In a devotion from 1624, the English poet John Donne argued: “No man is an island, all to himself; Every man is a piece of the continent, a part of the Main. "
This feeling still applies in modern consulting. Behaviors that other people display in their customers' lives – often the people they love most – can acutely affect them. When these patterns are incoherent, manipulative, or unhealthy, it can cause clients' problems to worsen, delay their counseling progress, or otherwise adversely affect their mental health.
Examples range from an adult client whose parents deal with anxious feelings by being critically or excessively involved in the client's life, to a client whose spouse has experienced trauma in the past and becomes angry Tends to break out.
These types of scenarios are not uncommon and often crop up when counselors and clients begin to unpack the problems that brought them into therapy, says Jen Ohlund, a Licensed Associate Counselor (LAC) to adolescents and adults at advises a practice in Mesa, Arizona. One indicator that a client is not getting the support they need from the people in their life may be that despite hard work by both the client and the counselor, they are not making progress in counseling.
During counseling, a practitioner may hear clients say, "I feel better, but I go home and I am told the same things over and over [unhealthy]" or "I will do all I can and nothing changes, ”says Ohlund.
"Any progress you make is shot down by the other person," she explains. "Then we introduce boundaries. We talk about what a healthy border is and equip it with [psychoeducation] so we can't control how other people react. We can't always walk on eggshells. Sometimes other people need theirs Work through triggers, and if they don't, we have to set limits. "
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See the whole picture
Empathetic listening and counseling confirmation can serve as important first steps for clients struggling with guilt, anger, sadness, or other feelings triggered by the behavior of loved ones, says Ohlund. Just talking about what worked and what didn't can be powerful, as can reassuring a counselor that many people are facing similar challenges and that the client is not alone when experiencing the same emotions.
“Often they don't want to feel that way. You care for that person and love them, ”said Ohlund, a member of the American Counseling Association. "They may feel overwhelmed [or] frustrated by their loved one, or they may turn inward and beat themselves up. They feel like they are not doing something right [or] and are not doing enough to meet the needs of [the other person’s] to meet. "
Advisors can also watch out for indicators that indicate that clients are struggling with isolation, lack of boundaries (e.g. receiving an extremely high number of text messages from a family member), or feelings about which they are concerned Your loved one can “never say no”. In these cases, clients may not have other people in their life to act as a sounding board to give them a clear perspective. One way counselors can help clients mitigate the unhealthy messages they receive from a loved one is to help them connect with other people who offer positivity and a voice of clarity. This will help customers self-regulate, notes Ohlund.
Michelle Fowler, a LAC at the Arizona Center for Marriage and Family Therapy, urges counselors to help these clients through a fixation lens. “We are wired in such a way that we need and react to one another. Doing therapy in a bladder is very unrealistic, ”says Fowler. “The relationships around the customer have the greatest impact on their well-being. We neglect to ignore or not address these contacts if they are a source of [a client’s] hardship or possibly a resource in support of recovery. "
Asking specific questions during the admissions process is a great way for clinicians to understand the supportive factors in a client's life, says Breanna Lucci, a licensed mental health counselor at a group practice on the north Massachusetts coast. These questions can include:
Who is in your support system? Who can you contact for assistance?
Who makes you happy
What are your standards in a relationship and how do you know a relationship is healthy?
Does your family know you are going to therapy and do they support this decision?
Describe your living environment. Is it supportive?
Who (other than your advisor) do you enjoy talking to about mental health-related issues?
Lucci also finds that discussions about a client's self-talk can reveal external factors affecting their mental health. She uses motivational interviews with customers to examine these external influences more closely.
For example, if a customer says, "I'm worried but I just need to get over it," Lucci, an ACA member, asks, "Why are you feeling this way?" Where have you heard this? "Or if you say," I was told that I was stupid, "then she breaks down, which means" stupid "to the customer, and asks," Who said that? How did it affect you? "Going through a client's language choices in this way can reveal patterns and how things that you have heard and internalized from others have become part of their self-talk and self-esteem. The goal of this work, Lucci points out, is always to that the client himself arrives at these findings.
Carrie E. Collier, a licensed professional counselor specializing in Bowen Family Systems theory in her Washington, DC practice, agrees that the language clients use in meetings about their relationships is valuable Share information about the customer's context and response to others.
