This video reviews ways to help children heal from trauma
Please also review AIHCP’s Healthcare Certification programs, especially its Trauma Informed Care Program
trauma informed care
Trauma Informed Care: Resiliency and Post Traumatic Growth
I. Introduction
The complex interplay between trauma, resiliency, and post-traumatic growth serves as a profound area of study, offering insights into the human experience following distressing events. Trauma, often defined as a deeply distressing or disturbing experience, can have a far-reaching impact on individuals, challenging their psychological resilience and emotional fortitude. However, not all who endure trauma succumb to its debilitating effects; instead, many exhibit a remarkable capacity for recovery and transformation. This phenomenon, known as post-traumatic growth, encapsulates the notion that individuals can emerge from traumatic experiences with newfound strengths, perspectives, and appreciation for life. Understanding this relationship is vital, as it highlights the adaptive potential inherent in human beings, fostering a sense of hope and possibility even amidst suffering. Thus, this essay will explore these interconnected themes, seeking to illuminate how trauma can serve as a catalyst for personal growth and resilience (Richard G Tedeschi et al., 2025-07-23).
Please also review AIHCP’s healthcare certifications
A. Definition of trauma and its prevalence in society
Trauma, fundamentally understood as an emotional response to distressing events, manifests in numerous ways, affecting individuals mentally, physically, and socially. It encompasses a wide range of experiences, from personal losses and accidents to exposure to violence and natural disasters, resulting in significant psychological repercussions such as anxiety, depression, and post-traumatic stress disorder (PTSD) . Prevalence rates indicate that a substantial portion of the population encounters some form of trauma during their lifetime; studies suggest that nearly 70% of adults in the United States have experienced at least one traumatic event, with many grappling with the long-term effects (Bhugra D, 2021-02-04). This widespread incidence underscores the urgency to address trauma within various societal contexts, including healthcare, education, and community support systems, as its impacts extend beyond the individual, influencing familial relations and community dynamics. Understanding trauma’s definition and prevalence is vital for fostering resilience and facilitating pathways to healing.
B. Overview of resiliency and its importance in coping with trauma
Resiliency plays a crucial role in the process of coping with trauma, as it encompasses an individual’s ability to adapt and thrive despite adverse experiences. This psychological strength allows individuals to employ effective coping strategies, which can lead to post-traumatic growth (PTG). For instance, research focusing on survivors of the 2004 Indian Ocean tsunami reveals that those who utilized problem-focused coping were significantly more likely to experience PTG, highlighting the importance of adaptive strategies in long-term recovery (Hidayati SHS et al., 2025). Similarly, studies on veterans demonstrate that resilience and effective stress coping styles aid in their adaptation after combat experiences, allowing for personal growth and improved psychosocial well-being (T Kudrina et al., 2024). Therefore, fostering resiliency not only enhances coping mechanisms but also serves as a foundational element for individuals to find meaning and strength in their lives following trauma, ultimately facilitating their journey toward recovery.
C. Introduction to the concept of post-traumatic growth
The concept of post-traumatic growth (PTG) emerges from the recognition that individuals often derive positive transformations in the aftermath of trauma. This idea challenges the traditional view that trauma merely leads to psychological distress, emphasizing instead the potential for adaptive changes. Research indicates that those exposed to significant trauma, such as first responders during critical incidents, may exhibit varying profiles of post-trauma responses, including PTG alongside post-traumatic stress symptoms (Brickman S et al., 2023). Furthermore, qualitative studies among populations like female military veterans reveal that the meaning-making process following traumatic experiences can foster resilience and personal growth (A’mie M Preston et al., 2022). These findings underscore the complexity of trauma recovery, suggesting that while pain and suffering are prevalent, they can coexist with significant personal development. Understanding PTG not only enriches our comprehension of traumas effects but also highlights the importance of supporting adaptive coping strategies in therapeutic contexts.
II. Understanding Trauma
Trauma, an intricate and multifaceted phenomenon, profoundly affects individuals, often altering their psychological and emotional landscapes. It can stem from various sources, including personal loss, violence, or natural disasters, and its impact is not merely a fleeting experience but can lead to lasting effects on ones mental health and overall functioning. Understanding trauma involves recognizing both the immediate and ripple effects it can have on an individual’s life, as well as their relationships and sense of self. Importantly, the concept of trauma does not only encompass adverse experiences but also integrates individual responses to these experiences, which can lead to diverse manifestations of distress or resilience. Furthermore, examining the neurological and psychological mechanisms behind trauma helps illuminate pathways for healing and recovery, suggesting that recognizing ones trauma is the first step toward fostering resilience and facilitating post-traumatic growth (Ritblatt SN et al., 2022-09-28).
A. Types of trauma: acute, chronic, and complex trauma
Understanding trauma necessitates a distinction between its various types: acute, chronic, and complex trauma, each possessing unique characteristics and implications for recovery. Acute trauma typically results from a singular distressing event, such as a natural disaster or personal assault, leading to immediate psychological impacts often seen in symptoms of post-traumatic stress disorder (PTSD). In contrast, chronic trauma entails prolonged exposure to stressors, such as domestic violence or long-term illness, resulting in more deeply ingrained psychological issues and affecting an individual’s capacity for resilience. Complex trauma, characterized by exposure to multiple traumatic events, often in the context of interpersonal relationships, complicates recovery further by fostering feelings of helplessness and mistrust. Research highlights that addressing the specificities of each trauma type can improve therapeutic strategies, particularly for those recovering from complex conditions where acute episodes may emerge as complications, reflecting the critical need for tailored interventions in the aftermath of trauma (O Adegboye et al., 2025), (Litvinchik А. et al., 2025).
B. Psychological and physiological effects of trauma on individuals
Trauma exerts profound psychological and physiological effects on individuals, significantly shaping their resilience and potential for post-traumatic growth. Psychological responses to trauma often include anxiety, depression, and post-traumatic stress disorder (PTSD), which can hinder emotional stability and interpersonal relationships. Research indicates that individuals with a history of childhood trauma exhibit heightened trauma symptomatology, impacting their capacity to cope with subsequent stressors and increasing the risk of revictimization in adulthood (Brooks et al., 2015). Physiologically, trauma can precipitate changes within the brain and body, including alterations in stress response systems that may lead to chronic health issues. Furthermore, integrating arts and creative therapies has emerged as a promising avenue in addressing the health challenges faced by trauma survivors, thereby fostering healing and enhancing overall well-being (N/A, 2013). Understanding these intricate interactions is essential for developing effective interventions aimed at promoting resiliency and facilitating recovery.
C. The role of social and environmental factors in trauma experiences
Understanding the role of social and environmental factors in trauma experiences is crucial for comprehending the pathways to resiliency and post-traumatic growth. Social support significantly influences an individual’s ability to cope with trauma, as evidenced during the COVID-19 pandemic, where coworker support emerged as the strongest predictor of post-traumatic growth among nurses facing unprecedented challenges (Seo J et al., 2025). This highlights the importance of social networks in facilitating recovery and adaptation. Additionally, environmental factors such as job conditions and resource availability contribute to the potential for growth following traumatic experiences, underscoring the need for supportive organizational structures. Moreover, for emerging adults with a history of childhood trauma, external resources like professional services and social networks serve as protective factors that enable resilience and adaptation (Bahardeen FA et al., 2025). Collectively, these elements illuminate the complex interplay of social and environmental influences that shape trauma experiences and promote recovery pathways.
III. The Concept of Resiliency
Resiliency plays a critical role in how individuals cope with trauma, serving as a fundamental psychological resource that fosters adaptation and recovery following adverse experiences. It is important to distinguish resiliency from concepts such as post-traumatic growth (PTG), which refers to the positive changes emerging from crises. While PTG signifies a transformative process that can lead to enhanced personal development, resiliency encompasses a broader set of skills and traits that can be cultivated in response to any form of adversity, not just traumatic events (Yu.S Kotovska, 2023). In contexts fraught with instability, such as the ongoing conflict in Ukraine, fostering resiliency becomes essential for youth who are particularly vulnerable to emotional disturbances and anxiety (Syniakova V et al., 2025). Thus, interventions aimed at enhancing resiliency, such as emotional regulation and coping strategies, become vital components in the overall framework for psychological support and post-traumatic recovery.
A. Definition and characteristics of resiliency
Resiliency, defined as the capacity to adapt and recover from adversity, plays a crucial role in the process of post-traumatic growth. This characteristic is not merely about enduring but involves actively engaging with and transforming one’s experiences into opportunities for personal development. Individuals demonstrating resiliency often employ adaptive coping strategies, which can include acceptance and planning, as evidenced in studies where effective coping mechanisms mediated the relationship between resiliency and post-traumatic growth (Ogi Nńska-Bulik et al., 2015). Furthermore, resiliency embodies the ability to reframe traumatic experiences, allowing individuals to reconstruct their value systems and gain insight into their lives, as highlighted by recent findings in Positive Psychology (Poseck BV et al., 2006). By understanding the characteristics of resiliency, such as emotional regulation and social support, we gain valuable insight into how individuals not only survive but thrive following trauma, ultimately facilitating a path to growth and enhanced well-being.
