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CHAPTER 9

Developmental, Transitional, and Situational Crises Throughout the Life Span

Shane Haberstroh, Katherine A. Feather, and Madelyn Duffey

As we explored in previous chapters, catastrophic events arise in the lives of people every day. Counselors trained in trauma-informed approaches and equipped with basic disaster mental health and crisis counseling tools can

work to provide compassionate care and connect people with needed resources. Other times, people seek counseling when situations exceed their trusted and fa- miliar ways of coping and living life (James & Gilliland, 2017). Throughout the life span, people experience many stressors that invade their lives with toxic stress and uncertainty but do not rise to the threshold for a posttraumatic stress disorder (PTSD) diagnosis.

Chronic mental or physical issues, disorienting life events, expected and un- expected losses, developmental and identity transitions, new situations, and illnesses and role stressors can wear down people’s capacity to cope. Expected life transitions may feel bittersweet, and unexpected events can shake individu- als deeply. As people mature, families, friends, and communities also grow and change, and not all change is growth oriented. Sometimes groups, people, and loved ones seem to devolve into chaos. However, although crises and transitions can leave people shaken, they can also serve as a point of reflection and beginning of personal growth.

The Relational Foundation: Integrative Perspectives People do not develop well in isolation, disenfranchisement, and disconnection (Jor- dan, 2018). Attuned counselors emphasize a relational core at the heart of human de-

Introduction to Crisis and Trauma Counseling, edited by Thelma Duffey, and Shane Haberstroh, American Counseling Association, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/amridge/detail.action?docID=6173695. Created from amridge on 2024-02-28 03:55:16.

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velopment. When clients encounter troubling times, the quality of their relationships can either mitigate their pain or exacerbate their situations, and the therapeutic rela- tionship can serve as a strong and reliable alliance. In fact, voluminous research sup- ports the power of the counseling relationship (Wampold & Imel, 2015), reporting that the quality of the relationship, as experienced by clients, is the most powerful predic- tor of growth (Wampold & Imel, 2015). Research indicates that the healing relational qualities in counseling supersede technical approaches and serve as the foundation for many manualized treatments (Wampold & Imel, 2015). Given the primacy of our therapeutic connections, our relational intentionality and clarity shape the experience of the counseling relationship and process for us and our clients.

Integrative Considerations When working with people who face new life roles, stressful life events, and abrupt planned and unplanned changes, counselors integrate relational principles and practices, grief models, trauma work, and crisis counseling approaches to concep- tualize losses in context and to harness shared creativity to inspire some practical solutions. Within this chapter, we explore relational processes, integrative frame- works, and practices that guide our understanding of life crises and transitions.

Relational Process

The experience of mutual empathy (Jordan, 2018) demonstrates our understanding of a person in their context. Knowing you really matter to another human being can break the bonds of exclusion and private suffering. As we discussed in Chap- ter 3, microinvalidations accentuate differences and further alienate people from one another. As counselors, we may partner with people who have more social privilege than we do. Alternatively, we may work with others whose social loca- tion mirrors ours, and we may also connect with people who endure a life of scar- city and oppression. As counselors, our ethical principles place our clients’ welfare first (American Counseling Association, 2014), and we should invest the energy to understand a person’s world and pain as they experience it.

A Life and Identity in Context

Destabilizing life events occur within work, family, and broader social contexts. Within all social strata and systems, constellations of power, privilege, oppres- sion, and rejection exist and cause distress and isolation. By example, many people commit suicide who seem successful (Centers for Disease Control and Prevention [CDC], 2018), and numerous deaths by suicide seemingly have no clear precursor. Moreover, a significant number of people commit suicide when faced with life cri- ses and relational strife (CDC, 2018). These statistics speak to the miseries people experience, how seeming success does not protect individuals from the deepest pain, and how shame and the pains of life can seem unsurmountable. In other words, a person’s pain, confusion, and anxieties make sense in their context.

Perspectives on Loss

Theories of grief chart life experiences during and after losses. When conceptual- izing chronic and transitional life stresses, we consider how people move between

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the sharp anguish of their loss and living a new and unknown life. The dual process model (Stroebe & Schut, 2010) of grief work highlights the untidiness of change. Individuals may find themselves feeling sorrow one moment, hope in the next, and confusion in between. This process normalizes and validates the seemingly chaotic feelings around transitions and stressors and stands in contrast to messages people receive that urge them to move on or get over their situation and feelings. These messages ignore the fact that people’s losses are part of their stories. People often live with pangs of loss while charting a new life framed by their memories and ex- periences. See Sidebar 9.1 for more information on the grief process.

