Assignment on Addiction and Drugs Counseling

Module 4 Assignment

                                                            Counselor as a person

 

Module 4 Assignment

For this module, you’re going to complete a few short “reverse case studies”.  In other words, you’re given the outcome, and you have to devise a short case study to fit each situation.  Your case studies need only be a few sentences long, but make sure that you provide enough basic information to illustrate the situation.

 

You should create the following scenarios:

  1.  A specific time when it is appropriate to self-disclose in response to questions about your qualifications.
  2. A time when you’re not comfortable disclosing your recovery status.
  3. A time when you ARE comfortable disclosing your recovery status.
  4. A time when you’re asked if the work you’re doing is within your scope of practice
  5. A time when someone asks you a question about your religious beliefs. 

Then, for each of the scenarios you create, cite an example from the reading to support why the disclosure is or is not appropriate.

 

                                            Reading Materials

Should counselors disclose?

March 1, 2010 by Brian Duffy, LMHC, LADC-I

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Let’s get one thing straight: Some of the best addiction and mental health counselors I know do not identify themselves as people in recovery. They might or might not be in recovery, but they’ve managed to make it a non-issue.

For example, I once worked with a wonderful lady, Elizabeth, who would respond to the “Are you in recovery?” question in the following way. She’d simply say, “Honey, I’m recovering from life.”

Her response made it clear she wasn’t going to disclose, one way or the other. It also reminded her client that we all have our demons, that life is hard, and that addictions come in all sizes and shapes.

The setting makes a difference

To be fair, one of the reasons Elizabeth didn’t disclose was that she was working in a hospital inpatient detox unit. She was part of a treatment team consisting of doctors, nurses, social workers and addiction counselors. Hospital policy dictated that no one disclose whether he/she was in recovery-and for good reason.

The treatment team needed to speak with one voice and avoid “staff splitting,” a favorite pastime among more experienced patients. If some of the staff identifies as being in recovery, a patient might say, “I’ll speak with her but not with him.”

In an outpatient setting, or where it is less likely that clients will play staff members against each other, the need for staff anonymity is less pronounced. So let’s talk about reasons for self-disclosure.

In support of self-disclosure

It’s no secret that self-disclosure can create an instant bond with clients. The fact is that many clients think counselors must be in recovery in order to be of any value. For sure it’s a fallacy, but it’s a perception, and counselors in recovery can use that perception to establish an immediate and effective connection with a client.

Further, counselors in recovery are able to tell stories they’ve heard at recovery meetings (or perhaps their own stories) to show a client that he’s not the only person to have “those” feelings or to have done “those” things. Storytelling is an important foundation of 12-Step recovery. The stories have a ring of truth. They demonstrate the denial of the active addict, they reveal the insanity of embarrassing behaviors, and they shed light on the maddening mix of emotions one finds in early recovery.

Lastly, the self-disclosing counselor is sometimes able to guide the client through the confusing and intimidating task of making connections with safe, sober people at recovery meetings. Providing tips on getting the most out of one’s 12-Step experience can go a long way toward fortifying the relapse prevention plan.

Pitfalls of self-disclosure

Despite assumptions to the contrary, the simple act of revealing one’s status as a recovering addict will notbuy instant and ongoing credibility. We all know counselors in recovery who are fairly ineffective in their jobs. Very often, they talk too much (read: preach) and never really understand the client’s perspective. Sometimes these counselors use individual or group sessions as an AA meeting, showing off their knowledge of the AA literature as well as their oratory skills.

And what of the counselor who discloses his long battle with cocaine addiction, only to encounter a client who says, “Yeah, but you’ve never done heroin. You can’t understand me.” One of the most difficult skills we must master involves giving the client time to recognize the discrepancy between his words and his actions. This Motivational Interviewing technique is not enhanced when the counselor is talking.

For counselors not in recovery

My first paragraph alluded to my colleagues not in recovery, or at least not disclosing their status. One of the reasons they are such effective counselors is they made a point of learning the language of recovery, particularly 12-Step recovery. These professionals went to AA meetings, read the literature, listened to the stories, watched the fellowship in action, asked questions, studied the steps of recovery, and grew completely comfortable with the program’s jargon and spiritual aspects.

This is not something we can absorb from a book. It’s more “organic.” It takes time and effort-and people who want to be addiction professionals must do their homework. Clients will quickly recognize the clinician who speaks their language and will become more trusting, more willing to participate openly in treatment.