B. Factors that contribute to individual resiliency
Resilience, that key ingredient for coping with trauma and even growing from it, comes from all sorts of places, like having people who support you, the way you think, and getting help from specific programs. Take online social support, for example. It really stepped up during tough times like the COVID-19 pandemic. Connecting with others and sharing what you’re going through can seriously boost your emotional resilience. Studies show it can make you more grateful and help you see things in a new light, which can lead to post-traumatic growth (Hao X et al., 2025). Then there are programs like the Maeum Program in South Korea. It’s a stabilization-centered intervention that has been shown to help people deal with psychiatric symptoms and actually grow after trauma. These types of programs usually focus on teaching people about what they’re going through and giving them coping strategies. This reinforces those resilience factors that are so important for recovering and adapting after something traumatic (Oh IM et al., 2025).
C. The impact of social support systems on resiliency
It’s hard to overstate how important social support systems are when it comes to helping people bounce back from trauma. Think of social support as a safety net – it boosts a person’s ability to handle stress and tough times. When people have strong bonds with family, friends, and their community, that really helps them stay emotionally stable, which is super important for resilience. Research has shown that people who have solid social networks tend to report fewer trauma symptoms and are generally doing better overall in their lives. This highlights just how crucial those community connections are for healing. On top of this, certain systemic issues – we’re talking about things like implicit racism and stigma – hit marginalized groups especially hard. This makes it clear that we need support systems designed to address those specific issues (Rich J, 2016). When we really get how different trauma experiences can be, and how they affect people in different ways, we can see that having comprehensive social support systems is essential for helping people grow after trauma and supporting them as they work toward recovery (Brooks et al., 2015).
IV. Post-Traumatic Growth
Post-traumatic growth, or PTG, shows how people can actually grow after really tough times. It’s not just about bouncing back to normal like resilience; PTG means that bad experiences can actually make you see things differently, feel stronger, and have better relationships. Studies show that after trauma, people might find a new love for life, feel more for others, and rethink what’s important to them (Shakespeare-Finch J et al., 2024-02-27). These changes often happen because of big questions and struggles that come up when you’re healing, pushing you to really think about what you believe in. Because of all this, PTG highlights a hopeful part of being human. It shows that we don’t just sit back and take trauma—we can actively rebuild who we are and make our lives better even after we’ve suffered.
A. Definition and key components of post-traumatic growth
Generally speaking, post-traumatic growth, or PTG, considers positive psychological shifts that may follow difficult life events, especially trauma. This idea has become noteworthy because it emphasizes that individuals, in most cases, may come away from such experiences with a greater sense of personal strength, deeper connections with others, and a changed perspective on what they value in life. Key elements of PTG involve changes in how one views themself, a heightened feeling of purpose, and the formation of new priorities and values. Furthermore, PTG emphasizes the significance of how individuals perceive their growth, rather than relying just on what can be observed outwardly (Keidar M, 2013). The resilience shown while dealing with trauma highlights that, even though such events are exceptionally difficult, they also provide chances for deep personal change and revitalization, as studied within Positive Psychology (Poseck BV et al., 2006).
B. Stages of post-traumatic growth and personal transformation
Generally speaking, post-traumatic growth illustrates a pretty significant transformation that people might go through after experiencing trauma. It’s marked by several stages that help with healing and personal development. At first, someone might feel shock and confusion, which leads them to rethink what’s important and how they see life. As they work through their emotional stuff, they often find they’re more resilient, so they can adapt and take on new chances to grow. For example, studies have shown that renal transplant recipients often report positive changes in their mental state after surgery, seeing optimism and personal growth as key results of their experience (Kamran F et al., 2016). Moreover, research suggests people often rebuild their values after trauma, implying that even when things are tough, there’s room for positive changes in life. Ultimately, these stages of post-traumatic growth emphasize the human capacity to become stronger and more resilient when facing life’s challenges (Poseck BV et al., 2006).
C. Case studies illustrating post-traumatic growth in individuals
Considering specific instances of people who have gone through traumatic events gives insight into the nuanced connection between hardship and development after the trauma, which shows a route of strength and change. A good example of this is the psychological changes seen in those who lived through the Iran-Iraq war. (Hashemi M et al., 2025). Their enduring early trauma could nurture better emotional strength and coping tactics. Even when trauma’s effects remain, their stories show how people can build resilience and improve their cognitive abilities. Similarly, young adults from Klang Valley, Malaysia, said that social support and creative activities were essential in their growth because they assisted them in overcoming challenges brought on by past traumas (Bahardeen FA et al., 2025). These particular cases emphasize that even though trauma frequently results in tremendous pain, it can also spark significant personal growth, which reinforces the idea that strong coping mechanisms can emerge from even the worst situations.
V. Conclusion
To sum up, the ways that trauma, resilience, and post-traumatic growth interact really shows how complicated it is for people to react to upsetting situations. Like recent research shows, including looking at how palliative care nurses use self-reflexive blog writing, people can still grow and become more resilient even when dealing with big problems, like those that came up during the COVID-19 pandemic (N Lalani et al., 2025). Also, what mental health workers went through during the Israel-Hamas conflict points out how trauma has two sides: personal resilience can help protect against feeling anxious and stressed, but it can also lead to post-traumatic growth (Dahan S et al., 2024). This complicated relationship suggests that trauma, while obviously upsetting, can also kick-start big personal changes if people have the right ways to cope and good social support. For that reason, it’s very important for people and professionals to understand these things when working on trauma recovery, which opens the door for ways to use resilience to help people heal and grow.
Please also review AIHCP’s Trauma Informed Care program as well as its other healthcare certification programs
A. Summary of the relationship between trauma, resiliency, and growth
Navigating tough times involves a complex dance between trauma, resilience, and personal growth. Sure, trauma can hit hard, but research suggests resilience often softens the blow, influencing how much growth we see afterward. For instance, (Her T et al., 2025) points out that resilience and, interestingly, thinking things over intentionally can really help in reflecting and processing emotions post-trauma. Empathy and a belief in one’s own abilities also play a role. Studies on nursing students, for example, show that these traits can lessen the negative impacts of trauma and encourage positive results ((Doaa L Shahin et al., 2025)). So, boosting resilience and empathy in education and therapy is key. It’s not just about bouncing back; it’s about growing and changing for the better because of what we’ve been through. Adversity, then, holds surprising potential for transformation.
B. Implications for mental health practices and interventions
For those in the mental health field, it’s incredibly important to really grasp how trauma, resilience, and even growth after trauma can affect how we treat and help people. Recognizing the important part that spirituality can play – as a resource – is vital for helping people build resilience and heal after tough times. When people use their faith to cope, it seems they often function better and even find ways to grow from the experience, like seeing loss and suffering in a new light (Dr. Bajpai P, 2025). Moreover, schools can be key in supporting the mental well-being of teenagers. A caring and understanding environment helps them bounce back from difficulties and maybe even grow stronger (Khoirunnisa M et al., 2025). So, using trauma-informed approaches, focusing on spirituality, and encouraging supportive settings can greatly improve our methods of intervention. Ultimately, this can lead to better results for people dealing with the many layers of trauma.
C. Final thoughts on fostering resilience and promoting growth after trauma
To summarize, when thinking about trauma, promoting resilience and personal development isn’t just important for individuals—it can really help whole communities. Interventions that work best focus on improving mental resources. Things like resilience, belief in yourself, and good memories are key; research shows they help people grow after hard times (Ime Y et al., 2025). A complete view suggests older models need updating. It is important to think about values. People will need to reconstruct their personal priorities and beliefs after trauma (Y Nazar, 2024). Acknowledging the psychological and value-based elements, practitioners can then design specific therapies to help survivors heal. Personal strengths mixed with social factors greatly affect how each person recovers. Resilience is key, and it is a communal asset in overcoming life’s difficulties.
Additional Resources
Sutton, J, (2019). “What Is Post-Traumatic Growth? (+ PTG Inventory & Scale)”. Positive Psychology. Access here
Collier, L. (2016). “Growth after trauma”. APA. Access here
Gills, K. (2024). “What Makes Us Resilient After Trauma?”. Psychology Today. Access here
“6 Essential Lessons from a Survivor: Building Resilience After Trauma”. Mind Resilient. Access here
Neurobiology and Trauma
When a person is confronted with a life and death situation, the body responds with a fight, flight, or freeze response. Other responses can include fawning, or complete total shutdown of the body. These behavioral responses to stressors, life altering events, or trauma in forms of abuse or loss correlate with inner workings of the sympathetic nervous system which activates the body to respond. While in the acute phase of reaction to threats, this evolutionary reaction system is good and beneficial but when trauma becomes stuck and unresolved resulting in constant hyperarousal or hypoarousal manifested in PTSD, then it can become pathological and require intense therapy to resolve the unresolved trauma. This article will review the inner workings of trauma response within the brain and why unresolved trauma becomes an issue for some individuals.
Please also review AIHCP’s Healthcare Certifications, especially in Trauma Informed Care, Grief Counseling and Crisis Intervention
The Brain and Threat Reaction
All reactions within the body are due to stressors. When something is perceived as a threat, the body responds. This fear circuitry promotes safety and survival (Evans, 2014, p. 20). The old part of the brain is the emotional part and possesses the feelings while the newer more evolved part of the brain processes the feelings from an intellectual perspective. Both these processes interact in stress response over riding each other. The primary reactions to stress include the autonomic nervous system which activates the sympathetic for fight or flight, the hypothalamic-pituitary-adrenal axis which releases hormones and cortisol for stress response and the limbic system of the brain which processes threats and emotions during a threat.
Evans notes that the fear response to threats is a crucial part of human survival and the process in which human beings react to fear in the brain is essential (2014, p. 21). Unfortunately, some events are not processed properly in the moment due to extreme emotional imprinting and this leads to unresolved issues.
