05/01/2009

Integrative Career Counseling: Helping Clients Who Are Depressed, Stressed and Sometimes a Mess

By Karen James Chopra

Clients have high hopes for career counseling, and they expect to make steady progress.  They are often paying for counseling out of their own pocket, or they have a limited number of outplacement sessions.  They are scared, because they need to find a job, or in pain, because going to their current job each day is so hard.   Career clients are primed to want immediate results.

But many of them aren't ready to move that quickly.  They come to us with a range of emotional issues that interfere with the career work they need to do.  Some are depressed, some are anxious, others are angry and frightened.  Some are experiencing difficult life events, like divorce or the illness or death of a loved one.

If clients are to achieve their career goals, these emotional issues must be addressed.  But clients get impatient with any work that doesn't seem to be directly related to career work, and they often terminate career counseling prematurely, because they "aren't moving fast enough."  This doesn't need to happen.   

Clients want speed and the counselor needs time.  I have spent years trying to reconcile these two imperatives, and the result is Integrative Career Counseling (ICC).   ICC ensures that the client sees a relentless focus on career results, while providing a framework for the counselor to efficiently address emotional issues that impede the client's work.   Because ICC is a collaborative model, the counselor gets the client's wholehearted participation in the entire process.    

Four Levels of ICC

The ICC model suggests that all clients be approached initially at Level 1: Career Counseling.   Clients working at Level 1 are motivated and capable of implementing career plans.  They complete most assignments, and often do additional work on their own initiative.  Sessions focus on problem solving and planning next steps.  Any emotional distress apparent in the client does not interfere with her ability to accomplish career goals.  It is only when a client stops making progress that the counselor needs to consider working at other levels.

At Level 2, Emotionally-Aware Career Counseling, the counselor addresses emotional roadblocks to progress on career goals.  Clients at this level are often in the grip of emotional thinking, which causes them to behave irrationally or stop working.  These clients often fail to complete assigned tasks, and display a wide range of emotions during sessions, especially fear, anxiety and anger.  Clients at this level respond well to basic counseling interventions like active listening and reframing.  The counselor can usually work simultaneously on emotional and career issues.  As soon as the client can resume work on the career plan, work at Level 2 is complete.  If, however, the client continues to struggle, it may be that Level 3 counseling is necessary.  

At Level 3, Therapeutic Career Counseling, clients are struggling with issues such as severe depression, personality disorders, or untreated trauma.  Counselors often find these clients frustrating.  They don't complete assignments and may refuse to take responsibility for their lack of progress.  They need interventions that address early experiences, maladaptive defense mechanisms, self-defeating rules or concepts, and unresolved trauma.  Several sessions may be devoted to therapeutic work before the client is ready to return to Level 1.

Level 4, Therapy with a Career Focus, is for clients facing severe emotional challenges, including active suicidal ideation, a manic episode, panic attacks or major depression.  Interventions at this level must include an assessment by a psychiatrist if the client is not currently in treatment, and concurrent psychiatric treatment.  During this time, clients may welcome continued discussion of long-term career plans, but stabilizing the client is the first priority.  

Career counselors do not have to be therapists to use the ICC model.  Most counselors with a master's degree have the background to work at Levels 1-3.  At Level 4, all counselors should seek referrals, supervision and consultation.

Governing Principles of the ICC Model

There are several principles guiding the ICC model:

• The focus of the work is the client's career goals.  Therapeutic work is limited to what is required to reach the client's goals.
• The territory covered by the work is anything that the counselor or client feels is relevant.  So, for example, if the client wants to talk about what happened this morning with her husband, the counselor and client examine that interaction with a focus on how the incident relates to the career work.
• The process is transparent.  The counselor describes what she sees and explains what she proposes doing next.  For example, a counselor will observe that no networking has occurred this week, explain that fear and anxiety often impede the efforts of jobseekers, and propose exploring the client's unspoken fears and assumptions in more detail at Level 2, Emotionally-Aware Career Counseling. Counselor and client should always know the level where work is occurring.
• The client must consent.  The counselor must tell the client what piece of work is being proposed and why.  If the client objects to the proposed work, the counselor works with the client to create an alternate plan.  Often, after alternate plans fail, a client will consent to more in-depth work. 

An ICC Case

Maura, a 45 year old business executive with nearly 25 years experience in trade associations, came to me about a year ago wanting to make a complete career change.  She needed to work for another 10-15 years, and wanted to identify work that she truly loved, but she didn't know what that might be.

Prepping for ICC Success 

From my first phone conversation with Maura, I started laying the groundwork for the successful implementation of the ICC model.  These are the steps I use with every client.

1.      Introduce ICC concepts in the first conversation

Implementing the ICC model begins with a brief phone conversation with every potential client to ensure a good fit and to introduce ICC concepts.  After listening to Maura's hopes for a more satisfying career, and her frustration about not knowing what that might be, I responded "It's not unusual not to know, and sometimes the process of finding the dream job can be scary and frustrating.  We will address the fears as they come up, so they don't get in the way of your discovering your dream job."

