Online Social Networking (i.e., “Facebooking”) with Therapy Clients

October 27, 2008 – 11:45 am

It finally happened.  I have profiles on YouTube, Facebook, LinkedIn, Digg, Reddit, Technorati, Ning, Squidoo, XING, Yahoo Answers, GodTube, MySpace, Yedda, Furl, Blogger, StumbleUpon, del.icio.us, Yelp, and Google Talk… to name a few. Most of these I hardly use. Some of them I’ve been on once to create the account and only remember it when I receive newsletters in my e-mail inbox, which I unceremoniously delete.
My students and colleagues have been finding me online for a few years now, so I’m used to getting the occasional “friend request” from someone I teach or work with. However, last week I received a Facebook friend request from Cecil, a 20-something British-American therapy client.* I immediately considered declining the request, but stopped short.

“I am trying to establish trust and rapport with Cecil,” I thought. If I decline his request to join such a non-exclusive network, could it harm our therapeutic rapport? Truly, I would accept a friend request from a stranger’s grandmother’s Labradoodle without thinking twice… so why not Cecil?

Potential Problems
Adding Cecil as a “friend” on Facebook will grant him access to mostly benign information: a few of my photos, and some biographical information. However, it will also allow him to see comments and photos of the students, colleagues, family, friends and pets I have added before him.

I must consider, first, that perhaps Cecil has not considered what it will be like to view my friends and family—people who have a personal relationship with me that he does not know, but one that he might desire himself. Moreover, if Cecil is in any way a dangerous person, such access to my loved ones becomes risky, even downright scary.

Second, Cecil may regret being “in network” when he realizes that “my” people can see his profile, which could be a breach of confidentiality.

Third, Cecil may have unspoken expectations about our online connection that I cannot accommodate, such as:

  • Will Cecil expect me to write back and forth with him?
  • Will Cecil want me to post on his Web page?
  • Will Cecil want me to NOT post on his Web page?
  • Does Cecil expect, or hope, to be added to my “Top Friends” list?

Fourth, I might not be able to respond adequately to inquiries from others who ask about the British guy (Cecil) who is now in my network, and who is (possibly) commenting on my Web page.

Fifth, I might be allowing Cecil to use our relationship as a friendship, which could hinder our therapeutic goal of him developing relationships outside of counseling.

Taking all of these concerns together, including Cecil in my network could easily blur professional-personal boundaries.  For all of these reasons, I have decided that I need a policy, not just for Cecil, but for any client who requests an online connection in the future.

Online Networking Policy

It is hard not to conclude that the wisest policy is to dissuade any “Facebooking” between yourself and your clients. However, such relations may not be wrong per se, and might be justifiable under certain conditions:
1.) Never solicit a connection.
A connection severely jeopardizes client confidentiality and should never be initiated by  the therapist.
2.) Discuss with the client his/her reasons for requesting a connection.
Is the client using the counseling relationship as a friendship? Does he or she want to be a  bigger part of your life? Addressing motivations could be good “grist for the mill” in the  therapy process.
3.) Address the risks and benefits.
Clients may underestimate the potential for negative emotions they might feel being in  your network. Also, address client expectations—what purpose does the client believe the  online connection will serve?
4.) Clean up your profile.
Minimize the risk of blurring professional-personal boundaries by making your account  less personal. Some time ago, I decided this was a necessary endeavor: Gone are the  pictures of my sisters and me making faces at the camera. Gone is the survey that says  my “superhero personality type” is the Green Goblin.

Many of my new accounts are for my counseling practice, not me personally. I considered making two profiles for each Web site (one personal, one professional), but rejected the idea when I realized there is nothing to prevent my clients from soliciting a connection with the “wrong” profile.

Today, Cecil is still on my “friend request” pending list, neither declined nor approved. I might approve him, but not before we talk.

Note to Readers: Please send your policies and “case histories” on this developing clinical-ethical issue to ThriveBoston@gmail.com.

*Obviously, names and faces have been changed.

****This article may be distributed and republished without permission if this footer is included: Written by Anthony J Centore Ph.D., Counselor at Thrive Boston Counseling and Life Coaching, http://www.thriveboston.com - Call: 617-395-5806   ****


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Overcoming Workaholism: Counseling Information on Workaholism and Tips for Achieving Balance

October 20, 2008 – 5:20 pm

PORTRAITS

 

Henry can’t even recall the last time he felt he was able to truly relax.  What he can recall, however, just how difficult it was for him growing up in poverty.  All he seems to care about these days is ensuring that he does not have to experience those struggles ever again.  He constantly worries that if he stops working so hard, then he will lose everything that he has established for himself.