Mobilizing Resources

A life crisis is a new territory where people can feel lost and alone. People can be stretched beyond the strategies and relationships that sustained and comforted them through many other life experiences. Given that crises upend familiar ways of being in the world, prepared counselors can help clients chart a new life course and explore valuable information and connections within the community. As counselors, we stay abreast of community resources and network with partners in the community who of- fer specialized services. We develop resources and explore groups that provide finan- cial planning, employment support, medical practice, and legal issues. For example, when we worked to develop the Sutherland Springs coordinated response grant after the mass shooting, we partnered with multiple agencies, law enforcement, legal ser- vices, schools, and social service agencies to support people dealing with their trauma but also the exacerbated and interrelated stress that emerged. When we develop com- munity partnerships and share accurate and helpful information for clients, we can help customize their map to navigate the stresses and confusions of this new territory.

Crises of Identity Development Developmental transitions, growing self-awareness, social pressures, and stressful events can strike the heart of people’s identity. As people learn about who they are, their awareness is influenced by societal expectations, their demographic and cultural backgrounds, and interactions with the world. Developmental crises oc- cur throughout life, and many traditional developmental theories often describe human growth in a linear or task-oriented manner. From these perspectives, iden- tity crises may result from failing to meet developmental milestones, unsuccessful self-individuation, or dissolution of ego strength (Jordan, 2018).

The notion that people’s identity is multifaceted and a convergence of many factors (Gemignani & Hernández-Albújar, 2019) highlights that their sense of who

Sidebar 9.1 • Grief Process The grief process used to be viewed as a linear process, and people were believed to move through each step before they could get to the next. Although grief can follow this process, current literature talks about how grief is different for everyone and does not always follow a certain path. Have you ever experienced grief or a big change? Did you ever feel like you took two steps forward and one back?

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they are grows from an intersection of roles, cultural influences, power positions, earned and unearned privileges, and their own unique histories. Although an in- tersectional identity speaks to a person’s diversity and uniqueness, we are acutely aware that many people experience subtle and overt forms of racism, bullying, op- pression, and stigmatization, especially when they appear different or experience shame in their social circles.

People’s multiple identities are vibrant expressions of their whole personhood. Intersecting identities or intersectionality signifies the interrelated nature of social classifications such as race, ethnicity, class, nationality, gender, sexual orientation, religion, age, and disability as they apply to an individual or group, as well as how people with privileged and stigmatized identities experience these interconnect- ing systems (Ching, Lee, Chen, So, & Williams, 2018). Counselors help clients rec- ognize, as well as label, everyday psychological distress stemming from systemic, rather than personal, flaws and encourage clients to embrace their connection with others to build resilience against oppression (Ching et al., 2018).

Ultimately, the work of counselors is to appreciate clients’ multifaceted intersec- tions and contexts; integrate our knowledge into crisis response care; and work to dismantle forms of oppression at the individual, community, and societal level. All of the transitions and situations we highlight in this chapter speak to life and role stressors that entangle themselves in role expectations and personal and social identities, potentially leading to feelings of isolation and chronic anguish.

Childhood and Developmental Stressors in a Family Context

“I’m afraid the thing that is broken in me is also broken in him,” Rick said as he told the story of his 10-year-old son, Jacob, who was being bullied at school. Ja- cob’s parents felt helpless as they watched their son withdraw into himself after being sent to the office repeatedly for throwing his classwork in the garbage in frustration. “It’s like he has crumpled in on himself,” his mom, Jeanne, shared. “Maybe it’s us? Maybe he can sense somehow what’s going on. He won’t tell us anything.” As they spoke more about their circumstances, they shared a story of multiple and compounded life crises. As they watched their son wither, met with school administrators who responded with legalese instead of compassion, and felt their own emptiness and fears blossom, they had to also navigate several per- sonal and familial losses. A week after they decided to separate, Jeanne’s physician referred her to an oncologist.

Considering this situation from a relational perspective, we consider Jacob’s social context. We explore how he may be experiencing power abuses at school. We discover his experiences with peer and teacher relationships. We validate that when he reaches out to his parents, even in the smallest ways, he is showing re- lational resilience. We also move from the idea that something is broken within Jacob and Rick to exploring disconnections, power in context, and isolation as our primary focus.

