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Effective Practices for Counselling People with Mental Health and Physio-neural Disorders

Effective counsellors adjust their methods and approaches to meet the needs of individual clients. This article presents some strategies and practices to consider when working with this broad and diverse group of people.

Before you begin, you may want to learn more about disabilities that fall into the following broad categories:

Counselling clients with mental health disorders

What do I wish I’d known when I first started working with people diagnosed with a mental illness?

“I wish I had known how deeply disabling in terms of confidence and one’s sense of competency mental illness can be. I don’t think any of us grasp the depth of despair that individuals who suffer from mental health disabilities experience, and the amazing ways in which they cope.”

—Sandra Taylor, Alberta Health Services

Mental health disorders have a profound impact on the Canadian economy, costing $50 billion per year in health care and lost productivity. More than 80% of disability claims in Canada relate to mental illness. And the longer people ignore their mental health issues, the more severe they become, and the more they cost.

Until not long ago, mental health professionals believed work caused too much stress for people with mental health disorders. They feared work impaired people’s ability to manage their disorder.

But recent research shows that work is closely tied with mental wellness. The absence of work can deepen anxiety and depression. It can also create financial issues such as insecure housing and food. In fact, the pressures of not working can turn mental illness into a downward spiral of despair.

Unfortunately, up to 90% of people with serious mental health disorders are unemployed, even though roughly 80% of them very much want to work. Alberta has seen a particular uptick in mental illness in recent years with the downturn in the oil industry.

Mental health concerns go well beyond those directly experiencing job loss. Families and friends of the unemployed as well as communities where unemployment is high all experience difficult mental health impacts. Even those who keep their jobs may suffer, as they experience a form of survivor guilt. 

As the baby boomers retire and the labour shortage grows, it becomes increasingly important to support as many people as possible to take part in the labour force in whatever way is possible for them.

Communicating with clients who have mental health disorders

Stigma may be the single biggest barrier to communicating with clients with mental health disorders. While barriers to full participation in society are coming down for people with other disabling conditions, myths about mental illness still abound.

It’s hard for people to admit they have any non-apparent disability. However, while disabling physical and neurological conditions may have a clear diagnosis, mental health disorders are less clearcut.

It can take great courage for clients with mental health disorders to come forward knowing employers and coworkers may think they are weak, and their concerns are trivial. They may fear losing job, friends, and family relationships if they seek help.  

As a result, mental health disorders may not be diagnosed until symptoms have become severe. For example, an individual may have:

  • Become so depressed they cannot get out of bed.
  • Charged thousands of dollars to a credit card in a manic episode.
  • Lost a job or relationship in a fit of rage arising from a personality disorder.

The more severe symptoms grow, the more difficult and costly it becomes for people to recover fully. This makes early diagnosis and treatment essential. This can only happen by reducing stigma. People must not fear the consequences of asking for help.  

With a combination of drug interventions, therapeutic counselling, career support, and employer accommodations, most people with mental health disorders can find and sustain rewarding jobs.

It may be part-time or remote work, self-employment, an internship, or volunteer work. But if the work holds meaning for the client, it can be a key piece in rebuilding mental health.

Mental health and our sense of time

“If you are depressed, you are living in the past.

If you are anxious, you are living in the future.

If you are at peace, you are living in the present.”

―Lao Tzu

Considerations when working with clients who have not been diagnosed

Career counsellors must begin by knowing the answers to key questions about mental health disorders: What are psychoses and neuroses? What are common signs of a manic episode? What are the differences and similarities between depression and anxiety?

Counsellors must know what behaviours should trigger concerns about mental wellness, what questions to ask clients and how to phrase them, when to refer clients for assessment, and which professionals to refer them to.

Considerations when working with clients who have been diagnosed

Counsellors should understand the key effects of drug treatments, such as fatigue and brain fog, and their potential impacts on the career counselling process. They should know the main types of counselling, such as cognitive behavioural therapy (CBT) for anxiety and dialectical behavioural therapy (DBT) for borderline personality disorder, and how to integrate them with their approach to career counselling.

