Recovery Blog

Techniques and Elements of an Effective Trauma Counselling Session

Trauma is complex in its impacts, and therefore treatment needs to be complex as well. In a gradual way, we need to strengthen various aspects of a survivor’s well-being: emotional, physical, cognitive, spiritual and social.

Explain to clients that their symptoms are not a sign of weakness, a character flaw, being damaged, or going crazy.

Frame reexperiencing the event(s), hyperarousal, sleep disturbances, and other physical symptoms as physiological reactions to extreme stress.

Communicate that treatment and other wellness activities can improve both psychological and physiological symptoms (e.g., therapy, meditation, exercise, yoga). You may need to refer certain clients to a psychiatrist who can evaluate them and, if warranted, prescribe psycho-tropic medication to address severe symptoms.

Discuss traumatic stress symptoms and their physiological components.

The way a person reacts to trauma depends on many things, such as the type and severity of the traumatic event, the amount of available support for the person following the incident, other stressors currently being experienced in the person’s life, the existence of certain personality traits, natural levels of resilience, and whether the person has had any traumatic experiences before.

Common reactions include a range of mental, emotional, physical and behavioural responses. These reactions are normal, and, in most cases, they subside as a part of the body’s natural healing and recovery process. 

Examples of common reactions to trauma are:

  • feeling as if you are in a state of ‘high alert’ and are ‘on watch’ for anything else that might happen
  • feeling emotionally numb, as if in a state of ‘shock’
  • becoming emotional and upset
  • feeling extremely fatigued and tired
  • feeling very stressed and/or anxious
  • being very protective of others including family and friends
  • not wanting to leave a particular place for fear of ‘what might happen’

Hyperarousal

  • A common symptom that arises from traumatic experiences is hyperarousal (also called hypervigilance).
  • Hyperarousal is the body’s way of remaining prepared. It is characterized by sleep disturbances, muscle tension, and a lower threshold for startle responses and can persist years after trauma occurs.
  • Hyperarousal is a consequence of biological changes initiated by trauma.
  • Although it serves as a means of self-protection after trauma, it can be detrimental.
  • Hyperarousal can interfere with an individual’s ability to take the necessary time to assess and appropriately respond to specific input, such as loud noises or sudden movements.
  • Sometimes, hyperarousal can produce overreactions to situations perceived as dangerous when, in fact, the circumstances are safe.

Sleep Disturbance

  • Sleep disturbances are very common in individuals who have experienced trauma.
  • They can come in the form of early awakening, restless sleep, difficulty falling asleep, and nightmares.
  • Sleep disturbances are most persistent among individuals who have trauma-related stress; the disturbances sometimes remain resistant to intervention long after other traumatic stress symptoms have been successfully treated.
  • Numerous strategies are available beyond medication, including good sleep hygiene practices, cognitive rehearsals of nightmares, relaxation strategies, and nutrition.

Disrupts Daily Life

  • Traumatic experiences can affect and alter cognitions.
  • From the outset, trauma challenges the just-world or core life assumptions that help individuals navigate daily life.
  • For example, it would be difficult to leave the house in the morning if you believed that the world was not safe, that all people are dangerous, or that life holds no promise.
  • Belief that one’s efforts and intentions can protect oneself from bad things makes it less likely for an individual to perceive personal vulnerability.
  • Traumatic events—particularly if they are unexpected—can challenge such beliefs.

Impacts Your Thinking

  • Cognitive errors: Misinterpreting a current situation as dangerous because it resembles, even remotely, a previous trauma (e.g., a client overreacting to an overturned canoe in 8 inches of water, as if she and her paddle companion would drown, due to her previous experience of nearly drowning in a rip current 5 years earlier).
  • Excessive or inappropriate guilt: Attempting to make sense cognitively and gain control over a traumatic experience by assuming responsibility or possessing survivor’s guilt, because others who experienced the same trauma did not survive.
  • Idealization: Demonstrating inaccurate rationalizations, idealizations, or justifications of the perpetrator’s behavior, particularly if the perpetrator is or was a caregiver.
  • Intrusive thoughts and memories: Experiencing, without warning or desire, thoughts and memories associated with the trauma. These intrusive thoughts and memories can easily trigger strong emotional and behavioral reactions, as if the trauma was recurring in the present.
  • The intrusive thoughts and memories can come rapidly, referred to as flooding, and can be disruptive at the time of their occurrence.
  • If an individual experience a trigger, he or she may have an increase in intrusive thoughts and memories for a while.

