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Tuesday, March 22, 2011

Does Religion Belong in the Counseling Environment?

It used to be that counselors avoided talking about religion or spiritual issues with clients; the subject was considered inappropriate in the counseling environment.  Today, however, there has been a paradigm shift in Schools of Social Work, which now teach that assessing a client’s spiritual needs and/or beliefs is as important to the counseling process as assessing what is happening in the client’s social and personal environment. I tend to agree.

When I do an initial assessment with a client, I ask a lot of questions, ranging from important events in your medical history to substance use to mental health history and spiritual beliefs. I want to know what sustains my clients in difficult times.  Not everyone follows a spiritual path, and some people are spiritual but not religious. Some people cling to their religious beliefs when they face life challenges, while others completely abandon previously held belief systems.   This information is important to the counseling process because, as a social worker, I want to evaluate all of the various elements of my client’s environment and belief systems to understand how those have either worked for or failed my client.  If my client tells me that they couldn’t survive without the fellowship of their church, I will encourage them to maintain that relationship and participate as much as possible.  The fellowship of a church family can be a wonderful source of support for those who follow a religious path.  On the other hand, if my client tells me they have no spiritual belief system or they have abandoned a previously-held system, then I am probably going to encourage them to find and develop an alternative support system in the community.  It might be through joining a book club or getting together with friends for a weekly hike. It might be through AA or joining a committee that is working on a special project.  The important message here is:  a support system is an important element in the healing process. Humans do not function well in isolation.

When we are part of a group that shares similar beliefs or values, we feel validated as an individual.  We know that we are part of something bigger than ourselves, but to which we make valuable contributions.  We find camaraderie, friendship, and purpose.  When we participate in a group effort – whether it is to build a park or find a deeper meaning in God, we are no longer isolated in our own thoughts and feelings.  For someone who is feeling depressed or who has low self-esteem, a group can help illuminate the path out of darkness.

I believe that, as a counselor, I have an ethical and moral obligation to accept my clients “where they are”, which essentially means, I will never turn someone away because of their religious or spiritual beliefs, or lack thereof.  Nor would I ever offer religion or spirituality as an option to clients who tell me they have no spiritual path.  That’s not my job.  My role is to help the client understand what does or doesn’t work to help them feel supported in their journey.  It is important for my clients to know that I will ask about your spiritual or religious beliefs during our initial assessment.  If your answer is one that indicates this is an important area for you, we will explore it further to see how you might strengthen your connections to something that is helpful to you.  On the other hand, if your answer is “no”, we will move on to other things that you find helpful.  The services I provide will be the same, regardless of your answer.  I will support you in your time of need; together, we will figure out a plan to resolve whatever is causing your distress.   I will respect who you are and what you believe.  In for some reason I feel your beliefs are interfering with your mental health, we will talk about it and why I believe it is necessary to challenge your beliefs. But, cognitive distortions are a topic for another time. 

If you are experiencing distress in your life and feel you need help to work through it, please give me a call and let’s see what we can do together to help you find your way back to a peaceful and rewarding life.  We all need help sometimes in our lives. I believe that you already have the answers to your questions, but you just need help in working through the confusing emotions that can accompany change.  Sometimes you need to just be still and listen – your life is calling. The Mindfulness Solution: Everyday Practices for Everyday Problems

I would be interested in hearing readers’ views on this topic. Please feel free to post your comments! 

Wednesday, January 5, 2011

Children and Therapy - What Happens?

Whether a child has been referred for therapy by another agency or a parent  who has decided it would be in the child’s best interests to see a professional, the first thing that both parents and kids want to know is – what’s going to happen?

Therapy with children is not the same as therapy for adults.  Children process their feelings differently than adults and therefore, therapeutic interventions with children must take into account several things:
1.      What is the child’s level of maturity?
2.      What changes have occurred in the child’s behavior?
3.      What life events have occurred or will occur in the near future that affect the child’s sense of self or security?
4.      How is the child currently processing feelings?
5.      What does the child like to do and what are his/her interests?

Therapeutic interventions with children involve activities that don’t normally seem like therapy – but which actually do have a very specific purposes in a therapeutic environment.  For example, a child who has experienced trauma might best be able to express the event through drawings that represent feelings they experienced when the event occurred.  A younger child might express his feelings through imaginative play.  Adolescents can often make a connection through music.   A child who has experienced trauma might benefit from a more structured program of trauma-focused cognitive behavioral therapy.

Children process many feelings, especially trauma, on a sensory level – meaning they experience it through sensations rather than through thought processes.  This is why traditional “talk” therapy isn’t an approach we usually use to work with children.  Although your child might come out from a session and tell you they didn’t do anything but play with the dollhouse, we were actually doing some very specific work. Your child’s play tells me things about his or her feelings and experiences; likewise, through play, I can teach your child how to manage with those feelings  or help them learn alternative behaviors.

During the first visit, I usually meet with only the parent(s) in order to complete paperwork, discuss confidentiality, review policies, gather insurance or payment information,  and get a good history  (from the parents’ perspective) of what has happened to bring the child to therapy.  During the second visit, I meet with the child alone or, in the case of a young child, with the child and parent.  I always tell children what to expect from me, as well as what I expect from them. Then, we spend some time getting to know one another.

During subsequent sessions, we might engage in therapeutic play, art, games, or structured activities, where children learn to name and express their feelings in an appropriate manner. They learn to manage their stress and discomfort. They learn what things they can be in control of and what they cannot.  We work on building self-esteem and children learn they do have some power. More importantly, they can practice positive ways to use it.  