They must understand that clients may go through months or years of trial and error to find the drugs that work best for them. They must also know that therapeutic counselling can go on for years, raising profound emotional issues that can affect career counselling and discourage the client from continuing.

Even at the client’s lowest moments, the career counsellor can play a crucial role in supporting the client to continue the therapeutic process by:

  • Reminding the client of the progress they’ve already made
  • Noting that there are times when career goals are less important than personal goals, and vice versa
  • Noting that personal and professional progress support each other, making it worthwhile to pursue both at different times
  • Discussing changes the client might make in their work life to accommodate personal needs, like temporarily reduced hours or workload, or a short leave
  • Advocating with the employer on the client’s behalf, or supporting the client to self-advocate, for any such adjustments
  • Supporting the client when the time comes to return to normal working conditions
  • Encouraging the client to focus on self-care, such as good eating and rest habits, to support and continue their progress

Considerations when working with employers

When employees experience setbacks and need accommodations, employers and coworkers can also become discouraged or even resentful. Counsellors may need to work with employers and coworkers to accommodate any increase in their work and stress levels.

The goal in accommodating any employee is always to build a diverse, welcoming, and supportive workplace without causing serious losses for the employer or other workers. More than that, it is to build a workplace where each worker’s contributions are valued and each of their needs supported as and when required.

Career counselling approaches

Employment is part of recovery

“In the past, people with mental illness were often discouraged from working, but today we understand that work is not only a possibility, but it can also play a vital role in recovery.”

―Mental Health America, Meaningful Work and Recovery

In recent years, a growing number of post-secondary institutions have moved away from a model that separates career and mental health counselling. As more universities experiment with coordinating the two types of counselling, new models have emerged. Key among these is the cognitive information processing (CIP) model.

Cognitive information processing

CIP theory combines traditional elements of career counselling, self-knowledge, understanding of options, and decision-making processes with meta-cognitive thinking. Meta-cognition refers to thinking about how we think, learn, and make decisions.

CIP theory assembles several processes to help clients make career decisions:

  • Individual Learning Plan (ILP). Clients collaborate with their career advisor to develop an ILP tailored to their specific needs and ways of learning.
  • Pyramid of Information Processing. At the base of this pyramid is knowledge of self and options. Above that are decision-making skills. At the top is meta-cognition.
  • CASVE Cycle. This acronym stands for communication, analysis, synthesis, valuing, and execution. Counsellors stress that conscious or subconscious negative thinking, which underlies most mental health disorders, can impede a person’s ability to solve career (or other) problems.

Some of the tools used in this process include:

  • Career Thoughts Inventory (CTI). Counsellors use this tool to measure negative thoughts that impede decision making.
  • Decision Space Worksheet (DSW). Clients use this visual tool as a way to put their thoughts and options in priority order.

For additional information, you may wish to read Strengthening Mental Health through Effective Career Development: A Practitioner’s Guide. Written by Alberta career counsellors Dave Redekopp and Michael Huston, this guide for professionals is downloadable as a free PDF, or available for purchase as a paperback or e-book.

Success factors

As with all disabilities, a key factor in success is focusing on what the person can do. This will vary with the type of disorder and the side effects of any medication.

For example, medications for bipolar disorder can cause fatigue. Remote or part-time work may allow the person to schedule work for times when they are alert. A person with a personality disorder might be doing intensive counselling to learn relationship skills. Working 1 or 2 days a week at the job site might help them build work relationships, while working remotely the rest of the time could help them focus solely on productivity.

Another key factor in success is reducing stigma. Perhaps the biggest part of this is persuading employers to give people with mental health disabilities a chance to prove what they can do, with a few accommodations.

Employers should have a good track record for flexible scheduling, part-time and remote work, and job-sharing. In addition, they should offer health and disability plans that recognize mental health as part of overall health by including mental health benefits and paid or unpaid mental health leave.

