Presented  by  Jeff  Cline,  LPC-­‐S,  NCCClinical  Director  @

Overview� Section  I:  Wellness,  the  Cornerstone  of  the  Profession

� Section  II:  Threats  to  Wellness,  Distress  and  Impairment

� Section  III:  Emphasizing  Wellness  in  Counselor  Education  and  Clinical  Supervision

� Section  IV:  Wellness  Research  

Section  I:  Wellness,  the  Cornerstone  of  the  Profession  

In  the  Midst  of  the  Puzzles  and  Counseling  JourneyThere  is  a  quietness  that  comes  

in  the  awareness  of  presenting  names  and  recalling  places  

in  the  history  of  persons  who  come  seeking  help.  

Confusion  and  direction  are  a  part  of  the  process  where  in  trying  to  sort  out  tracks  

that  parallel  into  life  a  person's  past  is  traveled.  

Counseling  is  a  complex  riddle  where  the  mind's  lines  are  joined  with  scrambling  and  precision  to  make  sense  out  of  nonsense,  

a  tedious  process  like  piecing  fragments  of  a  puzzle  together  

until  a  picture  is  formed.  

(Gladding,  1978,  p.148)

Therapeutic  Benefits  of  the  Well  Counselor

�Well-­‐counselors  are  more  likely  to  produce  well-­‐clients!�Modeling  a  wellness  lifestyle�Better  able  to  connect�More  attentive  to  emotional  and  cognitive  content

�More  energy  and  creativity  in  session� Less  likely  to  violate  boundaries

What  Replenishes  Your  Well?

Wellness  Defined� More  than  the  absence  of  illness—World  Health  Organization

� Holistic  wellness  is  a  multidimensional  construct  that  involves  individuals  achieving  optimum  health  in  the  various  spheres  of  life-­‐-­‐mind,  body,  and  spirit.  Myers,  Sweeney,  and  Witmer  (2000)  define  wellness  as,  � “a  way  of  life  oriented  towards  optimal  health  and  well-­‐being  in  which  body,  mind,  and  spirit  are  integrated  by  the  individual  to  live  life  more  fully  within  the  human  and  natural  community.  Ideally,  it  is  the  optimum  state  of  health  and  well-­‐being  that  each  individual  is  capable  of  achieving”  (p.  252).

Wellness:  The  Cornerstone  of  the  Profession� No  health  profession  has  emphasized  clinician  well-­‐being  more  than  professional  counseling.� 20/20:  A  Vision  for  the  Future  of  Counseling’s  definition  of  counseling:  "Counseling  is  a  professional  relationship  that  empowers  diverse  individuals,  families,  and  groups  to  accomplish  mental  health,  wellness,  education,  and  career  goals”  (Kaplan,  Tarvydas,  &  Gladding,  2014;  p.  366).

� Council  for  Accreditation  of  Counseling  and  Related  Educational  Programs  (CACREP,  2009)  required  counselor  education  programs  to  exhibit  wellness  learning  objectives  in  their  curriculum,  and  stated  that  graduates  should  demonstrate  proficient  integration  of  these  competencies  in  clinical  practice.

� The  2014  ACA  Code  of  Ethics Section  C:  Introduction  prioritizes  clinician  self-­‐care  by  mandating,  “counselors  engage  in  self-­‐care  activities  to  maintain  and  promote  their  own  emotional,  physical,  mental,  and  spiritual  well-­‐being  to  best  meet  their  professional  responsibilities”  (p.  8).  

Why  is  Wellness  So  Important?� Protecting  vulnerable  clients  in  accordance  with  primum  nil  nocere, “first,  do  no  harm”  is  the  principal  ethic  of  all  health  professionals.

� Counselors  who  engage  in  wellness  practices  and  self-­‐care  behaviors  experience  less  personal  and  professional  distress  and  an  improved  professional  quality  of  life  (Meyer  &  Pontoon,  2006).

� “It  is  not  possible  to  give  to  others  what  you do  not  possess”  (Corey,  2000).