In any fear, terror, or stress moment, the brain analyzes the threat. Within seconds, the sympathetic nervous system is activated to the perceived threat. The body releases norepinephrine and epinephrine , also known as noradrenaline and adrenaline into the body. The hypothalamus and pituitary gland also then releases cortisol into the body. This increases blood flow and heart rate, tightens muscles and prepares the body for fight or flight. In turn the amygdala processes these emotions and stores them. While the amygdala is operating, the prefrontal cortex or thinking part of the brain is less active. Once the threat is distinguished, the body is supposed to return to a base line state. Evans refers to this process as fear extinction (2014, p., 21). Individuals who continue to experience heightened fear responses when the threat is no longer an issue exist in a state of dysfunction with unresolved trauma since the brain cannot tell the difference between the memory and current non-threatening state.
Key to stress response are three key parts of the brain. This includes the hippocampus, the amygdala and the prefrontal cortex which make up the limbic system. These three interplay with each other and are key to fear extinction, emotional regulation and cognitive reasoning (Evans, 2014, p. 22). They also play a key role in storing memories from short term to long term storage and differentiating between past and present threats. The hippocampus deals with memory and context. It plays a key role in processing and storing memories and when the hippocampus is in dysfunction this can negatively effect trauma resolution. The amygdala during the stress response also becomes activated. The amydala is the alarm system of the brain. Those with PTSD are said to have a hyperactive amygdala due to unresolved trauma which prevents fear extinction (Evans, 2014, p.24). The pre-frontal cortex which manages cognitive thought, emotional regulation and decision making. It can also become impaired during trauma. When not working, it can lead to subjective fears and lack of emotional regulation and loss of rationale. Under normal circumstances, fear is extinguished and the body returns to a normal state via the hippocampus processing the context of here and then, the prefrontal cortex processing the event, and the amygdala activation decreasing. In cases when trauma is unresolved, the hippocampus is unable to process the here and now, while the amygdala remains hyperactivated, preventing the prefrontal cortex from processing the event. This hinders the ability of the hippocampus to store the memory properly in the past and the hyperactivation of the amygdala inhibits the prefrontal cortex from problem solving (Evans, 2014, p. 31-32).
Unresolved Trauma and PTSD
Individuals exposed to extreme cases of pain, loss, abuse, war, or inhumane treatment have the potential for PTSD. Post Traumatic Stress Disorder or PTSD is one of the most common forms of unresolved trauma disorders that individuals face. Once considered only a war time disorder, it now can effect any trauma survivor of abuse, rape, or natural disaster. Yet it is important to note that the same horrific event may be processed by some and not others. Most can process the traumatic event within 3 months, while others may experience prolonged trauma (Evans, 2014, p. 29). Numerous subjective variables about the person’s genetics, brain structure, past trauma, resilient traits and social support all play roles why some persons process trauma without dysfunction and others do. It is not a sign of weakness but merely an inability for a particular case and reason that the brain is unable to properly process the situation. As seen above, this sometimes has much to do with the amygdala and the inability to extinguish the fear.
Due to these issues, hyperarousal or hypoarousal can occur in those with PTSD. This leads to re-experiencing symptoms, avoidance, as well as hyperarousal which can lead to hypervigilance (Evans, 2014.. p. 29). Those with PTSD are unable to regulate emotions when hyperarousal or hypoarousal occur. To learn more about hyperarousal or hypoarousal and emotional regulation, please click here. Whether hypoarousal and its symptoms of numbing, withdraw and dissociation, or hyperarousal and its symptoms of anxiety and hypervigilance, the brain is unable to differentiate the past trauma with current triggers. This can cause flashbacks where the person loses contact with time, or location. Only until the person learns grounding techniques and ways to regulate emotion can he/she find a window of tolerance to experience the event, process it, recreate new neuropathways associated with the memory, and store it long term without unresolved trauma symptoms.
Many counselors utilize exposure therapies such as EMDR, or cognitive therapies such as CBT to help clients and victims revisit and reframe the event in a healthy fashion and learn to process it as well as manage and regulate emotions that can be triggered due to the event.
Conclusion
The purpose of this short article was more so to understand the parts of the brain associated with the stress response and how the brain normally operates to better understand why when it does not operate correctly, one experiences unresolved trauma and PTSD. An overactive amygdala and underactive prefrontal cortex play off each other and cause the inability for the body to continue the process of fear extinction. This causes an inability of the hippocampus and prefrontal cortex to properly process, understand and store the memory. While most resolve traumatic experiences within 3 months, some do not. There are many subjective variables as to why one person and not another may experience unresolved trauma. Trauma Informed Care specialists understand the neuroscience behind PTSD and help the client or victim find windows of tolerance and teach them emotional regulation and grounding techniques to heal from cope as well as heal from past trauma.
Please also review AIHCP’s Trauma Informed Care Program as well as its many healthcare certification programs.
Reference
Evans, A. & Coccoma, P. (2014).”Trauma Informed Care: How Neuroscience Influences Practice”. Routledge.
Additional Resources
“The Neurobiology of Trauma: Understanding the Brain’s Response to Adverse Experiences 2025”. Kaplan Therapy. Access here
“How the Brain Reacts to Stress and Trauma” Science News Today. Access here
Kubala, K. (2021). “The Science Behind PTSD Symptoms: How Trauma Changes the Brain”. PsychCentral. Access here
“Trauma and the Brain: PTSD Brain Diagrams Explained” (2024). NeuroLaunch. Access here
Trauma Informed Care: Vicarious Trauma, Compassion Fatigue, Burnout and Regulating Self
It is only natural for many counselors to become sickened, disgusted, angered, or enraged when discussing trauma with a victim. The stories of abuse against the innocent cry for justice. As counselors, or safe guarders, in many ways, these emotions are important in helping the counselor or social worker become instilled with the desire to find justice of the victim and legal punishment for the perpetrator. Hence, it is natural to feel. Counselors are not robots and as human beings, they can become influenced and effected by the details of the stories of victims. These effects can appear in forms of vicarious trauma, compassion burnout, or even loss of emotional control in a counseling session. As healthcare professionals, it is imperative that counselors, social workers and pastoral caregivers are able to monitor themselves in order to be there for the client/victim. In this article, we look at vicarious trauma, burnout and regulating self and how it is important to identify these things and utilize the skills of regulation in counseling, but also every day life.
Please also review AIHCP’s Healthcare Certifications as well as its Trauma Informed Care program, as well as AIHCP’s Grief Counseling and Crisis Intervention programs.
Absorption Vulnerability: What is Vicarious Trauma, Compassion Fatigue and Burnout?
It falls under the umbrella of vulnerability absorption. Counselors can become affected by their clients and the stories told by them. Within these types of absorption, counselors can face compassion fatigue, vicarious trauma, or burnout. Within compassion fatigue, the trauma and stories of the victim wear down the counselor emotionally. It affects their ability to be empathetic and optimistic in the therapeutic relationship.. Vicarious trauma, on the hand has a different type of reaction to trauma. Vicarious trauma is when a counselor or mental health professional is indirectly affected by the trauma of the client/victim (Compton, 2024, p. 236) but in this type of trauma, the counselor experiences types of post traumatic stress symptoms. It goes beyond the emotional wear of compassion fatigue but also affects the beliefs and behavior of the counselor. Burnout on the other hand does not include the trauma of the victim, but has more to do with large caseload, working long hours and inter stress dynamics at work (Compton, 2024, p. 236). All symptoms of burnout as well as vicarious trauma and compassion fatigue are detrimental to the therapeutic relationship because it weakens the counselor’s ability to actively listen, employ empathy, help the client heal and remain regulated. Some may overlap and also play on each other.
Compton points out that counselors who are more susceptible to vicarious trauma and absorption vulnerability usually have past trauma that is triggered in counseling through the indirect trauma of the client (2024, p. 238). Hence indirect exposure to horrible stories of abuse, one’s own past trauma history and the triggers associated with it can engage within the counselor various trauma responses. Like the client, the counselor can experiences challenges to one’s own beliefs and world views and also cause an existential crisis of faith (Compton, 2024, p. 237). This can later filter into the counselor’s home life causing counselors to either avoid those in need, or to overcompensate with becoming to involved. Overinvolvement and lack of professional boundary can lead the counselor into seeing the client as oneself and lead to clouded vision as well as trying to do too much beyond one’s skill level in some cases.
Regulating One’s Emotions
When hearing horrific stories of abuse, it can be difficult during a session for a counselor to be able to maintain the needed co-regulation for a client. A counselor, like a trauma survivor, can enter into states of hyperarousal or hypoarousal. In other articles, we discussed the nature of hyper and hypoarousal states of the client, but these same states can also affect the counselor in negative ways. In regards to hyperarousal, a counselor may become more irritated, anxious, or upset, while also feeling an increased heart rate as the sympathetic nervous system is activated. Likewise, a counselor may become dissociated, numb or lost due to the reaction of the parasympathetic system. In both cases, the counselor is losing the ability to regulate.
Settling oneself without upsetting the client is key. In the hyperarousal state, the counselor needs to settle and ground oneself by calming the mind through breathing, grounding, or other cognitive exercises that relax the sympathetic nervous system, while in the hypoarousal state, a counselor needs to activate by stimulating the brain or creating movement. Many times, it is encouraged in these activation or settling techniques to discreetly include the client who may well also be experiencing tension. Hence any of deep breathing exercises or cognitive grounding techniques, as well as movement, stretching, or even a cold glass of water can help a counselor and client regain emotional regulation. Many of these grounding techniques and how to utilize them are mentioned in other AIHCP articles. Please click here to review grounding and containment strategies.