"An individual is not in a vacuum – there is always reciprocity in relationships," says Collier, director of the Bowen Center for Family Studies in Washington. “Fear is contagious; When a person lives with other people, there are many shared emotions. I am trying to help a person really understand what is theirs and what the other person is and what he or she is putting in and what is [others] in it. … As a consultant it is important to see the whole context and the landscape. It's not just a person sitting in the office with me. It's not a cause and effect. It is relationships and people that react to each other, and this is exactly what the counselor and client face. "
Promote understanding
With individuals surrounded by unhealthy patterns, it is vital for consultants to be aware of resources (both in their region and online) that can help clients better understand what their loved ones are go through, and support the client outside of counseling sessions, says Lucci.
As a licensed drug and alcohol counselor, Lucci is familiar with numerous search resources in her area, including a recovery center that offers interventions and free family workshops. She recommends Johann Hari's TED lecture entitled "Everything you think you know about addiction is wrong" (see bit.ly/3aqbpV4) often to clients whose family members struggle with addiction. She also has a list of organizations that offer support groups and other resources to help people whose loved ones live with mental illness or who are struggling with parenting issues, caring roles, work stress, a family member in prison, and a host of other challenges. The support groups and educational materials of the Depression and Bipolar Support Alliance (dbsalliance.org) and the National Alliance on Mental Illness (nami.org) can be particularly helpful, she adds.
By looking for ways of safe support outside of counseling, this client population "can be healthy in spite of their circumstances, and part of that is [learning] acceptance," says Fowler, who counsels adolescents, individual adults, and couples. Understanding the bigger picture that governs a loved one's behavior (including, in some cases, mental illness) empowers clients and can help them “gain empathy or understanding so that it doesn't feel like a personal attack,” explains Fowler.
About a third of Fowler's case numbers are adolescents, and for these clients questions about the adults in their lives can provide vital information about the support they are or are not receiving at home, she says.
“One place where I always start, especially with the teenagers I see, is the assumption that they probably wouldn't if they could go to the adults in their circle to meet their [presenting] Solve problem in a supportive way. Be in my office, ”says Fowler, an ACA member. “Sometimes it turns out that the parents have mental health problems and the client does the best that can be expected. It definitely doesn't happen in a vacuum. … If someone else is really the reason or part of the reason they're having problems, is that a person who might be involved in therapy? Is this someone who could potentially help or does the client need coping skills to deal with [this person]? When it comes to parents and children, I definitely want the parents to come in as much as possible. But if this parent is not going to be a safe person because they have their own struggles or are unwilling to adjust, be open and see the child's perspective, then how can I support the coping strategies? "
One example that Fowler saw among their case numbers are customers who identify as LGBTQ and have "received very clear messages from their family that they are not open to talking about it". These clients need to work independently on their identity and mental health problems – an experience she describes as "a personal journey to make peace with themselves while remaining in their current environment".
For couples and individual clients, a dose of honesty can be required from a counselor about how much their situation might improve, Ohlund notes. "We [counselors] don't necessarily give advice to clients, but I also think it's important to be clear that if you continue to stay in this relationship, in some situations it will look like. If you have all of these coping skills and limits If you learn and nothing else changes, the relationship won't get any better. You can keep the relationship going and be stable, but success is another matter entirely, "says Ohlund." It's important not to be vague. Be very clear [about] what it would look like if you chose different options so that you can weigh it appropriately. "
Even if clients grow through counseling, the other person in the relationship cannot change. Ohlund notes that this concept is so important that it is written on the informed consent forms in the practice she works in.
"This is one of the most difficult parts of therapy: if you are growing and developing, the people around you may not be able to," says Ohlund. "Once [clients] learn coping and communication skills and feel more secure … they may find that relationships around them are changing, or they don't even want [those relationships] in their life"
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Counselors can serve as important resources to help these clients work through self-assessment, anger, and other emotions, while equipping them with coping mechanisms such as mindfulness, self-care, and self-compassion exercises, says Ohlund. She admits that it takes time to help customers see things through a new, healthier lens. Along the way, it's important to help customers focus on the things in their life that are going well, she says.
Rewriting unhealthy patterns
Fowler once worked with a teenage client whose main problems were depression, self-harm, and thoughts of suicide. The client's parents had had a tumultuous divorce seven years earlier, and her father had since remarried. The parents had 50-50 custody of the teenager and continued to argue, sometimes in front of her.