� Counselor  effectiveness  depends  more  on  the  personal  characteristics  of  counselors  than  on  school,  training,  or  theory  (Hanna,  &  Bemak,  1997).

� Balance across wellness dimensions� Balance and variety in work-related tasks� Balance within each day and week� Balance between work and leisure

Wellness  =  Balance

Part  II:  Threats  to  Wellness:  Distress  &  Impairment

Well ImpairedStressed Distressed

Well  and  Stressed  – No  impact  in  the  counseling  session  (Compartmentalized)  Distressed – Beginning  to  interfere  (distracted,  unprepared,  etc)  NOT  SIGNIFICANTLY  IMPACTEDImpaired – Getting  my  needs  met  before  my  client’s  

Special  Risks:  Challenges  for  Professional  Helpers

� Our  inability  to  say  no-­‐The  treadmill  effect

� The  covert  nature  of  the  work� Constant  empathy,  interpersonal  sensitivity,  and  one-­‐way  caring

� Elusive  measures  of  success  (how  do  we  measure  success?)

� Low  Morale:  Cynical,  critical,  negative  colleagues  and/or  supervisors

� Legal  and/or  ethical  concerns� Cognitive  deprivation

� Unreasonably  large  caseloads  � Large  percent  of  clients  with  trauma

� Large  percent  of  clients  with  high  risk  behaviors

� Administrative  supervision  (as  opposed  to  clinical  Supervision)

� Policies/procedures  interfere  with  effective  client  care

� Anxiety/fear  of  negative  evaluation  by  others

� Other  Challenges?

When  Wellness  Erodes:  Impairment� Therapeutic  impairment  occurs  when  there  is  a  significant  negative  impact  on  a  counselor’s  professional  functioning  which  compromises  client  care  or  poses  the  potential  for  harm  to  the  client.

� Impairment  may  be  due  to:� Substance  abuse  or  chemical  dependency

� Mental  illness� Personal  crisis  (traumatic  events  or  vicarious  trauma,  burnout,  life  crisis)

� Physical  illness  or  debilitation    

� Distress  without  intervention  often  leads  to  impairment:� Burnout  � Compassion  Fatigue

� Vicarious  Traumatization

BurnoutMaslach,  Jackson,  &  Leiter,  1996

� Emotional  exhaustion,  depersonalization  &  reduced  feelings  of  personal  accomplishment

� Typically  attributed  to  work  environment  or  job  choice

� Vacation  or  a  job  change  helps  considerably

Compassion  fatigueFigley  1995

� "Compassion  Fatigue is  a  state  experienced  by  those  helping  people  in  distress;  it  is  an  extreme  state  of  tension  and  preoccupation  with  the  suffering  of  those  being  helped  to  the  degree  that  it  can  create  a  secondary  traumatic  stress  for  the  helper."  

� “A  function  of  bearing  witness  to  the  suffering  of  others”  

� Experiencing  the  trauma  our  clients  have  suffered,  or  recalling  our  own  past  traumas  due  to  the  exposure  through  our  clients.  

17

Vicarious  TraumatizationPearlman  and  Saakvitne,  1995  

ACA  Task  Force’s  Research  on  Impairment  (2003)

� Survey  of  the  American  Counseling  Association  (ACA)  Membership� Most  counselors  have  known  a  counselor  they  would  consider  impaired  (63.5%)

� In  those  cases  Supervisors  (54.3%)  and  Colleagues  (64.2%)  were  also  aware  of  the  impairment

� In  most  cases  the  impaired  counselor  did  not  receive  disciplinary  (77.8%)  action  or  therapeutic  intervention  (73.7%)� http://www.counseling.org/wellness_taskforce/index.htm

Well ImpairedStressed   Distressed

When asked about their own wellness ACA members reported:

81% - Well 15% - Stressed

4% - Distressed 0% - Impaired

Well ImpairedStressed   Distressed

When asked about their colleagues wellness ACA members reported:

47% - Well 33% - Stressed

12% - Distressed 4% - Impaired

Section  III:  Wellness  in  Counselor  Education  and  Clinical  Supervision

Why  Emphasize  Wellness?� Counselors-­‐in-­‐training  (CIT)  and  newly  licensed  professionals  experience  multiple  life  stressors  that  leave  them  vulnerable  to  various  forms  of  distress  (Smith,  Robinson,  Young,  2007).