Watching a child suffer is heartbreaking. It can leave us feeling lonely, frustrat- ed, and powerless. Recent data from the National Center for Education Statistics (2019) indicated that nearly 7 million children receive special education services in the United States. These numbers do not account for the estimated 20% of young

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children who also suffer from a mental health issue such as depression or anxi- ety. Frequently, children who struggle with mental health issues do not receive adequate services (Whitney & Peterson, 2019). As schools continue to budget to deliver adequate programming, families and children may miss much needed ser- vices and begin to lose hope.

The cumulative impact of early adverse childhood experiences often leads trau- matized children to be diagnosed with multiple and often inaccurate diagnoses. Researchers at the National Child Traumatic Stress Network conducted several studies (van der Kolk, 2014) related to the impact of multiple childhood traumatic stresses. They concluded that a vast majority of children in their studies experi- enced multiple traumas, and many of them did not reach the threshold for PTSD for any one event (van der Kolk, 2014).

A team of researchers and clinicians sought to include developmental trauma disorder (DTD) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013); however, the DSM review team rejected the proposal for inclusion (van der Kolk, 2014). The move to include DTD as a diagnostic category represents an epistemological shift in the view of trauma- related disorders to a social malady rather than a dysfunction within a person. That is, DTD would be drastically reduced by the elimination of social contexts that foster child abuse, assault, chronic maltreatment, poverty, bullying, and the many faces of neglect. Developmental traumas can influence a person’s growth by limiting their experience of nurturing relationships and growth-oriented relational bonds (D. J. Siegel, 2012).

Parenting Children With Disabilities: A New “Normal”

The added demands of raising a child with a disability is a source of significant stress and can shift the foundation of the whole family (Dabrowska & Pisula, 2010; Guralnick, Neville, Hammond, & Connor, 2008). As parents learn that they will not be raising a neurotypical child, they may experience stress adapting to their new and unexpected roles. Such adjustments include coping with disappoint- ment, guilt, uncertainty, and grief (Neely, Amatea, Echevarria-Doan, & Tannen, 2012; Sheehan & Guerin, 2018). It is important to note that painful feelings can decrease with time, but grief can be triggered by both internal and external fac- tors. Triggers are often related to developmental milestones (e.g., starting school, graduation). These situations resurrect feelings of loss that occurred when their child was first diagnosed. When these milestones occur, caregivers may be faced with the difference between their imagined or hoped for future while facing the realities of loving a child with a different ability.

Many parents strive to create supportive and nurturing environments for their family and child, but many are never told how. The joys and challenges of parent- ing a child with a different ability can be stressful because of the complex needs of the child and caregivers. Families who receive little instruction on how to best meet their responsibilities face an increased risk for psychosocial distress and physical health problems (Resch, Benz, & Elliott, 2012). Fortunately, counselors can work with parents through these times, sharing the burdens and helping the fam- ily learn practical strategies for living (Hohlfeld, Harty, & Engel, 2018). However,

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before addressing psychoeducation and skills training, we build trusting relation- ships with the parents (Sheehan & Guerin, 2018). Counselors play a dynamic role in supporting parents of children with different abilities and promoting greater life satisfaction. Some helpful recommendations for counselors working with this population are presented next.

Parent Education

Caregivers understand their child’s physical, social, developmental, and family history better than anyone else and are respected and valuable partners in the counseling process. Counselors offer information specific to parenting a child with specific needs as well as the accurate facts about disability, validate and normalize the adjustment process, and offer linkages to resources in the community. Coun- selors appreciate how language can disempower and humanize the child and their family. For example, counselors need to avoid disempowering terminology, “Your autistic, handicapped child,” and instead use more empowering language (i.e., use the child’s name; say “people with disabilities, different abilities”; or ask how people wish to identify themselves), honoring the idea that a disability is only one aspect of a person’s identity. Finally, we educate and support parents, help- ing them develop their assertive communication and advocacy skills, which may serve them in many situations (e.g., pre-K–12 school systems, medical practices, and within their community).

Skills Training

Early intervention and skills training set the foundation to build on a child’s po- tentials for developmental, social, and functional growth (Hohlfeld et al., 2018). We teach parents techniques and skills and connect them with helping specialists in their community. For example, Stepping Stones Triple P (Positive Parenting Pro- gram) is a leading prevention program that supports parents with children with disabilities by providing skills and principles to help parents cope with behav- ioral and emotional upheavals (Ruane & Carr, 2019). This program also educates parents on how to (a) adopt an assertive approach to discipline, (b) adapt to the reality of their child’s disability, (c) establish realistic expectations about the devel- opment of their child, (d) link children in in a shared community, and (e) practice effective self-care (Ruane & Carr, 2019). For an exhaustive summary of marriage, couples, and family counseling interventions for autism spectrum disorder (ASD), see Feather (2016).

