Grief Thoughts

Stressful events, such as experiencing a trauma or losing a loved one can take up a lot of space in our minds. Inspired from Gretchen Miller’s “Trauma Thoughts” activity, here is an art activity to help clients show how the stressful event(s) affects their mind. In relation to my work, I will be focusing on “Grief Thoughts”. This activity would be great for groups or individual counseling.

Give clients a blank outline of a brain like the one pictured here, or have them draw their own head/brain. Have the clients draw, write, or collage the different ways that grief is taking space in their mind. It can be memories, emotions, physical symptoms, etc. Try using this time as a way to discuss how it can feel like their lives are being taken over, and how people experience similarities, as well as differences in the way they react. You can also brainstorm healthy coping strategies. To go a step further, maybe use the space around the brain to collage, draw, or write healthy coping strategies, positive thoughts, things they would like to take up space in their mind, etc.

Self-Harm Distractions

Working with teenagers that have experienced trauma, I've come across many that use self-harm as a way to cope with their pain. Some hurt themselves to feel like they have control over their life and body. Some hurt themselves as a cry for help. Some hurt themselves as a way to relieve emotional pain. There are a multitude of reasons why people harm themselves, yet even with all of the information available now explaining self-harm, it's still very misunderstood. Teens are very susceptible to using self-harm to cope, especially if they have experienced trauma, so if that is a population you are interested in working with, I urge you to do research on it.

When working with a teen that self-harms, some of the first steps we take are figuring out together their triggers that lead to self-harm, how self-harm is a tool for coping to them, and how they feel after they self-harm. From there, we are able to move forward to begin finding alternatives. As a helping professional, your first urge may be to tell clients how unhealthy it is and how they need to find alternatives to coping, but you must remain calm. It is not an easy thing for people, let alone teens to share, and doing something like that may lead to feelings of shame and guilt. So please, take a breath, and DON'T panic. It may be shocking, especially if they show you their injuries, but remember that they are sharing their pain for a reason--to get help.

Something I've found to be very successful is this Distractions list, provided by the National Self Harm Network. The list contains a myriad of alternatives to choose from when feeling the urge to self-harm. What I love most is this list is that the distractions are listed into different categories, such as Comforting, Fun, Inspiring, etc., so that there is something of interest to everyone. Some examples of distractions include writing a to do list, popping bubble wrap, sewing, and squeezing ice cubes. The graphics are pretty cute, too :)

Genograms

When working with clients that have a history of abuse or unstable relationships, I find it helpful to do a genogram with them. As Wikipedia explains it, a genogram "...is a pictorial display of a person's family relationships and medical history." It's like a more detailed family tree, that helps clients to observe family relationships and patterns, giving them a better understanding of how those patterns have affected them in the present. The attached image gives basic symbols that are used on a genogram, but I always encourage clients to add their own symbols if they find important patterns or feel like something should be included that's not already listed on the genogram key.

I usually have client's start with their grandparents on each side of the family and work their way down to their immediate family, while also having them include any other family relationships that were a major part of their life. Genograms can be confusing, so it's important to walk through this exercise with your client. I try to have them get down the relationships first, before having them add any symbols.

After the relationships are on paper, the client's add symbols for how the relationships were (i.e. fused, hostile, abusive, etc.) and any important experiences/ailments family members may have experienced (i.e. substance abuse, mental illness, etc.). The paper will get very messy, so I always warn my client's that the genogram is not meant to be pretty.

At the end, I go over the relationships on the paper, any patterns the client observes, and how the family relationships and patterns have affected them in the past and in the present. It allows you to learn more about your clients, and as one client told me, being able to see the patterns of abuse on paper really solidified for her why she tended to enter abusive relationships. If you are looking for genogram examples, you can find some here.

Self-Care

Between having more responsibilities at work, studying for the licensure, and the holidays approaching, I have been incredibly busy! Not to mention intense situations happening in our nation and my own community. That’s why I want to take a moment and stress the importance of self-care.

I know that right now it can be difficult to focus on yourself. Whether you have exams coming up, are travelling, preparing to see family, etc., you may feel like you don’t have time for much of anything! But if you don’t take care of yourself, you may be putting your physical and emotional health at risk.