 

Marie can’t get herself to slow down.  She is constantly picking up after her two children, cooking, and cleaning in attempt to main her spotless household.  Unfortunately, she can never actually enjoy her home and family as a result. 

 

DEFINITIONS & KEY THOUGHTS

 

Workaholism occurs when one does not maintain a healthy balance between their work and the other contexts of their life (i.e., marriage, family, community).  For workaholics, work is their principal avenue for finding success, approval, and respect.

 

For many in today’s society, workaholism has become a powerful obsession.  It is a health-robbing, sleep-depriving, and greed-festering addiction and should be recognized as so.  However, it is a problem that continues to go unchallenged- and often even rewarded- in many cases.

 

Workaholism is important to realize that workaholism is not only an issue for men and women in the workplace, but also for those who strive to have the “perfect” family and home.

 

Symptoms of workaholism may include:  inability to rest; a constant sense of urgency in every activity; working 60 to 70 hours a week or more; a need for acceptance or significance in the eyes others through one’s work; viewing work stress as a challenge to overcome or a means to finding significance; problems with rigidity, self-image, or with intimacy in relationships; valuing performance over showing grace and love; being seen by others as irritable, without humor, inattentive, or always in a hurry; and worrying more about providing financial security and a better lifestyle than about the emotional demands of family.

 

Generally, those who are addicted to work feel a compulsive need to do everything perfectly and better than others, that their worth can only be measure through their achievements, pain from their past, self-critical, and a deep sense of emptiness.  They constantly struggle with their pride, believing that they must measure up to the impossible standards that they have set for themselves.  Lastly, they believe that others view their constant and selfless work as being honorable.

ACTION STEPS

 

When helping a person to overcome workaholism, it is important to avoid using any evaluative remarks.  Communicate unconditional love and affirm the individual’s inner qualities and bravery in addressing their problem.  Express empathy to the individual regarding the stress that they are under and reassure them that they will find a way through the pressure.  Because the individual may not be aware why they are under such stress and may not be fond of self-reflection, it may be necessary to encourage them to explore what factors could be contributing to their workaholism.  In doing so, it may be helpful to move the focus from the individual to what they feel they must to in order to be accepted by others.  Reassure them that others are concerned with who the individual is, rather than what or how much they do.

 

The following action steps can be followed when helping someone to overcome workaholism:

 

1.     Assess the problem.  Determine why the individual feels the stress they do at work.  Help them to understand that workaholism is truly an addiction and that it must be treated as such.

2.     Evaluate the past.  Identify any negative massage that the individual has received regarding their self-worth.

3.     Find a balance.  Evaluate the individual’s weekly schedule and filter out any unnecessary involvements that are contributing to the individual’s addiction to working.  Encourage the individual to find a balance between work, family, and other relationships by having them “schedule” times for play and leisure.  Emphasize the importance of treating these times as a priority. Explore different ways that the individual can incorporate enjoyable activities into their schedule.

4.     Slow down.  Assist the individual in establishing a slower pace for each day.  Remind them the importance of sufficient rest, exercise, and eating right.

5.     Get support.  Encourage the individual to seek help for a group or counselor.  Remind them that all change takes time.


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Trauma: Counseling Information on Trauma and Help for Overcoming a Traumatic Event

October 20, 2008 – 5:13 pm

PORTRAITS

 

James woke suddenly in the middle of the night.  His heart was pounding in his chest and his sheets were tangled around him.  His nightmare had seemed so real that at first he couldn’t figure out where he was.  His accident has occurred years ago, but lately he had been having frequent dreams about it.

 

Ali had been in several bad relationships throughout college- usually with older men.  She is beginning to realize that her desperate need for affection from men comes from the time she watched her father walk out on her mother.  Her memory of that night and the pain she felt hasn’t faded a bit.

 

DEFINITIONS & KEY THOUGHTS

 

Trauma is considered to be any situation that shakes one to the core and is beyond their control.  Examples of trauma include childhood abuse, rape, abortion, a car accident, domestic violence, or many other types of events. 