Parent Environmental and Social Support

Counselors share resources and connect parents with services in the community and tailor social services for children. Parents who join with social supports report- ed higher levels of well-being, and they appreciated the tools and shared resources provided by people facing common concerns (Hohlfeld et al., 2018). Parental well- being and family adaptation is tied to social connections, in which individuals in the network offer emotional support and provide experiences and solutions about various problems (Guralnick et al., 2008; Resch et al., 2012). I (Katherine) have found through my conversations and research with mothers of children with ASD

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that they often treasured the connections with others who understood their situa- tion. These mothers felt relieved because they were no longer alone and could ex- press their experiences with another parent. See Sidebar 9.2 for more information on parent education.

Parent Well-Being

When people manage the many routine stresses of parenthood, coupled with the unique stressors facing parents of a child with disability, wellness may dwindle because of the nature of these circumstances. Given that these stresses may settle into a family’s life permanently, the chronic stress can take its toll. Isolation may increase as a function of their many roles and responsibilities. Parents’ needs for nurturance, self-compassion, and connection may not be met because of the sun- dry associated tasks (Dabrowska & Pisula, 2010). Parents who share in a commu- nity of support gain access to helpful information and services and often experi- ence higher levels of overall well-being (Resch et al., 2012). Therefore, counselors develop resources and information to reduce distress and increase parent well- being. Practical efforts and social connections reduce systemic distress and can support the family and child as they navigate developmental milestones and po- tential behavioral issues; these connections also provide parents with meaningful support (Guralnick et al., 2008).

Additional Stressors During Parenthood

Adjusting to Parenthood

Nguyen always wanted to be a mother. Her husband, Eric, was less enthusiastic about the prospect of parenthood. Although Eric was open to the idea of hav- ing a child, he could not imagine having one anytime soon. He worried about undertaking the responsibility of a new life and the lifestyle changes that come with children. After discussing the possibility of adding to their family for 2 years, Nguyen and Eric decided to move forward. Pregnancy proved difficult, but the couple conceived through in vitro fertilization. Despite Eric’s initial hesitancy, he was an attentive partner, and the two prepared for the arrival of their new baby, Amelia, as a team. He and Nguyen decided that she would stay home until Amelia began primary school.

Although Nguyen expected a difficult labor, and acknowledged hers as being painful, she described her labor as otherwise uneventful. After dreaming of being

Sidebar 9.2 • Parent Education Throughout this chapter, we include resources for individuals wanting more information about parent education and parent well-being. Creative outlets may also help families express their experiences and strengthen their connections with each other. Some examples of these activities include dancing, gymnastics, team sports, music, and painting. These outlets could connect a child with other children through creative expression, and the parent could also connect with other parents sharing similar experiences.

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a mother for years, Nguyen was hopeful that she would find joy in her new role. Much to her surprise, although there were moments of joy in new parenthood, and she loved Amelia fiercely, she struggled considerably. Nguyen had difficulty breastfeeding and felt criticized when she decided to stop. Lack of sleep severely affected her mood and lucidity. Eric also struggled with sleep, and the two began to argue frequently. Nguyen also realized that she was quicker to anger with her friends, and she often felt overwhelmed by small tasks. Little things she used to take for granted, such as time alone and moments of silence, seemed like part of her past. A meticulous researcher and planner, Nguyen expected many of these struggles. What caught her off guard most was a powerful sense of loss, anger, and isolation. Nguyen had fought to be a mother, so why did she still dream of her old life? Every life stage can bring a mixture of feelings, and parenthood is no excep- tion. Becoming a parent is a massive transition in many people’s lives. This was the case for Nguyen. Even though she desperately wanted and loved her child, adjusting to motherhood was turbulent.