Feeling Different

  • An integral part of experiencing trauma is feeling different from others, whether or not the trauma was an individual or group experience.
  • Traumatic experiences typically feel surreal and challenge the necessity and value of mundane activities of daily life.
  • Survivors often believe that others will not fully understand their experiences, and they may think that sharing their feelings, thoughts, and reactions related to the trauma will fall short of expectations.
  • However horrid the trauma may be, the experience of the trauma is typically profound.

Triggers

  • A trigger is a stimulus that sets off a memory of a trauma or a specific portion of a traumatic experience.
  • A trigger is any sensory reminder of the traumatic event: a noise, smell, temperature, other physical sensation, or visual scene.

Flashbacks

  • A flashback is reexperiencing a previous traumatic experience as if it were actually happening in that moment. It includes reactions that often resemble the client’s reactions during the trauma.
  • Flashback experiences are very brief and typically last only a few seconds, but the emotional aftereffects linger for hours or longer. Flashbacks are commonly initiated by a trigger, but not necessarily.
  • Sometimes, they occur out of the blue. Other times, specific physical states increase a person’s vulnerability to reexperiencing a trauma, (e.g., fatigue, high stress levels).
  • Flashbacks can feel like a brief movie scene that intrudes on the client.

Dissociation

  • Dissociation happens because the person is engaged in an automatic activity and is not paying attention to his or her immediate environment.
  • Dissociation can also occur during severe stress or trauma as a protective element whereby the individual incurs distortion of time, space, or identity.
  • This is a common symptom in traumatic stress reactions.
  • Dissociation helps distance the experience from the individual.
  • People who have experienced severe or developmental trauma may have learned to separate themselves from distress to survive.

Behaviour

  • Traumatic stress reactions vary widely; often, people engage in behaviors to manage the aftereffects, the intensity of emotions, or the distressing aspects of the traumatic experience.
  • Some people reduce tension or stress through avoidant, self-medicating (e.g., alcohol abuse), compulsive (e.g., overeating), impulsive (e.g., high-risk behaviors), and/or self-injurious behaviors.

Self-Harm and Self-Destructive Behaviours

  • Self-harm is any type of intentionally self-inflicted harm, regardless of the severity of injury or whether suicide is intended.
  • Often, self-harm is an attempt to cope with emotional or physical distress that seems overwhelming or to cope with a profound sense of dissociation or being trapped, helpless, and “damaged”

Assessment for Immediate Safety Concerns

Trauma-informed screening is an essential part of the intake evaluation and the treatment planning process, but it is not an end in itself. Screening processes can be developed that allow staff without advanced degrees or graduate-level training to conduct them, whereas assessments for trauma-related disorders require a mental health professional trained in assessment and evaluation processes. The most important domains to screen among individuals with trauma histories include:

  • Trauma-related symptoms.
  • Depressive or dissociative symptoms, sleep disturbances, and intrusive experiences.
  • Past and present mental disorders, including typically trauma-related disorders (e.g., mood disorders).
  • Severity or characteristics of a specific trauma type (e.g., forms of interpersonal violence, adverse childhood events, combat experiences).
  • Substance abuse.
  • Social support and coping styles.
  • Availability of resources.
  • Risks for self-harm, suicide, and violence.
  • Health screenings.

The assessment of harm and risk of harm is the dynamic process of gathering and analysing information to assess:

  • Past harm - harm previously experienced by a child which may have an ongoing cumulative impact
  • Current harm - being the level of harm that exists for the child in the present, including an assessment of the child’s immediate safety
  • Risk of harm - the likelihood and level of harm that may occur to the child in the future
  • Existing protective factors - factors that may mitigate against risk of harm.

People self-harm for a number of reasons, including:

  • To feel better
    Self-harm can release pent-up feelings such as anger and anxiety, or, people who feel numb use self-harm as a way to feel “something”
  • To communicate their emotional pain
    Those who self-harm for this reason will obviously display their wounds as a way of reaching out for help.
  • To feel a sense of control
    People who self-harm may feel powerless and lack self-esteem. Self-harm may be used as a way to regain control. This is particularly common for those who have suffered abuse. There is often a pronounced feeling of powerlessness, self-loathing, and an absence of self-esteem.
  • To punish themselves
    People who self-harm may lack self-esteem and think they are at fault for the way they feel.

