed to replenish his or her resources [28]. Practice Mindfulness Helping professionals often feel like they have to fix others or have all the answers. This is a faulty cognition. Oftentimes, the most healing and powerful act a counselor can do is being in the moment with the client, holding the space for his or her feelings and thoughts. Mindfulness practice can facilitate this. The practice of mindfulness (i.e., present-focused attending to ongoing shifts in mind, body, and the surrounding world), integrated into daily life, can help counselors to develop enhanced patience, presence, and compassion [38]. It can help counselors to stay calmly focused and grounded, which allows them to be less reactive and engage with greater equanimity [38].
TRANSFERENCE AND COUNTERTRANSFERENCE
The term transference was coined by Freud to describe the way that clients “transfer” feelings about important persons in their lives onto their counselor. As Freud said, “a whole series of psychological experiences are revived, not as belonging to the past but applying to the person of the physician at the present moment” [44]. The client’s formative dynamics are recreated in the therapeutic relationship, allowing clients to discover unfounded or outmoded assumptions about others that do not serve them well, potentially leading to lasting positive change [45]. Part of the counselor’s work is to “take” or “accept” the transferences that unfold in the service of understanding the
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