Parents who eagerly anticipate the birth of their newborn may feel a mixed sense of joy and loss after the baby’s arrival. These sentiments are not always societally understood, and new parents can feel pressured, and even judged, when they com- municate frustration and discomfort. New parents accustomed to pleasing others or presenting well in public may hide these struggles. Relational-cultural theory de- scribes this form of hiding as antithetic to authenticity (Jordan, 2018). In relational- cultural theory terms, authenticity relates to being able to represent oneself fully and freely (Jordan, 2018). Therefore, hiding, which is opposite to authenticity, may create a crisis of meaning and belonging for new parents. New parents like Nguyen may love their babies deeply and also profoundly miss their friends, activities, and—as Nguyen indicated—“the quiet stillness” she once took for granted.

Like Nguyen, new parents may feel shame over their developmentally appropri- ate, yet socially invalidated, emotions, and they may keep these feelings to them- selves. Doing so increases their chances of isolation. In addition, financial stressors may also exacerbate parents’ adjustment to parenthood. Although parents may be overjoyed by a recent birth, they may also feel particularly stressed and conflicted when economic challenges arise. In some families, a tenuous medical history may prompt parental concerns with the anticipated birth of a child, and they may feel alarmed and fearful over their child’s future physical or emotional health. In those cases in which the pregnancy was not expected, the prospect of parenthood can be perplexing. For parents who suffer a traumatic childbirth, these adjustments can be particularly challenging.

Traumatic Childbirth

Caroline and her husband, Stewart, celebrated their eighth wedding anniversary by painting a nursery in preparation for the birth of their first child. The couple met as student athletes in college, and after years of building their careers and nurturing their relationship, they yearned to begin growing their family. Caroline had cut off communication with her mother 3 years before her son’s, Caleb’s, birth, following decades of verbal and emotional abuse. More than anything, Caroline wanted to create a loving and happy home. She was excited but anxious about giving birth, especially after the doctor informed her that the child would be large.

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Five weeks before her scheduled due date, Stewart rushed Caroline, who was in severe pain, to the hospital. Caroline experienced several serious complications during labor, including hemorrhaging and maternal sepsis. Shortly after giving birth, she began experiencing frightening panic attacks. Multiple factors added to Caroline’s postpartum distress. She was estranged from her mother and grieved maternal support and guidance. As an athlete, Caroline prided herself on her physical strength and ability to control her body. Her birth experience, and the ensuing physical and emotional trauma, was chaotic and frightening. Caroline felt disconnected, disempowered, and betrayed by her body. The anxiety and pan- ic attacks made it hard for Caroline to be the mother she had envisioned herself to be, and she felt lost coping with the trauma of delivery. Although experiences like Caroline’s are not unique, they are sometimes obfuscated by happier narra- tives of “successful” childbirth. If both mother and child made it through delivery, shouldn’t everyone feel relieved and fortunate? See Sidebar 9.3 for more informa- tion on disconnection after childbirth.

Pregnancy and childbirth can lead to several mental health concerns (Chartier et al., 2015). These concerns are particularly salient when parents view the birth as having been physically or emotionally traumatic (Inglis, Sharman, & Reed, 2016). Studies have shown that 1%–6% of women develop PTSD after giving birth (Al- corn, O’Donovan, Patrick, Creedy, & Devilly, 2010). The perception of negative emotions and distress during childbirth and obstetrical emergencies are among the highest predicting factors for a mother to develop PTSD (Anderson, Melvaer, Videbech, Lamont, & Joergensen, 2012). Because perceived distress is inherently subjective, it is important for counselors and other medical and mental health professionals to listen to a mother recount her own experience during childbirth rather than projecting their own beliefs, opinions, or values on her. It is important that counselors recognize how lonely, isolating, and confusing these experiences can be and respond to their clients in ways that foster connection, help them make sense of their confusion, and let them know they are not alone in the experience.

Nguyen and Caroline’s stories differ in several respects, yet they share salient commonalities. Both women were overjoyed at the prospect of parenting, and they dearly loved their babies. Both were financially secure and, by both accounts, knew their privilege in being parents of healthy children. However, this awareness only increased their loneliness, panic, and feelings of guilt.

Even when people seem to “have it all,” no one is immune to the stress and the small and large crises that life transitions bring. Counselors attuned to these dynamics recognize the varied cultural, familial, and logistical expectations new

Sidebar 9.3 • Disconnection After Childbirth Caroline felt a sense of disconnection from her body after giving birth. Social media depicts how wonderful being a mother is, and although this may be true, the process of becoming a mother is a different journey for every woman. Feeling disconnected from her body, Caroline may benefit from a loving-kindness meditation or slow-moving exercises when she feels ready. These activities could include tai chi or yoga. What are your thoughts on this?

