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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
This comprehensive counseling tool kit for stress management provides clinicians with hundreds of client exercises and activities. Representing a variety of therapeutic approaches, this workbook offers creative techniques for helping clients handle traditional concerns, including anxiety, depression, anger, and grief in addition to heightened present-day issues, such as natural and human-made disasters, the misuse of social media, political divisiveness, social injustice, and mass shootings and other violence.
Drs. Muratori and Haynes give their personal and professional perspectives on successfully working with clients therapeutically and also invite a number of expert clinicians to share their experiences and exercises they have used that have been effective with clients. The final section of the workbook presents strategies for counselor self-care and client life after counseling.
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Table of Contents
Cover
Title Page
Copyright Page
Dedication
Foreword
Preface
About the Authors
About the Contributors
Acknowledgments
Downloadable Materials (for clients)
Part I: Introduction and Central Role of Resilience
Chapter 1: Introduction
Need for and Purpose of the Workbook
The New Normal
Stress and Resilience in Troubled Times
Organization of This Workbook
Contributors to This Workbook
Therapeutic Homework
Research on Therapeutic Homework Compliance
About the Workbook Activities
Ethical Considerations in the Use of Out-of-Session Activities
Instructions and Suggestions for Using Workbook Exercises and Activities
Conclusion
Chapter 2: Cultivating Client Resilience
For Counselors
Ordinary People Do Extraordinary Things and Demonstrate Resilience
Cultural Issues and Resilience
What We Have Learned About Helping Others Therapeutically
The Counselor’s Task With Clients
Notes
For Clients
Developing Resilience in One’s Life
How Does Resilience Work in Your Life?
What Are the Characteristics of Resilient Individuals?
Workbook Material for the Client
Exercises and Activities
Part II: Addressing Common Mental Health Issues
Scope of the Problem
Chapter 3: Anxiety and Stress
For Counselors
What We Have Learned About Helping Others Therapeutically
The Counselor’s Task With Clients
For Clients
Anxiety and Stress
Defining Stress and Anxiety
What Can We Do About Our Stress and Anxiety?
Workbook Material for the Client
Exercises and Activities
Chapter 4: Depression and Loneliness
For Counselors
What We Have Learned About Helping Others Therapeutically
The Counselor’s Task With Clients
Notes
For Clients
Dealing With Depression and Loneliness
What Are Some Things I Can Do Today?
Workbook Material for the Client
Exercises and Activities
Chapter 5: Anger
For Counselors
What We Have Learned About Helping Others Therapeutically
The Counselor’s Task With Clients
Notes
For Clients
Dealing With Anger in Your Life
What Is Anger?
Early Messages About Anger and Conflict
How Can You Better Manage Your Anger?
Workbook Material for the Client
Exercises and Activities
Chapter 6: Self-Esteem
For Counselors
What We Have Learned About Helping Others Therapeutically
The Counselor’s Task With Clients
Notes
For Clients
Strengthening Your Self-Esteem
Beatles Wisdom
What Is Self-Esteem?
Enhancing Your Self-Esteem One Choice at a Time
Workbook Material for the Client
Exercises and Activities
Chapter 7: Grief and Loss
For Counselors
Multicultural Issues and Grief
What We Have Learned About Helping Others Therapeutically
The Counselor’s Task With Clients
For Clients
Dealing With Grief and Loss
Workbook Material for the Client
Exercises and Activities
Part III: Coping With Trauma, Disaster, and Adversity
Scope of the Problem
The Specialty of Disaster Mental Health Counseling
Multiculturalism in Crisis and Disaster Counseling
Trauma and Its Impact on the Brain
Chapter 8: Individual Response to Trauma, Disaster, and Adversity
For Counselors
Cognitive, Emotional, and Behavioral Components of Reacting to a Crisis
What We Have Learned About Helping Clients Therapeutically
One Counselor’s Experience as a Disaster Counselor
The Impact of Trauma on a Community
The Counselor’s Task With Clients
Notes
For Clients
How People React to a Disaster
Workbook Material for the Client
Exercises and Activities
Chapter 9: Trauma Recovery and Posttraumatic Growth
For Counselors
Assessing Clients’ Needs During Recovery
What We Have Learned About Helping Clients Therapeutically
The Counselor’s Task With Clients
Notes
For Clients
Recovering From a Disaster or Trauma
Key Steps in Recovering From a Crisis Event
The New Stress of Climate Change
Workbook Material for Clients
Exercises and Activities
Chapter 10: Coping With Chronic Illness and Health Issues
For Counselors
What We Have Learned About Helping Clients Therapeutically
The Counselor’s Task With Clients
For Clients
The Crisis of Chronic Illness and Other Health Issues
Workbook Material for the Client
Exercises and Activities
Part IV: Emerging Crises and Intensifying Stressors
The Unraveling of Civil Society in America
Scope of the Problem
Chapter 11: Political Differences, Value Conflicts, and Tribalism
For Counselors
Divided We Stand
What We Have Learned About Helping Others Therapeutically
The Counselor’s Task With Clients
For Clients
Dealing With Political Differences, Value Conflicts, and Tribalism
The Stress of Living in Polarizing Times
Suggestions for Coping With Political Differences, Value Conflicts, and Tribalism
Workbook Material for the Client
Exercises and Activities
Chapter 12: Social Injustice Against Marginalized Groups
For Counselors
What We Have Learned About Helping Others Therapeutically
Learning What We Don’t Know and Leaning Into Discomfort
Counseling Marginalized Clients in a Changing World
The Counselor’s Task With Clients
For Clients
Social Injustice Against Marginalized Groups
Suggestions for Coping With Social Injustice
Workbook Material for the Client
Exercises and Activities
Chapter 13: Forces of Social Media and Technology
For Counselors
What We Have Learned About Helping Others Therapeutically
Individual- and System-Level Interventions
The Counselor’s Task With Clients
For Clients
Forces of Social Media and Technology
Technology: For Better or For Worse
Suggestions for Coping With Forces of Social Media and Technology
Workbook Material for the Client
Exercises and Activities
Part V: Going Forward: Counselor Self-Care and Client Life After Counseling
Chapter 14: Compassion Fatigue, Vicarious Traumatization, and Burnout
For Counselors
Counselors in Pain: The Self-Care Paradox
Scope of the Problem: Burnout, Counselor Impairment, Fatigue Syndromes, and Vicarious Traumatization
Mitigating the Effects of Stress and Bolstering Resilience Through Self-Care
Exercises and Activities
Chapter 15: Preparing Clients for Life After Counseling
For Counselors
Saying Goodbye and Parting Ways: Ending the Therapeutic Journey
Exercises and Activities
For Clients
Exercises and Activities
Recommended Resources for Clients
References
Appendix A: Additional Exercises for Common Mental Health Issues
Appendix B: Internet Resources for Counselors
Technical Support
End User License Agreement
List of Illustrations
Chapter 7
Figure 7.1 Square Breathing
Guide
Cover
Table of Contents
Begin Reading
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Michelle Muratori
Robert Haynes
Coping Skills for a Stressful World
A Workbook for Counselors and Clients
6101 Stevenson Avenue, Suite 600Alexandria, VA 22304www.counseling.org
Copyright © 2020 by the American Counseling Association. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.