Warning Signs

People who self-harm may:

  • appear withdrawn, or quieter or reserved than usual;
  • stop participating in their regular activities;
  • have rapid mood changes;
  • get angry or upset easily;
  • have had a significant event in their lives, e.g. a breakup with significant other;
  • suffer poor academic/school performance when they usually do very well;
  • exhibit unexplained cuts or scratches;
  • wear clothes that are inappropriate for the weather, e.g. wearing long sleeves on hot day.

What to Say            

What to say and what to do if someone you know is self-harming:

  • Ask how they are feeling.
  • Do not be judgmental.
  • Be supportive without reinforcing their behaviour.
  • Educate yourself about self-harm.
  • Acknowledge their pain.
  • Let them know you will meed to intervene and break confidentiality if there is risk of harm to self or others (this is required by law).
  • Do not avoid the subject.
  • Do not focus on the behaviour itself.
  • Encourage them to seek professional help.

Discuss the Stages of Trauma Recovery

Any event that places a person’s own life or the lives of others at risk results in the human body going into a state of heightened arousal. This is like an ‘emergency mode’ that involves a series of internal alarms being turned on. Emergency mode gives people the capacity to access a lot of energy in a short period of time to maximise the chance of survival. 

Most people only stay in emergency mode for a short period of time or until the immediate threat has passed. However, being in emergency mode uses up vital energy supplies and this is why people often feel quite tired afterwards.

The normal healing and recovery process involve the body coming down out of a state of heightened arousal. In other words, the internal alarms turn off, the high levels of energy subside, and the body re-sets itself to a normal state of balance and equilibrium. Typically, this should occur within approximately one month of the event.

It is normal to have strong emotional or physical reactions following a distressing event. On most occasions though, these reactions subside as a part of the body’s natural healing and recovery process. There are many things you can do to help cope with and recover from such an experience.

A traumatic experience is any event in life that causes a threat to our safety and potentially places our own life or the lives of others at risk. As a result, a person experiences high levels of emotional, psychological, and physical distress that temporarily disrupts their ability to function normally in day-to-day life.

Examples of potentially traumatic experiences include:

  • natural disasters, such as a bushfire or flood
  • being a victim of, or witness to, a crime, act of violence or armed robbery
  • being involved in, or witnessing, a serious car or transport accident
  • being in an airplane that is forced to make an emergency landing
  • being physically assaulted
  • being exposed to images, news reports or social media posts of these types of events.

Recovery from trauma starts with the assessment and stabilization of your physical and mental condition by a qualified expert.

As you prepare to go home, memories and feelings from the event may follow you more than you can anticipate or control. This is normal. Your care team will discuss with you all the symptoms you might experience — including scary thoughts, flashbacks, nightmares, and panic — and will provide you with resources to help you cope. 

Phase 1: Safety and Stability

Your care team will discuss with you what your ongoing needs will look like after you’re discharged. You’ll also have a pharmacist consultation to learn how any prescribed medicines, supplies or medical equipment will contribute to your recovery. To ensure your healing stays on track, it’s important to diligently follow your doctor’s orders. Be patient with yourself; you’ll need time to heal.

Psychological recovery will begin once your brain recognizes that the benign places, things, people, and environments triggering you are not true dangers and don’t warrant the same fight-or-flight response as a legitimate threat.

A mental health expert can help you navigate this first phase of trauma recovery. You’ll learn to handle overwhelming emotions, regulate feelings, and manage fears. You’ll also gain tools to reduce the temptation to turn to risky coping behaviors, such as drug and alcohol abuse. Perhaps most importantly, you’ll learn how to re-stabilize when confronted with triggers.

Phase 2: Remembering and Grieving

Once you’ve recovered your sense of safety and stability following the traumatic event, your mental health specialist will encourage you to process your trauma and acknowledge what you’ve lost. This doesn’t mean reliving the event but exploring and integrating it (rather than dissociating from it) in a safe environment.

This psychological processing often occurs in tandem with the body’s healing. Know that physical pain or setbacks might slow your mental and emotional recovery, even serving as a source of triggers. Your mental health specialist will help you navigate this process. If you need crisis help at any time, you can call our 24-hour hotline.