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parents may have placed on themselves and the real challenges that can come with life-changing transitions, such as new parenthood. Counselors can create a space where clients can share their genuine feelings and experiences, and they can sup- port them as they navigate these adjustments. They can also guide new parents in finding ways to connect with the people and activities they enjoy and to develop their self-compassion. Transitions can be critical times in the lives of many people, and self-compassion can counter.

Stress and Loss in the Workplace

Sexual Harassment

Sexual harassment is a major concern for people in the workplace and within school and university settings. Although this term was coined to describe male treatment of women, it now encompasses both genders in its application (R. Sie- gel, 2012) and includes unwanted verbal and sexual advances in the workplace. Sexual harassment can be a confusing experience for subordinates or people with less power. It can occur in the workplace, at university settings, and in any setting where there is a power differential. It is viewed by the U.S. government as a form of discrimination and stands in direct violation of Title VII of the Civil Rights Act of 1964 (U.S. Equal Employment Opportunity Commission [EEOC], 2019b).

The EEOC (2019a) has posited that any

unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute sexual harassment when this conduct explicitly or implicitly affects an individual’s employment, unreasonably interferes with an indi- vidual’s work performance, or creates an intimidating, hostile, or offensive work envi- ronment. (para. 2)

This policy acknowledges the full range of dynamics that can constitute harass- ment, and it stipulates that the means by which harassment occurs can be both direct and indirect. Complaints can be filed by any person who is affected by the behaviors, even if he or she is not directly harassed (EEOC, 2019a).

Quid pro quo is one common example of harassment (Mellon, 2013). For example, a supervisor might say, “you will have this opportunity if you give me this form of sexual gratification.” It can also be communicated as “you will not have this raise if you do not do that for me.” The EEOC (2019a) is clear, however, that it is not neces- sary for these two conditions to be present for harassment to exist. Sexual harass- ment can be a deeply isolating and confusing experience. Counselors working with clients who undergo this violation can offer education, support, and advocacy.

Job Loss

Growing up, Richard always knew he wanted to make a comfortable living, al- though he never had a clear vision of how to do so. There were not many oppor- tunities in his neighborhood, and his parents juggled multiple unsatisfying jobs to make ends meet. Richard’s big break came when his uncle helped him get a job as a bell hop in an independent boutique hotel he worked at across town. Richard found that he enjoyed working with hotel guests. The guests loved Richard, and management took note. Over the next 26 years, Richard worked in several differ-

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ent departments within the hotel. He was eventually promoted to management. Richard considered getting a degree in hospitality management now that he was more financially secure but felt that it was too late for him to go back to school. The hotel had become Richard’s second home, and the staff like his second fam- ily. Two days after Christmas, Richard received word that the hotel was closing. At age 45, Richard had only been on one job interview, which he secured through family. He was terrified at the thought of not being hired or having to take a lower position because he did not have a degree. Most of all, Richard was heartbroken at the thought of leaving the place, and the people, that he had grown to love.

Job loss is often pervasive and adversely affects personal and physical well- being. Specifically, job loss negatively affects life satisfaction, mental health, and life domains (i.e., financial and relationship strain, poorer health and quality of life, diminished identity and self-esteem; Synard & Gazzola, 2019). Research illustrates the link between unemployment and mental health concerns, such as depression, somatization, anxiety, and substance use (Bluestein, Kozan, & Connors-Kellgren, 2013). We also note there are positive effects of job loss, which include personal growth following adversity, greater self-awareness, new career paths and explora- tion, and improved relationships (Waters & Strauss, 2016). According to Bluestein et al. (2013), there is an emotional continuum of job loss: On one end, individuals can experience unemployment as “the bottom falling out” (i.e., distraught, trau- matized, angry), and on the other end, there is a mixed response to unemploy- ment, characterized by a sense of loss but opportunities for growth. The ways in which people cope with job loss and unemployment are complex because of individual (e.g., psychological protective and risk factors), social (e.g., proximal re- lational resources, one’s intersecting identity), economic (e.g., financial resources), and political (e.g., policies, governmental support) factors, which have a profound impact and shape the experiences of unemployed people (Bluestein et al., 2013).

