How exciting!

I'm a little unsure of what kind of counseling you're talking about, though. I'm getting the impression it's almost like secular chaplaincy stuff, or is it specifically end-of-life counseling?

>what the life is like

I don't work in a hospital setting, so I have little insight into that (I work at a non-medical hopsice; the grief counseling I do looks more like traditional psychotherapy, where clients come in once a week at an appointed time for a 50min. session). The therapists I've known who have worked in hospitals tended to find the lack of privacy and the kind of slapdash nature of the counseling difficult, but those were also people trained in the more traditional psychotherapy model, so I'm not sure how much of an obstacle that would be for everyone. A friend did say that she was leaving the hospital setting, though, because she was tired of trying to do therapy work with people who didn't necessarily want it.

One thing I struggle with a lot that probably will apply to you is the need to leave your clients at work, metaphorically. You need to be aware of your own boundaries and honor them, and make sure that you're not carrying your clients' needs with you at all times. Various professors suggested various rituals for this kind of thing, like washing your hands at the end of the day; I find that walking home from work tends to help me clear my head.

> how to best serve our clients

My advice on this might change depending on what exactly you're doing, but generally, I think providing a nonjudgmental, accepting, empathetic presence is the best way to serve clients. I've been working a great deal lately on trying to separate activism from therapy; I think therapists who burn out, and who don't recognize that they're acting from ego, are often coming at counseling from an activist standpoint ("*I* must fix my client's problems!") rather than a therapist standpoint ("I must be a nonjudgmental presence during this time while my client solves her own problems."). The first atttitude fosters dependency, the second empowerment.

I find, personally, that the more vulnerable the client, the harder I have to work at this distinction, which is why I mention it in regards to a hospital setting. (It might not apply quite as much if you're doing more social work-y, client advocacy type work.)

> how to work best on my listening, empathy, and interpersonal skills to be as effective in this role as possible.

Get therapy on your own, if possible. Meditate. Pursue your own psychological and spiritual growth and knowledge as much as possible -- there is nothing more dangerous than a therapist who does not recognize his own biases and blindspots. You don't always have to be able to overcome them, but you do need to be aware of when they're popping up in your work with clients (in other words, you need to own your own shit).

I think there's a distinction in working with clients between meaning-making work and problem-solving work. Grief and end-of-life work is pretty much always meaning-making work; working with clients who are ill might be a mixture of the two. Most people are pretty comfortable with problem-solving work, but be aware that you want the *client* to be solving the problem (though you can provide resources to help). Meaning-making work is harder, and trickier, and more slippery... and (in my opinion) much more important. There are no answers, only exploration. The therapist's role in meaning-making work is to sit patiently while the client struggles through his or her own explorations, providing a safe, accepting space where big questions can be asked without being shut down with glib advice, cliche, or intellectual wankery; the therapist's accepting presence assures the client that another human being can hear the client's uncertainty, anger, fear, remorse, or even joy without backing away, that such seemingly overwhelming emotions are acceptable and speak-able.

Even problem-solving work has meaning-making components. If a client comes to you with a concrete question, in general he or she has not yet solved it not because they lack the tools to do so (though this sometimes happens) but because they have not yet resolved the meaning behind the possible choices.

For general therapeutic techniques, if you can find transcripts or videos of Carl Rogers, he's really ridiculously wonderful at active listening. I've also been reading a lot of Irving Yalom lately; "The Gift of Therapy" has some nice, concrete suggestions with case studies and the whole thing's extremely readable.

In general, the most common interventions with clients are "normalizing" (reassuring a client that everything they're feeling and thinking is well within the range of expected, given their situation) and "processing" (just talking out all the angles of whatever's bothering them). I probably spend a good three-quarters of most early sessions saying things like, "Of course you feel that way; your dad just died. Tell me more about that anger/guilt/sadness."