Phase 3: Restoring Relationships

The final stage of recovery is about empowerment. You might worry that you’ll never be the same as you were before the traumatic incident, but the trauma you endured doesn’t need to define who you are.

Your mental health specialist will help you achieve and celebrate cognitive resolution so you can come to terms with and move forward from your trauma. Depending on your readiness, they may recommend that you participate in community re-entry exercises to help you return to normal life with the guidance of rehabilitation experts.

Discuss Post-Traumatic Growth

Many people find healthy ways to cope with, respond to, and heal from trauma. Often, people automatically re-evaluate their values and redefine what is important after a trauma.

Such resilient responses include:

  • Increased bonding with family and community.
  • Redefined or increased sense of purpose and meaning.
  • Increased commitment to a personal mission.
  • Revised priorities.
  • Increased charitable giving and volunteerism.

Post-traumatic growth (PTG) can be defined as positive personal changes that result from the survivor's struggle to deal with trauma and its psychological consequences.

The process of post-traumatic growth can lead to improved relationships with others, more compassion, openness, appreciation for life, spiritual growth, personal strength, and a renewed sense of possibilities in the world.

This personal growth extends beyond pre-trauma functioning. Therefore, PTG it is not merely a bouncing back to the level of functioning prior to the trauma, but rather a sense of positive growth beyond pre-trauma functioning.

Importantly, recent research has highlighted that post-traumatic growth is not the opposite reaction to that of post-traumatic stress; rather these are two separate kinds of responses that can occur within the same person simultaneously, and over time, and that the experience of distress can actually promote the development of growth.

To evaluate whether and to what extent someone has achieved growth after a trauma, psychologists look for positive responses in five areas:

  1. Appreciation of life
  2. Relationships with others
  3. New possibilities in life
  4. Personal strength
  5. Spiritual change

Some of the ways you can take inventory of PTG is to:

Writing a Narrative

  • The trauma narrative is the client’s telling of the story of their traumatic experience(s).
  • Clients should begin by focusing on the facts – the who, what, when, and where of the experience. Next, they can add the thoughts and feelings that arose during the experience.
  • Once they are comfortable listing or describing their thoughts and feelings during the experience, they should move on to the most difficult or disturbing moments of their trauma.
  • Finally, the client should take what they have produced so far and wrap it all up and create a seamless narrative, in addition to adding a final paragraph about how they feel now, what they have learned, and if they have grown from the experience.

 Exposure

  • Imaginal exposure therapy is applied in this step, in which the client reads his or her trauma narrative and the therapist guides the client through processing of the event.
  • The therapist will then help the client explore their emotional responses and themes that came up during processing, discussing the primary feelings associated with the trauma.
  • After the session, the client has some homework – he or she will go home and set some time aside each day to process through the traumatic experience, focusing on purging the emotional aspects of it.
  • It will likely be emotionally challenging to dredge up these memories and tie some intense feelings to them, but that is where these emotions belong: with the traumatic experience that spawned them, rather than displaced onto the self or others.

Heal

  • In step three, the focus is on helping the client put the pieces back together, but in a new and stronger configuration than before.
  • The therapist will emphasize three concepts to the client:
    1. Freedom of choice – The therapist explains that, while the client did not choose to experience the trauma that led them here, they are in control of their choices going forward. The narrative therapy concept of “rewriting the ending” is discussed to help the client see that he or she can create their own path.
    2. Finding meaning from the experience – The therapist discusses how the client can find meaning in their experience, however, is appropriate and feasible for them.
  • Finally, the therapist walks the client through the transformative journey of the Hero archetype by telling stories, tying the client’s spiritual and cultural beliefs into the stories to make them more meaningful for the client. The client may benefit from hearing the many stories in which the hero undergoes significant trauma and becomes a better, stronger person from it.