The surroundings with mother and father were opposite. The only communication she received from her father was about correction or discipline. His home had much stricter behavioral and schedule expectations than her mother's home, and the client also had step-sibling relationships for navigating her father's house. Since the client's friends lived closer to her mother's house, she had more opportunity and freedom to communicate with her peers when she stayed with her mother.
The teenager was "upside down" that she could trust, recalls Fowler. She displayed attention-grabbing behaviors online and had been hospitalized for thoughts of suicide before Fowler worked with her.
Fowler took a different approach than the teen's former therapist, who did not involve the parents in the counseling sessions. Fowler focused on rewriting the communication and response patterns of parents, children, and parents to parents who had become unhealthy. She also invited the client's mother, father, and stepmother to counseling, first in a group session without the client and later with one of the adults in sessions with the client.
Fowler used emotionally focused therapy with the teenager to learn how to explain to her parents what she was feeling. The method focuses on exploring primary emotions and practicing communicating those emotions in such a way that the client's attachment figure can receive them, explains Fowler. By helping the client share – and the parents really hear what she was saying – the mother and father could better understand the severity of their daughter's depression and the effects of their discord on them. That experience also used her father's empathy and allowed him to put his anger aside, recalls Fowler.
Fowler also worked with the adults on how to respond to their daughter in a helpful and supportive way. "I explained that [she] seeks support and security and doesn't feel loved or recognized, so she looks for it elsewhere," says Fowler.
Parents agreed to stop arguing in front of the teenager, and the father had a change of heart and began planning activities to spend time with his daughter in a positive way. Within a few months, the teen felt much better and her self-harming behavior and thoughts of suicide disappeared, says Fowler. Although their parents still need to monitor the use of their cell phone, the client's situation has improved significantly.
"All of these disputes, apparently overnight, went away," says Fowler. "I know the changes the parents made were a huge factor in helping the child."
The father "did some persuasion" to change, Fowler remembers. His frustration with his daughter was based on the feeling that she was unsafe online and made herself available to strangers. Ultimately, Fowler used these feelings as a lever to explain that he had the chance to be the safe man in his daughter's life.
"That was the window that helped him see … [and] understand how he had the opportunity [to make] to feel loved by his daughter," says Fowler.
Set limits
Setting boundaries is one of the most important coping mechanisms a counselor can provide to clients who are surrounded by unhealthy patterns. Although customers cannot control a loved one's behavior, they can control the boundaries they want to set in the relationship, Ohlund notes. This work has to be led by the client and will look different for each person depending on their preferences and needs.
Boundary exploration is best done in a session where the environment is calm – before the client has to confront a loved one in the heat of the moment. Customers shouldn't set limits until they can comfortably enforce them, emphasizes Ohlund. The counselor and client should also talk about what it feels like to push the boundary, including understanding and preparing for the possibility that it will make the other person feel worse, including inducing anxiety or abandonment.
Sometimes people may not understand these new frontiers. "Those who benefit from having no limits do not want to deal with what is going on with them and will fight a lot against it," Ohlund emphasizes.
Ohlund often works with clients to set boundaries, the phases of which can be adjusted if or when a situation arises. For example, if a customer has a spouse or family member who is prone to critical or angry outbursts, the first step may be for the customer to leave the room or move to another part of the house. If the behavior continues, the customer can leave the house for a short time. Similarly, they could temporarily block the phone number of a family member who tends to send a barrage of text messages when that person is upset.
“This is much better than just asking them to stop. What will you do if [the behavior] doesn't stop? We need to set a boundary that we are in control of so that we don't get sucked in or drawn in, ”she says.
Ohlund once had a client whose mother did not approve of some of the options he and his partner had chosen to raise their children. She repeatedly exceeded her limits and put her opinion on the children. The situation turned the client's children against him, says Ohlund.
The mother continued the behavior, although her son talked to her about it several times. With Ohlund's support, he finally set a limit that if his mother continued to degrade his parenting style to his children, he would cut off his family's contact with her for a month.
The mother did not stop her behavior, so the client made contact and broke it off. During this time, his mother criticized him against other members of her extended family. "He knew it was the right decision, even though it was difficult," says Ohlund. "Eventually the mother came by, although it took a considerable amount of time to get to this point."
This customer's decision to hold on to their limit produced a positive outcome, but this is not always the case. Sometimes people disapprove of the border, which can lead to a breakup or distance in the relationship, says Ohlund. "The reality is that [people] has no control over whether or not someone else will answer. It can be very daunting and grieving and seeing something as a loss. It's something you work very hard on, but it is beyond your control, "she states.