While counselors track clients emotional and physical reactions, counselors can also scan their own body for hyper or hypoarousal. Compton recommends scanning one’s own body in intense moments to detect these emotional changes within the body. In addition, Compton recommends evaluating ones subjective unit of distress on a scale of 1 to 10 via the SUDS scale (2024,. p. 249). It is important to understand not only the window of tolerance of one’s client but also oneself. Again, the window of tolerance refers to the optimal time a person is able to discuss trauma in a rational and calm way without triggers activating a fight, flight or freeze response. In charts, the window of tolerance is colored as a green zone, while hyperarousal is dictated a red zone, while hypoarousal is regarded as the gray zone. When in the red zone of hyperarousal, a counselor needs to stop and engage in calming activities, while when in the grey zone of hypoarousal, a counselor needs to activate and arouse the mind and body (Compton, 2024, p. 248-249).
Key regulation, a counselor needs to identify triggers that can cause these reactions. As human beings counselors too have triggers that can cause various reactions to a story or person. Past trauma, one’s own biases, and one’s own way of handling things can cause internal division with the client and it is important to identify these triggers. These triggers can cause issues with providing unconditional positive regard and empathy to the client. In displaying empathy, sometimes, according to Compton, can fall into two categories- self-orientated empathy and others-orientated empathy. In regards to self-orientated empathy, one feels the pain of others but it affects the person directly and impacts their ability to help, while others-orientated empathy allows one to feel but gives the necessary space and distance to help others in suffering (2024, p. 254). To review AIHCP’s previous article on unconditional positive regard and empathy, please click here.
Counselors when they do feel emotions should not dismiss the feeling as bad or good. Emotions, according to Compton, are not dangerous in themselves but a counselor simply needs to allow and notice them but constrain them for the benefit of the client (2024, p. 256-57). In addition, certain stories may also lead rumination or the inability to shake a certain thought or memory that has invaded the mind during counseling. Compton suggest focusing such worries and thoughts to goal solving thoughts (2024, p. 258). Again, emotions and thoughts are natural, but as professionals, one needs to identify them and properly regulate them in counseling.
Self Care
Counselors, like any caregivers or safe guarders, experience many terrible thing through the stories they hear. The ability to absorb but yet to effectively care is a thin line from falling victim to vicarious traumas. Hence it is so important for counselors to be skilled in self-regulating, but also skilled in understanding professional and emotional boundaries. Counselors need to ensure that their brain and body is able to find the necessary time to heal and rest. Self care is in many ways stewardship of self. It involves understanding that one is not the ultimate solver of all problems and understanding the value of time and how to utilize it for the greatest good. Sometimes, it is the mind that needs the most rest. Allowing the mind freedom from unnecessary trauma or images when away can allow one to find peace at home. Instead images or stories or movies that may invoke triggers should be avoided. Hence according to Compton, it is important to be a steward of one’s mind, body, time and relationships with others. This involves boundaries as well as enjoying the good in life. It can be very difficult to avoid the fog and darkness of abuse and the counselor needs to have balance. Spirituality, hobbies, time off, boundaries, as well as utilization of grounding techniques and the mastery of them is key. Deep breathing, relaxation, meditation, and digesting good and wholesome content is important for counselors to be able to continue to give quality care to each hurt soul
Conclusion
Counseling and safe guarding victims of trauma takes a toll on healthy minds. Positive energy and coregulation of the counselor in the therapeutic relationship can be weakened through vicarious trauma, compassion fatigue or burnout. Hence it is critical to understand one’s own triggers, as well as the ability to regulate one’s emotional responses. Self care is essential to maintain a healthy balance to keep counselors up to the large task of helping victims heal.
Please also review AIHCP’s Trauma Informed Care program, as well as its other Mental and Behavioral Health Certifications.
Resource
Compton, L & Patterson, T (2024). “Skills for Safeguarding: A Guide to Preventing Abuse and Fostering Healing in the Church” Intervarsity Press.
Additional Resources
Compton, L., & Patterson, T. (2024, March 14). Absorption Vulnerability: A New Look at Compassion Fatigue. Traumatology. Advance online publication. Click here
Vicarious Trauma: “What To Do When Others’ Distress Impacts Your Well-Being”. (2024). Cleveland Clinic: Health Essentials. Access here
Matejko, S. (2022). “What Is Vicarious Trauma?”. PsychCentral. Access here
Luster, R. (2022). “Vicarious Trauma: A Trauma Shared”. Psychology Today. Access here
Signs of Trauma and Abuse Video Blog
It is imperative within trauma informed care to be aware of and looking for signs of trauma or abuse in clients. This video looks at some signs of abuse and trauma. Please also review AIHCP’s Trauma Informed Care program, as well as its Crisis Intervention program and Grief Counseling program. AIHCP offers a variety of healthcare certification programs. Please click here
Trauma and Counseling Video Blog
Trauma informed care specialists in counseling are aware of the existence of trauma in clients. Sometimes, trauma emerges in counseling. How the counselor or social worker presents oneself is key in helping the victim/survivor feel secure and safe in discussing it. In some cases, counselors may need to help the person ground oneself due to the increase of anxiety and panic when trauma emerges. This video looks at trauma and how to help clients who need help regulating emotion due to unresolved trauma
Please also review AIHCP’s Trauma Informed Care program as well as all of AIHCP’s healthcare certifications.
Trauma Informed Care Video Blog
Great video on an introduction to Trauma Informed Care. Please review AIHCP’s numerous behavioral health and healthcare certifications
Trauma Counseling: Regulating Trauma and Emotion During Counseling
Many times in counseling when discussing trauma, emotions can emerge tied to the unresolved trauma that can de-regulate a client/victim/survivor. Discussing issues of abuse, or loss, or traumatic memories whether current or in the past can cause individuals suffering from unresolved trauma to dissociate from the present, flashback to the past, or enter into states of emotional dysregulation. Licensed counselors who specialize in trauma care and crisis intervention have strong understandings to utilize techniques to help ground and contain negative emotions associated with trauma. Unlicensed mental health professionals in crisis response or even pastoral care may sometimes come across individuals who also need these same techniques due to acute crisis or trauma. It is hence important to understand how to help individuals suffering from PTSD, acute trauma, or unresolved trauma with the appropriate techniques to help victims or survivors find stabilization. This article will focus more on in session counseling and long term trauma care than immediate psychological first aid which is addressed in other blogs. Primarily, we will discuss the therapeutic relationship’s window of tolerance with a victim/survivor, how to expand this window, and review various techniques found in grounding and containment to help others find calm and peace.
Please also review AIHCP’s Trauma Informed Care Program, as well as its Crisis Intervention program and also all of AIHCP’s Healthcare Certifications.
Window of Tolerance
In counseling, individuals can experience emotional dysregulation due to unresolved past trauma. Simple triggers of retelling the story, to similar images in a room, or a familiar scent can reset a person and dissociate, flashback, or cause intense states of hyperarousal or hypoarousal. Compton explains that individuals can experience two types of dysregulation. In hyperarousal, the person becomes angry, anxious, hypervigilant, or impulsive (2024, p. 208). Compton points out that with hypoarousal the opposite occurs when the person experiences withdraw, numbness and lack of emotion even in some cases to a state of dissociation (2024. p. 209). In the fight or flight response, counselors will see anger and anxiety, but during the freeze response, counselors will see the shutdown. These are natural ways the body and brain responds to past trauma. The key is how easily can one’s system return to a state or emotional regulation when dealing with these triggers or reminders that cause emotions to emerge. Individuals in trauma can be stuck in a variety of phases, some may exist in a state where they feel no safety anywhere, others may exist in a state where safety may not be an issue but trust is totally lacking. It is the goal of the counselor through the therapeutic relationship to help victims again find phases of regained power, regained self esteem and eventually the phase where they can again reintegrate with society and form healthy relationships. It is within the Window of Tolerance of a person’s emotional state where this healing can occur.
The Window of Tolerance is term phrased by Ogden, Minton and Pain that refers to the optimal window of time between hyper and hypoarousal states in which a person can experience balance (Compton, 2024, p. 209). Within this period of time, therapeutic counseling can occur where the trauma can be discussed and better ways to cope can learned by the client. During this time as well, the reasoning part of the brain as opposed to the emotional part has more awareness to communicate, reason, learn and grow (Compton, 2024, p. 209). Counselors can help clients learn how to operate and heal within the window but also learn ways to expand this window in real world settings through a variety of skills. Counselors can help clients co-regulate their emotions within the window and expand it through supplying empathy, support, a safe and secure environment and also preventing re-trauma by limiting or eliminating potential triggers.
Counselors during this time through the therapeutic relationship can help with focusing on the needs of the client and being aware of discomfort or physical manifestations associated with mental discomfort. Compton points out that the term “interoception” best describes the ability of a counselor to have this type of awareness of what is happening inside someone based on what the body is displaying or doing in the moment (2024, p. 196). this is why watching for non-verbal cues is key in counseling during the selective attention skill of focusing. During this important window, counselors should engage their clients. By focusing, reflecting and providing context, counselors can help survivors understand their trauma better (2024, p. 197). In addition to engaging, counselors need to help clients process emotion and then help them reflect on it. The biggest part of processing is not only discussing it, understanding it, and reframing it but to also learn how to manage it.
