Risk Factors

Barriers to Reporting and/or Seeking Help
In our survey of ACA Members, we found that Counselors endorsed a number of barriers to reporting an impaired colleague (fear of denial by others, stigma associated with impairment, fear of reprisal, lack of awareness of procedures/programs). For similar reasons, counselors are often reluctant to speak openly about the ways that they may be feeling stressed, distressed and even impaired. A common myth in the helping field is as follows: Since counselors are well educated about mental and emotional struggles, and
because we are skilled at helping others address their concerns, we are somehow immune, or at least less susceptible to struggles of our own. Compounding this myth is the belief that when we do experience some sort of personal difficulties that we should be able to overcome them without seeking assistance ourselves. This "counselor heal thyself" mentality is a reflection of the stigma that seems to persist, not only in the general population but among the community of helpers.

Risk Factors for Counselor Impairment
There are a number of characteristics of counselors, and components of the work that counselors do, which make them especially vulnerable (Yassen, 1995). Those who practice in the helping field often have an acute sense of empathy to the experiences of others. It is not simply the empathy that counselors possess, but empathy coupled with the intimate exposure to the struggles and suffering that clients present, which can take a toll (Figley, 1995). Moreover, counselors are taught that the counselor is the instrument of change, and that the therapeutic relationship is a prominent component of success in treatment. This may serve to increase counselors' strong feelings of responsibility for positive therapeutic outcomes and reinforce already unrealistic expectations they have for their own infallibility (Cerney, 1995).

Skovholt's "High Touch" Hazards
Skovholt (2001) describes "high touch" hazards, those characteristics of professionals in the helping fields which make them more susceptible to burnout. Those hazards include: (1) Clients have an unsolvable problem that must be solved (2) All clients are not "honors students" (they may not have the skills or resources to meet their goals) (3) There is often a readiness gap between them and us (4) Our inability to say no (5) Constant empathy, interpersonal sensitivity, and one-way caring (6) Elusive measures of success and (7) Normative failure. These hazards challenge counselors' personal wellness, and highlight the need for supportive environments, an on-going assessment of our own wellness, and strategies for resilience.

Systemic Factors That Increase Our Vulnerability
Contextual factors can compromise the ability of individuals and systems to practice effective self-care. Agencies may set unrealistic expectations for clinicians to carry a large caseload, with many seriously troubled clients. Managed care policies may require that hospitals discharge clients before the clinician determines they are ready. A client may express anger and resentment when a clinician sets limits on availability after hours. Often
counselors are told directly and indirectly that they need to work longer, see more clients, produce results in shorter time periods with more multiply stressed clients, and put aside their own needs in the service of others. Other factors that increase vulnerability include the ability to obtain quality supervision, the nature of our clientele (e.g. vulnerable children,
complexity of problems, safety concerns), and the nature of our workplace (e.g. insufficient resources or vacation time, lack of input into the decision-making process of the organization, current policies prohibit best practice treatment).

Personal Risk Factors
Personal factors also contribute to our vulnerability. How prepared do we feel to be doing the work we are doing? What is our training, education and experience? Are there current stressors and/or changes in our life outside of work? What is our natural coping style? If we have a personal history of trauma or hold beliefs that it is not okay to seek help, we are more at risk for becoming impaired (Catherall, 1995; Cerney, 1995; Saakvitne, Pearlman & Staff of TSI/CAAP, 1996). Real life expectations and commonly held myths about counselor invulnerability create barriers to establishing and maintaining strong wellness routines.

Secondary Traumatic Stress
One particular issue that contributes to counselor vulnerability is exposure to primary and secondary trauma and violence. When counselors either witness or experience violence firsthand (in the workplace or in their personal lives), they are more vulnerable to developing traumatic stress symptoms which can lead to impairment. The concept of vicarious traumatization applies to all helping professionals and does not require primary exposure to violence (Saakvitne, Pearlman & Staff of TSI/CAAP, 1996). Vicarious traumatization is a cumulative process of personal change in helpers that happens through empathic connection with clients. The concept is applicable even when clients are not disclosing personal histories of trauma; in the process of connecting with clients, we are connecting with their pain and our empathy with that pain has an impact.

When issues of secondary traumatic stress are not addressed they can become systemic-resulting in high levels of absenteeism and turnover, rampant mistrust of colleagues, feelings of anger and isolation, and incidents of ethical misconduct (Catherall, 1995;Yassen, 1995). An intervention becomes possible when we assess the ways we have been impacted, speak openly as a community, and take steps towards positive change. As counselors, we must demonstrate the same level of commitment to self-awareness, self-care and balance for ourselves as we have for clients.