American Counseling Association6101 Stevenson Avenue, Suite 600Alexandria, VA 22304
Associate Publisher • Carolyn C. Baker
Digital and Print Development Editor • Nancy Driver
Senior Production Manager • Bonny E. Gaston
Copy Editor • Kay Mikel
Cover and text design by Bonny E. Gaston
Library of Congress Cataloging-in-Publication Data
Names: Muratori, Michelle C., 1965–author. | Haynes, Robert (Robert L.), 1945–author.Title: Coping skills for a stressful world : A workbook for counselors and clients / Michelle Muratori, Robert Haynes.Description: Alexandria, VA : American Counseling Association, [2020] | Includes bibliographical references.Identifiers: LCCN 2019053885 | ISBN 9781556203893 (paperback)Subjects: LCSH: Life skills. | Stress management. | Therapist and patient.Classification: LCC HQ2037 .M87 2020 | DDC 646.7—dc23LC record available at https://lccn.loc.gov/2019053885
Dedication
To clients who are struggling to navigate and make sense of these troubled times, and to their counselors who are braving the journey with them.
• • •
Foreword
Emerging crises have ruptured our nation along lines of ethnicity, race, sexual orientation, gender identity, social class, culture, religion, values, partisanship, and more. Those seeking counseling report an increase in the stress and anxiety associated with these crises. Coauthors Michelle Muratori and Bob Haynes have written a workbook unlike any other in the field, providing a comprehensive toolkit to assist counselors as they work with clients coping with both traditional and emerging crises and stressors. This uniquely focused workbook provides narrative material for counselors and clients along with a comprehensive assortment of exercises and activities for out-of-session work to further enhance and facilitate a client’s counseling experience.
This workbook addresses these topics and many others in a user-friendly and practical way for both counselors and clients. Here are some key features:
Practical exercises and activities for clients to reflect on, to explore, and to practice outside the counseling session are a basic part of most chapters.
Each topical chapter contains a
narrative overview for the counselor
. The authors share what they have learned about working therapeutically with themes in the lives of clients.
Chapters contain practical
narrative information for clients
to explain the concepts they are working on in counseling (such as depression or coping with crisis) and to provide the basis for the exercises.
The client sections in the workbook may be freely photocopied and given to clients for their work outside of the counseling session.
A separate chapter addresses counselor compassion fatigue, burnout, and vicarious trauma, which can result from working with trauma victims, and focuses on self-care exercises and activities to enhance counselors’ wellness.
This is a practical toolbox for counselors. Counselors are free to adapt the exercises and activities to meet the needs of their clients, which affords increased flexibility and creativity. Clients have the opportunity to carefully consider their pressing concerns, and the exercises and activities will actively engage clients in self-reflection and guide them in practicing new skills beyond the counseling session. Many of the common reasons clients seek counseling are addressed in this workbook, and the importance of developing resilience and focusing on wellness are emphasized.
Counselors providing brief therapy can use the out-of-session activities to enable clients to extend their work into daily life. In addition, client feedback from these activities will provide significant material for counselors to explore with their clients at the next session. This can only make the counseling endeavor more effective and efficient for both client and counselor.
We have not seen a workbook that offers narrative for counselors, narrative for clients, and exercises and activities for clients for such a large range of counseling topics. In addition, the authors address the newly emerging topics facing our country, our culture, and our clients. The exercises and activities tie nicely into the narrative discussions, and they reflect a variety of theoretical perspectives.
A unique feature is the contributions by experts in the counseling and psychology fields, who share their experience with exercises and activities they have found effective in their work with clients. These experts describe a variety of exercises and activities pertinent to reality therapy, pain management, trauma recovery, and activities for hospice clients, just to name a few.
Michelle and Bob bring their varied clinical backgrounds to the development of this workbook. They are deeply concerned about the human cost of recent divisive trends across American society and around the world today, which are making clients’ lives increasingly more stressful. They have written a timely book that provides counselors with tools to help their clients navigate these stressful times. This team has combined their abilities and years of professional experience to produce a top-quality practical guide for counselors and their clients.