I’ve been very cognizant about checking in with myself and making sure that I’m doing enjoyable things outside of work. I’ll admit that after a long work day, usually the last thing I want to do is see people, go out, or do anything productive. But that means that I just have to try harder. I’ve come up with a weekly goal for spending time with loved ones and going out to be sure that I don’t get stagnant (but also making sure I don’t overwhelm myself). I’ve been trying my best to keep up with eating healthy and exercising (though it can be so difficult this time of year!). And I’ve been trying new things, like visiting local parks I’ve never been to and going for long hikes down unfamiliar trails.

If you are having difficulty thinking up self-care activities, this is a great list of self-care activities I hand out to my clients! What are some of the things you like to do for self-care?

Self-Esteem Heart

Expressive art can be a great tool for working with someone that has low self-esteem or body image issues. The self-esteem heart is a great activity for helping clients explore the causes and triggers of low self-esteem, as well as create a discussion around ways to cope.

Print out a picture of an anatomical heart, and have the client write down words that are related to their low self-esteem (i.e. hurtful names they've been called, negative self-talk, etc.) on the heart. I try to have clients come up with at least 5 words.

When they are finished writing, have the client cut out the heart and color it (make sure the words are still readable). After the heart is colored in, have them glue the heart to construction paper or card stock.

On another piece of paper (or to save paper, use the leftover paper that the heart was cut from) have the client write phrases, sentences, or words that can be coping mechanisms for or that challenge the negative words in the heart. Have them write at least enough positive or coping phrases for each vessel on the heart. Have the client glue each positive word or phrase coming out of the vessels (or out of the heart if they extras). The result will have those phrases flowing outwards of the heart vessels, symbolically releasing the negativity.

When I asked one client how she felt when she looked at her finished self-esteem heart, she said she felt a little better, but that all the words and negativity were still there. She felt like they were just floating around inside of her, and hadn't gone away. She was absolutely right; this one activity wouldn't shed her of all that hurt and make her love herself. I told her that there will always be people, or maybe even her own inner voice, that will try to keep these words surrounding her; that will try to make her become those words. But using her healthy coping tools, changing her inner voice, and continuing on the path towards healing will help her to get to a point that she can love herself. That she can feel confident. And eventually, she will be able to hear those words and know in her heart that they are not the truth.

Picture and idea inspired by Katarina Thorsen.

Control Circles

Control is something that comes up often during my sessions. Survivors have had their power taken away from them in the worst ways, and regaining control in their life can be difficult. It's even harder for teenagers, who already have little control in their lives as it is. When clients tell me how they are feeling overwhelmed due to feeling like they have little control in their lives, I have the create "Control Circles".

On a sheet of paper I have the client draw a small circle, and a bigger circle around it. In the center circle, I have them write all the things they can control (sometimes they may need help this section; if they are having difficulty, ask them if they can control what they eat, what they wear, how they handle their feelings, how they treat others, etc.). On the outside circle, I have them write things that they can't control in their lives (try to gently direct them to keep it more on an individual level of things that affect them, otherwise they may have a pretty big list of things that may not actually be currently affecting them, such as war).

Most of the time people will list more things they can control than they can't. In this case, this activity is a great tool to help them keep things in perspective. Remind them that although they may feel overwhelmed by the things they can't control, they still have more power in their life than they realize. If a person lists more things out of their control than in their control, use it as an opportunity to assist them in exploring what they could do or change to help them feel more in control (i.e. setting boundaries, time management, cooking, etc.).

I have found this to be useful for working with both teens and adults. Idea inspired from The Creative Counselor

Termination Tree

I recently terminated with a client, and wanted to make a special ritual for our last session. I printed out a picture of a tree (or you can have the client draw or paint their own tree), and told my client that on each branch, I wanted him to write different things he's learned in counseling.

It's a great way to help your client review how far they've come, what kinds of progress they've made, and opens up for discussion any concerns or thoughts they may have.

He discussed his long-term plans for maintaining his progress. He was very thankful for all the interactive activities we did, and was so proud of himself (and he had every right to be)! It was a very touching ending to our therapeutic relationship.

You can find where I got the idea and picture from here