I was interested in Addiction Professional‘s online poll last fall on the topic of self-disclosure. Asked whether it is generally a good idea for addiction counselors to self-disclose their recovery status to patients, 57 percent of respondents said yes. Yet judging from the accompanying written comments by many participants, there was general agreement that any decision about whether to disclose one’s status should be made on a case-by-case basis. Many respondents said clinicians must know why they are disclosing, and that the motive must be for the client’s benefit.

Some poll respondents wisely guarded against using the individual or group sessions as their own session. It’s a trap that can ensnare even the most experienced addiction counselor. Our constant mantra should be, “What am I saying and why am I saying it?”

Conclusion

There is no simple answer regarding self-disclosure. It depends upon the setting, the client, and the reasons for the disclosure. Those of us in recovery should remain judicious regarding when (and how) to disclose.

We must be ready to say to clients: “I’m your counselor, not your sponsor.” We must keep our session from becoming just an extension of AA. We must keep the focus on the client, his triggers and his coping skills. And we must downplay the importance of a counselor’s recovery status by asking, “Does the dentist need a hole in his tooth in order to repair yours?”

For Brian Duffy’s perspective on the questions counselors can ask to achieve productive treatment sessions, visit

http://www.addictionpro.com/duffy0509.

 

Brian Duffy, LMHC, LADC-I, is a mental health counselor at SMOC (South Middlesex Opportunity Council) Behavioral Health Services in Framingham, Massachusetts. His e-mail address is

briand@smoc.org. Addiction Professional 2010 March-April;8(2):14-15

 

      Reading Materials

 

COUNSELING TODAYCOVER STORIES

Stumbling blocks to counselor self-care

By Laurie MeyersFebruary 23, 2015

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As a counselor, which of the following elements are absolutely essential for you to do your job well?

  1. a) Thorough grounding in counseling methods and techniques
  2. b) A strong sense of empathy and compassion
  3. c) Adequate sleep
  4. d) Regular vacations or breaks
  5. e) All of the above

The correct answer is e) All of the above. You probably knew that already. But do you also think that answers A and B far outweigh the importance of C and D? If so, you may not be tending to your own wellness the way that you should. All counselors need to regularly engage in a healthy self-care routine to help mitigate the very real risk of burnout.

Many people struggle to attain a healthy work-life balance. Counselors often work with clients toward achieving that balance by helping them understand the concept of self-care and how to nourish wellness. But sometimes counselors get so busy and focused on helping others that they neglect to monitor their own wellness. Counselors may also operate under the assumption that their training and emotional insight somehow inoculate them against burnout — or at least help to prevent it. That is a fallacy. Counseling, like other helping professions such as medicine, nursing, psychology, social work and teaching, has a high burnout rate. Individuals in each of these professions are at greater risk for burnout because of the empathic and close relationships they must form to do their jobs.

“It’s important for people — for counselors in particular — to realize that this is hard work,” says Gerard Lawson, an American Counseling Association member and associate professor of education at Virginia Tech. Though counseling work is not typically physically demanding, emotionally it can take a toll, he says.

Research has shown that the strength of the therapeutic relationship between the counselor and the client is the most important predictor of successful outcomes. But forming, maintaining and operating within that bond are not easy tasks, notes Lawson, a licensed professional counselor (LPC) who studies counselor wellness and burnout. Due to the nature of counseling work, this bond is often forged with people who are struggling or in pain. Confronting those emotions day in and day out can take a toll over time, sometimes leading to vicarious trauma, Lawson explains.

“We are seeing some of the hardest things,” says ACA member Elizabeth Venart, an LPC and director of The Resiliency Center of Greater Philadelphia, where she practices and also provides trauma and resilience training to other mental health professionals. “We often meet people at the worst times in their lives.” In addition, the essential professional component of empathy is the “conduit” through which other people’s experiences can profoundly affect counselors, she says.

On top of that, it’s hard not to want to “fix” every client, says Charles Crews, an ACA member and associate professor in the Texas Tech University College of Education. Although it sounds cliché, many times counselors really do care too much, he notes. “They want to help every single person who comes in,” he says.

Although counselors should want to help every client, when a client isn’t progressing, it can be easy to become disenchanted or hardened, says Crews, whose doctoral dissertation focused on counselor burnout. Less experienced counselors may also start to battle discouragement, doubting themselves and their skills, he adds.