Tracking and Identifying Emotional States
Within trauma counseling, it is important to utilize the window of tolerance but it is also equally important to track the client’s body and behavior for signs of either hyperarousal or hypoarousal. It is also important to track oneself, since sometimes the stories and events relayed can even shock a counselor and cause deregulation within. It is important to note that most individuals exist within a normal operating existence of balance when viewing safety and conditions. The securing of safe environments and the scanning by the brain to ensure safety within a environment is referred to as neuroception. A person in a calm and secure state is not activating the sympathetic nervous system but is existing in normal state where the cognitive functions of the brain are operating. When the sympathetic nervous system strikes it can close down cognitive functioning and increase emotional responses. Fight, flight or freeze, or even fawn can emerge as reactions to this. Interesting enough in cases of hypoarousal, the parasympathetic system, the calming aspect of our nervous system, can deactivate an individual due to the intensity of the trauma or recalling the trauma. When working with survivors or victims, merely recalling traumatic events can cause a hyper or hypoarousal response. This can affect healing and reduce the window time tolerance to discuss the trauma with the cognitive functions operating.
Tracking emotions and signs is hence an important skill for a counselor in any session but even more so when helping individuals in intense grief, loss, crisis or intense trauma. In states of hyperarousal a person will display various physical and also behavioral symptoms. In essence the person cannot calm down. Clients in hyperarousal can display anxiety, irritability, panic or rage. They may have racing thoughts, or an inability to concentrate and may display signs of hypervigilance during the session. Physically they have increased heartrate, muscle tension, clenched jaw, closed fists, display sweating or have a racing heart rate. Behaviorally, they can display an overall restlessness which may be affecting their sleep and impulse control. They may fidget and move and express emotions easily during the session. This can lead outside the counseling room to regular life in feelings of being on edge, easily irritated, over-thinking social interactions, and feeling uneasy in social settings (Mindset Explained, 2025).
When tracking, a counselor also needs to track possible signs of hypoarousal. Hypoarousal can be induced by either the sympathetic or parasympathetic. It is usually tied to parasympathetic functions that relax the body but in these cases it shuts the body down as a self defense mechanism to the trauma or even thought of the past event. A person experiencing hypoarousal will display detachment, numbness and seem withdrawn and lacking motivation. Cognitively, they may be slow to speak and appear confused and lacking details about events. Physically they will seem lethargic and have a slower heart rate, display fatigue, or over relaxed muscle state. During a session, they may zone out or seem distracted. Behaviorally this can lead to intense isolation outside the counseling room. Many may have a hard time getting out of bed, or detach from loved ones, feel powerless and lose interest in things they like to do (Mindset Explained, 2025).
In both cases, counselors need to be aware of these signs but also know when to utilize activation strategies for hypoarousal or settling techniques for hyperarousal. In these cases, settling or activating becomes the choice a counselor needs to make. In states of hypoarousal activities that help the person activate the nervous system include helping the client begin to move, via stretching, or walking around can be a first good start. Other ways to activate include grounding techniques that are tied to touch and sense, such a the feeling of a cold object or ice cube, or the splash of water on the face. Other forms of breathwork, as well as cognitive activation through counting or labeling things in the room can also aid the client. Sometimes music can be helpful, or even the scent of a candle (Mindset Explained, 2025).
With hyperarousal, the concern is to settle, not activate. Hence, breathing exercises, ground techniques such as holding something, or touching something, as well as sensory and cognitive ways to help the person remain in the present. Progressive muscle relation techniques as well as guided meditation and visualization can help a person induce the parasympathetic system as well. We will discuss more types of ground and containment strategies later in this article. What is optimal is a stable state of being. Stable and emotionally regulated states allow the window of tolerance to be utilized in therapeutic sessions. Healthy states permit better focus, cognitive functions, stronger relationships, better sleep and better energy levels to cope with stressors and potential triggers (Mindset Explained, 2025).
One thing to consider and be aware of is that while helping others, counselors can also enter into various states of hyperarousal or hypoarousal. The term reciprocal defense mobilization is the mirroring of emotional states. While ideally the counselor is the co-regulator in a session providing energy, trust and security to the person, sometimes horrible stories or emotional breakdowns can affect the counselor. In fact, past trauma of the counselor can also be triggered in counseling. This type of vicarious trauma can have acute affects on the session but also long term affects and burnout for the counselor. If a counselor is affected via hyper or hypoarousal, the ability to listen, exercise empathy, or help the person heal can be at risk. Hence counselors may sometimes need to activate or settle themselves. It is harder though for a counselor to express these feelings or exhibit certain strategies while counseling and because of this counselors need to be able to subtly activate or settle themselves. In cases of hypoarousal, a counselor may notice one’s own signs of shutting down and look to activate by clenching one’s fist or hand or shifting or tapping one’s foot. A counselor can also discuss both parties standing up and stretching as a ploy to not only help the client but oneself. A break or a pause can be helpful for both client and counselor in these cases. During hyperarousal, a counselor can label, or count, or focus on one’s own breathing.
One should consider basic strategies to manage both hyperarousal and hypoarousal in daily life. In regards to hypo, utilize frequent exercise if possible, alone, if public gyms are unsettling. Utilize breathing and mindfulness, and create and stick to routines that give a sense of accomplishment and work on connecting with others, especially those who are closest. Even if a short phone call or text! For hyperarousal, one will utilize more grounding techniques in daily life which will be discussed below and also employ relaxation and meditation, as well as with creating a calmer environment with music, or scented candles (Echowave, 2025).
Grounding and Containment
A person during counseling who becomes hyperarousal needs various help to manage his or her emotions within the session. These skills and techniques can help not only help them regulate and expand the window of tolerance in session but also be applied later to out of session in the world experiences. The two most common types of skills taught in counseling for individuals with unresolved trauma and PTSD are grounding and containment.
Grounding techniques can be sensory, cognitive or somatic in nature. In sensory grounding, the counselor utilizes the five senses to help a survivor find placement in the present. In regards to the sense of touch, it can be as a simple as feeling the feet on the ground or the soft touch of the couch on the finger tips. A counselor should help the survivor with calming words describing the sensation one feels as the fingers sway across the texture of the couch, or the firm feel of the foot against the hard floor. In some extreme cases, ice in a person’s hand can be used to help a person find the present. In all cases, the sense of touch should be used especially carefully when counselor or client come into contract via a tap on the shoulder or a hug because these things could possibly be a trigger to the prior abuse (Compton, 2024, p. 214). With sight, the counselor can direct the client to note anything in the room they see and what color it may be or details one may not have noticed before. The scent of smell can help calm through oils, incense or candles that can help a person find calm but again be aware of your client’s history and scents that could trigger him or her. With taste, sometimes, one can focus on a piece of candy available and the taste of it, or imagine a particular dessert. The counselor gently inputs into the mind these scenes to help the client find regulation (Compton, 2024, p. 212). From a cognitive approach, a counselor can have a client count from a higher number down to zero to exert awareness of the now or have the client name things within the room to help the person find connection to the present. From a somatic approach, breathing exercises can be employed to help grounding. In fact, breathing exercises are sometimes the first utilized to help a person calm. Deep breathing initiate the parasympathetic nervous system which reverses the affects of the fight or flight response. The deep inhale and exhaling can lower the heart rate and help a person find calmness. Usually the breathing is done with some type of visualization. One common theme is balloon breathing where the client is told to imagine a balloon inside oneself and as one inhales to imagine the balloon inflating and while exhaling to imagine the balloon deflating (Compton, 2024. p. 212). The breathing should be coming from the abdomen and not the chest since chest breathing is usually associated with anxiety. To ensure proper breathing, one can tell the client to put his or her hand on ones chest and stomach and see which part of the body is moving more. One can also utilize touching the shoulders to see if the shoulders are rising which is indicator of chest breathing.
While grounding helps a survivor find the present and remain engaged, containment skills can help clients learn to control uneasy emotions. The tool of containment helps clients break away from traumatic memories and feelings (Compton, 2024, p. 215). Containment tools include visualization and various expressive arts. Most of these tools are also utilized with breathing techniques and can be used in session as well as in the real world. When working with clients expressive arts are similar to play therapy with children. They can help a person find calm when discussing difficult issues. Compton references vertical regulation as way for the survivor to draw lines of different colors up and down a page while deep breathing. Other expressive arts include dance and music to help with hypoarousal to push energy into the person. Liturgical or spiritual music can be utilized if it provides the necessary calm, or secular music that the client enjoys (2024, p. 211). Creative writing is another expressive art used to contain emotion. In expressive writing, one can write a note to oneself, or a parent, or God, or anyone the client freely wishes to write too. The message can be a positive one that employs safety and security (2024, p. 212). Visualization and breathing remain one of the most used containment practices in sessions. With guided breathing and the visual scripts from the counselor, the client can visualize safe and secure places when facing trauma memories or uncontrolled emotions. One classic visualization technique is imagining the a container in which the client can put all the unwanted emotions into and cover with a lid. The counselor guides the client to understand that any intrusive thoughts at any time can be stored in this container, box, or chest when needed (Compton, 2024, p.216). The key is to discover a safe, secure and calm place. Many times counselors will lead a guided visualization of a place the client finds peaceful. Whether a cabin in the mountains, or a spot on the beach, the counselor can take the client back to that place or peaceful place in time. During which the client will close his or her eyes, breath deeply and follow the voice of the counselor describing the calm associated with these places and times. Butterfly hugs are also a tool that can be utilized during visualization in which the client is taught to hug oneself and allow their hands to tap their back in assurance and calmness (Compton, 2024, p. 217).