After the shock of a job loss, we help people develop positive daily routines (i.e., cognitive and behavioral adaptation responses to the loss), and we explore past coping and resilience strategies (Synard & Gazzola, 2019). Also, we nurture and explore a person’s strengths and curiosity in their new and potentially unstable life (Synard & Gazzola, 2019). We may consider reframing unemployment and en- courage supportive and realistic optimism during periods of joblessness to lessen some of the stress (Bluestein et al., 2013). The change process can be enhanced through a counselor’s positivity; however, a mutually empathic relationship, and true compassionate understanding, creates a partnership where we can consider new opportunities that may unfold over time (Synard & Gazzola, 2019). Most im- portant when it comes to unemployment, we coordinate community-based ser- vices and assist with unemployment benefits, which may buffer financial hardship and, ultimately, psychological stress (Bluestein et al., 2013). We also explore the many career counseling tools available to us and our clients to help gain clarity on values, strengths, and potential pathways for new training or job opportunities (https://www.onetonline.org/).

Physical Challenges and Rehabilitation Adults and children differ in development and maturity, and people in all age groups may face other developmental and medical issues. Young children, people

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living with developmental disabilities, and those with medical needs may be more susceptible during sudden destabilizations. Notably, people with a disability are more likely to experience sexual assaults. For example, about 50% of young boys and girls who are deaf report being sexually assaulted, and these numbers are drastically higher than those of their nondeaf counterparts (Center on Victimiza- tion and Safety, 2015). Counselors seek to especially address any physical, struc- tural, or social needs to consistency and linkages to medical and specialized ser- vices when needed (American Red Cross, 2012).

Disabling conditions and chronic illness affect the lives of about 53 million adults who experience physical, sensory, psychiatric, or cognitive disabilities (CDC, 2018; Courtney-Long et al., 2015). Individuals with disabling conditions and chronic illness face physical and psychological crises, increased stress, experi- ences of loss and grief, as well as changes to their body image and self-concept; they also experience stigma and uncertainty in their life (Livneh & Antonak, 2005). Adjustment to a disability is an essential part of the rehabilitation counseling pro- cess (Stuntzner, 2017).

The process of adjustment is nonlinear, with possible setbacks, new medical issues, and increased distress when adverse events occur. Through these ups and down, counselors foster compassion and encourage self-compassion for people enduring these difficult times (Stuntzner, 2017). Strategies to strengthen self- compassion can include meditation (e.g., loving-kindness) as well as practicing compassion and self-compassion (for an overview of the eclectic theoretical coun- seling approach, see Stuntzner, 2017). As people negotiate their new identities and debilitating experiences, they may benefit from counseling relationships fo- cused on gaining new and realistic perspectives of their situations (Livneh, 2015). Livneh and Antonak (2005) summarized comprehensive interventions developed for clients with chronic illness and disabling conditions. They recommended that counselors should (a) assist with the exploration of the personal meaning of their condition (i.e., processing feelings of loss and grief), (b) provide relevant medical information (i.e., prognosis; functional and vocational implications), (c) encourage supportive family and group services (i.e., educational, psychotherapeutic, coping skills training groups), and (d) teach adaptive coping strategies for community functioning (i.e., assertiveness; interpersonal, decision-making, and stigma man- agement skills).

Transitions and Stressors in Later Adulthood

Empty Nest

A bustling household becomes eerily quiet when the seemingly endless school days, rushing to extracurricular activities, celebratory moments, and holidays end and a new exciting chapter begins in a family’s life. When children leave home for the world of work or even college, parents have to start their new chapter and may experience empty nest syndrome. The empty nest phenomenon is a time of crisis when the absence of their child creates a vacuum of interactions, responsibilities, and routines. Empty nesters may even feel directionless, lonely, and lost as they adjust to life without being a steady caregiver. Stresses related to marital discord may materialize when children leave the home because the parent-child relation-

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ship often served as a buffer between the couple (Gold, 2013). Apart from the chil- dren, a life together as a couple can seem foreign, as changing parental roles may lead to an intense renegotiation of the marriage (Gold, 2013).

Filling the relational void when children leave home while coping with the pre- vailing feelings of loss and identity may inform the counseling process. Counselors consider how grief and the loss related to a parent’s identity lead to redefinitions of roles and interests. Counselors partner with empty nesters to engage in self- discovery and consider new friendships outside of the child-rearing role. Connect- ing parents to a support group can link parents with others to feel validated, sup- ported, and connected. If there is marital discord present with empty-nest couples, the couple works to develop a new partner-focused versus child-focused marriage (for a summary of eight tasks of a couples’ counselor when working with empty nesters, see Gold, 2013). Counselors facilitate reconnection through developing shared meaning (i.e., rituals, roles, goals, and symbols) and intimacy, so couples can continue on the new journey together (Beaty, 2016).