 

Whatever the situation may be, a trauma could ultimately lead to mental disorders or even suicide.  Recovery from a trauma is often slow and commonly includes flashbacks. 

 

Traumas are able to influence people in various negative ways (i.e., making unhealthy decisions) without even being remembered.  They can overwhelm a person’s usual adaptations or coping mechanisms to life.

 

When an individual undergoes a trauma, each component of their ordinary response to danger continues to occur in an altered state for a long time after any actual danger is over.  Individuals experience profound and lasting changed in their psychological arousal, memory, cognition, and emotion.  For a long time after the trauma occurs, the individual does not feel safe.

 

Symptoms of trauma include: intense fear, panic disorders, anger, depression, loneliness, flashbacks, attachment disorders, loss of control, helplessness, and threat of annihilation.  Sometimes panic, anger, flashbacks, and anxiety contribute to an individual being diagnosed with having Post Traumatic Stress Disorder (PTSD).

 

Traumatic reactions occur when the individual is exposed to a situation that threatens the wellbeing or life of that individual or another.  In such situations when an individual is unable to either escape or resist, their system of self-defense becomes disorganized and overwhelmed. As a result, a traumatized individual becomes hyper-vigilant and behaves as if their nervous system has been disconnected from the present.

 

Traumatic memories become encoded in abnormal forms of memory that break spontaneously into one’s consciousness in the form of nightmares and flashbacks.  In such occurrences, the traumatic event is not just remembered but is completely relived.

 

Traumatic memories are not verbal linear narratives, but instead can have a frozen wordless quality.  They are deeply imprinted due to the circulation of high levels of stress hormones like adrenaline.

 

 Although deep, traumatic memories can also be suppressed.  Together the intrusion and constriction of the memory form a dynamic that doesn’t allow the individual to resolve their experience or achieve balance.

 

The following are the two major categories of trauma:

 

  1. Invasion trauma.  This type of trauma occurs when something damaging happens to an individual.  Emotional invasion occurs when and individual feels shamed, blamed, or criticized (either verbally or nonverbally).  Physical invasion occurs when an individual is physically abused or when an individual witnesses the physical abuse of another.  Sexual invasion occurs when an individual is sexually touched or penetrated in a way that disrespects their personal boundaries or leaves them feeling violated and confused. 
  2. Abandonment trauma. This type of trauma occurs when damage is created as a result of something not happening to an individual (i.e., feeling loved, nurtured, and protected).  Abandonment trauma can be more difficult to pinpoint because the individual does not know what they are missing, because they have never had it.  Emotional abandonment occurs when care, attention, nurture, love, and affirmation are not given.  The result of such abandonment trauma is profound loneliness.  Physical abandonment occurs when an individual’s basic needs for shelter, food, and clothing are not met.  Other types of physical abandonment occur when individuals are not touched enough, or do not receive enough modeling or information regarding physical self-care.  Sexual abandonment occurs when individuals are not educated or modeled healthy sexuality.  The lack of correct or adequate information can have disastrous results.

 

Note that the above categories often overlap; damage in one area of an individual’s life can have a great effect on another area.

ACTION STEPS

 

If an individual exhibits behavior that suggests past trauma that they cannot remember or attach to any event, a very lengthy treatment may be necessary for them. 

 

Although traumatic events can be quite terrible and the emotional damage caused from them can be quite overwhelming, healing is possible.  A traumatized individual will require comfort, acceptance, reassurance, and a nonjudgmental listening ear.   They must feel safe and have an understanding that they way they are feeling is completely normal for what they have been through.

 

The following action steps can help individuals to overcome trauma:

 

1.     Understand the nature of the trauma.  If it can be remembered, talk about what happened.  Do so gently and do not allow for any denial.  Although the memories are likely very painful, discuss them with honesty.  Try talking with a counselor or in a support group and choose what is right for you.  Understand that you didn’t deserve or cause what has happened to you and that depending on the type of trauma you have experienced, you may have to make some changes in your life in order to not be hurt again.

2.     Express the feelings. Express whatever your true feelings are regarding your traumatic experience.  Whether it be anger, grief, or sadness, let it out.

3.     Know that you will heal. Your healing will come with time and help.  Engage in the process of healing either through group or individual counseling.