 Finalize

  • The final step of the PTG involves tying up loose ends and putting the finishing touches on the reorganization of the traumatic memory.
  • The “mind as a filing cabinet” metaphor is a great one to use in this step. In this metaphor, the memory of the traumatic experience is likened to a file that is unorganized, scattered throughout the filing cabinet that is the mind. Instead of each component being neatly sorted with the others, they are separated into dozens of different folders with no rhyme or reason, making it confusing and potentially disruptive when one of them is inspected.
  • In the previous three steps, these components were identified, hunted down, and moved to the right folder, while a few new pages were added documenting the growth experienced through the process. This step finalizes the folder and files it away in the cabinet. It can be revisited in the future, but it is no longer anything more than another in the hundreds and thousands of files and folders that make up the cabinet.
  • At this point, the client is ready to move on to another disorganized file, if there is another file that is in need of reorganization.
  • Whether the therapy will continue on to another file or not, the therapist should commend the client for all of his or her hard work over the course of therapy and encourage them to continue incorporating PTGP into his or her life. The client should leave feeling empowered over their trauma and ready to move forward with a new and improved perspective on life.

Provide Psychoeducation

Therapeutic techniques such as Socratic questioning aim to help patients to become cognizant of, and to synthesize, information that they already have. However, many patients experience psychological distress because they lack critical information: the essential component of many cognitive models concerns patient’s misappraisals or misperceptions of a stimulus. In cases where patients are lacking critical information then psychoeducation (giving information) is a hugely important psychological intervention. Psychoeducation can include:

  • Information given verbally in a therapy session;
  • Written material in the form of Psychology Tools information handouts, guides, and chapters;
  • Exercises or homework tasks where patients are encouraged to discover information for themselves.

Demonstrate and Walkthrough Grounding and Containment

Grounding is a practice that can help you pull away from flashbacks, unwanted memories, and negative or challenging emotions.

These techniques may help distract you from what you’re experiencing and refocus on what’s happening in the present moment.

Grounding techniques can be utilized to anchor the mind and the body in the present moment. Building grounding skills assists with differentiating between sensations and emotional reactions triggered from past traumatic experiences.

Grounding skills increase awareness that there is safety in the present moment. An individual can anchor themselves in the present moment through the utilization of their senses such as sight, touch, taste, smell, and sound.

By utilizing the senses an individual can attempt to identify factual objects in the environment that shift one’s focus to the present moment such as counting all of the blue objects in the room 

The positive associations created during the exercise can be cued throughout the day by the use of cue words, objects, and scents. Carry objects associated with safe memories or utilizing scents that signify safety and compassion as reminders throughout the day.

If negative associations begin to develop during the use of the guided safe place imagery, distancing techniques may be utilized to regain safety during this meditation.

It is important to focus on one’s breath during this exercise to facilitate centering and relaxation. A person may imagine stressors being released during exhalation and the enhancement of good sensations when he or she is breathing in.

For some individuals listening to soothing music during this exercise can enhance a calm state and disrupt distracting thoughts from interfering.

Grounding Exercises

Put your hands in water

Focus on the water’s temperature and how it feels on your fingertips, palms, and the backs of your hands. Does it feel the same in each part of your hand? 

Use warm water first, then cold. Next, try cold water first, then warm. Does it feel different to switch from cold to warm water versus warm to cold? 

Pick up or touch items near you

Are the things you touch soft or hard? Heavy or light? Warm or cool? Focus on the texture and color of each item. Challenge yourself to think of specific colors, such as crimson, burgundy, indigo, or turquoise, instead of simply red or blue. 

Breathe deeply

Slowly inhale, then exhale. If it helps, you can say or think “in” and “out” with each breath. Feel each breath filling your lungs and note how it feels to push it back out. 

Savor a food or drink

Take small bites or sips of a food or beverage you enjoy, letting yourself fully taste each bite. Think about how it tastes and smells and the flavors that linger on your tongue.

Take a short walk

Concentrate on your steps — you can even count them. Notice the rhythm of your footsteps and how it feels to put your foot on the ground and then lift it again. 

Hold a piece of ice

What does it feel like at first? How long does it take to start melting? How does the sensation change when the ice begins to melt? 

Savor a scent

Is there a fragrance that appeals to you? This might be a cup of tea, an herb or spice, a favorite soap, or a scented candle. Inhale the fragrance slowly and deeply and try to note its qualities (sweet, spicy, sharp, citrusy, and so on). 

Move your body

Do a few exercises or stretches? You could try jumping jacks, jumping up and down, jumping rope, jogging in place, or stretching different muscle groups one by one. 