� Many  CIT’s  and  young  professionals  possess  limited  knowledge,  skills  and  training  related  to  maintain  personal  and  professional  well-­‐being  (Venart  et.  al.,  2007).  

� Young  professionals  who  have  a  more  complex  understanding  of  professional  counseling's  emphasis  on  holistic  wellness  are  more  equipped  to  sustain  well-­‐being    (Lenz  &  Smith,  2010).

Wellness  Model  of  Supervision  (WELMS;  Lenz  &  Smith,  2010)

Incorporating  Wellness  in  Clinical  Supervision  

� Education:  � Model  and  discuss  holistic  wellness  with  supervisees.  � Recommend  wellness-­‐based  scholarship,  participate  in  trainings,  professional  organizations,  etc…  

� Assessment:  � Administer  the  Five  Factor  Wellness  Inventory  (5F-­‐Wel)  and  Career  Sustaining  Behaviors  Questionnaire  (CSBQ)  to  determine  a  baseline  level  of  functioning  with  all  new  supervisees.  

� Encourage  supervisees  to  be  self-­‐aware  of  their  personal  and  professional  quality  of  life.  

Incorporating  Wellness  into  Clinical  Supervision

� Planning:  � Develop  an  individualized  wellness  plan  for  each  supervisee.    Encourage  them  to  develop  their  own  definition  of  wellness.

� Encourage  the  integration  of  holistic  wellness  into  work  with  clients.  

� Evaluation:  � At  each  individual  supervision  session,  have  a  10  minute  check  in  to  review  personal  well-­‐being.

� Have  quarterly  reviews  that  highlights  personal  and  professional  goals,  barriers  to  progress,  and  level  functioning.

Creating  a  Culture  of  Wellness  in  the  Workplace

� Educate  your  staff  and  supervisors  on  the  concepts  of  counselor  distress,  impairment,  career-­‐sustaining  behaviors,  and  wellness.  

� Develop  or  sponsor  wellness  programs  (such  as  in-­‐service  trainings  and  day-­‐long  staff  retreats)  

� Provide  clinical  supervision  (not  just  task  supervision)  � Encourage  peer  supervision  � Maintain  manageable  caseloads  � Encourage/require  vacations  � Do  not  reward  "workaholism"  � Encourage  diversity  of  tasks  and  new  areas  of  interest/practice  � Establish  and  encourage  Employee  Assistance  Programs  (EAPs)

Encourage  Career  Sustaining  Behaviors� Brodie  (1982)  identified  

career-­‐sustaining  behaviors  (CSBs)  as  actions  that  counselors  take  to  enhance,  prolong,  and  fully  enjoy  one’s  work  experiences.    Specific  areas  of  CSBs  include  sources  of  interpersonal  support,  beliefs  related  to  continuing  education,  gender  and  professional  life  issues,  use  of  leisure  time,  coping  behaviors,  career  satisfaction,  and  recommendations  and  implications  for  graduate  training.  

  List  of  Career  Sustaining  Behaviors  Rupert  and  Kent  (2007)  