I speak with the parents briefly at each session, keeping them informed of their child’s progress and providing them an opportunity to ask questions or express concerns.  When appropriate, parents are included in at least some of the sessions.  I also make it clear from the outset that if your child doesn’t want to come to therapy, I will never force them to be there.  I do ask, however, they come for at least three sessions before they make a decision to quit.  Usually, by the third session they feel quite comfortable and want to come back for more sessions.  I also always make sure children know they can go back and forth from my office to the waiting room to touch base with parents as often as they want or need to.  This is especially important for younger children or those who have a lot of anxiety.  

I encourage anyone who wants to learn more about how therapy works with kids to call me and ask questions.  The idea of a child seeing a therapist doesn’t have to be scary for parents or kids and we are happy to answer your questions any time. We want for you and your children to feel safe and supported in an environment where healing may occur. 

Sunday, December 26, 2010

Courts Awarding Custody to Abusers and Domestic Violence Homicides Is There a Connection?

 I've been thinking about starting this blog for some time now.  My counseling experience has been in working with adult survivors of intimate partner violence and with children who have experienced physical, emotional, or sexual abuse.  I don't claim to be an expert, but I have focused on learning everything I can about the dynamics of abuse and the effects of trauma on those who are most vulnerable.  What I have learned concerns me greatly.  However, I have also learned that with support and appropriate treatment, survivors of trauma can heal. 

Domestic violence is defined as a pattern of physically, sexually and/or emotionally abusive behaviors used by one individual who is, was, or wishes to be in an intimate relationship with another, and which are used as a means to maintain power and control over their partner.  Research has taught us that it is not the result of alcohol, substance abuse, stress, or anger. Those are separate issues which often contribute to - but are not the cause of - intimate partner violence.  Statistics and research have also taught us that that the victims of intimate partner violence are most often women and that the most dangerous time for these women and their children is when they try to leave an abusive partner.

Children who live in homes where domestic violence occurs usually know more about the violence than their parents realize.  They are awakened at night by the yelling and screaming that reverberates through their bedroom walls.  They hear the threats and accusations that always accompany the fight. When their parents believe they are sleeping, these children are often lying awake, silently frozen, fearing not only for their mothers’ lives, but also for their own. Some children take action and try to get between the fighting parents, putting themselves in harm’s way in hopes of breaking up the fight. Sometimes the children are also injured. 

Even babies and young children who live in violent homes learn that the world is not safe. To them, life is dangerous and unpredictable because they never know when the next outburst is going to occur.  They remain on edge. They stay alert to signs that someone might be getting agitated.  They might exhibit symptoms of anxiety or sleep disturbances.  They might have difficulty concentrating or sitting still and older children might act out in school. Sometimes their symptoms of post-traumatic stress are misdiagnosed as Attention Deficit Hyperactivity Disorder (ADHD).   Toddlers and school-aged children might repeatedly demonstrate violence in their play. Worst of all, they learn that they can’t trust anyone.  

Unfortunately, when a mother finds the courage to escape the abusive relationship, the children often become pawns that the abuser uses in his/her most complex strategy to maintain power and control - that of child custody. An abusive partner knows which tactics will work most effectively when his partner tries to leave. This is one of the greatest injustices these children will endure. 

Although many abusers have little to do with the children during the relationship, they may suddenly  focus their attention on the children when their partner decides to leave. He knows that (in most cases) a mother will go to great lengths to protect her children, possibly even choosing to remain in the relationship to ensure their safety.  However, for those who dare to leave, child custody becomes the new battle ground and the one of the abuser’s most effective weapons against his victim.  Whether he vows to gain full custody of the children or worse yet – threatens to harm them – he knows he will gain the upper hand by bringing the children into the fight.

How do we safeguard our children?  How do we fortify and protect a child’s self-esteem and sense of safety when their lives are filled with chaos?  First, it is important for children to have at least one safe, supportive adult who encourages them.  This person might  be a teacher, a grandparent, an older sibling or a neighbor.  Having a safe, reliable adult involved in the child’s life helps to build resilience and preserve self-esteem.

A second strategy for helping children heal from trauma is providing access to a counselor who has experience working with domestic violence and  traumatized children. Counseling allows even young children the opportunity to process their experiences through therapeutic play, where they can learn effective coping strategies and practice these strategies in a safe and neutral environment.    

And finally, we have to build a community that advocates for the safety and rights of children.  It is unfortunate that much too often the complexities of a contentious separation or divorce overshadow the true needs of the children. Anyone who is charged with the responsibility of making decisions that affect a child’s life and who hear allegations of abuse and/or domestic violence in the home, must thoroughly educate themselves about the dynamics and long-term effects of intimate partner violence and abuse on survivors and their children.  Making a life-changing decision that will affect a child's safety and well-being should be considered only after all of the facts of the case have been thoroughly investigated. Further, it is important to learn and understand the difference between an abuser’s public persona and his private behavior. An abuser rarely shows his disdain in public and instead appears to be very calm, collected, and concerned only for the welfare of his children.  

Counseling for survivors of domestic violence and other types of trauma is available from a variety of resources in our community.  Whether or not you have insurance, help  is only a phone call away.  Please reach out and don’t suffer in silence.  Trained professionals can help you and your children heal. For more information, call Cynthia Starnes, LCSW at the Behavioral Wellness Counseling Clinic in Charlottesville, VA  at (434) 202-2477.