Pay attention to how your body feels with each movement and when your hands or feet touch the floor or move through the air. How does the floor feel against your feet and hands? If you jump rope, listen to the sound of the rope in the air and when it hits the ground. 

Listen to your surroundings

Take a few moments to listen to the noises around you. Do you hear birds? Dogs barking? Machinery or traffic? If you hear people talking, what are they saying? Do you recognize the language? Let the sounds wash over you and remind you where you are. 

Feel your body

You can do this sitting or standing. Focus on how your body feels from head to toe, noticing each part.

Can you feel your hair on your shoulders or forehead? Glasses on your ears or nose? The weight of your shirt on your shoulders? Do your arms feel loose or stiff at your sides? Can you feel your heartbeat? Is it rapid or steady? Does your stomach feel full, or are you hungry? Are your legs crossed, or are your feet resting on the floor? Is your back straight?

Curl your fingers and wiggle your toes. Are you barefoot or in shoes? How does the floor feel against your feet? 

Try the 5-4-3-2-1 method

Working backward from 5, use your senses to list things you notice around you. For example, you might start by listing five things you hear, then four things you see, then three things you can touch from where you’re sitting, two things you can smell, and one thing you can taste. 

Make an effort to notice the little things you might not always pay attention to, such as the color of the flecks in the carpet or the hum of your computer.

Cognitive grounding skills

Reorient yourself in place and time by asking yourself some or all of these questions:

  • Where am I?
  • What is today?
  • What is the date?
  • How old am I?
  • What season is it?
  • Who is the country’s political leader?
  • What is happening now; what is the context?

The following are examples of behaviours to use for reorientation to place and time:

  • Pick up a newspaper or pull up the daily newspaper on your browser. Notice the date and read a current article.
  • Call a friend and ask the person to talk with you about something you have done together recently.
  • Step outside and determine the temperature. Is it warm? Is the sun shining? Is there a cold breeze? What season is it?

Sensory Awareness Grounding

  • Spritz your face (with eyes closed), neck, arms and hands with a fine water mister.
  • Put your feet firmly on the ground.
  • Listen to soothing music or familiar music you can sing along to. Dance to it. How does it make your body feel?
  • Rub your palms; clap your hands. Listen to the sound. Feel the sensation.
  • Hold something that you find comforting. It may be a stuffed animal, a blanket or a favourite sweater. Notice how it feels in your hands. Is it hard or soft?
  • Carry something meaningful and tangible in your pocket that reminds you of the present. Touch it to remind yourself that you are an adult.
  • Try to notice where you are and your surroundings, including the people present. If you have a pet, touch its fur and speak its name out loud.
    Ride a bike, stationary or otherwise. Lift weights. Do jumping jacks.

Containment Exercises

traumatic event represents a breakdown in containment where both the internal and external containers have been damaged.

Containment exercises provide a way to separate one’s self from painful, intense emotions until they can be processed in the safety of the therapeutic relationship. The purpose of containment is to help an individual regain control of emotions by creating the freedom to choose when and where these emotions will be processed.

Containment is a way of practicing more control over your thoughts and feelings. When people feel they have more control over what they think about and what they feel, they are more content. The skill takes lots of practice, so keep trying and don’t give up!

Shelve It

When a thought intrudes on what you are doing or trying to concentrate on, imagine you are pushing it aside or “shelving it” for later. You can tell yourself, “I’m not working on that right now. I am working on this. I will come back to that other issue later.”

The Container

Containment can be achieved by thinking of an actual container that is large and strong enough to hold painful emotions and memories. This exercise is enhanced by remembering that the container can only be opened when it is safe to do so.
Imagine a container that is big enough and the right shape to hold a problem or a pain that you are having. This container should close tightly when you want it to close. What size is the container? What shape? What color? Does it have a lock?

Imagine that you are putting your problem or your pain into this container. Make sure it all goes in there. When you are ready, close the container tightly. Lock it if you need to. You may have to do this several times before you feel that the problem is put away, and then you can move on to something else.

If you like, you can send your container to Deity for help with the problem.

Remember that you can open the container when you need to deal with the problem, and you can

use a real container if you need to...with objects, writings, photos, etc. inside.

Let Go for Now

Imagine that you are somewhere safe and comfortable, and you are very relaxed.