 Maintain  sense  of  humor    Maintain  self-­awareness/self-­monitoring    Maintain  balance  between  professional  and  personal  lives    Maintain  professional  identity/values    Engage  in  hobbies    Spend  time  with  spouse/partner/family    Maintain  sense  of  control  over  work  responsibilities    Take  regular  vacations    Engage  in  physical  activities    Spend  time  with  friends    Try  to  maintain  objectivity  about  clients    Reflect  on  satisfying  experiences  of  work    Perceive  clients’  problems  as  interesting    Vary  work  responsibilities    Remain  active  in  professional  development    Discuss  work  frustrations/seek  support  from  colleagues    Seek  case  consultation    Not  feel  sense  of  responsibility  for  clients’  problems    Conscious  effort  to  put  aside  thoughts  of  the  clients  outside  of  work    Discuss  work  frustrations  with  spouse/partner/family    Maintain  regular  contact  with  referral  networks    Turn  to  spiritual  beliefs    Turn  to  spiritual  activities  Attend  religious  services/spiritual  support  group    Seek  guidance  from  a  spiritual  teacher    

NEA  Mental  Health  Wellness  Association� NEA  Mental  Health  Wellness  Association  

is  a  monthly  gathering  of  professional  helpers  that  provides  a  positive  social  network  in  support  of  professional  and  personal  well-­‐being.    

� Benefits/Goals:� Identify  strategies  to  maintain  balance  

and  personal  wellness� Highlight  career-­‐sustaining  behaviors  

that  support  professional  well-­‐being� Receive  peer  support  and  guidance  from  

seasoned  professionals� Share  professional  resources  

� If  interested  contact  BLCC:� 1601  James  St.� jcline@betterlife.org� 870-­‐935-­‐4673� www.betterlife.org

Section  IV:  Wellness  Research

Wellness  Research� Within  professional  counseling  and  related  fields,  wellness-­‐based  research  has  been  extensive.  Specific  areas  of  study  include:  � clinical  practice  (Myers,  Sweeney,  &  Witmer,  2000);  � counselor  education  (Wolf,  Thompson,  &  Smith-­‐Adcock,  2012);  � clinical  supervision  (Lenz  &  Smith,  2010);  � counselor  professional  identity  (Mellin,  Hunt,  &  Nichols,  2011);  � counselor  ethics  (Hendricks,  Bradley,  Brogan  ,  &  Brogan,  2010);  � counselor  job  satisfaction  (Connolly  &  Myers,  2003;  DeStefano  et  al.,  2005);  

� counselor  well-­‐being  (Cummins,  Massey,  &  Jones,  2007;  Lawson  &  Myers,  2010).

Wellness,  Career  Sustaining  Behaviors,  and  Burnout,  Among  Rural  Counselors  

� Dissertation  research  conducted  by  Jeff  Cline,  doctoral  candidate  at  Regent  University.  

� This  study  will  tie  together  and  link  previous  research  conducted  in  the  areas  of  counselor  wellness,  career  sustaining  behaviors,  counselor  distress  (burnout),  and  rural  mental  health.

� This  study  will  highlight  rural  counselors  overall  professional  quality  of  life  and  the  relationship  between  personal  wellness  and  various  subtypes  of  burnout.

� This  study  will  highlight  what  specific  self-­‐care  and  career  sustaining  behaviors  rural  counselors  use  to  remain  personally  well  and  enhance  the  quality  and  longevity  of  professional  life.  

Instrumentation� Demographic  Questionnaire:  The  Demographic  Questionnaire  was  designed  by  the  primary  

researcher.  Demographic  questions  will  assess  participants’:  (a)  gender,  (b)  age,  (c)  race,  (d)  licensure  status,  (e)  years  of  experience,  (f)  primary  client  population,  (g)  primary  work  setting,  (h)  hours  worked  weekly,  (i)  training  in  wellness  and/or  burnout,  (j)  professional  activities  to  support  wellness,  (k)  attendance  of  CACREP/Non-­‐CACREP  program.

� Five  Factor  Wellness  Evaluation  of  Lifestyle  (5F-­‐Wel, Myers  and  Sweeney,  2005): The  5F-­‐Wel  is  a  91-­‐item  instrument  that  measures  a  persons  degree  of  wellness.  The  5F-­‐Wel  consists  of  one  higher  order  factor  of global  wellness,  five  second-­‐order  factors,  five  wellness  factors,  and  17  third-­‐order  wellness  factors.  The  5F-­‐Wel   is  scored  on  a  four-­‐point  Likert-­‐type  scale  ranging  from  4  (strongly  agree)  to  1  (strongly  disagree)  with  scores  ranging  from  25–100.