—Marianne Schneider Corey, MA
—Gerald Corey, EdD
Preface
We are writing this workbook to aid counseling clients living in a world in distress. People are experiencing “global anxiety” at levels rarely, if ever, seen before. Our world is increasingly plagued by political upheaval, divisiveness and tribalism, interpersonal violence, hate crimes, terrorism, social injustice, the omnipresence of social media, cybercrimes, and speed-of-light news cycles bombarding our televisions, computers, and smartphones. In addition, the tangible effects of climate change are increasing the size and severity of natural disasters. The 2018 Camp Fire, the most destructive wildfire in California history, caused 86 deaths, led to the evacuation of 52,000 people, destroyed more than 18,000 structures, and left an estimated 100,000 people traumatized by the event, the losses, and the aftermath. In 2019, California experienced the two largest earthquakes in 20 years (of magnitudes 6.4 and 7.1, respectively) within the span of 2 days that set off nearly constant aftershocks for weeks and caused widespread damage. Although lives were spared, these massive quakes left people terrified, anxious, and afraid to sleep in their homes. In recent years, catastrophic storms and hurricanes have caused widespread devastation from Maine to Florida and throughout the states along the Gulf of Mexico. Hurricanes Harvey, Maria, and Dorian damaged the environment in addition to destroying homes and businesses. The loss of life from these and other natural disasters are painful reminders of our vulnerability and our limits as human beings.
Tragedies of a different sort—those that are self-inflicted—have also spiked in recent times. According to the Centers for Disease Control and Prevention (2019), death from alcohol, drugs, and suicide in the United States in 2017 hit the highest level since 1999, the year these statistics were first collected. Counselors are seeing an increase in the number of clients who report living in a state of hypervigilance, suspicion, and distrust (Meyers, 2017). As the frequency and intensity of these forces and events increase, a growing number of clients will need the support and direction of counseling and therapy to deal with these crises and resultant long-term stress.
Our hope is that this workbook will support counselors in working with clients who must navigate these stressful times. The primary focus of this workbook is twofold: (a) to assist counselors and therapists by providing materials to use with clients experiencing this increase in global anxiety and stress; and (b) to assist clients in exploring, understanding, and managing crises and stressors in their lives. We wanted to create a counselor- and client-friendly workbook for use as a clinical tool in counseling sessions and for subsequent client homework. We include material to assist counselors in the counseling process and homework material for the client, such as therapeutic activities and exercises that can be completed in or between sessions. This counseling toolbox can greatly enhance the therapy experience and facilitate the work of counselor and client.
We offer our personal and professional perspectives throughout and include a fair amount of scholarly literature to support our claims. In the narrative sections, we share some of our own stories and discuss what we have learned about working with clients therapeutically. We also have invited a number of clinicians to share their experiences with the use of therapeutic exercises and activities in counseling to give you multiple perspectives on using this clinical tool.
We recommend that counselors read through the entire workbook to become familiar with the content and the sections you might most want to make use of in counseling. Exercises and activities represent a variety of theoretical and therapeutic approaches and reflect the wide-ranging needs of clients. Some exercises are preceded by narrative to further explain the concepts addressed by the exercises; others are straightforward and can be easily grasped. Counselors have our permission and that of the publisher to copy the client material to give to your client, and you also have permission to adapt any exercises as you see fit to better meet the unique needs of your clients. We discuss the ethical issues applicable to the utilization of such tools with clients in Chapter 1 and offer guidelines for assigning these activities. We hope this workbook will prove to be a practical and valuable clinical resource in your library of professional books and literature.
About the Authors
Michelle Muratori, PhD, is a senior counselor at the Center for Talented Youth at Johns Hopkins University, in Baltimore, Maryland, where she works with highly gifted middle school and high school students who participate in the Study of Exceptional Talent and their families. She earned her MA in counseling psychology from Northwestern University in Evanston, Illinois, and her PhD in counselor education from the University of Iowa, where she developed her research and clinical interests in gifted education. Her graduate research on the academic, social, and emotional adjustment of young college entrants earned her recognition from the Iowa Talented and Gifted Association, the National Association for Gifted Children, and the Mensa Education and Research Foundation and Mensa International, Ltd. At the University of Iowa, Michelle also earned the Howard R. Jones Achievement Award, the Albert Hood Promising Scholar Award, and the First in the Nation in Education Scholar Award.
Since 2005, Michelle has been a faculty associate in the Johns Hopkins School of Education and teaches courses in the master of science in counseling program. In 2014, she was honored with the Johns Hopkins University Alumni Association Excellence in Teaching Award. Michelle regularly presents at national conferences in counseling and gifted education and is a member of the American Counseling Association, the Association for Counselor Education and Supervision, the Association for Specialists in Group Work, the Maryland Counseling Association, and the National Association for Gifted Children. When not engaged in these professional activities, Michelle enjoys writing, attending concerts, watching late-night comedy shows and movies, and spending time with her family and friends.
Michelle’s publications include:
Counselor Self-Care
(2018), with Gerald Corey, Jude T. Austin II, and Julius A. Austin, published by the American Counseling Association.
I Never Knew I Had a Choice
(11th ed., 2018), with Gerald Corey and Marianne Schneider Corey, published by Cengage Learning.
Clinical Supervision in the Helping Professions
(3rd ed., 2021), with Gerald Corey, Robert Haynes, and Patrice Moulton, published by the American Counseling Association.
Early Entrance to College: A Guide to Success
(2007), published by Prufrock Press.