To clear your mind of worries, imagine that you can see something moving past you, on which you

can place your worries or thoughts and let them go for now. For instance, you could be lying on your back looking at the clouds in the sky, and as a cloud floats by you place your problem on the cloud and let it float away, then the next problem on the next cloud, etc. You may have to do this several times before you feel more in control.

The Train

As thoughts or emotions enter your consciousness, imagine you are sitting on a hillside watching a train, and these thoughts and emotions are cars on the train. You can notice them and let them go by. 2. The important thing is NOT TO GET ON THE TRAIN. The idea is to notice your thoughts and feelings without participating in them or intensifying them. 

Assist Client to Develop a Self-Care Plan

Aspects of self-care

Self-care is a personal matter. Everyone’s approach will be different. It relates to what you do at work and outside of work to look after your holistic wellbeing so that you can meet your personal and professional commitment. Below are the different aspects to self-care and example strategies that other people have found useful:

  • Workplace or professional
  • Physical
  • Psychological
  • Emotional
  • Spiritual
  • Relationships.

NOTE: The activities and suggestions below are a guide only and it is important to choose activities that are meaningful to yourself and your own goals.

After discovering the different aspects of self-care, complete the self-care plan activity below.

Workplace or professional self-care

This involves activities that help you to work consistently at the professional level expected of you. For example:

  • engage in regular supervision or consulting with a more experienced colleague
  • set up a peer-support group
  • be strict with boundaries between clients/students and staff
  • read professional journals
  • attend professional development programs.

Physical self-care

Activities that help you to stay fit and healthy, and with enough energy to get through your work and personal commitments.

  • Develop a regular sleep routine.
  • Aim for a healthy diet.
  • Take lunch breaks.
  • Go for a walk at lunchtime.
  • Take your dog for a walk after work.
  • Use your sick leave.
  • Get some exercise before/after work regularly.

Psychological self-care

Activities that help you to feel clear-headed and able to intellectually engage with the professional challenges that are found in your work and personal life.

  • Keep a reflective journal.
  • Seek and engage in external supervision or regularly consult with a more experienced colleague.
  • Engage with a non-work hobby.
  • Turn off your email and work phone outside of work hours.
  • Make time for relaxation.
  • Make time to engage with positive friends and family.

Emotional self-care

Allowing yourself to safely experience your full range of emotions.

  • Develop friendships that are supportive.
  • Write three good things that you did each day.
  • Play a sport and have a coffee together after training.
  • Go to the movies or do something else you enjoy.
  • Keep meeting with your parents' group or other social group.
  • Talk to you friend about how you are coping with work and life demands.

Spiritual self-care

This involves having a sense of perspective beyond the day-to-day of life.

  • Engage in reflective practices like meditation.
  • Go on bush walks.
  • Go to church/mosque/temple.
  • Do yoga.
  • Reflect with a close friend for support.

Relationship self-care

This is about maintaining healthy, supportive relationships, and ensuring you have diversity in your relationships so that you are not only connected to work people.

  • Prioritise close relationships in your life e.g. with partners, family and children.
  • Attend the special events of your family and friends.
  • Arrive to work and leave on time every day.

Create your own self-care plan

For each category above, select at least one strategy or activity that you can undertake. You might notice areas of overlap between these categories. It is important to develop a self-care plan that is holistic and individual to you.

  • Fill your self-care plan with activities that you enjoy and that support your wellbeing. 
  • Keep this in a place where you can see it every day. Keeping it visible will help you to think about and commit to the strategies in your plan. You can also share it with your supervisor, colleagues’ friends and family so they can support you in your actions.
  • Stick to your plan and practice the activities regularly. Just like an athlete doesn’t become fit by merely ‘thinking’ about fitness, as a worker you can’t expect to perform effectively without putting into practice a holistic plan for your wellbeing.

Re-assess how you are going at the end of one month and then three months. Plans can take over a month to become habits, so check-in and be realistic about your own self-care plan. After a while, come back and complete the self-care assessment again to find out how you are going with your new habits.

A word of caution

Once you have created a self-care plan it is important to ask yourself, “what might get in the way?” What can you do to remove these barriers? If you can’t remove them, you might want to adjust your strategies. Think honestly about whether any of your strategies are negative and how you can adjust your plan to avoid or minimise their impact.

It can be challenging if your workplace is not supportive of self-care activities, but you can still do things outside of work to help yourself. It is import that your plan resonates for you and that you put it in to action starting now.

