Find Men's Issues Therapists, Psychologists and Men's Issues Counseling in Los "I support my clients in strengthening their self-worth, relationships, careers. By Holly Sweet - My early experience with male clients soon taught me that working and emotionally in control got in the way of their intimate relationships. my doctoral program and no training on men's issues in therapy in my internship. The Facts About the Therapist-Client Relationship. Psychotherapy This is necessary in order to focus on your problems exclusively. How can.
Building Trust Building trust has been described as the earliest developmental task and the foundation on which all others are built Erikson, Establishing trust is broadly accepted as fundamental to the development of a therapeutic relationship.
However, because adults who were abused or neglected by their parents have experienced betrayal in their most significant relationships, they often find it difficult to trust others. Clients who were not abused by persons close to them also experience problems with trust, but for those who have been betrayed by people on whom they were dependent, issues of confidentiality and privacy are especially critical.
Trust makes an individual vulnerable to criticism, abandonment, and rejection. Clients may therefore be mistrustful and suspicious of the counselor, making the development of a trusting relationship a potentially long and difficult task. Reflecting the transference discussed above, they may fear the counselor or see him as abusive, manipulative, or rejecting. The counselor must not personalize these feelings but be consistent and reassuring, never taking trust for granted Courtois, As clients deal with childhood abuse and neglect issues, they may face a series of crises.
These crises give the counselor opportunities to build trust. In such situations, the counselor can remain consistent and available, helping to allay clients' fear of abandonment and rejection. Many tenets of a good therapeutic relationship unconditional positive regard, a nonjudgmental attitude, and sincerity are also essential for establishing a foundation of trust.
When the Client "Falls in Love" With the Counselor Because of the difficulties many abused clients have with intimacy, the new experience of having someone who listens and whom they can trust can sometimes lead them to believe that they are in love with the counselor. Sadly, many survivors of abuse are so accustomed to negative feelings shame, fear, guilt, anger that positive feelings joy, trust, contentment, playfulness are unfamiliar to them.
Such clients may not understand their own feelings, and they may not have the skills to differentiate them. In some cases, if a client has recently stopped abusing drugs or alcohol, romantic obsession or sexual fantasies can substitute for the substance addiction as a way of reducing tension. Powerful romantic feelings may be directed toward the counselor, threatening the therapeutic relationship. The counselor may first become aware that a client is having strong transference issues by subtle changes in the client's demeanor or by more obvious signs, such as requests to see the counselor in a nonprofessional setting.
The counselor must, above all, avoid transgressing the boundaries of the relationship and continue to emphasize the guidelines discussed when the counselor established the treatment frame. He should not consent to personal requests, even if they seem innocent e. Second, even if he only suspects a client of harboring sexual feelings for him, he should immediately bring the matter to the attention of a colleague.
This consultation will serve not only to protect himself, should legal complications arise later, but can also help him work through the difficulty in the therapeutic relationship itself. If the counselor senses that a client is developing romantic feelings for her, she can try to discuss the matter openly by asking questions, such as "I sense that you are feeling very strongly about something today.
Therapist Gender Does it Matter?
Is there something in particular you want to talk about? Clients should be encouraged to examine the feelings rather than act on them. The tension of this interaction can lead to a "teachable moment" in which the client learns to better differentiate his feelings. The counselor should remind the client repeatedly of the purpose of their sessions, emphasizing what she and the client will and will not do as part of the relationship.
Clients often substitute an attraction to the counselor for an attraction to the abused substance as a way to avoid dealing with unresolved feelings or emptiness. Another, less confrontational way to deal with this type of situation is to maintain the boundaries of the client-counselor relationship but to use clients' feelings to help them discover solid but non-sexual relationships with people who listen.
The client can be assisted to differentiate feeling good from feeling sexual desire. The counselor can explain that the "attractive" aspects of their relationship, such as trust and feeling safe, are qualities that clients will want to look for in their personal relationships. Similar problems of inappropriate attachments and boundary issues can occur in group therapy, and counselors whether as group leaders or in separate individual counseling must be prepared to work with their clients on this dynamic.
Therapist Gender Does it Matter?
Here, too, a treatment frame should be established at the outset that addresses interactions between group members and between the group leader and members. Clients should avoid letting any of these relationships become too personal and should be made to understand why, in this setting, developing sexual relationships would be counterproductive.
Counselors, in turn, must understand and support the bonding that occurs when clients make disclosures in a safe and sympathetic environment--and the confusion group members may have about their feelings of dependence on or responsibility for other group members Valentine and Smith, in press. These are therapeutic issues to be addressed in the group that can contribute to the clients' healing from the effects of abuse Briere, ; Courtois, The counselor's reaction to attempts at seduction Because of low self-esteem, incest survivors or other survivors of abuse may feel that the only way they deserve a relationship with another person is if they offer sexual involvement Courtois, If a victim of sexual abuse acts seductively toward the counselor, the counselor should understand that transference issues are in operation and that the victim is trying to sexualize the relationship.