• • •
Robert Haynes, PhD, is a clinical psychologist, author, and producer of psychology video programs for Borderline Productions. Bob received his doctorate in clinical psychology from Fuller Graduate School of Psychology in Pasadena, California, and is a member of the American Counseling Associ ation and the Association for Counselor Education and Supervision. He has been actively involved in professional psychology through private practice as well as consulting, leading workshops, and writing on a variety of topics. In addition, Bob taught psychology, criminology, and management courses at the University of California at Santa Barbara, California Polytechnic State University San Luis Obispo, and California State University Sacramento. He also served as Chair of Site Visiting Teams for the Committee on Accreditation of the American Psychological Association. Bob retired after 25 years as training director of the accredited clinical psychology internship program at Atascadero State Hospital in California.
The topic of stress and crisis management has been a focal point in Bob’s professional career, and he led stress debriefings and taught stress management classes for more than 20 years. Bob has also provided consultation and training in clinical supervision, criminology, disaster mental health, psychotherapy methods, stress management and burnout, suicide assessment and intervention, and theoretical approaches in counseling.
Bob’s publications include:
Managing Crisis: Personally and Professionally. (2021). Chapter 14 in M. S. Corey & G. Corey,
Becoming a Helper
(8th ed.), published by Cengage Learning.
Take Control of Life’s Crises Today! A Practical Guide
. (2014), published by Aventine Press.
Clinical Supervision in the Helping Professions: A Practical Guide
(2nd ed., 2010), with G. Corey, P. Moulton, & M. Muratori, published by American Counseling Association.
Bob has produced a number of psychology training videos in collaboration with Marianne Schneider Corey and Gerald Corey, including Groups in Action: Evolution and Challenges (2006); Ethics in Action, Student Version CD-ROM (2003); and The Art of Integrative Counseling (2001).
• • •
About the Contributors
Jude T. Austin II, PhD,
assistant professor at University of Mary Hardin-Baylor, Belton, Texas.
Julius A. Austin, PhD,
clinical therapist, coordinator of the Office of Substance Abuse and Recovery at Tulane University, New Orleans, Louisiana.
Gerald Corey, EdD,
author and professor emeritus of human services and counseling at California State University, Fullerton.
Marianne Schneider Corey, MA,
author, licensed marriage and family therapist, and consultant.
Gary Haynes, MA,
retired high school science teacher and former volunteer at Saddleback Memorial Hospital in Mission Viejo, California.
Kellie Nicole Kirksey, PhD,
holistic psychotherapist and certified rehabilitation counselor, Cleveland Clinic Center for Integrative and Lifestyle Medicine.
Crissa S. Markow, MSW,
project director, Volunteer Programs, Sandford Center for Aging, University of Nevada, Reno.
Mark A. Stebnicki, PhD,
professor and coordinator of the Military and Trauma Counseling Certificate, Department of Addictions and Rehabilitation, East Carolina University, Greenville, North Carolina.
Judy Van Der Wende, PhD,
licensed psychologist in private practice, Simi Valley, California.
Robert E. Wubbolding, EdD,
director of the Center for Reality Therapy in Cincinnati and professor emeritus of counseling at Xavier University.
Acknowledgments
This workbook is the result of the collaboration among the authors, guest contributors, reviewers, publisher, editorial staff, and many others who provided valuable input along the way. We would like to thank Jerry Corey and Marianne Schneider Corey, who provided so much to the development and writing of this workbook as reviewers, consultants, and contributors. We also thank those who provided feedback and guidance: Cheryl Haynes, Gary Haynes, Crissa Markow, Jennifer Sullivan, Sage Sullivan, and the peer reviewers.
This workbook has been made possible by the American Counseling Association and the support, guidance, consultation, and editorial wisdom of Carolyn Baker, ACA’s associate publisher. We also truly appreciate the attention to detail and the editorial excellence provided by Kay Mikel, our copy editor. This project would not have been possible without the expertise and guidance of the superb editorial team of Carolyn and Kay.
Finally, a heartfelt thank you to those who took the time to share their professional and personal experiences as contributors to this workbook.
Downloadable Materials (for clients)
Exercise and Activity Worksheets are available for download. To find out how to access and download these worksheets, please visit the website: www.wiley.com/go/Muratori/CopingSkills
Part IIntroduction and Central Role of Resilience
In Part I you will find foundational materials that set the tone for subsequent parts. Chapter 1 provides a road map for navigating the workbook, offering a rationale for and an overview of the workbook as well as practical tips for using the exercises and activities. One of our overarching goals is to help clients develop greater resilience in an increasingly stressful world, and Chapter 2 is devoted to the topic of resilience. It begins with a brief discussion of the concept of resilience and includes an explanation of resilience especially for clients. The chapter concludes with a series of client activities, exercises, and questions designed to be a catalyst for clients as they explore a variety of topics and issues related to resilience.
Chapter 1Introduction
Reality is the leading cause of stress among those in touch with it.
— Lily Tomlin
• • •
Coping Skills for a Stressful World: A Workbook for Counselors and Clients is a clinical tool designed for counselors and other mental health practitioners who are looking for exercises and activities that can assist clients struggling with stress and other mental health concerns related to or exacerbated by the stressful times in which we are living. The materials in this workbook can be photocopied and assigned to clients as therapeutic homework and subsequently discussed or processed in session. We have included concrete tools to facilitate productive therapeutic work, and it is our hope that this resource will enhance the therapeutic process with your clients and make your job easier and more efficient.
This chapter is primarily addressed to the counselors, therapists, and other mental health practitioners working in any number of professional settings. We provide our rationale for creating the workbook along with suggestions for how to get the most out of it. We describe how we came to collaborate on this project and the disturbing trends we both see unfolding in society that undoubtedly add to the stress levels of clients and the counselors who serve them. We describe the organization of the workbook, offer information about therapeutic homework compliance, and discuss relevant ethical issues in the use of out-of-session activities. We conclude with instructions and guidelines for using the out-of-session exercises with clients, and we encourage you to refer to this section as often as needed.
