The healthy tree: a metaphorical perspective of counselor well-being.

Counseling is a risky and rewarding business. While counseling invites mental health counselors to participate with their clients in the awesome process of human growth and healing, it also may threaten their well being through exposure to their clients' trauma and its painful consequences. The authors present a metaphor of a healthy tree to organize an overview of recent research regarding the risk and protective factors of vicarious traumatization of counselors. Implications for the practice, supervision, and management of counseling are presented.

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In the epilogue of his book concerning burnout prevention, Skovholt (2001), aptly compared the well-functioning counselor to a healthy vibrant tree. His analogy suggested that just as a tree must take in sunlight, water, carbon dioxide, and withstand external stressors ranging from pruning to insects, so too, must the counselor work hard at staying healthy. Extending his metaphor, this brief review of the literature regarding vicarious traumatization suggests that what keeps the counselor healthy and well-functioning are the vibrant branches of professional and personal activities, the nurturing soil of professional and personal relationships, and the deep roots of professional and personal ideology, as depicted in Figure 1.

[FIGURE 1 OMITTED]

Before exploring what makes us strong, it may be helpful to discuss the difficulties that threaten to weaken and impair counselors. Much attention has been focused in the literature on the stressors that impact counselors throughout their career (e.g., Figley, 1995; Stramm, 1999; Lerias & Byrne, 2003). Like the dangers to our metaphorical tree, the stressors for counselors are many and varied. From the leaf mites of managed care to the lightening bolt of a malpractice suit, the professional dangers loom large. It is beyond the scope of this article to address all facets of the various stressors inherent in the counseling profession and their impact on the lives and careers of mental health counselors. Rather, it is our intention to focus on the specifics surrounding what is known thus far about vicarious traumatization and the counselor's role in its prevention and development. According to Pearlman and MacIan (1995), vicarious traumatization refers to "the transformation that occurs within the therapist (or other trauma worker) as a result of empathic engagement with clients' trauma experiences and their sequelae" (p. 558). These researchers stated that "vicarious traumatization implies changes in the therapist's enduring ways of experiencing self, others, and the world" (p. 558). Essentially, through the development of empathic relationships with traumatized clients, some therapists themselves may become traumatized. The impact of this traumatization is not limited to the therapeutic environment and may trickle into other aspects of the therapist's life. Understanding vicarious traumatization is essential in order to assess those at risk, promote protective factors, treat those who are already suffering from its impact, and protect clients from enduring further, albeit unintended, trauma at the hands of impacted counselors.

Previous research has identified various symptoms associated with vicarious traumatization. Schauber and Frazier (1995) found the impact on counselors of working with adult sexual abuse survivors to include professional difficulties such as: problems managing therapy (including maintaining boundaries, setting limits, and premature termination), difficulty dealing with clients' negative emotions, and problems with systemic issues such as the legal system and insurance payments. In addition Schauber and Frazier (1995) found the respondents in their study to report such personal difficulties as negative changes in their beliefs about the world and increased negative emotion including anger and fear. Other empirical investigations have found vicarious traumatization to be associated with avoidance reactions (Weiss, Marmar, Metzler & Ronfeldt, 1995); increased social isolation, anger, anxiety, and sadness (Sexton, 1999); and intrusive thoughts and self-doubt (Pearlman & MacIan, 1995).

The consequences of vicarious traumatization on affected counselors and the lives of their clients were summarized by Trippany, Kress, and Wilcoxon (2004), in their review article. They stated that vicarious traumatization alters basic psychological needs, such as those for safety, trust in self and others, esteem for self and others, intimacy, and control. Such drastic changes in one's view of the world, self, and other people are related to the counselor's existential and spiritual beliefs, and thus vicarious traumatization may have a devastating impact upon the very foundation of one's life. They asserted that, "without a sense of meaning, counselors may become cynical, nihilistic, withdrawn, emotionally numb, hopeless, and outraged" (p. 35). Just as certain parasites and insects can erode the internal structure of a seemingly healthy tree, so too, can vicarious traumatization leave the counselor with a sense of emptiness and profound loss. The potential impact of vicarious traumatization on the counselor's relationship with clients was also discussed by Trippany and her colleagues (2004). Applying what the research has suggested are the consequent symptoms associated with vicarious traumatization to the counselor's professional behavior, they warned of the potential for clinical error, therapeutic impasse, countertransference issues, and counselor irritability.