4.     Know that you will have victory. You will not only heal from your trauma, but you will triumph over it.  Think about the positive strengths that will come out of the healing process.  Know that in time you will be able to forgive and will be set free from the pain.  Most importantly, realize that someday you will be able to help and comfort those who have experienced similar traumas.

 


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Suicide: Information on Suicide and Counseling for Suicidal Individuals

October 20, 2008 – 5:02 pm

PORTRAITS

 

Nicole got extremely drunk at a party and made a fool of herself in front of her entire high school.  She left the party, humiliated, and began thinking about each of the other stupid things she had done lately.  When she saw the glow of headlights coming up behind her, she decided to run out into the middle of the road.

 

Tony had severe diabetes and his only hope was to have his leg amputated.  The day before the surgery, he wrote a note to his family and overdosed on his pain medications.

 

Carly drove off of a bridge two days before her college graduation.  Not long after, her parents found out that she had failed all of her classes and was told that she would not be able to graduate.

 

DEFINITIONS & KEY THOUGHTS

 

Suicide is the tragic and fatal culmination of a psychological process caused by unresolved events that lead to hopelessness and depression.

 

An individual who is considering suicide in unable to see any hope that their future will be any better than their painful past of present.

 

The risk of suicide is highest within a year after a failed attempt.

 

One the norm, males are prone to utilizing more violent means for suicide than females, and are often more successful.  Females, on the other hand, seem to attempt suicide more often, but are less successful than males because they tend to utilize less lethal means. 

 

It has been found that suicide often goes hand in hand with substance abuse seeing as substances are connected to twenty to fifty percent of all suicides.

 

Those who are more at risk for suicide include those who have recently begun taking antidepressants, and those with subsiding depression. 

 

Suicidal individuals often do not see any option other than death.  They do not see the big picture and wholeheartedly believe that suicide is a reasonable thing to do.

 

Note: Any threat of suicide should always be taken seriously.

 

ACTION STEPS

 

  1. Get help immediately. Protecting the life of a suicidal individual is the most important priority.  One should not worry about embarrassing the individual by calling for help from the police or paramedics if that individual has a plan or the means to commit suicide.  Do not attempt to transport a suicidal individual to the hospital on your own- it is far too dangerous.  If the suicidal individual is under the influence of alcohol or drugs, arrange for them to be under constant supervision while they are detoxing or sobering up.  If the individual is no longer suicidal once sober, they should be encouraged to seek substance abuse treatment. 
  2. Follow up.  Check-in with the suicidal individual often after their attempt.  If their thoughts are not improving, encourage them to seek further help.

 


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Suffering: Counseling Information for Coping with and Overcoming the Consequences of Pain, Loss, or Failure

October 20, 2008 – 4:54 pm

PORTRAITS

 

Lucy just couldn’t get though the pain that began when her youngest child was killed in a car accident.  She could barely function with her other children or husband because her suffering was so intense. 

 

Jill and Bobby recent lost everything in a hurricane.  Their house was demolished on the only things them have now are the clothes on their backs, some old photographs and books, and two beds at a local shelter. 

 

DEFINITIONS & KEY TERMS

 

Suffering can occur for many reasons.  It may be the result of a personal failure, the loss of a friendship through gossip or hurtful words, or a financial situation resulting from an inability to carefully budget money.  It can also be due to another person’s failure (i.e., a drunk driver) or forces that are outside of an individual’s control (i.e., natural disaster).  Whatever the cause may be, suffering is a part of life that produces character and is common to all people.  Suffering is, however, much easier to cope with in situation when it is purposeful and when its end is in sight.

 

ACTION STEPS

 

If an individual is suffering for the consequences of a personal failure, they may also be dealing with shame and guilt.  In this situation it is important for the individual to confess their wrongdoing, to think about the lessons they have learned from it, and to come up with their own plan to more forward.

 

If an individual is suffering due to the failure of another, it is important for them to have someone to listen to their story and to help in guiding them through their pain. 

 

If an individual is suffering due to circumstances that are beyond their control, it is important for them to take small steps in handling the situation.  To take the situation on in one big chunk is way too much for anyone to handle, but in steps they will be able to get though it.

 

No matter what the cause, suffering can do three very valuable things to an individual’s life if permitted to:

 

  1. It can clarify what an individual truly cares about- especially when pain is unabated and inexplicable. 
  2. It can deepen an individual’s discontent with the wrongdoings of the world.
  3. It can motivate an individual to do good things.  It can also give rise to tenderness and solace.