Need for and Purpose of the Workbook
Our goal is to provide tools for counselors to use in assisting their clients in navigating stressful situations they encounter in daily life. We emphasize building upon the internal resources clients possess. Clients tend to be much more resilient than they think they are, and they often find strength and creative solutions to the challenges they face even in problem-saturated stories. Most people have some degree of resilience upon which they can build.
Stories of resilience inspire and instill hope in us, but the truth is that people are not all equally resilient. As a mental health professional, you may serve individuals who are fragile or vulnerable (to varying degrees) and who may lack the social support to respond to adversity in a resilient manner. After all, clients tend to seek the support of a therapist when they are having difficulty coping with their circumstances— not when they are handling life’s stressors effectively and with ease. We believe resilience is a much-needed skill in today’s stressful world. American society is fractured along lines of ethnicity, race, sexual orientation, gender identity, social class, culture, religion, values, and partisanship, and the mental health needs of clients will continue to grow in these divisive times. A driving force behind our decision to collaborate on this workbook was the need to create a resource that would assist clients in developing or strengthening their resilience.
The New Normal
We live in a global community, and we can expect to hear about misfortunes occurring virtually anywhere and at any time. Sometimes this news hits close to home, and other times the news is happening halfway around the world. Within the span of a single day, we may hear stories about the effects of climate change and severe weather events that wreak havoc; crises affecting immigrants, asylum seekers, the LGBTQ+ community, people of color, women, or other vulnerable or marginalized groups; mass casualty tragedies caused by gun violence; terrorist plots carried out or foiled; and accusations of sexual misconduct. To make matters worse, all of these news stories arrive against the backdrop of a constant barrage of “breaking news” about political developments. Disturbing trends have gained momentum in the United States and around the world: an increase of neo-fascism/authoritarianism, cybercrimes, terrorism, hate, racism, xenophobia, homophobia, bullying/cyberbullying, misogyny, and other oppressive forces. It is not an exaggeration to say that it is almost impossible to keep up with the news today. Our exposure to stressful news and information is continuous through the proliferation of social media platforms and 24-hour news channels. Everyday living has become exponentially more stressful in today’s world. This is the new normal.
Stress and Resilience in Troubled Times
In today’s stressful world, an increasing number of clients will need support in dealing with crises and long-term stress. A recent American Psychological Association (APA, 2017b) survey about the state of stress in the United States found that Americans are stressed about the future of the nation. Some 59% of adults surveyed indicated that they find this to be “the lowest point in our nation’s history that they can remember—a feeling that spans generations, including individuals who have lived through World War II and Vietnam, the Cuban missile crisis, the September 11 terrorist attacks, and high-profile mass shootings” (p. 1). A Gallup poll found that 55% of Americans experience stress throughout much of their day, compared to 35% globally, and 45% reported worrying a lot about their lives (Chokshi, 2019). Meyers (2017) noted that counselors are seeing a huge increase in the number of clients who report living in a state of hypervigilance, suspicion, and distrust. One counselor reported that the negative emotional climate in the country—filled with revenge, resentment, and hatred—is harming people’s mental health (Meyers, 2017). Others have said that “America is suffering a nervous breakdown” (Frances, 2017). The polarization occurring in our nation, in geographical and online communities, and even in families is exacerbating and causing stress, anxiety, isolation, loneliness, anger, and loss for many people. Based on our conversations with friends and colleagues in the mental health field, we suspect that clinicians may also be vulnerable to heightened stress when listening for hours each week to distressed clients, particularly those who might hold sharply different values and views on certain “hot button” political topics.
Some counselors may feel discouraged and even overwhelmed by the magnitude of their clients’ stress and mental health issues coupled with their own stress navigating this polarized and chaotic world. If you fall into this category, it is important to remember that we are also witnessing heroic actions and have reason to feel hopeful. It would be remiss to downplay the positive and selfless actions individuals and groups have taken to defend our hard-earned rights. We have seen advocacy and humanity at its finest. In response to oppressive and discriminatory practices and policies affecting marginalized groups, advocacy groups and ordinary citizens have taken swift action in opposition to such restrictions, demonstrating a new level of social activism. The Me Too (or #MeToo) movement has gained visibility and traction worldwide in response to sexual harassment and assault, and it provides a platform for survivors of abuse to voice their pain and to demand justice.
In the past few years, large-scale protests have been organized to defend human rights and to give voice to the voiceless and those who have been marginalized. “Grounded in the nonviolent ideology of the Civil Rights movement, the Women’s March [January 21, 2017] was the largest coordinated protest in U.S. history and one of the largest in world history” (Meyer & Tarrow, 2018, p. 1). Marches, protests, and rallies varying in size and scope have raised awareness of issues ranging from the gun violence epidemic and unjust immigration policies and practices to the protection of the environment and of science itself.
In addition to these widely publicized displays of social activism, we witness smaller acts of kindness and courage on a daily basis that remind us that there is hope for humanity. Paradoxically, as vulnerable as people may be in stressful times, we repeatedly see their capacity for resilience, and we must hold on to that. The nearly miraculous rescue of members of a youth soccer team trapped in a cave in Thailand in July 2018 is a prime example of courage and heroism, the will to survive, and resilience (Suhartono & Paddock, 2018). Many examples of resilience have been described throughout history, and many more challenging and stressful situations will test people’s hardiness, resourcefulness, resilience, and ability to cope in the future.