Jennifer Sharp, an ACA member and assistant professor at Northern Kentucky University, says that many of her students come in wanting to change the world. “They don’t understand the barriers,” she says. “We come in [to the profession], and we don’t have realistic expectations.”

ACA member Jonathan Ohrt, an assistant professor in the counselor education program at the University of South Carolina, agrees. He says that counselors-in-training need to give serious consideration to what their professional lives might look like, taking into account their individual work styles, interests and values. Understanding the potential challenges of the work environment for counselors is also particularly important because factors such as inappropriately heavy caseloads, inadequate supervision and poor peer support have a significant influence on burnout rates, say Ohrt and Sharp.

“We don’t necessarily think about what specializations we might be best at,” Ohrt says. He adds that students should ask themselves, “What is my job satisfaction if I work in this setting? Will I be happy? Will I be able to work with addiction? Am I going to be comfortable working in school settings where teachers, the principal and parents are all pulling me in different directions?”

Ohrt says graduate students should also ask themselves the ultimate question: “Do I want to be a counselor?”

Signs of burnout

Having realistic career expectations might help newer counselors to prepare for some of the job’s stresses, but even established counselors need to understand the signs of impending burnout and the steps they can take to avoid it.

According to Lawson, who served as chair of the ACA Task Force on Counselor Wellness and Impairment several years ago, research shows that burnout has three stages.

Emotional exhaustion: Every counselor experiences a bit of exhaustion at one time or another. But when practitioners feel drained as soon as they step through the office door, even with plenty of sleep and after time away to get recharged, that’s generally a sign of emotional exhaustion, Lawson says.

“Sometimes in session, you can see counselors might steer away from a topic that they know is going to be difficult to talk about because they just can’t do it,” he says. “They don’t have anything left there to give to this client, and that’s not good for the client.”

Depersonalization: At this stage of burnout, counselors start viewing clients not as people but as cases. “Sometimes it slips into our language,” Lawson notes. “You’ll hear counselors talk about ‘I have another borderline this afternoon.’”

Lawson acknowledges that this may occasionally be nothing more than a kind of shorthand in the counselor’s language. But usually, he says, it’s more serious, indicating that the counselor is no longer connecting with clients as people and instead reducing them to their problems.

Reduced feelings of accomplishment: At this stage of burnout, a counselor feels that whatever he or she does won’t make a difference. The counselor has, in effect, “checked out,” Lawson says.

Other signs that a counselor is burning out can include a decreased level of involvement with family and friends, a failure to engage in normal social activities and increased instances of tardiness or absenteeism. Sharp says that counselors in a downward burnout “spiral” may also display the inability to handle crises and a noticeable increase in negativism, cynicism and defensiveness.

Burning bright, not out

“I don’t know that there’s a specific antidote to how I keep [burnout] from happening to me, which is why we focus so much on wellness when things are going OK,” Lawson says.

An emphasis on wellness helps counselors to build up their emotional resources so they will be better able to handle bumps in the road when they occur, Lawson emphasizes. Counselors can do a number of things to engage in self-care. Maintaining professional boundaries, seeking supervision and support from colleagues, drawing a clear line between home and office, participating consistently in activities and hobbies, and taking regular vacations are all important parts of the wellness picture.

Perhaps nothing is more important to maintaining counselor wellness than refusing to navigate professional issues in isolation. That is why it is so critical that practitioners actively seek out peer support and ongoing supervision, Lawson says.

“Burnout is a long-term process, a long-term degradation,” he says. “But compassion fatigue, vicarious trauma, those things can happen very quickly. Good clinical supervision is top of the list [of preventive measures] — having someone you can debrief with, someone to help you shoulder the burden. And for people who aren’t in supervision, [having] a colleague or a peer [whom] you can turn to and consult with or debrief with, even if it’s not a formal supervision-type relationship.”

Lawson emphasizes that the supervision should be clinical in nature. “I think in our world, supervision has become a product of being sure that all the boxes are checked and all the t’s are crossed and all the i’s are dotted,” he says. “And that’s important to get reimbursed for the work we do and to be sure that we’re complying with all the expectations. But good clinical supervision is different from that, and that’s where a supervisor is able to ask, ‘What’s happening in the work you’re doing for this client?’ and ‘How are you doing working with this client?’”