� Career  Sustaining  Behaviors  Questionnaire (CSBQ,  Brodie,  1982;  Rupert  &  Kent,  2007)  The  CBSQ  is  a  25  item  instrument  designed  to  measure  personal  and  professional  activities  engaged  in  by  helping  professionals  that  enhance  and  prolong  work  life.    A  7-­‐poing  Likert-­‐type  scale  ranging  from  1  being  (not  important) and  7  being  (highly  important) to  assess  specific  strategies  that  help  professional  maintain  a  healthy  professional  role.

� Maslach  Burnout  Inventory  (MBI,Maslach  and  Jackson,  1986):  The  MBI  is  a  16  item  inventory  designed  to  measure  three  subscales  of  burnout   syndrome  including  emotional  exhaustion,  depersonalization,  and  reduced  personal  accomplishment.  A  7-­‐point  Likert-­‐type  scale  ranging  from  0  (Never)  to  6  (Every  day)  is  used  to  assess  the  participant’s  frequency  of  experiencing  the  feelings  described  in  the   item.

Target  Population� The  target  population  for  this  study  consisted  of  board  licensed  counselors  from  the  following  states:  Alabama,  Arkansas,  Florida,  Georgia,  Kentucky,  Louisiana,  Maryland,  Mississippi,  North  Carolina,  South  Carolina,  Tennessee,  Texas,  Virginia,  and  West  Virginia.

� To  participate,  you  should  be:� Currently  state  board  licensed  in  one  of  the  following  Southern  American  states:  Alabama,  Arkansas,  Florida,  Georgia,  Kentucky,  Louisiana,  Maryland,  Mississippi,  North  Carolina,  South  Carolina,  Tennessee,  Texas,  Virginia,  or  West  Virginia.

� Provide  services  to  clients  who  reside  in  a  rural  area  greater  than  50%  of  the  time.  (For  this  study  a  “rural”  area  consists  of  a  country  (parish,  borough)  that  does  not  have  an  urban  cluster  (city)  with  greater  than  50,000  people.

Participating  in  the  Survey  � Counselors  who  complete  the  survey  will  be  eligible  for  1  of  10  $25  Amazon  gift  cards.  

� The  researcher  created  an  online  survey  utilizing  Survey  Monkey      https://www.surveymonkey.com/r/ruralcounselorwhich  includes  an  informed  consent  document,  the  demographic  questionnaire,  and  the  three  research  instruments  the  5F-­‐WEL,  the  CSBQ  and  the  MBI.    

� At  the  end  of  the  survey  will  be  a  conclusion  page  which  thanks  counselors  for  their  participation,  provides  researcher  contact  information,  and  includes  resource  recommendations  to  websites  that  address  counselor  wellness  and  burnout.

Wellness  Resources� http://www.creating-­‐joy.com/taskforce/tf_wellness_strategies.htm  ACA  Task  

Force  on  Wellness  and  Impairment� http://wellness-­‐research.org/  Jane  Myers  Wellness  Research� 5  Factor  Wellness  Evaluation  of  Lifestyle    

http://www.mindgarden.com/products/5fwels.htm� National  Wellness  Institute  website  at  http://www.nationalwellness.org/� www.counselorwellness.com  Elizabeth  Venart’swebsite  � The  Association  for  Creativity  in  Counseling    http://www.aca-­‐acc.org/� www.aservic.org  Association  for  Spiritual,  Ethical  &  Religious  Values  in  

Counseling� http://www.spiritualityhealth.com/newsh/items/selftest/item_234.html  

Inspirit  and  Well-­‐being  tests� http://www.counseling.org/Resources/  ACA  Downloads:  Multicultural  

Counseling  Competencies  and  Standards� http://exercise.lifetips.com/  Exercise  Tips