Organization of This Workbook
This workbook is divided into five parts, each focusing on a central theme. The first section introduces the workbook format and explains the concept of resilience. The next three sections focus primarily on client issues (e.g., anxiety, depression, self-esteem, crisis and trauma, and emerging issues of divisiveness, hatred, and tribalism) and provide counselors with an overview of each issue followed by a variety of exercises, activities, and therapeutic homework assignments intended for clients. The final section looks forward and focuses on self-care for counselors and life after counseling for clients.
Part I
,
“Introduction and Central Role of Resilience,” sets the tone for the remainder of the book and includes suggestions for maximizing the use of exercises and activities for clients and ethical issues to consider in the use of homework for clients.
Chapter 2
provides critical information about fostering resilience in clients as well as exercises and activities for your clients.
Part II
,
“Addressing Common Mental Health Issues,” contains therapeutic exercises and activities for clients battling anxiety and stress, depression and loneliness, anger, self-esteem issues, and grief and loss. These mental health issues tend to be rooted in intrapersonal or interpersonal conflicts, and similar material may be found in other counseling workbooks. We thought it essential to include this content because clients who are able to strengthen or improve their mental health functioning are likely to fare much better when facing external crises.
Part III
,
“Coping With Trauma, Disaster, and Adversity,” addresses a variety of topics disaster mental health practitioners and crisis counselors routinely encounter. We include exercises for clients coping with natural disasters, climate change, and other environmental issues, as well as human-caused disasters such as mass shootings and terrorism. Material for clients coping with chronic illness and health problems is also included here.
Part IV
, “Emerging Crises and Intensifying Stressors,” taps into themes such as navigating sharp political differences with family and friends, value conflicts with others, and tribalism in modern society. It also addresses the timely topic of combating social injustice against marginalized groups, such as people of color, immigrants, and the LGBTQ+ population, issues that appear to be rampant in today’s world. Although racism, xenophobia, and homophobia have persisted for a very long time and may seem to be too deeply entrenched in society to be considered “emerging,” we argue that these injustices have intensified and deserve to be included here. In addition to offering activities for clients who are facing these stressors, we provide exercises for clients dealing with stress associated with the use of social media and technology.
Part V
,
“Going Forward: Counselor Self-Care and Client Life After Counseling,” has reflective activities and exercises for counselors who serve clients burdened by stress and trauma. We recognize that the ever-growing demands placed on counseling professionals may put counselors at greater risk of vicarious traumatization, compassion and empathy fatigue, and burnout. Although counselor self-care is not the primary focus of the workbook, its importance underlies the theme and purpose of the workbook and makes it complete. The final chapter prepares clients for life after counseling and offers tips and strategies for incorporating self-care into their everyday lives.
Appendix A
provides additional client exercises applicable to a wide range of issues and problems. We encourage counselors to review this resource along with the exercises at the end of chapters.
Appendix B
provides an annotated list of online resources for counselors who want to expand their knowledge on topics and themes we have presented. Collectively, these resources provide a wealth of information that may support clients who not only are dealing with mental health issues but also are struggling with legal issues, marginalization and social injustice issues, and the effects of environmental and public health issues.
Contributors to This Workbook
A unique feature of this workbook is the inclusion of contributions by other counselors and mental health practitioners from a wide range of professional backgrounds who share exercises, activities, and therapeutic homework assignments that have been especially useful and effective in their clinical practice with clients under stress or in crisis. The contributors’ writings are sprinkled throughout the workbook and provide homework ideas these practitioners have used and how those ideas worked out for them. Contributors, along with their credentials, are listed in the front of the book.
Therapeutic Homework
Like many counselors and other helping professionals, you may be overextended and may welcome tools and therapeutic activities for clients in distress that will make your job a bit easier. The practical exercises in this workbook can be incorporated into the treatment plans of clients experiencing crisis, and they may be especially appealing if you have limited time to devote to treatment planning. These exercises are intended to assist clients in continuing their therapeutic work outside of counseling sessions, thereby expediting the counseling process. Having clients think about and work outside the counseling session will accelerate their work in session. It will facilitate the therapeutic process by assisting them in further exploring and conceptualizing the various issues discussed in therapy, which may help to generate options for remediation. As noted by Trask, Barounis, Carlisle, Garland, and Aarons (2018), “therapeutic homework is a fundamental skill-building component of the majority of evidence-based therapies and is associated with better treatment outcomes” (p. 821). In a meta-analysis comparing the effectiveness of the same therapy with and without the use of homework, Kazantzis, Whittington, and Dattilio (2010) found that approximately 62% of clients in therapy who did homework improved, compared to 38% of clients who received the same therapy without homework.
Research on Therapeutic Homework Compliance
Perhaps you have encountered client resistance to doing homework. Do any of these excuses sound familiar? “I didn’t get around to it last week.” “Oh, it slipped my mind.” “My dog ate it.” (Actually, my [Michelle’s] dog once chewed off a sizable chunk of a counseling textbook. It can happen!) Research has demonstrated the value of therapeutic homework for clients (e.g., Kazantzis et al., 2010; Miller 2010; Trask et al., 2018); however, clinicians often wonder how best to motivate their clients to follow through and complete (or at least make significant progress toward completing) out-of-session tasks. Miller (2010) notes that questions remain about the factors that influence client commitment and action. Assuming the client finds the therapeutic homework recommendation acceptable (i.e., appropriate for the problem, fair, reasonable, and nonintrusive), a number of factors may affect whether or not the client implements a suggested exercise or activity. The severity of a client’s symptoms may play a role in determining compliance. One group of investigators speculated that “symptom severity acts as a motivator to comply with whatever call to action is suggested by the therapist. The client may perceive the homework as a way to gain control of symptoms or to be actively engaged in symptom relief efforts” (Scheel, Hanson, & Razzhavaikina, 2004, p. 47). However, a client’s psychopathology has the potential to “deprive the client of the energy and willingness to act on the therapist’s recommendation” (p. 47). Client factors such as personality characteristics may be linked to homework compliance, but more empirical research is needed before any conclusions can be reached. It does seem likely that therapeutic homework completion would be enhanced by assessing the client’s readiness for change (Prochaska & DiClemente, 1982) using motivational interviewing techniques or other methods.