If a direct supervisory relationship isn’t possible, counselors should look at the alternative resources available to them, Sharp says. “For example, in school counseling there are not a lot of opportunities for supervision. But one of the things I would do is talk to a more senior school counselor and set up a time twice a month to talk,” she explains. Sharp adds that if a counselor doesn’t have any colleagues within the same school, he or she could look to other schools within the district to find a senior-level counselor.

If counselors don’t have supervisory resources, they should turn to a colleague or peer, Lawson says. Ultimately, what matters is that counselors have someone they can check in with to gain perspective or just to talk to about how certain clients are affecting them.

Venart leads a regular supervision group for counselors who are working to obtain their licensure. Through the years, several group participants have decided to continue meeting together for peer supervision even after completing their licensure hours. Venart stresses the importance of educating new counselors to view supervision as an ongoing, careerlong necessity. She suggests that counselors look for colleagues to connect with in their current workplaces, from former jobs or past professional trainings, or perhaps among the people they met in their graduate programs.

While working on his dissertation, Crews found that if counselors felt they were part of team — even one of their own making — it seemed to have a beneficial effect on their job satisfaction and degree of wellness.

Lawson concurs. His research has concluded that participating in professional organizations plays an important role in peer support, and counselors who are part of such organizations are generally more “well.”

Accepting limits

In addition to offering encouragement, supportive peer groups can help counselors to recognize and accept their boundaries and limitations. This is important because one of the difficult realizations about being a counselor is that it’s not possible to help everybody, Lawson says.

“I think part of the struggle for counselors is when they meet somebody and they want desperately to help them solve their problem,” he says. “Sometimes we counsel people who have problems that are not really solvable.”

He explains further: “I am thinking specifically about things like domestic violence or intimate partner violence. I may meet with someone who is experiencing intimate partner violence … and they’re going to go home to the same violent situation because it’s unsafe for them to leave. [When under no legal mandate to report] I have to sit with that week in and week out knowing that I can’t solve that problem. So I need to have good boundaries about what I can do and what I can’t do. … For me to become more and more invested in them doesn’t help them more. It just means that it takes a greater toll on me.”

When the need is so great, it is easy for counselors to convince themselves that just a little more time or effort, either in the office or outside of it, will solve all the client’s problems, observes Crews. “I work with traumatized kids, and it is really hard not to want to get more involved in their lives,” he says.

However, in his practice and in his role coordinating the school counselor program at Texas Tech, Crews has learned that no counselor can control what happens in a child’s life outside of the counseling office. “Often, school counselors are dealing with parents who do not understand what is going on with their child. You do all this work with [the child] from 8 to 4,” he says, “but then they go home.”

Addiction counseling is another area that requires counselors to have a firm grasp of what they can and cannot do, Crews notes. “Counselors get tired out. They [feel like they] keep banging their heads against the wall because their clients relapse, but that is the nature of addiction,” he says. That doesn’t mean that clients struggling with addiction can’t be helped, but relapse is often part of the process, and counselors need to be able to make peace with that, Crews says.

Counselors also need to recognize when they have reached their limits. “I think one of the things that is really difficult for counselors is to say that ‘I can’t take on another individual who is experiencing such trauma or immediate risk, and there are a lot of good folks out there who can do that work,’” Lawson says. He emphasizes that it is crucial for counselors to realize these limitations before a potential client becomes an ongoing client, however. Disrupting the therapeutic alliance after it has developed can be damaging for the client.

Other times the solution might involve some creative scheduling rather than putting a moratorium on certain types of clients. “I had a period of time when I had many depressed adolescents on my roster in my practice,” recounts ACA member Stacey Chadwick Brown, a licensed mental health counselor with a private practice in Fort Myers, Florida. “Then I noticed that when I had six depressed teenagers in a row on one day, I got depressed.”

Brown didn’t want to turn any of the adolescents away, but she knew she needed to make some adjustments to safeguard her own mental health. After giving the situation some thought, she realized she just needed to spread the clients’ sessions throughout the week rather than scheduling them all on one day.

Sometimes, tweaking schedules can help counselors who are feeling overwhelmed. But other times, caseloads are simply too heavy, and that can be detrimental to both practitioners and their clients, Lawson says. “You have to have pretty good judgment and be able to say, ‘I’m already working 60 hours a week. I’m probably not the best person to take on this next client.’”

In certain environments such as large practices, clinics or agencies, counselors may not have total control over the number of cases they are handling, notes Sharp, a national certified counselor and former school counselor. However, with some planning, counselors may still be able to set some boundaries, she says.