Unfortunately, some counselors do become sexually involved with their clients, thus exploiting the counseling relationship and violating the trust the client has placed in them. Such behavior is unethical, unprofessional, and in some States, illegal. Counselors who become sexually involved with clients may be reenacting the role of victimizing caretaker.
Most treatment programs have policies prohibiting such behavior and will fire staff members who violate these policies. In addition, they are likely to register a complaint with the State licensing agency; professional associations will censure or expel members who have sexual contact with clients. In some States, sexual contact with clients is illegal, and counselors will be prosecuted.
Some in the treatment field believe that males should not treat female survivors of male sexual abuse. Although some women may feel safe only with a female counselor, many male counselors can provide effective treatment if they give adequate attention to abuse issues and their own reactions to clients. Furthermore, sensitive handling of the case by a male who does not exploit the client can provide a new, positive male role model.
Whenever possible, the client's preference regarding the counselor's gender should be respected; unfortunately, many facilities do not have adequate staffing to allow choice. In such situations, it is important to openly acknowledge the client's feelings and validate them as understandable reactions.
This can reduce feelings of helplessness and help prevent the client from leaving treatment prematurely. Dealing With Disruptive or Dangerous Behavior Clients in treatment for substance abuse may act rebelliously or violently, a situation that can be exacerbated by an undisclosed history of child abuse.
Counselors working with this population have sometimes been victims of physical assault or other violence by clients. It is the program's responsibility to be aware of and inform counselors of any client's history of violence which may be more common among adolescents in substance abuse treatment. Counselors should have a personal safety plan, and policies should be in place that require them to call law enforcement and press charges if they are threatened.
As well as taking steps to ensure their own safety, it is the responsibility of counselors to create and maintain a safe environment in which clients can explore and address issues. It is the client's responsibility to behave in ways that do not threaten others either physically or emotionally. Early in treatment--at the very outset, if it is a group setting--counselors should communicate and enforce ground rules about how clients can safely and appropriately deal with anger and other feelings of discomfort.
Knowing what is expected of them and the other group members contributes toward their experiencing the group as a safe place to share and be heard.
Ground rules should include maintaining members' confidentiality and not sharing any information outside the group, no threats or acts of violence, no verbal abuse, no interrupting other members, and no disruptive behavior.
Counselors can help clients learn how to express their feelings constructively by validating their affect but not their expression if it is abusive or violent. Abuse survivors commonly are concerned about their safety--or their potential reactions to others--while reliving painful events. Counselors can help clients face these feelings by reinforcing the present safety of the counseling environment.
In a calm voice, the counselor should ask clients to explore rather than act out anger or disruptive behavior. The goal is to emphasize to disruptive clients that their feelings are acceptable as long as their behavior remains appropriate. Clients are allowed to have angry feelings--and verbally express them--but they are not allowed to hit anyone, to throw things, or be otherwise violent or disruptive.
In this way, clients can be helped to separate their feelings from their actions. The counselor may find that some individuals become caught in obsessive loops, unable to let go of the precipitating issue or to stop being angry. In some cases, this can indicate hidden problems that may need to be explored further i. Constant rage can be a symptom of manic depression or bipolar disorder.
Counselors can help create a safe atmosphere for clients and reduce acting out by practicing "grounding" techniques such as the following: Have the client sit in a relaxed posture in a chair with eyes closed or open, if he is uncomfortable closing themfocusing on his breathing. Ask him to concentrate on feeling the chair supporting his weight and the floor underneath his feet.
Have the client recognize how grounded he is in the present. No matter how anxious he may become reliving moments from his past, he is still safe and grounded in the present. The counselor should be aware of the hypervigilance characteristic of abused clients and not make any sudden moves, or get up out of a chair while the client has his eyes closed; the issue of personal safety is paramount for most of these clients.
Practice breathing techniques with the client, having her synchronize her breathing with yours. These techniques will relax the client. This exercise may have intimate overtones that could confuse clients with transference issues, and counselors should be selective in its use. To stop the current action or behavior pattern, allow the disruptive client to leave the room for a few minutes. The counselor must take care to avoid joining in the client's disruptive behavior in any way.
Disruptive behavior can best be contained if the counselor stays in his role, maintaining calm, comforting, reinforcing behavior that is appropriate for the approach and setting. However, it is appropriate to use authority and security personnel when physical harm is threatened.
Avoiding the 'Rescuer' Role Because of strong countertransference reactions, coupled with a desire to meet clients' needs, the counselor may want to defend or "rescue" clients.
He may offer too much advice or even concrete assistance, viewing clients too narrowly only as victims of mistreatment. A counselor who is not self-aware or does not hold himself accountable for his own personal emotional health may feel that he is the only one who really knows or understands his clients.