INTERNAL AND EXTERNAL PARASITES

Researchers investigating risk factors have suggested that there are certain counselor-centered and environment-centered variables associated with vicarious traumatization. Individual factors that have been identified as increasing one's risk for the development of vicarious traumatization include the following: having a personal history of trauma (Pearlman & MacIan, 1995); having a history of psychiatric disturbances (Brewin, Andrews & Valentine, 2000); suffering from current life stress, being female, being younger (Weiss, Marmar, Metzler, & Ronfeldt, 1995) and having less professional experience and training (Pearlman & MacIan, 1995). Thus, the counselor, like our metaphorical tree, is more at risk as a sapling or if in previous seasons it has been infected by disease or parasites that have weakened its system. The erosion within the trunk of an infected tree created by internal parasites will, over a period of time, make the tree susceptible to other diseases and may lead to its eventual demise. Similarly, the individual risk factors associated with vicarious traumatization may increase counselor vulnerability over time.

In addition to individual risk factors, researchers have suggested particular environmental variables that may increase one's probability of vicarious traumatization. Included among these lists of factors are as follows: high levels of empathic engagement with traumatized clients, high degrees of severity in the traumas being discussed, lack of social support, feelings of helplessness in relation to the clients' traumatic experiences (Lerias & Byrne, 2003), high amounts of exposure to graphic details of the traumas, role playing the traumatic experiences during therapy; successive sessions with traumatized clients, large caseloads of sexual abuse survivors (especially for female clinicians), working with children who have been victimized (Brady, Guy, Polestra, & Brokaw, 1999), and working in clinical settings (Pearlman & MacIan, 1995). As leaf mites devour, drought starves, and air pollution suffocates, the previously hearty tree begins to weaken and bend under the enormous environmental strain. Also, the counselor may feel that these environmental burdens and struggle to stand strong. The counselor does not face these stressors without professional and personal assets, however. While both internal and external forces may deplete the counselor, individual resources may renew and protect the counselor's personal and professional vigor.

VIBRANT BRANCHES

Prudent nursery owners will not only want to know what will put their trees at risk, they will want to know the factors that are associated with those trees that stay healthy. In particular, it is useful in the nursery to know which positive factors are controllable. Likewise, the research has identified protective factors in the area of vicarious traumatization. Factors that have been demonstrated to be associated with protection from vicarious traumatization include implementing self-care strategies, focusing on positive aspects of working with trauma survivors, and having strong spiritual foundations (Brady et al., 1999); having greater experience as a trauma therapist (Kramen-Kahn & Hansen, 1998; Pearlman & MacIan, 1995); working in a supportive environment (Eidelson, D'Alessio, & Eidelson, 2003); having a sense of personal autonomy and avoiding over-identification with clients (Miller, 1998). These factors may form a defensive barrier, mediating the impact of trauma work, just as a tree's branches and leaves are the first line of defense against disease, infestation, and environmental toxins.

Self-care is one way in which counselors can exert influence upon their environment and potentially minimize the risks associated with conducting trauma therapy. Included in the myriad of self-care behaviors are the following: maintaining one's sense of humor and objectivity, engaging in leisure and physical activities, seeking out social support, consulting with supervisors and colleagues regarding difficult cases, continuing one's education, and attending personal therapy (Brady et al., 1999; Kramen-Kahn & Hansen, 1998; Trippany et al., 2004). Such self-care behaviors are viewed not only in relation to their mitigating influence upon vicarious traumatization, but also as important components in maintaining a high quality of care for trauma survivors (Brady et al., 1999).

Like vibrant branches that allow the tree to take in sunlight and breathe, personal and professional activities of counselors may promote health and wellness, foster resilience, and protect the counselor from the negative effects of vicarious traumatization. If the trunk of the tree represents the counselor's personal and professional identity or self schema (Pearlman & Mac Ian, 1995; Trippany, Kress, & Wilcoxon, 2004), then its branches are professional and personal activities. These branches originate from the trunk of identity, impact the environment and return nourishment to the tree. The branches that are professional in nature may vary in focus and significance. The large branches, representative of the mental health counselor's primary practice, may include such variables as nature of their clients and their presenting problems. The occasional professional activities in which the counselor is involved such as preparing and delivering a talk or attending a conference may be represented by the small twigs of the tree. According to Norcross (2000), these divergent activities are essential to counselor well being and are necessary components in one's repertoire of self-care behaviors. In regard to effective self-care strategies and the importance of diversification within one's professional life, Norcross stated:

   In extrapolating from the empirical research on psychotherapist
   self-care and from mental health professionals' writings on
   self-renewal, I discern a recurring theme: the diversity and
   synergy of professional activities. The diversity is grounded in
   conducting multiple forms of therapy (e.g., individual,
   couples/family, group therapy), engaging in multiple activities
   (e.g., psychotherapy, assessment, research, teaching, supervision,
   consultation), working with multiple types of patients and problems
   (e.g., age, ethnicity, disorders), and balancing professional
   responsibilities with personal needs (p. 712).