Therapist factors and client perceptions of therapists are also likely to have an impact on whether or not clients follow through on therapeutic homework. A study conducted by Weck, Richtberg, Esch, Höfling, and Stangier (2013) showed that “therapist competence in reviewing homework was significantly correlated with patient homework compliance” (p. 169). Another team of researchers showed that clients’ perceptions of their therapist’s empathy also affects whether a client is amenable to completing homework tasks between sessions. Those who rated their therapists as more empathic reported significantly higher levels of subsequent homework compliance than clients who perceived the same therapist as less empathic (Hara, Aviram, Constantino, Westra, & Antony, 2017). Lenehan, Deane, Wolstencroft, and Kelly (2019) also emphasized the importance of establishing a strong working alliance and the therapist’s ability to ensure that therapeutic homework tasks are well aligned with clients’ treatment goals.
About the Workbook Activities
We offer exercises (in most chapters and in Appendix A) that can help clients strengthen their coping resources in a multitude of ways. Some exercises focus on the power of using metaphors, humor, or the expressive arts to reframe one’s circumstances; others draw on the principles of mindfulness, cognitive restructuring, or emotion regulation to reduce stress and improve functioning.
As you will see, the exercises and activities in the workbook are inspired by and reflect a variety of theoretical perspectives. Therapeutic homework is not confined to a single theoretical orientation; it is now widely regarded as a legitimate practice for psychotherapy in general. To provide counselors with a more comprehensive toolkit of exercises that meet the needs of diverse clients who have experienced unique stressors ranging in severity and duration, offering activities that vary theoretically and afford flexibility and an array of options seems imperative. Clients have different needs and concerns, and they respond well to different methods and interventions. The activities we offer may:
Promote deep reflection and the exploration of unfinished business from one’s family of origin (psychodynamic approaches).
Assist clients in identifying cognitive distortions and promote cognitive restructuring or the disputation of irrational or inaccurate beliefs with the aid of rational emotive behavior therapy and cognitive therapy (REBT and CT).
Draw from the principles of third-wave cognitive behavioral therapies such as dialectical behavior therapy or acceptance and commitment therapy (DBT and ACT).
Guide clients through Wubbolding’s WDEP model and help them prepare a plan for reducing their stress (reality therapy).
Assist clients in resolving their ambivalence about change during stressful times with the aid of motivational interviewing (MI) techniques.
Help clients deconstruct a problem-saturated narrative and reauthor their story in a more constructive way (narrative therapy).
Aid clients in reframing their circumstances through the lens of gender socialization and empower them (feminist therapy).
Tap into clients’ creativity as a therapeutic resource through the use of poetry, music, and other artistic mediums (expressive arts therapy).
Empower clients to generate solutions to their problems by looking for exceptions to the maladaptive ways they have reacted to stress and build on them (solution-focused brief therapy).
Help clients engage in social action as one avenue for addressing adversity and oppression (social justice and multicultural counseling).
These workbook exercises and activities can, and should, be modified to meet the individual needs of clients and not be used in a “cookie cutter” fashion. You have our permission to photocopy any of the For Clients materials or create exercises of your own that are inspired by the activities we suggest. These activities are designed to be a tool to augment your clinical work, and they must be selected judiciously based on your professional wisdom and training. Ultimately, you must rely on your clinical judgment to determine whether any exercise or activity is appropriate to use with a particular client.
Ethical Considerations in the Use of Out-of-Session Activities
We believe it is essential to address the ethical issues surrounding the use of therapeutic out-of-session activities in counseling. We asked Marianne Schneider Corey and Gerald Corey, who have written extensively on the topic of ethics in the helping professions (Corey & Corey, 2021; Corey, Corey, & Corey, 2019), to address this topic.
Ethical Issues in Using Out-of-Session Exercises and Activities
Marianne Schneider Corey and Gerald Corey
Exercises and activities used outside of the therapy session can yield many benefits, but ethical considerations in utilizing them effectively and ethically should be addressed prior to their use. In this piece, we provide guidelines for counselors who want to ask their clients to engage in activities outside of the therapy sessions. If you use out-of-session activities, you certainly need to be competent in employing and monitoring these activities. Our hope is that you will have personally experienced any activities and exercises you expect clients to carry out. It is not enough simply to read about therapeutic activities; practicing them and reflecting on their value is of paramount importance.
It is an ethical imperative that you have a theoretical rationale for introducing activities to clients. Not only do you need to know why you are suggesting an exercise, but you also need to explain in simple language why you are inviting clients to practice activities out of sessions. Activities should not be used in a mechanical fashion or without considering the needs of each individual. In short, activities that are a part of this workbook must be customized to fit the goals and needs of each client. It is key for counselors to tailor out-of-session activities to a client’s specific problems. These activities need to be geared to what clients hope to achieve, not necessarily what the counselor deems meaningful.
Your relationship with your clients provides the foundation for implementing these activities. It is necessary to prepare and orient your clients to the therapeutic value of exercises and activities that you will collaboratively design with your clients. We find that we need to be mindful that we are not the experts when it comes to the goals of our clients. We have expertise in applying knowledge and skills to assist clients in reaching their life goals, but clients are the experts in terms of knowing who they are and what they want. We do our best to enlist our clients as therapeutic partners and to create a collaborative approach to counseling. Homework is not simply assigned; rather, it is discussed during the therapy hour with the aim of helping clients achieve what they want in life. If the therapist merely gives homework assignments to clients, they are less likely to implement the tasks out of session than if they are involved in making decisions about how they can become actively engaged beyond the therapy office. Clients are more likely to implement the assignments in daily life if they are involved in the process of creating their own assignments. It might be useful to ask clients to think about activities they can carry out between sessions as a way of summarizing the highlights of each therapy session.
