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

Using Poetry

As I’ve stated before, I love poetry therapy. “Broken” by Becky Birtha, a survivor of sexual abuse, is a poem I like to use with sexual violence survivors, especially of childhood sexual abuse.

When discussing a poem with client, I first ask them their feelings about the poem and whether they enjoyed it or not. If they did, I ask them to explain to me how they feel the poem is relevant to their life or their situation. We examine the lines that really stick out to them and why they are easy to relate to.

Poems and song lyrics (especially for teenagers) can be such a powerful counseling tool. Being able to see your thoughts, situation, feelings, etc. put on paper by someone else makes you feel less alone. And sometimes it’s comforting for people to see their thoughts explained in a way that they weren’t able to.

Life Timeline

This is an activity I love doing with clients of all ages. It's called a life timeline. On the left side of the timeline, the client inserts points with significant events that happened in their past. For example, the client might put how at 3 years old they moved to another state, 8 years old they joined a soccer team, 12 years old they tried drugs for the first time, etc. On the right side, the client inserts points with goals they have for their future. I posted an example in the second photo.

When doing this activity with adults, it allows them to reflect on how far they've come and how strong they are to be able to survive so much. When doing this activity with teens, it allows them to see that they still have a whole life ahead of them, and that they've only experienced a small bit of what life has to offer.

You can find a life timeline template here

Trauma Masks

People experiencing trauma tend to feel one way on the inside, but display a totally different person on the outside. Trauma Masks are a great way for trauma survivors to illustrate that.

Give your client a blank mask outline. On the front side of the mask, have them illustrate how they feel others see them. On the back side of the mask, have them illustrate how they view themselves/how they feel inside. You can imagine the striking differences you’ll see!

Explore the differences on the masks together and discuss the meaning of any pictures or words they used. Try asking about the feelings they have when they look at the masks. You may get a lot more insight into the person than you ever would have expected!

 Picture from here.

I Am Poem

I am a big advocate for the use of poetry therapy, and have found it to be a very useful tool for counseling. This particular poetic technique is called an "I Am" poem. The poem is a fill-in-the-blank exercise, which is great for clients who don't feel confident to write a free write a poem of their own.

I have had many clients question their identity. They feel like their abuser or perpetrator has taken away their true self, and they are left feeling broken. Oftentimes survivors of sexual violence will say how they feel like they died during the sexual trauma, and they just wish they could go back to "normal".

This poem is a simple and effective tool to help clients really think about who they are. Many of my clients have learned something new about themselves when filling in the blanks, and it left them feeling excited!

Image used from here

Regaining Closure

Most of us have had people in our lives that hurt us, and we never got the chance to tell them how we truly feel. Imagine being a survivor, where people have hurt you in some of the worst ways imaginable. Survivors often have mixed emotions towards their perpetrators: anger, hurt, sadness, maybe even love if they were close with the perpetrator or were related to them. Holding these feelings deep inside without finding a healthy release can lead to many physical and emotional issues.

Recently I was working with a client who was sexually abused by a family member. I told her to write a letter to him that we wouldn't send. The letter could be as short as one page or as long as 10 pages; the length didn't matter, what mattered is that she felt she wrote to him everything she needed to say. I also told her that I wouldn't read it unless she gave me permission.

The next week she brought in her 2 page letter. In the letter, she discussed her feelings towards the perpetrator and how his actions have affected her life. The letter ended with hope for her future. After processing how it was for her to write the letter, I told her we were going to have a funeral for it. She could dispose of any way she wanted (except burning, due to fire hazards). She chose to use the shredder in the office. I asked if she had any last words, and allowed her to shred the letter herself.

When I asked how she was feeling, she stated that she felt a weight had been lifted. She couldn't believe how something so simple as writing a letter could make her feel so free. She has even decided to continue doing this ritual on her own!

Survivor's Strength

Many of my clients tell me they feel weak. They feel like a failure. They feel broken; like damaged goods. I am incredibly sincere when I tell them that survivors are some of the STRONGEST people I know. Survivors have gone through some of the most terrible, unimaginable violations to their souls and bodies, yet they get up in the morning and try to put the pieces back together. I tell them that the fact that they are coming into my office, willing to discuss the horrors they've been through, show incredibly strength and resilience. There is life after trauma!

Emotions Worksheet

When working with survivors of sexual or domestic violence, especially teenagers, they can be very slow to open up. Many survivors are understandably weary about trusting people. When working with survivors of sexual violence, many of them will say they do not like to think about or talk about what has happened to them. This leaves many counselors wondering how they can approach the subject.

I tell all my clients that they do not have to tell me any details they don’t feel comfortable. It’s not about process the event(s), it’s about processing their feelings around what happened. As soon as I say this, many of my clients begin to visibly relax.

So how can you get the conversation about their feelings started? I use this worksheet that lists many different feelings, and have them circle which ones apply to them. I then discuss each emotion they have circled and how it is affecting their life. This has been especially useful with teenagers!

Focus Card

My client was sexually abused for several years and used dissociation as a coping mechanism. For the past couple has been going into more detail about the sexual abuse she experienced, and as a result she found that she’s been more spacey. I had her make a Focus Card to help ground her and this is the beautiful piece she created! I got the idea for it here. A Focus Card is defined as:

"A Focus Card has an image on it that helps you right now focus and be present. It is as simple as that; finding an image that emerges from being still and being inwardly focused that gives you visually what you need to feel centered, calm and present in your life. It takes strength to build resilience, inner peace and stillness in a world that is full of chaos and madness. This small card is a glimpse of stillness, a small oasis that can remind you that sanity is not far away. This calmness can carry you through the rest of the day and you can refer back to the image when you need to re-focus. It helps us to remember that not all of our life has to be calm, or in order. But small pockets of it can be, just like this small focus image. Starting small—and not expecting or trying to make all of your life manageable all of the time—is a sane way to live your life. There can be little spaces of calmness and sanity in the middle of the busyness of a day. Look for these spaces in your workday and home life."