In all of these exercises, if the person is spiritual or religious, spiritual aspects and words can be utilized on a case by case basis to help the person find calm. For some, spirituality may be beneficial but for others who were exposed to spiritual abuse, it may not be warranted. If spirituality is accepted and desired, sometimes clients can breathe in with a statement about God and breathe out with a statement of safety, such as “God is good” and “I am safe”. In other cases, scriptural references that the client enjoys can be utilized from whatever sacred book he or she adheres to (Compton, 2024, p. 218).
In all cases, help the client be in control. The purpose it to help the client learn to regulate and being in control is key, especially when the survivor is not in session. In such cases, when introducing breathing techniques or new tools, instead of dictating, or saying “do this”, utilize phrases such as “would this be helpful to do this?”. This reduces distress and gives autonomy to the survivor who in many cases, if abused, was told what to do numerous times.
Conclusion
Many situations in counseling trauma victims/survivors require helping them to learn to regulate emotions. These skills are important both in session and out in the real world. In session, it helps extend the window of tolerance which then can be applied to real world situations. Skills in grounding and containment help clients with hyper/hypoarousal and maintain control and learn to deal with the symptoms of trauma in a positive fashion. These tools in counseling also allow for the discussion, reflection and processing of the unresolved trauma. It is important to remember that when treating trauma, it is a marathon not a sprint. These skills take time to implement and the body and mind need time to heal.
Please also review AIHCP’s Trauma Informed Care Program, as well as its many healthcare certifications in crisis intervention, grief counseling, stress management and Christian spiritual counseling. All programs are open to qualified healthcare and mental health professionals seeking four year certifications to utilize within the scope of their practice. The healthcare programs are online and independent study and have mentorship as needed.
Resource
Compton, L & Patterson, T (2024). “Skills for Safeguarding: A Guide to Preventing Abuse and Fostering Healing
“Hypo-Arousal and Hyper-Arousal: Nervous System Dysregulation”. (2025). Mindset Explained. Access here
“Feeling Hypo or Hyper Aroused How to Spot the Subtle Signs”. (2025). Echowave. Access here
Additional Blogs from AIHCP
PTSD-click here
Counseling Clients through Crisis, Danger and Harm-click
Additional Resources
“13 Grounding Techniques for When You Feel Overwhelmed”. Cleveland Clinic. Access here
Schuldt, W. “Grounding Techniques”. Therapist Aid. Access here
Sutton, J. (2022). “7 Best Grounding Tools and Techniques to Manage Anxiety”. PositivePsychology.com. Access here
Caporuscio, J. (2024). “Step-by-step guide on grounding techniques”. Medical News Today. Access here
Gale, A. (2025). “Hyperarousal vs. Hypoarousal”. Carepatron. Access here
Alpern, P. (2025). “Is the freeze response a form of hyperarousal or hypoarousal?”. The Trauma Journal. Access here
“Feeling Hypo or Hyper Aroused How to Spot the Subtle Signs”.
Counseling Clients Through Crisis, Danger and Harm
In counseling, especially Trauma Informed Care counseling, counselors will not always discuss issues of the past. Trauma from the past can scar emotionally and create many present issues, but many crisis situations exist also in the present. Counselors or social workers or pastoral caregivers may discover clients that are in distress due to day to day threats and dangers. This creates a difficult situation for counselors to discern legal and ethical obligations to protect someone from harm versus situations that while potential dangerous are not imminent and require the empathetic and therapeutic relationship to resolve. New counselors have especially deeper concerns in this murky waters, while more seasoned counselors have a better understanding when and how to report, hospitalize or walk with a person in crisis that is facing danger or harm. In this blog article, we will review various situations and how to deal with them, as well as important concepts in the therapeutic relationship that can help respect the autonomy and dignity of the person while also protecting the person.
Please also review AIHCP’s multiple certification programs in mental and behavioral health, including programs in Crisis Intervention, Grief Counseling, Christian Counseling and Trauma Informed Care.
The Importance of the Therapeutic Relationship in Resolving Crisis
Cochran points out that wrong decisions in counseling can have drastic consequences in helping those in crisis. This means that following ethical and legal protocols are key, but assessing imminent danger and potential danger is a key skill. Furthermore, even if as a counselor, one prescribes and writes down a plan for one to follow, there is never guarantee a client will listen. Many refuse to listen, or if feel coerced into doing something, fail to completely fulfill it because they do not believe in the course of action (2021, p. 222). This is where not only discernment and assessment come into play but also understanding the dynamic role of the therapeutic relationship and how it can help a client in potential danger or even in some cases, imminent danger, a way to properly find safety without violating the person’s autonomy. It is far more purposeful to help a person not only escape crisis and danger but understand how to progress and continue to heal and find better ways to to avoid it in the future.
Within the therapeutic relationship, Cochran emphasizes instilling within the client self responsibility that preserves dignity and integrity of the client with less restrictive interventions (2021, p. 222). Why? Simply because this allows the person to own the situation, understand the danger, be proactive in finding safety and share in the decision making process for finding that safety or care. If this means convincing someone who is suicidal to admit oneself to a psych unit at a hospital, or help a person report an abuser, it is also best to guide and help the client make decisions with the counselor so the client can be fully on board. When clients doubt, or question, or feel forced, they many times abandon the course of action and this is why the therapeutic relationship is so critical in helping clients escape danger. Of course, unfortunately, there are cases where the client refuses to listen to reason, or refuses to report a crime, or puts oneself in harms way. This is when a counselor reluctantly must obey legal obligations as a licensed counselor to protect a client. Obviously these situations involve imminent danger, criminal activity, and a client unwilling to work with the counselor in a plan of action. In addition to trying to utilize the counseling relationship to foster the best plans, it is also critical for the counselor to employ unconditional positive regard for the client and not just merely hear the situation, but to accept the person and the feelings behind it. While one may be expressing self harm, or threat of being hurt by others, or hurting others, the counselor needs to employ empathy to help the person not only choose the best option but to also help the person heal. Instead of judging, the counselor needs to hear the pain to better help the person correct the story (Cochran, 2021, p. 223).
Cochran points out that these situations of imminent threat to a client are some of the most difficult ones for counselors (2021, p. 249). When dealing with suicidal clients, or domestic abuse victims, leave any counselors, much less new counselors feel a strong stress level when dealing with life and death. Cochran points out that one of the biggest fears is never being 100 percent sure. If a client completes a non-self harm agreement, a counselor can be left with a nervous feeling if the client will keep his or her word and not harm oneself. In addition, Cochran points out that many times, counselors can be preoccupied with liability. Rightfully so, liability is a key concern, and when necessary, legal actions need taken, but to focus solely on liability at the expense of the over-all situation and maintaining focus on the client, then larger errors can occur in the handling of a situation (2021, p. 252). In addition to rookie jitters, lack of self confidence or experience, many new counselors sometimes also fear coordination with other counselors and professionals. They may fear this may broach confidentiality but in many agencies, clients are seen by numerous other professionals and the seal of confidentiality is within the staff. In addition, many times, the discussions of imminent danger can be discussed with family, or other professionals due to legal laws (2021, p. 253-254). If within the therapeutic relationship, family or other professional’s opinions can be inserted into the session without taking control away from the client. These situations since they are so life altering sometimes need other minds and ideas and experiences to help provide the best outcome for the client. When the client is working with the team and following a plan, instead of fighting against it and being forced into something, then these are the best situations. Unfortunately sometimes, not all situations are ideal nor the existence of a therapeutic relationship’s existence.
Situations of Crisis that Can be Potentially or Imminent in Threat or Harm
Most situations of crisis that pose potential to imminent levels of harm include suicidal ideation, domestic violence and sexual abuse. It is always best to utilize a therapeutic relationship in fostering the best play of action as opposed to arbitrary decisions, albeit sometimes when clients refuse to accept themselves, drastic decisions that may not fix the problem long term, but at least protect the client short term must be applied.
In all situations, it is best to help clients make the plan and be part of it. Cochran points out that it may be tempting to take over and make it your plan for the client’s safety, but a counselor wants a client to have personal investment and ownership of a plan (2021, p. 225). In planning, Cochran also calls for these situations to specifics in each plans that looks at all pitfalls or “what ifs” to help a client navigate the dangers of the crisis. In addition, when a clients hint or speculate about things that may seem harmful, it is the duty of the counselor to error on the side of caution to broach the subject when necessary and even more so, say the words of “suicide”, or “abuse” if necessary to bring to the light the situation. If a counselor feels a dangerous situation was implied, it should be saved for the end of the session to counter, but within the next few minutes to redirect to what was said to have a clear understanding of the danger the client is facing (2021, p. 226).
The Situation of Suicidal Threats
Suicide is nothing to ignore. Many times, individuals dismiss these threats as attention seeking, or merely a state of momentary sadness. While sometimes they may be benign statements, counselors, nor anyone should ever under estimate a possible suicidal threat. Instead each needs to be taken seriously and with compassion and without judgement. Each statement needs confronted and completely understood to see if it is merely a statement, or a wish that has potential or imminent harm intended. Suicide assessment charts are common place in any counseling office. These guides help counselors assess and discern situations but also help counselors better work with those who feel this way.
Counselors when broaching the subject of suicide, need to identify a plan of the person. This plan entails why, when and how a person would kill oneself. By discussing the details of each plan, counselors and trauma informed care specialists can better ascertain if the risk is minimal and requires therapeutic counseling or if it does pose a true and valid threat. If it is a legitimate threat or desire, counselors need to determine the lethality of the plan. The how of one wishes to kill oneself can be very revealing. If one merely hopes to crash into a tree, or punch oneself, as opposed to shooting oneself, overdosing, or leaving a car running in a garage, then plans that involve less likely hood of death can be categorized as a lower risk level. However, if more lethal methods are described, then the plan needs to be taken far more seriously. Compounding the seriousness and lethality of the threat, counselors need to address if the means to carry out a plan is possible. If a client owns a gun, or has a script that he or she could overdose on, then the level of imminent threat becomes a reality.