 


If You're A Mental Health Professional Develop Your Self-Care Plan

Helping yourself first is a principle that applies directly to counselling. Counsellors who neglect their own mental, physical and spiritual self-care eventually run out of ’oxygen’ and cannot effectively help their clients because all of their energy is going out to the clients and nothing is coming back in to replenish the counsellors’ energy.

Although most counsellors are familiar with self-care, many find it a challenge to put the concept into practice in their own lives. Wellness experts say as life gets busy, counsellors may tend to assume that they can, or even should, handle problems and stress on their own. But, these experts caution, counsellors who ignore their own needs will find their outlook on the profession going quickly downhill.

Here are some suggestions about how to take care of yourself when you are counselling others.

Healthy Eating

One important way to maintain and enhance your physical health is through healthy eating. The USDA's Center for Nutrition Policy and Promotion has prepared recommendations based on the most current research to help you evaluate and improve your food choices. Check out the Dietary Guidelines for Americans website's current dietary guidelines.

Physical Fitness and Immunity

Getting regular physical exercise and taking steps to protect yourself from contracting colds and flu bugs are fundamental aspects of self-care. 

Tips for Increasing Physical Activity(100 KB) includes ideas for boosting your overall level of physical activity as well as incorporating exercise into your daily routine.

Strengthen Your Immune System(144 KB) offers pointers to keep your immune system strong and your body healthy.

Reducing Stress

There are many ways to begin reducing your stress and some of them only take a few moments. Look over the suggestions in Some Simple Ways to Relieve Stress(73 KB) to see if there is something you can do right now (and do it!) and also make a note of the other activities you can incorporate into your daily life from now on. For specific suggestions on how to lower stress while you are at work try 21 Ways to Reduce Stress During the Workday(117 KB).

Another technique that some people employ to deal with their stress is to try to understand and address the factors that contribute to it. Practicing Stress Journaling(97 KB) can be useful in this regard.

Time Management

One of the most common complaints associated with feelings of stress is, “There isn't enough time!” Use the tips provided in Time Management(152 KB) to help you prioritize and schedule your time, set goals, and end procrastination.

Relaxation

Learning how to relax is vital for self-care. Fortunately, there are a number of well-developed techniques you can use. Step-by-step instructions on how to use progressive muscle relaxation and visual imagery to ease tension and increase relaxation are included in Effective Methods for Relaxation(537 KB). For other ways to achieve (or return to) a more peaceful state, check out the exercises described in Energy Management For Care Providers(106 KB) and Creating Your Special Place(100 KB). Additional techniques you might consider are yoga, Tai Chi, and massage – for online resources and local practitioners consult the Online and Other Self-Care Resources webpage.

Mindfulness

When we feel stressed and overburdened, it can often seem like we’re living on “autopilot,” disconnected from the here-and-now and our present experience. One remedy for this is mindfulness, which involves direct and nonjudgmental awareness of the present moment. You may have heard of mindfulness as a form of meditation, but it can also be a general orientation to your own experience. “When you are mindful, you are awake to life on its terms – fully alive to each moment as it arrives, as it is, and as it ends” (Sanderson, nd). For an introduction to how you can become more mindful, read through Mindfulness(170 KB) and learn mindful breathing.(110 KB) As with many of the materials listed in this section, these materials may be helpful for your clients as well.

Avoiding Compassion Fatigue

Compassion fatigue can develop from a combination of burnout (feelings of hopelessness and difficulties at work or in doing your job effectively) and secondary or vicarious traumatization (from exposure to the traumatic life experiences that your clients report). Check out Ways to Avoid Compassion Fatigue(81 KB) for key elements to enhance your resilience in the workplace.

Assertiveness

Learning to be assertive (rather than unassertive or aggressive) is a tremendously important skill for your emotional well-being – one that can positively impact your life both personally and professionally. Assertiveness enables direct and honest communication and important boundary setting, and it can address some of the situations that add to feelings of stress. Read over Assertiveness and Nonassertiveness(142 KB) to begin to learn and practice the skills.

Be Good to Yourself

Much of what we have described in these Student Self-Care webpages (and more), is summed up on a handy single page, Tips for Vitality and Serenity(82 KB). Check it out (and keep it handy), and be good to yourself!

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