Know that you don't have any answers. Your job is to jump in a wrestle with the questions, not to provide answers. You don't have to wrap every conversation up with a nice little bow. It's immensely relieving to me when I remember that, that I'm in the room with my clients to be a witness, not a judge. Also be aware of too much self-disclosure; you're there to hear their story, not tell your own.

(OK, that's probably all over the place, but that's what's popping up in my head right now, at least.)

Oh, I meant to add up there: Get feedback. From your clients, from your supervisors, from your friends, whoever. The counseling relationship is a relationship like any other, and who you are in any relationship will likely be who you are in a therapy relationship with clients. While staying aware that some people will, of course, project their own issues onto you, try to use whatever feedback you get to continue to improve your ability to relate honestly and without huge defenses to your clients.

I like that distinction about "meaning-making." Though I'm in an entirely different field, I find it resonates: much of what we do in historical settings, in environments that pull up family memory, history, issues of identity, is 'meaning making' too. I'll be thinking about the difference between that and 'problem solving.'

This is totally tangential to the question and the response, but I really got a lot out of reading that.

Dang, I came into this thread late thinking I could just read it... It's too late for this bunny to make a coherent post, but I promise I will after I've slept. Promise. And thanks for thinking of me LT. :)

Though I'm in an entirely different field, I find it resonates: much of what we do in historical settings, in environments that pull up family memory, history, issues of identity, is 'meaning making' too. I'll be thinking about the difference between that and 'problem solving.'

That totally makes sense, and most of the time when people talk about "meaning-making therapy," they use what I think of as "museum" examples -- helping people put together some sort of internal or external record of what their life has been, to make sense of seemingly arbitrary events, almost to curate themselves, in a way.

All right... I've had all day to think this over. :)

I want to hear from you about what the life is like, how to best serve our clients, and how to work best on my listening, empathy, and inter-personal skills to be as effective in this role as possible.

Occhiblu knows of what she speaks. Her points are all spot on. :)

For those who don't know... I am not a professional therapist, I am a hospice patient care volunteer. What I can tell you from my experience is that the gift of your presence, your rapt, uninterrupted (as best you can, meditative techniques can help here,) presence is the best gift you can ever offer as a listener. I suspect though, that listening will only be part of your job and you will have to take notes or some other jobbish stuff. So, learning to be present in your heart and body, while using your brain to keep records may be a skill you will have to learn. When I take visit notes, it is always afterward, so I don't have to practice deep listening and writing at the same time. I am not sure if I could do it, actually.

When I began my training, a chaplain invited me to envision myself as a bowl. Any sized bowl I wanted, color shape, material, etc., just so long as it was well and truly *me.* When I get to my client's home, I spend a few moments before getting out of my car, visualizing the bowl and its emptiness. I let go of my external trappings, check my false self and allow myself to be empty enough to hold my patient's feelings for awhile. Through my minimizing of self, I give my patient a strong container that they can pour their feelings into. Then when the visit is finished, I envision pouring those feelings (like tears or water) onto the flowers around their home or nursing home. Or if there are none available, I visualize pouring my bowl into the ocean. I allow myself the space to feel about my visit, and then I write my care visit notes. Then, I go about *my* day. This is how I do it.

I'm not sure how much two-way discussion you will have, with your clients. I try to keep mine minimal, because in my experience most patients just want to be heard. I'm focusing on the emotional, listening visits in this post. I am also lucky enough to have cut throat scrabble games with my clients too, but those are for a different post. :0)

I hope this helps. Best wishes to you in your new endeavor! I'd love to keep in touch and hear how it goes.

Tangent here, mainly for occhi and Miko: My friend Lois (who I think was one of the early promoters of the notion of museum experience as "meaning making") decided a few years ago to get an MSW and she's now doing a lot of work related to helping museums find social-service and therapeutic roles that complement their missions. Very interesting stuff.

tangerine, very cool!

LP, I love the bowl visualization. I may start using that one.