Consequently, while one's varied professional branches strengthen and protect the counselor, they must also blend together with the branches of personal activities to create and maintain a delicate balance. From parenting to hobbies, from homemaking to vacations, from physical exercise to rest, from socializing with friends to quiet meditation, these personal branches both energize and, at times, exhaust. Empirical studies of coping behavior (Follette, Polusny, & Millbeck, 1994; Pearlman, 1999) provide data that supports the importance of varied branches in the counselor's personal and professional life. Trippany et al. (2004) asserted that maintaining a balance between one's personal life and professional life is essential in maintaining one's self-schema and minimizing the negative impact of vicarious traumatization. Likewise, Kramen-Kahn and Hansen (1998) suggested that, "practicing what we, as clinicians, often preach to clients about prioritizing leisure activities will help create a renewing balance between work and play" (p. 133). They went on to urge those who train and supervise counselors not to assume that their students or supervisees will simply develop these essential self-care strategies. Rather, an emphasis on balance, time management skills, and the development of a broad range of self-care behaviors should be implemented within training and continuing education programs.

THE RICH SOIL

Just as the medium for the growth of the tree is the soil in which the seed is sown, so also, the environment of relationships in which the counselor functions determines the birth, growth, and health of the counselor's career and professional identity. According to Anne Roe's system of occupational classification (1957), one's early familial relationships will influence one's adult career choice. Specifically, Roe and Lunneborg (1990) found evidence that people in service or helping professions, such as counseling, are oriented toward people. This orientation is likely to be related to their early childhood experience and home environment. Other researchers have since argued similar points. In an intensive study of the essential qualities of 10 "master therapists," Jennings and Skovholt (1999) stated, "in their families of origin, many respondents developed skills of listening, observing, and caring for the welfare of others" (p. 7). A recent study supported the positive relation between counselor trainees' perceptions of their own early familial relationships and ratings of their warmth and sociability in counseling (Trusty, Skowron, Watts, & Parrillo, 2004).

Beyond the impact of interpersonal relationships on the choice of counseling careers and their counseling skills, interpersonal relationships, both professional and personal may sustain, renew, and enrich the counselor. A common thread woven throughout the self-care literature involves the importance of relationships--both professional and personal. Social support networks include family, friends, and significant others in one's personal life, and colleagues, peers, supervisors, and professional organizations within one's professional environment. According to Witmer and Young (1996), each support network forms a barrier against the counselor's stresses, thus providing protection from possible impairment. In an empirical investigation of counselor occupational stress, Sowa and May (1994) found that counselors who perceive themselves to have high levels of occupational stress reported significantly less self-care and recreational behaviors than those counselors reporting lower levels of occupational stress. Lerias and Byrne (2003) in their review of empirical studies of vicarious traumatization found that social support was a significant factor in the counselor's adjustment to trauma. They concluded that social support is a "critical predictor of adjustment ... Those with less social support tend to have more severe distress symptoms" (p. 134).

However, while one's personal support system is essential in maintaining wellness, Witmer and Young (1996) suggested that the stresses involved with being a counselor could negatively impact these indispensable personal relationships. They pointed out the irony that the work of the counselor threatens the personal support system that serves as a buffer for the stress of that work. Additionally, Skovholt (2001) indicated that while confidentiality is an essential aspect of the counseling profession, it can create a sense of separation from one's personal support network. Specifically, the counselor "is unable to share the successes, failures, frustrations, and confusion of work outside of the professional context; therefore, the value of social support, connection, and understanding as ways to reduce work stress gets greatly compromised" (p. 91).

While it is apparent that developing one's personal support network is an essential factor in avoiding vicarious traumatization, the literature suggests that it is not sufficient. Mental health counselors must also create and sustain professional support networks on which they can depend. In an ideal work environment, colleagues and supervisors are available to discuss cases within the framework of legal and ethical considerations of client confidentiality. Such professional consultation and support assists counselors in understanding and helping both the clients and themselves (Brady et al., 1999; Trippany et al., 2004). Skovholt (2001) discussed the importance of professional relationships in protecting counselors against the inherent stresses involved in this line of work, thus ensuring wellness and enabling professional growth. Skovholt asserted that receiving social support from coworkers, supervisors, and mentors, in addition to simultaneously providing professional social support to others, is critical to creating a balanced work environment and maintaining professional health (2001).