Retirement

As the CDC (2017) reported, Americans who work full time spend one third of their day in the workplace 5 days a week. Because people spend a considerable amount of time in the world of work, their career becomes a part of their identity and self-concept (Froidevaux, Hirschi, & Wang, 2016). The loss of the work role can bring new identities and roles as a person transitions from work life to retire- ment. In retirement, the loss of income, social contact, status, daily structure, and purposeful activity can create a social and vocational vacuum (Damman, Henkens, & Kalmign, 2015). One of the major life transitions in late adult life is retirement. However, there are inconsistent findings when it comes to retirement and adjust- ment. Some studies have reported lower life satisfaction and happiness, greater depression and loneliness, lower activity levels, partial identity disruption, and even death anxiety for retirees, whereas other studies have reported that people look forward to retirement and have overall satisfaction with retirement (Osborne, 2012; Wang, Henkens, & van Solinge, 2011).

The disengagement from work life may involve adjusting to the loss of the work role and the development of the meaningful postretirement lifestyle (Os- borne, 2012). When it comes to developing a postretirement lifestyle, counselors assist people with establishing meaningful activities, interests, and recreations that replace the void of work (Osborne, 2012). As a person prepares for retirement, Froidevaux et al. (2016) recommended retirees face questions about how to still feel useful through mattering and meaning, reflecting on how they will continue to make a difference in the world. Wang et al. (2011) suggested connecting retirees to social and emotional resources to support their adjustment.

Factors, Approaches, and Interventions That Foster Healing and Resiliency

As we discussed in this chapter, working with people who contend with major and often chronic crisis situations involves nurturing social connections in the counseling process and within the communities where people live. Incorporating

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tenets of crisis counseling models, we become knowledgeable about community resources, and we link people with supportive contexts and people who share similar struggles. We recognize the toll that the life crises take as well as how isola- tion and dismissiveness can deepen a person’s misery. By contrast, counselors can fully engage with and appreciate what these events mean to people in their con- text and work together to strengthen relational and social bonds. We also provide tangible resources, links to community supports, and a commitment to working with people throughout tumultuous times.

Amarah was referred to me (Katherine) by her primary care physician, who shared concern about Amarah’s stress and overall well-being. Amarah recently confirmed that her son, Sam, was diagnosed with ASD, and she was living in a world where that diagnosis made some sense, but she was filled with deep sad- ness and fear for her son’s future. Amarah shared that, since receiving the diagno- sis, she and her wife have distanced themselves from each other. Amarah stated, “Our marriage has really taken a turn for the worse.”

In our first meeting, Amarah shared, “I feel so terrible. I love my son so much, but I can’t shake these thoughts and even feelings that I wish he did not have au- tism. I hate it. and I love him so, so much.” Amarah imagined how her beautiful son would face future tormentors and would struggle with communicating his experiences. She felt hopeless, angry, alone, and tired. She could not see how she would have the strength to “do this every day for the rest of our lives.”

The importance of nurturing relational resilience and cultivating social connec- tions with Amarah could help break her from the loneliness borne from her stress- ful and isolating context. I also considered how Amarah felt the sharp pangs of grief for herself and her family—that, because of some twist of medical fate, the bright and exciting future she envisioned for her son and family seemed tarnished with the specter of this new unknown territory. She did not know where to turn. We spent time exploring her feelings of loss and considered resources that could provide some immediate relief and support. In our conversations, we validated her grief and explored permission to care for herself and her family, asking for help when she needed it. We began planning for her first support group meeting. Amarah felt a mix of trepidation, relief, and excitement to attend the meeting.

Future Directions and Emerging Research In Chapter 15, we discuss the work of the Human Dignity and Humiliation Stud- ies organization as a framework for social action and compassionate change. Given that many people lack access to mental health and social support, future directions for social change include enhancing our social service delivery system. A movement exists toward integrated mental health, addiction, and physical care (Ratzliff, 2016). However, these models are deeply embedded in the medi- cal traditions and can be driven by diagnoses and the provision of short-term solutions. Moving toward the future, we encourage the expansion of integrated systems to include readily available and well-funded counseling and social ser- vices that promote dignity and long-term relationships within the community. The current integrated care models may be the first step, and efforts to advocate for the work of counselors to fully serve people regardless of income, diagnoses, and social status are needed.

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