I also prepared Maura for how the process works, saying "our first session, and perhaps part of the second session, will be devoted to a thorough history-family and career--so that I know as much as possible about you when we start exploring career issues.  It takes some time up front, but it always saves time in the long run, because we won't have to backtrack."  Clients never object to a thorough history if they understand its purpose.

2.      Do Every Intake for Level  4 Work

The ICC model begins work with a client at Level 1, but it is not unusual to need to shift quickly to Level 4.  It is therefore critical that every intake be done with the assumption that you may need to work at Level 4:  Therapy with a Career Focus. 

The standard ICC intake gathers background information that may not seem relevant to career work, including a family genogram, medical and mental health history, family and client history of suicidality, current medications, history of substance use, trauma, recent losses, spiritual or religious affiliation, hobbies.  This provides an overview of the emotional and psychological issues the client faces.  As long as clients understand that this information may be useful during our work, they are perfectly willing answer these questions.  

Maura's intake revealed a physically healthy woman with a background of emotional and physical abuse.  Her father was an alcoholic.  She had been in therapy for a number of years to work through the trauma and her alcoholism.  As we reviewed Maura's painful past, I explained that growing up in an environment of abuse and alcoholism makes it hard for people to know what they want, since safety and survival are the overriding concerns.

3.  Keep your Eye on the Goal 

A client's goal is not a single, fixed point, but is constantly shifting, sometimes unconsciously.  For example, Maura was initially focused on a career that would replace her income from the last job.  "I've worked too hard to give up my income level," she told me.  When a job opportunity with a lower salary appeared, I checked on her financial goal again.  Maura said that if she could get that job, a salary cut wouldn't matter.   

An ICC counselor reconfirms the goal frequently and always before moving to a different ICC level.   Rather than be irritated by these repeated efforts to clarify the goal, clients are usually delighted that someone is listening so closely. 

Getting to Success

With the groundwork laid in the first phone call, a thorough intake completed, and Maura's shifting goals in sight, it was time to help her achieve success.

I started Maura at ICC Level 1-Career Counseling.  Immediately, Maura started to struggle.  I would toss out various ideas, and Maura, visibly upset, couldn't say whether she might like the job.  She felt the same about landscape designer, for example, as she did about being head of an association.  Her obvious distress was a signal to me that I needed to shift to Emotionally-Aware Counseling, Level 2.  If the emotion isn't addressed, it will impede the career work.

An inability to know what they want is often seen in survivors of trauma and abuse.  Working at Level 2, I focused on getting Maura back in touch with her desires.  I told her she needed to strengthen her "wanting" muscles, and asked her to make a list each morning of things she wanted that day, starting with what she wanted to wear and eat.   "How will this help me with my career exploration?"  Maura wondered.   I told her she needed to be able to feel desire in order to assess career options.  After several sessions of reviewing her lists and past memories of things she wanted, Maura was able to recognize which career she wanted.  With a career goal in hand, I shifted back to Level 1, and we worked on a resume and job search plan. 

The next bump came in the most unexpected place:  during a session on interview preparation.  As we rehearsed answers to possible questions, Maura visibly dissociated-she became spacey, and had troubling focusing on what we were saying.  Immediately, I went to Level 4, Therapy with a Career Focus.  We determined Maura's dissociative episode was triggered by her fear of having to tell interviewers about why she wanted a career change.  Her trauma background had taught her to keep everything important secret, so she returned to her childhood defense mechanism, dissociation. At my recommendation, Maura returned to therapy with her psychiatrist, and I shifted to Level 3, Therapeutic Career Counseling. 

Because Maura dreaded interviews, we practiced new ways for her to set boundaries on questions that made her uncomfortable.  Maura was at ease asking questions of others, so we developed substantive questions she could ask when she felt threatened.   It took five sessions over as many weeks for Maura to feel confident in her ability to interview effectively.  At that point, I shifted to Level 1, where we are working now.  At her choice, Maura has had 20 counseling sessions.   She knows what she wants and is confident during interviews.  As of this writing, she is scheduled for three interviews in her new field. 

The ICC model provides career counselors with the structure and clarity to plot a path through a range of emotional obstacles and help keep clients like Maura on track.

 Karen James Chopra, LPC, MCC, NCC, is the creator of Integrative Career Counseling (ICC), which was developed in her career counseling practice in Washington, D.C.   She has also worked in the outplacement industry for Lee Hecht Harrison and Resource Careers, and was a regular guest commentator on a local radio show "Your Career Life."   Recently, she has filmed several career "how to" videos for MonkeySee.com.  Her website is www.chopracareers.com/integrative-career-counseling, and her email address is:  Karen@ChopraCareers.com .