Collier emphasizes that the goal of boundary setting should be to guide clients on the basis of their principles in order to find out what is best for their own mental health. It's also about thinking about what worked and what didn't in the past.
“The goal is not to get the person [other] to change. That is very important [to understand]. When you do something on your own principle, it doesn't matter how the other person reacts. You don't want to tell them because it will help them or make changes, but because it is your principle. It will only work if the [client] have made their own fundamental considerations, ”says Collier. She advises counselors to ask good questions and to stay out of the client's emotional process: “Don't jump in and get involved in [a client’s] emotions. Just let them think about how they can do things differently. "
Lucci agrees that effective boundaries must be rooted in a customer's values. Part of this process may be to have a broader conversation about the client's relationship standards, including what they want the relationship to be and what they think is necessary to continue the relationship.
"Setting boundaries can be extremely uncomfortable for people, so I stress that [boundaries] is constantly changing and adaptable," says Lucci. “[This process] is not a meeting. It's a very slow process and it adapts, adapts, adapts. "
Clients working on setting boundaries may find it helpful to have the necessary discussions with a counselor before initiating it with loved ones. For example, how might it feel not to reply to a text from this person? Collier notes that a consultant can discuss this scenario with a client, acknowledge how difficult it will be, and assess whether it feels right. “Know that there will be an inconvenience; It will be difficult to say no, ”admits Collier.
It can also be helpful to focus on communication techniques with these customers, including how to address sensitive or triggering issues with a loved one in a non-defensive manner, adds Lucci. Counselors and clients can practice taking in comments and information from family members and then expressing themselves without starting the debate or becoming defensive. With this in mind, Lucci sometimes encourages clients to write down a dialogue and read it to her in the session.
"It is natural to be really concerned about these conversations, and a counselor can help alleviate some of those fears by preparing [with the client]," explains Lucci. She asks customers what the goal of the conversation is and how they want to go about it. "It's really important to listen to what the customer wants," she says. "I want the client to feel empowered and knowledgeable, but ultimately it is their own choice" how to deal with the situation.
The role of the advisor
Counselors play an important role in supporting clients whose mental health is negatively affected by the toxic patterns of others in their lives. These patterns may indicate that the other person needs to be counseled, but first and foremost, the counselor’s ethical duty is to help their client, whether it is appropriate or possible to include family members or others in their counseling sessions. (An important limitation is when counselors take steps to protect clients from “serious and foreseeable harm.” See Standard B.2.a. of the 2014 ACA Code of Ethics.)
"It's never my job to diagnose someone I don't know and someone who isn't a customer of mine," says Lucci. "But I can listen and hear the behaviors described by the customer and their effects. Then we focus on how [the client] can deal with those behaviors. I never want to assume how someone is feeling or what is going on. … First of all I want people to feel connected and make their own decisions about change. "
Advisors can also provide resources and support to clients in these situations while deciding what the relationship will be, adds Ohlund. However, this work requires patience on the part of the counselor, she notes.
“As advisors, we can sometimes foresee very far. We can see very clearly what to do in a situation, but it can take a long time for a customer to get there, ”says Ohlund. "Sometimes it's easy to be frustrated: Why can't you see [it]? Why do you keep these patterns?"
She advises counselors to be patient and not to feel that they are doing something wrong. "Instead, rest assured that you are doing everything you can to support a customer, and that's what they need – they may never have had this in their life," she says.
Similarly, Collier sees her job as being to sit with customers and ask questions to help them explore emotions and gain insight into their situation. Her focus is on the process rather than the symptoms that clients bring to the counseling. "I'm interested in how the person thinks about the problem and challenge, what worked and what didn't, what they tried and how they understand," says Collier.
Counselors also have to deal with relationship struggles in their own lives in order to better support clients seeking help with similar problems, stresses Collier.
"The client's ability to change and really think about their situation will only be as good as the person sitting in the room with them and their ability to see and think about situations," says Collier. “Our maturity level lends itself to what really helps a person, and that comes from examining relationships and patterns in our own lives. That goes beyond any technique or anything I can do with a client. We all have problems in our own lives and in our relationships, and we need to work on them so we can help customers and think objectively. "
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Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at [email protected].
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Opinions and statements in articles appearing on CT Online should not be assumed to reflect the opinions of the editors or guidelines of the American Counseling Association.