“Counselors need to be careful about what boundaries they can set without putting their jobs at risk,” she cautions. “[But] there are small adjustments you can do to make things more manageable, such as not scheduling things after 6 p.m. or not working 10-hour days.”

Work and life in harmony

Another boundary proves exceedingly difficult for many counselors: leaving work at work and embracing some true downtime.

It took Brown a while to learn how to separate her work from her personal life. “When I was younger, my worldview was different. I thought I could do anything,” she recounts ruefully. “Once I had my first baby, I guess I was just exhausted — and still working. I think that’s when things changed for me. That’s when I realized I had to compartmentalize more.”

Whereas Brown had previously responded to clients in the middle of the night, she decided to stop putting herself “on call.” Instead, she made sure her clients had resources for off-hours crises and informed them she would check in with them the next morning. Brown also stepped up her self-care by making sure she got enough sleep, eating well, getting exercise and taking extra walks in between counseling sessions with clients.

But there was another instance when Brown felt the need to step away from her work for a week to regroup. It occurred when the mother of one of her clients died in an accident that was both extremely traumatic and very public. Brown didn’t know the woman’s mother directly, but the combination of her tangential connection to the woman and the tragic circumstances behind her death made Brown feel that she was experiencing secondary trauma.

Part of that had to do with the shocking and public nature of the story. “It was in the news everywhere, and everyone was talking about it, but I couldn’t say anything,” Brown recounts. She realized that she needed to take a step back and reground herself professionally, which included increasing her focus on self-care. Among other steps, she met and talked things through with colleagues whom she regularly turns to for support.

“Usually what we do as counselors is say, ‘I’ll take on this client, this committee or this task, and I know I have to give something up to have time to do it,’” says Lawson. “And the stuff that we give up is the stuff that’s good for us — like sleeping and time with friends and vacations and all of those things that we know are good for us.”

“I think counselors are notorious for not taking time off, and we have convinced ourselves that we are indispensable in the lives of our clients,” he continues. “As a result of that, we don’t take a week or two weeks off to go recharge our own batteries, and the results can be pretty dire.”

Lawson acknowledges that leaving work behind can be difficult but says counselors can take some intentional small steps to do just that. “I think it’s really important for folks to have rituals for how they take care of themselves,” he says. “Part of that is how do they leave work at work and not take it home with them? So, even with my students, I recommend that when they get home from their internships or when they get home from their work, the first thing you do when you come through the door is change clothes so that you can literally shed the day. I hate to say it this way, but [it’s] so you don’t take the ‘residue’ of work home with you. You put on comfortable clothes — clothes that you’re going to want to spend time with your family in.”

Lawson also knows many counselors who maintain rituals for “closing time” at the office as part of their self-care routines. “Some people have plants in their office, and the last thing they do in the evening is water the plants and tend to them,” he says. “It is sort of a very grounding thing for them. It’s a nurturing thing, but it’s also a closing sort of ceremony for them at the end of their day.”

Other counselors like to leave a clean desk, clearing papers and charts and putting away files. “Then, when you lock that file cabinet, it’s sort of a symbolic ‘I’m putting that stuff aside so that I can move on and go home without it,’” Lawson says.

Lawson asserts that when counselors incorporate a deliberate process of leaving the day behind, they’re less likely to take work home with them too often.

Lawson has a personal story that he keeps in mind: “My grandfather was a police officer back in the days when they didn’t have radios, so they had call boxes around town,” he recounts. “The police officers would carry around these call box keys, and when [my grandfather] got home, he would hang up that key and would be done for the day.”

Crews’ wife teaches theater, where a common directive is, “Leave your issues offstage.” Crews has altered that advice and adopted it as his mantra: Leave it at the door.

“I had an actual floor mat that said, ‘Leave it at the door,’” Crews recounts. “It was a very physical thing. If I wiped my feet, I could leave it there and go on.”

Venart suggests that counselors try “writing and ripping” to help them close the day and leave their work at work. She thinks that the practice of writing about whatever was stressful that day and then ripping up the pages and throwing them away offers a symbolic ritual to help release whatever stress has accumulated. Venart also recommends visualization. For example, counselors might imagine a strong container in which they can transfer the stressful events and emotions from the day. Counselors can then “seal” the container, lock it and put it away somewhere safe.

Leaving room for play

The ability to leave work behind, both physically and mentally, is essential to counselor wellness, and one element that goes hand in hand with that goal is making time to engage in activities that are personally enjoyable, Lawson says.