THE DEEP ROOTS

The vibrant branches of our metaphorical tree are sustained by the rich soil, in which lays a less visible, but essential root system. The roots allow both stability in the wind and nurturance during drought. In counselors, too, it is the root system of personal meaning and professional theory that grounds and sustains, nurtures, supports, stabilizes, and protects the counselor. Within the counselor's personal life, the root system includes one's spirituality and one's related sense of hope. On the professional level, one's theories of personality and counseling regarding people and the nature of change are the deep roots that enable the counselor to stand tall in the face of adverse conditions, thus providing protection against vicarious traumatization.

Research indicates that while vicarious traumatization can impact negatively one's sense of spirituality and existential meaning, the risk of vicarious traumatization seems to be lessened when a counselor has a strong spiritual foundation (Brady et al., 1999; Sherwin, Elliot, Frank, Hanson, & Hoffman, 1992). On a daily basis, trauma counselors are faced with clients whose stories detail a range of atrocities and inhumane behavior. From childhood sexual abuse to spousal abuse, from terrorist attacks to natural disasters, from horrific accidents to planned suicides, counselors are often confronting the dark side of human nature while attempting to assist devastated clients to pick up the pieces of their lives. Skovholt (2001) asserted that a strong spiritual base can be an unending source of support and strength in light of the oftentimes demoralizing work of a counselor.

Accordingly, he suggested, "An active spiritual or religious life can help the practitioner search for meaning and understanding of these painful human realities seen at work on a daily basis" (p. 162). Bolstering this argument, Jennings and Skovholt (1999) indicated that among "master therapists," spirituality is an important method of sustaining and nurturing one's emotional health.

Related to the importance of the counselor's existential or spiritual beliefs is maintaining a sense of hope, which is an expectation of positive outcome that is built on the belief in one's own ability to initiate and sustain positive change and the flexibility to generate alternatives to reach one's goal (Snyder, 1994). Empirical research has demonstrated that dispositional hope buffers the impact of traumatic events on primary victims (Elliott, Witty, Herrick, & Hoffman, 1991; Irving, Telfer, & Blake, 1997) and those who care for them (Sherwin, et al., 1992). Although counselors repeatedly discuss and process traumatic events with their clients, they must retain a sense of hope and meaningfulness in life in order to effectively facilitate client growth and integration of the traumatic material.

On a personal level, spirituality and hope appear to be important aspects of one's root system, essentially keeping the counselor grounded and strong when confronted with a variety of potentially harmful stressors. A person's beliefs about both the transcendent and existential meanings of the universe, interpersonal relationships, suffering, death, and lifeafter death form one's spiritual identity. These beliefs impact interactively on the experience of traumatic events, such that one's spirituality affects the perception of the experience and the perception of the experience affects one's spirituality. Similarly, a counselor's theoretical schema, comprised of one's beliefs regarding the therapeutic relationship, the nature of change, the nature of human behavior and emotion, and other related psychological phenomena inevitably impact interactively on the experience of counseling and the counseling relationship. The theoretical schema affects how the counselor perceives the client and counseling experience, which in turn affects the client and counseling experience.

Therefore, one's professional theoretical schema may be considered as a protective factor of the counselor's root system. Having a strong foundation of theory, reinforced with continued professional growth opportunities, may protect and revitalize the counselor. Miller (1998) asserted, "theoretical understanding through continued training or scholarly review of the relevant professional literature may be valuable to trauma therapists by providing healthy emotional insulation through intellectual structure and distance" (p. 139). This suggests that the theory based roots of professional practice may allow the counselor to filter, organize, and neutralize the traumatic material of the client while maintaining the intimate and effectively bounded therapeutic environment in which client change can occur.