Counselors, however, can look for other clues to see the mindset of a client. Clients may casually state I would like to kill myself, but it may hurt my family too much (Cochran, 2021, 229), or may state what would my baby do at home? These types of clues are good ways to open the mind of the client to the counselor to better assess and determine. In addition to preventative factors, counselors should look for future orientation (Cochran, 2021, p. 229). If a client speaks of chores, events, or work schedules in the next coming weeks, then it is a good sign of no imminent threat, but if clients dismiss schedules, or events, or show no care these things, then a more imminent harm conclusion is warranted. Another closely related clue to imminent threat is switch or sudden change in emotion about life. If a client suddenly cares nothing about family, hobbies, or sports, or whatever interest that anchored to his or her reality, then this is a sign of danger that a counselor should take seriously (Cochran, 2021, p. 229). In addition, a counselor should question the client on previous attempts of suicide. Those with previous attempts pose a more serious threat to themselves. Also, a counselor should discuss drug and alcohol abuse and the role it plays on inhibitions in regards to a person questioning life and whether to take it or not.
Through therapeutic counseling, the relationship in these conversations needs to end with some type of non-self harm contract. The contract should include a time table of security, as well as persons to call if one feels sad or depressed or intrusive thoughts of harming oneself appear. With this contract is safety planning, where the counselor attempts to receive from the client a promise of no self harm at least between sessions, as well as a call list of individuals that can help, as well as a promise to avoid substances that can limit inhibitions to prevent suicide (Cochran, 2021, p. 231). One of the most important aspects of a plan is also removing any means that may exist. If a person has access to a gun, then their is a promise to remove it, and if necessary facilitated through a family member. If prescription medications are available, then the scripts are removed from the home or access of the person.
Some plans may not be able to be completed merely between the word of a counselor and client. Some plans may need temporary hospitalization, or family intervention. It is best that these plans are accepted by the client. Hospitalization is important for individuals who cannot promise their own safety or commit to a plan. It is good during this plan to discuss how the process will occur and the potential costs. It may be helpful to to guide a client to the best facility to meet his or her needs. It is also best to include family in this decision but also to not be afraid to ask for professional peer advice. If a client is a threat to him or herself and refuses these measures, then unfortunately, the short term safety of the patient outweighs the therapeutic alliance (Cochran, 2021, p. 237). It is always the best to have a client on board. Good counseling and good relationships foster the trust for a client to follow the suggestion of a counselor he or she perceives as genuine and trustworthy. Unfortunately, many in mental health may only see a client once or twice or in an emergency situation and may be forced making the tough but right decision on the spot. It is however important to at least try to work with the client and empathetically guide them instead of stripping the person of all autonomy without conversation and empathy and respect.
Domestic Violence and Sexual Abuse
A client who discloses sexual abuse or domestic violence poses a real ethical issue for some counselors. A counselor is ordered to report crimes of physical or sexual abuse. How it is reported is another thing. When joined together with the client in reporting physical abuse or sexual assault, a victim can retain autonomy and healing. A victim may have a difficult time reporting in confidence this horrific trauma and may have conflicting feelings for the perpetrator, or remain in intense fear, or have shame about the story becoming public. It is imperative to reflect these concerns with empathy and non-judgement but also reflect the imminent danger and legal responsibilities of the situation. In previous blogs, we have discussed the importance of safety, security and trust in trauma informed care and this is especially important here.
Situations that do not denote reporting that lack physical violence or sexual assault can be more tricky. There is definitely potential for harm and it may be imminent but has yet occurred. In cases of emotional and verbal abuse, a very careful plan must be construed that utilizes the strengths of the therapeutic relationship. Cochran points out that many relationships in crisis that carry emotional and verbal dysfunction may be unhappy but not necessarily imminent to harm (2021, p. 248). It is important for counselors to understand the underlying causes for the dysfunction, approach ways to reduce triggers by both parties, as well as ways to help them manage emotions. Counselors should also seek to understand the past history of violence, if any physical violence occurred in the past to help ascertain the situation and its lethality. Counselors may also suggest avoidance of high risk activities that lower inhibitions. The use of drugs and drinking can correlate with violence. Finally, whether, verbal or physical, anger in the home can be detrimental to children. Special considerations need to be discussed regarding what children hear and what they feel regarding the uneasy tension (Cochran, 2021, p. 249).
If a situation does not warrant reporting yet has potential or imminent possible harm scenarios, a plan needs developed that guarantees the safety of the client. Discussions on how to remove oneself from the situation, de-escalate, who to call, or where to possibly stay should all be highlighted. Counselors are there in the therapeutic relationship to discuss the possible hardships and issues that surround all decisions (Cochran, 2021, p. 249).
In some cases, the counselor may speaking with the offender. This may occur in solo sessions or couple counseling-The offender who admits to verbal or emotional abuse or to past incidents. In this therapeutic setting, the counselor is to display unconditional positive regard despite any disgust or disapproval. The point is this client or person has come for help. They may at first make excuses but through empathy and good counseling skills, a person can start to see what he or she is doing is wrong in the situation. This involves patience and no judgement to help facilitate the change necessary internally for the person to seek reform instead of being told to do something. The counselor can help these individuals identify their own triggers, as well as circumstances, or situations that affect them. The counselor can also identify if the client had been abused in the past and how to help the person heal and not pass on the same abuse. Plans can involve identifying triggers, avoiding substances, and seeking the necessary help that may be beyond individual counseling sessions (Cochran, 2021, p. 243).
Conclusion
Counseling is not always about past trauma or issues that do not pertain to present potential or imminent harm. Counselors need to understand their legal obligations when presented to report crimes or potential harm to a client or others, but they can also employ the therapeutic relationship which understands the pain of the individual and the distress of the entirety of the situation. Sometimes this involves helping the person come to the conclusion that direct help beyond counseling is required, other times it may involve a plan for non imminent or criminal threats to a person’s safety. The counselor in the therapeutic relationship manages the crisis with empathy but also respects the dignity and autonomy of the individual in coming to logical conclusions and safety plans that protect the individual and others. When a client works with a plan instead of being coerced, then healing is more possible. Unfortunately, some clients who are victims of crimes, or are a harm to themselves that refuse to work with a counselor, must be hospitalized, or the situation reported despite the pain it causes. These are difficult times for counselors, especially new counselors. Hence, it is important to employ a health therapeutic relationship when applicable, assess situations, consult with other professional peers and make the best decision for the welfare of the client. It is not an immediate assessment but one that is made with many considerations, facts, and complications considered for the best outcome that respects the law but also safety of a client.
Always remember though
“The American Psychological Association (APA) offers ethical guidance through its “Ethical Principles of Psychologists and Code of Conduct.” Under these principles, therapists can disclose information without client consent if deemed necessary to protect the client or others from harm. This authorization for disclosure also extends to situations where the client has given permission, or when required by law, such as when providing professional services, seeking consultation from other professionals, or obtaining payment for services.” (Deibel, 2024).
Trauma Informed Care Specialists, those in crisis counseling, and any licensed mental and behavioral health professional, as well as healthcare professional can face these situations and must have a clear understanding what to do but also have the skills necessary to facilitate health client interaction that leads to joint conclusions when possible.
Please also review AIHCP’s multiple healthcare certifications and see which ones best meet your academic and professional goals.
Resource
Cochran, J & Cochran, N. (2021). “The Heart of Counseling: Practical Counseling Skills Through Therapeutic Relationships” 3rd Ed. Routledge
Additional AIHCP Blogs
Suicide Assessment. Click here
Suicide Lethality. Click here
When Trauma Emerges in Counseling. Click here
Additional Resources
Health Information Privacy. US Department of Health and Human Services. Access here
Barsky, A. (2023). “Duty to Protect and the “Red Flag” Option”. Psychology Today. Access here
“Guidelines for working with clients when there is a risk of serious harm to others” APS. Click here
Diebel, A. (2024). “What is a Therapist’s ‘Duty to Warn’ and Why is it so Important?” Grow Therapy. Click here
Healthcare Certification Blog: Empathy in Counseling
Empathy is big word in counseling. It is also foundational in how counselors and pastors help others heal. One of the biggest misnomers of counseling is the counselor fixes the person and details the agenda a person must follow to heal. This is farther from the truth. Emotional pain is not so easy to heal as if a recipe in a cook book. Instead it is a messy, usually not outlined path of progress and regress, emotions, and time. The counselor is more a beacon that guides than a drill sergeant who commands. Empathy is one of the key skills that serves as a way to help the client heal and become resilient. This does not mean that confrontation is not sometimes needed when maladaptive ideas and practices are destroying a client’s life but it does mean that empathy gives room for mutual sojourning and walking together in the feelings of the situation. This allows for self awareness and real conversion within the person instead of superficial direction and forced change that never lasts. So why counselors would on many occasions love to tell the client this is what the you need to do and how to do it, the science of psychology and counseling suggests otherwise.
In this short blog we will take a closer look at the role of empathy in the therapeutic counseling relationship. Please also review AIHCP’s Healthcare Certifications and see which ones best match your academic and professional goals.