He attends too many meetings, provides sponsorship, helps clients with child care, lends them money, or dismisses fees. Counselors must deal with their own strong feelings in an environment separate from the client-counselor relationship so that they do not confuse their own issues with the clients'.
If the counselor notices that she is being placed in the "rescuer" role, it is recommended that this be directly addressed with the client. A client may in fact be comfortable in the victim's role and try to manipulate the counselor to intervene and rescue her in a variety of situations.
If the counselor does take on the rescuer role, clients do not learn about personal responsibility and how to deal with resolving conflict and issues on their own see Whitfield, Furthermore, clients may become angry when a misguided counselor crosses the line without the clients' permission by intervening in family relationships in an attempt to rescue or defend them. When this happens, the counselor not only has lost the ability to help his clients but also is likely to cause additional harm.
Rescuing may give the counselor a temporary relief from her own feelings of helplessness and anger, but it does not lead to positive outcomes for the clients. Clients will best be served by facilitating the development of empowerment. This may mean that the counselor allows clients to flounder at times.
Clients may sometimes report becoming involved in relationships that are clearly dangerous from the counselor's perspective. This often reflects the tendency for abuse survivors to be assaulted or abused again after the initial incident or period of abuse. Although the counselor may be tempted to directly advise a client against such a relationship, it is far more useful to work with the client to explore any propensity to excessive risks or self-endangerment.
The counselor's role is to help clients understand their vulnerability to revictimization and to empower clients by helping them recognize that they have the ability to set boundaries with others and no longer have to remain victims. Rescuing clients will not serve the longer term purpose of helping clients develop personal respect and safe boundaries free from abuse and violence.
Recognizing Professional Limitations The counselor must recognize when she is unable to work with a specific client. She cannot benefit clients who are abuse survivors if their issues cause her personal difficulties to the point where her own effectiveness is compromised.
Any counselor working with adult survivors should seek support and some form of supervision to review her feelings about the issues brought up by her clients. At the same time, it is the agency's responsibility to ensure that clients are receiving adequate, professional care.
From an ethical standpoint, it is better for counselors not to work with abuse survivors at all than for them to take on such challenges if they are not yet equipped to deal with these issues. If a counselor cannot work with a particular client, he should refer the client to a counselor who is better suited to that individual's needs.
Such transfer must be done after discussion with the client, and any issues that arise as a result of the transfer such as the client's possible feelings of rejection should be addressed in therapy, both before and after the move.
It may be advisable to get an understanding in writing that states that the client knows that treatment with that counselor has ended, at least for the time being.
This closes the contract, may lessen abandonment issues, and can help protect the counselor if the client later claims abandonment. Responsibility of the Agency To Support the Counselor Alcohol and drug counselors are often subject to great stress.
They can be expected to function well and provide effective treatment only if their agency's leadership gives them the appropriate support. Such support includes recognition for and appreciation of the role of the counselor and the stresses it entails.
As noted throughout this chapter, this is especially important when counselors are treating clients or families who have a history of child abuse or neglect, because the complexity and number of issues increase, as does the number of systems that must be dealt with. The agency's leadership should strive to impart a sense of vision to staff members that communicates how important their work is as part of the larger effort to break the cycle of abuse and neglect and their impact on society.
The Consensus Panel makes the following recommendations about how the agency can support the counselor: For an example, for a male child that does not have any healthy male role models in his life, to have a male therapist that is patient, supportive, and provides true helpful advice is a wonderful opportunity for this child to have a male to speak with and connect with to learn from and feel understood by.
For a female child that has observed males acting in a non healthy way, to have a male therapist offers this female a view of men as compassionate, helpful, and wise, which is a great seed to plant. The same concepts are true in reverse. For an example, for a male child that has a poor connection with his mother due to her severe mental health issues that has shown in her lacking in empathy, to have a female therapist that is understanding and therapeutic is a gift for a boy to see women can be empathetic.
For a female child to have been raised by a very judgmental mother to have a female in her life that is supportive of helping this girl work therapeutically at her own pace and work on self esteem issues with her would be a great experience with long term effects. The aforementioned are just but a few examples, of course there are many examples that can make the argument for a female or for a male therapist.
If gender matters to some, and although at times is not a significant factor in therapy, and other times it is, would it be concerning then if I shared with you that research is showing a significant decline for one of the genders as therapists?
Specifically, in a recent article in the New York Times this month entitled: A Good Man is Hard to Findthe decrease in male therapists was addressed. The key is to have true mindful awareness of what the difference in having a male versus a female therapist would mean to you and share your needs.
Male and female therapists wish for their clients to achieve their therapeutic goals and are invested in and interested in your thoughts and feelings. If you have a gender preference, you do have a right to make your request and have it fulfilled. At any point in the therapy relationship if you feel uncomfortable, whether it is about a gender issue, or anything else, know that a good therapist is one that wants to know your feelings and will be respectful of them. Karen Ruskin Follow Dr.