Education and supervision are two activities that have been consistently recommended in the literature regarding the prevention of vicarious traumatization. Pearlman and MacIan (1995), in their study of 188 self-identified trauma therapists, found that those with more formal education showed fewer signs of distress associated with vicarious traumatization. They concluded that "training and supervision of trauma therapists should include a solid theoretical foundation that includes an understanding of the effect of psychological trauma, a relational perspective, and attention to countertransference" (Pearlman & Mac Ian, 1995, p. 564). Foulette et al. (1994) studied the coping behaviors used by 558 mental health and law enforcement professionals who worked with sexual abuse victims. They found that 96% of the mental health professionals identified continuing education as a coping behavior. Foulette et al. (1994) also found that 58% of the mental health professionals reported using supervision as a coping strategy. Pearlman and MacIan (1995) reported in their study that only 17% of trauma therapists working in hospitals received supervision. Pearlman and Saakvitne (1995), included among the factors that contribute to vicarious traumatization, "... inadequate training in psychotherapy in general and trauma therapy in particular [and] insufficient supervision by experienced trauma-therapy supervisors ... (p. 152)." Adequate preparation, continuing education, and ongoing supervision all serve to deepen the professional root system, thus nurturing the healthy tree by allowing the counselor to "continually feed oneself with data from practice and from the bigger world of ideas and theories" (Skovholt, 2001, p. 131).

Taking together the varied branches, rich soil, and deep roots of the vibrant and healthy tree, the literature supports a holistic approach to counselor well-being. The research supports the importance of balance between one's personal and professional self in maintaining wellness and avoiding vicarious traumatization. A counselor's personal self is strengthened by diverse self-care activities, social support, spirituality, and hope. A counselor's professional self is also fortified by self-care strategies and professional social support, in addition to theory and continuing education. In considering counselor well-being, from the soil to the roots, from the trunk to the branches, the personal and professional selves of the counselor, though distinct, cannot be separated.

IMPLICATIONS

This review of the literature and the resulting heuristic device of the healthy tree suggest a holistic view of counselor wellness leading to an integrated approach to understanding both risk and resiliency regarding vicarious traumatization. The healthy tree suggests that professional and personal activities, relationships, and beliefs promote counselor well being as they interact to create, sustain, and protect the self-schema of the counselor. There are significant implications of this literature not only for mental health counselors, but also for those who train and supervise them.

The healthy tree suggests to counselors that both professional and personal components of their lives serve to promote their well-being. Each component of the healthy tree suggests choices for both personal and professional lifestyle that are protective for counselors working in the potentially toxic environment of trauma counseling. The vibrant branches suggest that the counselor seek a balanced, diverse, and integrated menu of professional and personal activities. The rich soil of the healthy tree encourages counselors to promote healthy and positive relationships both professionally and personally that will sustain them in their work. Finally, the deep roots of the healthy tree remind counselors to reach deep within themselves professionally to find the integrating themes that direct their counseling and to reach deep within themselves personally to find their source of meaning and source of strength. The healthy tree provides a metaphor that summarizes the ethical responsibilities for self-care and competence outlined in Section C of the Ethical Standards of the American Counseling Association (ACA, 1995) and Principle 7 of the Ethical Standards of the American Mental Health Association (AMHCA, 2000).

The healthy tree suggests to counselor educators and supervisors that they are stewards of the forest. Counselor educators who teach the skills and ethics of self-care are cultivating the forest. Counselor supervisors who assist supervisees in integrating their professional and personal growth are cultivating the forest. Administrators who implement policies and practices in mental health agencies that promote a diversity of professional activities, development of a positive network of colleagues, and opportunities for continuous personal and professional growth are cultivating the forest. This cultivation of the forest is not just a good idea for resource management, it is an obligation set forth by Section D and Section F of the American Counseling Association's Ethical Standards regarding counselors who teach, supervise, and manage other counselors (ACA, 1995). Similarly, the Ethical Code of the American Mental Health Counselors Association addresses specifically in Principles 8 and 9 the ethical obligations of both counselor educators and counselor managers to promote the well being of counseling students or employees (AMHCA, 2000).

The healthy tree suggests that resiliency in counselors is not an accident. Rather it is the cumulative effect of counselors' healthy decision making, time-management, positive relationships, continuing education, and maintaining a cogent theory of counseling and a spiritual awareness.

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Danielle Meyer is a graduate student in the Department of Psychological Counseling, Monmouth University, West Long Branch, New Jersey. Richard Ponton, Ph.D. was the field placement coordinator in the Department of Psychological Counseling, Monmouth University, West Long Branch, New Jersey. Richard Ponton is now with the Department of Human Services, Township of Ocean, Oakhurst, New Jersey. Correspondence concerning this article should be addressed to Dr. Richard Ponton, P.O. Box 910, Oakhurst, NJ 07755. E-mail: [e-mail].