Empathy vs Sympathy
Carl Rogers emphasized in counseling the critical importance of genuineness, empathy and unconditional positive regard. While these may seem like fluffy and soft terms that overlook right and wrong, they are critical to counseling in helping individuals discover right and wrong without scolding, admonishing, or ridiculing. Those in trauma or pain need a non-judgmental caring ear to listen and through that listening, foster change. The traumatized, mentally ill, and emotional unstable face a cold world already where they are marginalized, ridiculed, and judged. While abuse destroys human bonds, empathy can restore them. Counseling is a therapy that is not meant to make judgements but to help individuals discover healthy and good ways to heal. Instead of the dogmatic voice that says this is right or wrong (and it has a place), the counseling session looks to heal via listening and understanding and helping the person come to self actualization of the correct course. The counseling room is not the pulpit, but is a healing modality that looks to guide via a different route. Counseling understands empathy best produces change rather than lectures that only create more anger and disobedience and resistance. Ultimately empathy in counseling can lead a client to higher self-awareness, self experience and find a true joy in connecting and continuing the communication and connection with the counselor (Cochran, 2021, p. 64-67).
According to Cochran, empathy is not a thought process (2021, p. 56). Instead it is a natural connection with a person. It permits the counselor to feel what the other person feels. So when a gay man traumatically describes abuse at a young age, a counselor who is heterosexual does not see different sexual orientations, but the feeling of rejection and pain with their fellow human being. Likewise, a Caucasian counselor, can find empathy with a African American client who discusses the trauma of being racially profiled by the police. One does not need to share the event, or even agree with the client but they share the emotions felt by the client. This is the key difference between empathy and sympathy. Sympathy does not share in the feeling but it feels sorry for the person. Sympathy is good to have for someone but in counseling it is counter productive. Clients are not looking for someone to feel sorry for them but for someone to help them. They are looking for someone to feel what they feel and help them move forward. Empathy is hence walking with the person not just merely observing and offering condolences (Cochran, 2021, p. 57). Rogers states, empathy means to “sense the client’s private world as if it were your own but without ever losing the “as if” quality” (Cochran, 2021, p. 58). Of course, this does not mean, one who is empathetic must agree with the person’s choices, life styles or past actions, but it allows the counselor to help the person at a deep level to find healing and change.
This closely ties into Unconditional Positive Regard which is another key concept of Rogers which demands counselors fully accept the client in all their complete wholeness and shower them with unconditional understanding. Unconditional Positive Regard retains the autonomy of the client to learn how to change on their own terms. Rogers listed warmth, acceptance and prizing as three key elements of UPR. Warmth represents the care of the client and genuine empathy. It is the fertile soil that produces a an atmosphere of trust and disclosure. Acceptance is the ability of the counselor without bias to accept the immediate emotions of a person in counseling-whether illogical, angry, hateful, confused or resenting (Cochran, 2021, p. 103). Prizing involves raising the self esteem of the patient by accepting them with praise as they are but also highlighting their strengths and weaknesses in a honest and genuine way. Again, this type of emotional connection does not mean counselors accept statements, values, or actions of a client, but it does mean the regard is sincere and grants the client a sense of trust that if they make a mistake or trip and fall emotionally, there is no condition. When conditions are placed for approval, then the healing process becomes manufactured. It is through this type of positive regard that a client can flourish and heal because the client knows someone has their back in the good and the bad. This type of positive relationship in fact helps the client at an internal level look to become better intrinsically based not on reward but because it is the right thing to do. Once a client believe it is the right path without being told, then the client begins to truly transform and change. Through empathy, genuineness and employment of unconditional positive regard, the necessary emotional seeds can plant natural and self employed change at the guidance of a gentle counseling hand.
Displaying Empathy
Sometimes the hardest part for empathy to flourish in a counseling relationship is the counselor. Whether lack of practicing it or lack of patience for its fruits to develop, the counselor is ultimately responsible for establishing a secure and trusting environment where difficult emotions can be felt and discussed. One element is the fear of letting go. Some counselors may feel the need to control and direct a session and conditionally expect certain behaviors and decisions. They lack an empathetic skillset to confront a client with an emotional situation. It is hence important for counselors sometimes to allow the session to develop as the client dictates and to attempt to understand the client by what is revealed.
In expressing empathy, counselors need to match emotions with tones, expressions, movements and words (Cochran, 2021., p. 79 to 80). Sometimes naming the emotion and restating it to a client can help reflection but also show empathetic listening. This is also true when expressing empathetic confrontation which looks to indirectly help a person reflect on a statement. When stating a statement about what the person is feeling, state in in a declarative statement, but if uncertain, express it in a tentative declarative tone that is open for correction. In these reflections, a counselor can also reflect themes in paraphrasing one’s feelings. Themes that keep appearing in a person’s story or how one feels can be expertly restated and paraphrased to an individual to again not only show the counselor is listening but also to emphasize. This can be done in a statement but also in an attempt to empathetically confront a particular feeling (Cochran, 2021, p. 81-82). Empathetic confrontation eliminates the fear to allow clients to be confronted with some of their own statements. Counselors should be prepared to be corrected at times, if they misstate what a client said, or if their tentative declaration is misspoken. In these cases, this should not be seen as an affront but for a better opportunity to understand and help heal. Most clients will not be offended by this but thankful the counselor is listening and trying to understand. This can open to further and deeper exploration of the topic. Of course, it is also good to use appropriate questions to better understand. The questions must be natural however and not in the probing nature that looks to pick. This can make a client feel as if he or she is being interrogated.
Within empathetic counseling, it is important as the counselor to avoid making assessment statements or make the client feel as if he or she is being assessed. In addition, the counselor should not have a surprise hidden agenda that the counselor hopes to reveal and have the client realize. This leads to an unnatural direction that is void of truly listening and feeling. Counselors should also avoid doing most of the speaking and talking in these types of sessions, as well as avoid “me too” or “must feel” statements that can assume or take away from the client’s expression of feelings (Cochran, 2021, p. 82).
Counselors hence need to be able to employ empathy in multiple ways. Compton lists numerous ways, counselors can better express empathy and utilize it in counseling. He suggests becoming attuned with the client. Through attunement the counselor resonates the feelings of the victim/survivor (2024, p. 181). In addition Compton emphasizes the importance of co-regulation where the counselor is better able to help the client manage emotions. This is accomplished through mirroring and reflecting back, modeling after the client’s tone and motions and checking in on the level of distress a victim/survivor is feeling (2024, p. 182). The counselor enters into a posture of curiosity that portrays a genuine desire to understand the client (Compton, 2024, p. 183). In helping with emotions, counselors can also via prizing help highlight strengths of clients and adopt a perspective that looks how those strengths helped them survive and continue to survive.
Counselors also need to practice humility with empathy. Humility realizes that not all the right answers or skills are found within oneself but to look to the client as well as other professionals to find the needed solutions. This leads to not becoming over defensive if one is wrong with assumption, as well as being humble before a person’s experience as well as a person’s cultural identity (Compton, 2024. p. 183-184). Through this humility, the counselor looks to empower the victim/survivor to take an active role in healing and working with the counselor to find it.
Counselors in empathy must also display patience. The healing process is not linear or fast. It takes time to help someone find healing. When in empathy, feelings are not rushed but felt as they truly are and experienced until resolution and healing is found. During this process, empathy shares in the small victories and joys of self actualization, self worth and healing as the person transforms (Compton, 2024. p. 185).
Of course in all empathy, one finds that all important circle of trust. Within that trust comes a no-judgement zone and unconditional positive regard. However, trust is earned. Individuals suffering from abuse and trauma may not trust at first and be wary of words and especially physical touch. Through time and patience, confidentiality will be restored but again, empathy demands to feel what the moment dictates and the state of being currently within the client (Compton, 2024, p. 187).
Conclusion
Empathy is critical to helping people change because it is not authoritarian or dogmatic. Counseling is a healing modality and through empathy, one heals but also is guided through an empathetic ear with unconditional positive regard and genuineness that permits the person to see him/herself and come to conclusions that are healthy and good for his/her feeling. Counselors must be willing to let go of control, face hard feelings, eliminate personal judgement and bias, and allow the person to learn about oneself as the sessions continue. This does not mean the counselor can disagree internally, or not confront negative thoughts and emotions in an empathetic way, but it does does mean it gives the client a driver seat in pushing forward in self discovery, healing and a future way of living. Counselors need to facilitate the environment for this by displaying certain skills of empathy, unconditional positive regard and genuineness as espoused by Carl Rogers to achieve these results. Ultimately empathy in every venue of care is essential. It not just a counseling issue but also in all venues of healthcare itself.
Please also review AIHCP’s Healthcare Certifications, especially in Crisis Intervention, Grief Counseling, Christian and Spiritual Counseling and Trauma Informed Care programs.
Additional Blogs
Counseling When Trauma Emerges- Click here
Rogerian Counseling- Click here
Resource
Cochran, J & Cochran, N. (2021). “The Heart of Counseling: Practical Counseling Skills Through Therapeutic Relationships” 3rd Ed. Routledge
Compton, L & Patterson, T (2024). “Skills for Safeguarding: A Guide to Preventing Abuse and Fostering Healing in the Church” Intervarsity Press.
Additional Resources
The Role of Empathy in Effective Counselling. (2024). Mental Mastery. Access here
“Accurate Empathic Understanding: A Core Component of Client-Centered Counseling” (2024). Psychology Town. Access here
Sutton, J. (2021). “Unconditional Positive Regard: 17 Worksheets & Activities”. Positive Psychology. Access here
Cherry, K. (2024). “Unconditional Positive Regard in Psychology”. Very Well Mind. Access here