Assessment

Referring a client to a mental health professional requires understanding:

  • How a client’s mental health status can influence career assessments, either intentionally or unconsciously
  • Which assessments provide bridges between career and mental health counselling
  • How counsellors and clients might use these assessments to develop an individualized learning plan (ILP)

Common assessment tools include the Career Thoughts Inventory (CTI) and Decision Space Worksheet (DSW), both described under Career counselling approaches. An additional tool is the Minnesota Multiphasic Personality Inventory (MMPI), used by psychologists and psychiatrists to screen for mental health diagnoses.

Career counsellors should know enough about the key symptoms of common mental health issues to understand when to refer clients for assessment by a mental health professional. This is an excellent reason for career and mental health professionals to be in contact with each other, even if they’re not working in the same facility.

Counselling clients with physical or neurological disabilities

What do I wish I’d known when I first started working with people with physical and neurological disabilities?

“I wish I’d known more about what people with disabilities say and how they feel about their disabilities... People are along a continuum, from sensory or mobility disability since birth to learning to live with a newly acquired disability... Many don’t feel that they have a disability; rather, their disability is part of who they are as a person or they’re in transition learning and adjusting to who the new person is.”

—Patricia Sears, Specialized Support and Disability Services, University of Alberta

Clients with certain physical and neurological disabilities have distinct communication needs that may exceed the needs of people with other disabilities.

Communicating with clients who have hearing disabilities

In working with clients with hearing disabilities, remember to:

  • Look directly at lip-reading clients to allow for a clear view of your mouth
  • Face people with the light on your own face, if possible
  • Keep your hands away from your mouth
  • Speak a little more slowly and distinctly but try not to exaggerate your words; use common language
  • Use a normal tone of voice and pitch; increase your volume naturally only when the client asks you to
  • Tell clients if they are speaking too loudly or too softly
  • Be patient if clients want to sit closer
  • Allow clients who have difficulty speaking or pronouncing words the extra time it takes to express themselves; avoid interrupting or completing sentences for them
  • Ask clients with speech disabilities to repeat or rephrase conversation that is unclear to you
  • Write out explanations for clarification; allow your clients time to read and respond and encourage them to discuss these explanations with significant others
  • When using a sign language interpreter, look at the client not the interpreter

Communicating with clients who have sight disabilities

In working with clients who have sight disabilities, keep these things in mind:

  • Address people directly by name to ensure you have their attention.
  • Let clients know what is happening, such as by telling them when you are entering or leaving a room or performing a task.
  • Describe the contents of forms or other material you are using with clients; if possible, duplicate the material in their preferred mode, such as large type, braille, or audio recording.
  • Ask clients if they need help to get around. When you act as a guide, allow them to hold your elbow, and walk at a normal pace; describe where you are going and point out objects, doors, and stairs. When you help clients sit down, place their hand on the back of the chair so they can seat themselves.
  • When speaking with people who are visually impaired, use normal figures of speech, such as “It’s good to see you” or “We’ll have to see how that turns out.”
  • Respect the guide dog. The animal is on duty and is a vital tool for clients who are blind. Treat the dog as you would any third party there to assist clients. Do not pet a dog when it is on duty without first asking the client’s permission.
  • When discussing an object, place it in the clients’ hands and let them examine it.

Communicating with clients who have mobility disabilities

In working with clients with mobility disabilities:

  • Sit down on a chair so that you are the same height as clients in wheelchairs.
  • Arrange your office space before the need arises. Ensure traffic areas are wide enough for wheelchair access.
  • If your office won’t accommodate a wheelchair, meet in a conference room or larger space.
  • Check with clients who use wheelchairs before helping them enter or exit a room.
  • Respect that, for people with mobility disabilities, wheelchairs are part of their personal space.
  • Avoid negative expressions like “confined to a wheelchair.” A person with a mobility disability may see their wheelchair as providing them with freedom they would not otherwise have. Instead, try “person who uses a wheelchair.”
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