Some counselors find physical activities to be most helpful, while others enjoy tackling pursuits that sharpen the mind without being related to work.

Lawson likes to take a break from textbooks and other professional publications and read purely for pleasure, while Crews prefers playing video games and going out and being social.

Brown embraces her creativity. “I’m a crafter and a painter. That is really my therapy, my Zen,” she says. “When I am doing artwork, I am fully present.”

Venart is a proponent of grounding work, such as connecting with the body through deep breathing, posture and movement. She’s also a certified “laughter yoga” instructor. (“It’s an actual thing!” she exclaims.) The practice incorporates playful group exercises, laughter and deep yoga breathing. “Research has found that whether you are actually laughing or faking laughter, the [physiological] result is the same,” Venart explains.

Sharp advises counselors to embrace whatever brings them joy, community and a sense of belonging because those elements go a long way toward achieving wellness. “Develop a life outside work that is fulfilling,” she says, “because that can be a buffer and carry you through when work is not a source of fulfillment.”

Small town, big fishbowl

Practicing in a rural or small community poses a particular set of challenges to a counselor’s wellness, say Deborah Drew and Mikal Crawford, both of whom practice in, live in and have studied small rural communities. In these communities, counselors are isolated, yet never alone — and that’s not always a good thing.

“You’re living in a fishbowl,” says Crawford, who has previously presented with Drew on the ethics of self-care in small or rural communities at the ACA Conference. “When you’re living in the same community where you work, your personal life is exposed on a regular basis.”

It is difficult for counselors in rural or small communities to completely set aside work. Seeing clients at the gym, in the grocery store, on community committees, in clubs or at church is a regular occurrence, Crawford notes.

“It’s like, where do I go to let my hair down?” Drew exclaims, voicing a common lament.

Some practitioners cope with this fishbowl effect by finding social outlets in another community or by doing small things such as going to the grocery store or the doctor’s office somewhere else.

But the reality is that it is hard for counselors to truly relax when they’re constantly navigating such tricky boundaries, Drew and Crawford say.

“There is no such thing as avoiding dual relationships in rural areas,” Drew says, adding that they can pop up when a counselor least expects them. For example, Crawford says, imagine bringing on a new client, beginning to work with that client, then taking your car to the repair shop and finding out that the client is your mechanic.

The dual relationship could happen even closer to home. For example, the sole school counselor might have a child or relative who is also a student at the school, Drew says.

Sometimes, counselors in small or rural communities even discover that they are counseling two clients who are related to each other, Drew says. This circumstance is especially tricky because if the counselor discloses the link to the clients, the counselor could be breaking confidentiality. On the other hand, client A may disclose information in session about client B that client B hasn’t chosen to share with the counselor. At some point, the counselor will need to decide how — or whether — to manage seeing both clients. In some cases, it might be best to refer one or both clients, Drew says.

In these communities, seemingly everyone is connected by fewer than six degrees of separation, yet counselors often lack professional connections of their own, Drew and Crawford say. Counselors may have few colleagues to consult with and even fewer specialists to refer to. Practitioners in these communities have to learn to be generalists so they can handle a variety of needs, Drew explains. Counselors who are practicing or wish to practice in a rural area or small community need to ask themselves if they can learn to be OK with such challenges, Drew advises.

But for their own wellness, counselors in these environments still need to have people they can talk to about living and working in rural areas and who can help them work through the challenges, Drew says. She and Crawford recommend that these counselors seek out other mental health professionals, even if it involves driving a substantial distance. For example, Crawford cites a group of women practitioners that she talked to while doing research. They all lived and practiced in rural Vermont and New Hampshire and formed a support group that met monthly in a centralized location.

Professional organizations are also an important source of support, Drew and Crawford say, noting that in Maine, the rural practitioners are often the most active members in the state counseling association.

But they stress that counselors practicing in these comparatively isolated areas need additional support from colleagues and support networks to properly care for themselves and their clients. These counselors also need to be particularly intentional about practicing self-care by regularly engaging in activities that they enjoy.

At the same time, Drew and Crawford think that most counselors-in-training don’t truly understand how different it can be to practice in a small or rural area. Thus, they aren’t adequately prepared for the challenges — both personal and professional — that they will face.

“I think there is not enough training in the counseling profession that is specifically for rural areas,” Crawford says. “I think we need to focus on that. How can I not just survive in a rural area but thrive?”

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