Clients are more inclined to practice out-of-session activities if they can see how doing so will move them closer to achieving their goals. The emphasis always needs to be on the client’s agenda, not the counselor’s agenda for the client. Assignments are best designed collaboratively with the client toward the end of a therapy session and reflect topics that were explored in that session. Follow up is crucial, and a good way to begin a session is by inquiring about the experience of doing (or not doing) the homework. If clients do not complete their homework, it is not helpful to criticize or blame them; rather, the lack of completion of activities provides material for discussion: What got in the way of carrying out the assignment? Is the assignment congruent with the client’s personal goals? If clients complete their assignment, they can be asked questions such as these: What was helpful about the out-of-session activity? What was learned from doing the assignment? What challenges were involved in completing the homework?
We need to keep in mind that some activities and exercises can be counterproductive if applied to clients under certain circumstances. For example, some interventions in the therapy office, and in daily life as well, may bring up intense emotions. Activities that are likely to arouse intense emotions need to be assessed carefully to ensure that they are not misused. Encouraging clients to “get out their anger” by pounding on a sofa cushion can boomerang and be somewhat harmful to some clients. Care needs to be used in working with clients with a background of trauma. Exercises or activities used primarily to assist clients in reliving traumatic events can result in retraumatizing them. Clients are sometimes encouraged to carry work into their daily life that was initiated during a therapy session. For example, during a counseling session a client might have explored her hurt and anger toward a parent who failed to provide compassion and caring. The client may have lingering resentment toward the parent for withholding love, and this resentment can be interfering with present-day relationships. Therapists often suggest that these clients write a letter to the parent expressing this hurt and saying what they wish had transpired. These letters have symbolic value through the process of simply writing them and venting feelings that have been suppressed. It is not necessary that these letters be given to the parents; indeed, caution is needed in giving letters such as this to parents. Cultural factors need to be considered in deciding what to do with letters that are drafted as part of therapeutic homework. In some cultures, if adult children were to express painful feelings about the way they were reared or about their early childhood experiences, the outcome could be a source of division within the family. The result could certainly be anything but therapeutic. Giving a letter that was written in emotional circumstances needs to be carefully assessed, and the risks need to be discussed in a therapy session with the client.
Individuals in therapy are sometimes asked to interview members of their family of origin about the family processes or family history. Out-of-session exercises in which clients are encouraged to interview selected family members and the extended family can be viewed as intrusive and be the source of intense conflict. Before such activities are assigned, certain cautions and guidelines need to be addressed in the therapy office. In all cases, feedback from clients who carry out activities between sessions is of the utmost importance. Therapists need to provide a rationale for their clients about the value of the practice of giving regular feedback about their experience during the therapy session. Clients need to understand how their feedback on any activities they are doing outside of the therapy sessions is useful and a necessary part of the therapeutic process.
• • •
We suggest some additional recommendations regarding ethics:
Practice within your area of expertise and competency even with the use of out-of-session activities and exercises.
Therapeutic homework exercises should be described to clients as supplementary to counseling, and not a substitute for counseling.
As a part of the informed consent process, discuss fully with your clients how the activities and exercises will be utilized in counseling and how they can benefit from out-of-session tasks.
Allow clients to opt out of using exercises should they so desire.
Discuss possible adverse reactions to completing the activities and exercises. Reflecting on stressful or upsetting themes may trigger some clients (e.g., those who have not processed their trauma), so use your best clinical judgment in evaluating which exercises to assign and whether or not to modify them for any particular client. Be on the lookout for adverse reactions (e.g., stress, anxiety, depression, repressed memories) and intervene accordingly.
Empower clients to determine whether or not they want to complete an exercise if they start working on one and become overwhelmed or triggered. If they report back to you that they stopped working on the exercise because it increased their distress, be sure to praise them for exercising good judgment and for taking care of themselves. Processing this experience may be more therapeutic and valuable than the exercise itself.
The written responses are the property of the client. Clients have the right to share their responses with whomever they choose (remember, you are bound by confidentiality—clients are not). However, it may not be in their best interest to discuss their out-of-session work with others. Discuss with clients the pros and cons of sharing such information with others before this homework is assigned.
Discuss with clients how their written responses will be maintained to protect their privacyWould the client prefer that they be returned to you for safekeeping? Kept at home or stored on their computer or in the Cloud? Where will they be most secure? These are all issues to discuss with the client.
For more on legal and ethical issues including those of informed consent, see Wheeler and Bertram (2019).
It is essential to keep all relevant ethical issues in mind throughout the counseling process and ensure that activities and exercises are only used in the best interests of the client.
Instructions and Suggestions for Using Workbook Exercises and Activities
Richardson, Richards, and Barkham (2010) found that self-help materials have the potential to provide a valuable aid to counseling but that they should be used in conjunction with guidance and support from mental health workers. We agree wholeheartedly. To practice responsibly and ethically, practitioners must make a concerted effort to match the intervention strategies they use, including therapeutic homework assignments, to the unique needs and characteristics of the client. It is also important to strive for coherence between the goals of treatment and therapeutic homework tasks (Lenehan et al., 2019). We anticipate that clients will benefit most from doing selected activities if they have the space and time to process their reactions to them within the context of a supportive and healing therapeutic relationship. Some of these exercises may evoke powerful emotions and reactions that need to be worked through in therapy.