 

The following are a few more action steps for those who wish to put an end to their suffering:

 

  1. Have trust and seek lessons.  Trust that good can and will come out of your suffering.  Think about what you can learn from your situation.
  2. Take small steps forward.  Think about what you can do each day to work through your pain and rebuild your life.  Consider what you must do in order to function again.
  3. Get support.   Join a support group of individuals who have faced similar pain.  They can provide you with support, encouragement, advice, help you to get through your pain, follow up with you, and help you to develop some of the plans you need to move forward with your life. 

 


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Self-Esteem Counseling: Information for Bettering Self-Esteem and Overcoming Low Self-Esteem

October 20, 2008 – 4:47 pm

PORTRAITS

 

Samantha often finds herself pressured to succumb to the sexual advances of men in fear that she will be rejected if she does not.  As a result, she has earned a reputation of promiscuity with which she is extremely frustrated and hurt by.

 

Alice is convinced that her marriage has no hope.  However, aside from her husband and children she feels that she has no purpose in life.  Her children do not respect her and her husband often tells her that without him she has nothing.

 

Jerry has lived in the shadow of his older brother for his entire life.  At the age of 18, he is applying for colleges and sees the entire process as an opportunity to win the attention of his parents.  He isn’t sure if he would even like to attend college yet and is terrified of failing or being rejected.

 

DEFINITIONS & KEY THOUGHTS

 

Self-esteem is a person’s inner sense of worth that enables them to have the resilience and resistance to personal attacks or criticism. 

 

Generally, each person has a concept of his or her self-worth (which may be either accurate or inaccurate), and self-esteem is how that person feels about or evaluates that concept.

 

Having good self-esteem does not necessary entail extreme pride or having an inflated view of one’s importance, but rather an honest and accurate evaluation of oneself.

 

Having low self-esteem, on the other hand, may entail feelings of self-hate, refusal to get close to others, feelings that one is unworthy or undeserving, feelings of incompetence, refusal to trust others, and inability to accept oneself as a unique and special human being.

 

A person’s self-esteem can be jeopardized when they allow others to assess them or to determine his or her significance and value.

 

Many times, low self-esteem stems from prolonged periods of negative feedback from others.  Such feedback can be deeply wounding and painful.  

 

The society that we live in is one that is constantly assessing our value.  Whether is be through performance evaluations at work, grades in schools, or evaluations for loans, assessment of one’s value has become a major part of life.

 

Unfortunately, often times such imposition of value is presented as a means to an end.  For example if one doesn’t make a certain grade then they won’t pass a class.  This type of value imposition is the most detrimental.

ACTION STEPS

 

There are several things that one must do along the journey to having better self-esteem.  They must correct any incorrect beliefs that they may have about their own worth or significance and get over any distortions that they may have regarding their strengths and weaknesses.  They should also work on being able to make an honest and accurate assessment of their gifts, potentials, significance, strengths, and weaknesses.  They must heal from deep relationship wounds. 

 

When helping an individual with low self-esteem it is important to help them to develop a realistic assessment of their own unique abilities, skills, and character traits; telling them untruths will not be helpful.  Last, give them hope and encourage them to see that along the journey to having better self-esteem there may be bumps, but that they should remain patient and not give up. 

 

Keep in mind these action steps along your journey to better self-esteem:

 

  1. Recognize your value.  This does not mean having an inflated ego, but rather a simple understanding of your significance.  Think about your talents, abilities, character traits, physical traits, and accomplishments that set you apart from everybody else.  Think about your negative qualities and how you can make them positive.  Identify the positive people in your life who make you feel good about being you and spend more time with them. 
  2. Stop harmful thought patterns.  Identify the thought patterns and any other factors that have stood in the way of you realizing your own true worth.  Instead, think back on all of the good things that you have done in your life no matter how small or large they may be.  Consider how they may have had a positive influence on the people around you.
  3. Begin new thought patterns.  Counter negative thoughts with honest assessments of your value. 
  4. Be patient.  It has taken years of negative thoughts to get you to the place that you are at with your self-esteem.  Healing won’t happen overnight; it will require replacing all of your bad habits with good ones and may take awhile until you automatically begin to respond to negative thinking in a proactive way.  Don’t get discouraged.  Write any of your significant breakthroughs in a journal that you can go to whenever you need reassurance of your progress.