334 – Managing Triggers and Flashbacks

Selective Mutism – Ideal Client Load for Student Counsellors

In Episode 334 of the Counselling Tutor Podcast, your hosts Rory Lees-Oakes and Ken Kelly guide us through this week’s three topics:

• Firstly, in ‘Ethical, Sustainable Practice’, we look at managing triggers and flashbacks—offering insights into how counsellors can support clients dealing with trauma responses.
• Then, in ‘Practice Matters’, Rory speaks with Antje Bothin about her book Annika and the Treasure of Iceland and how it helps give a deeper understanding of selective mutism.
• And lastly, in ‘Student Services’, Rory and Ken discuss the ideal client load for student counsellors, offering guidance on balancing client hours in placement while maintaining self-care.

Managing Triggers and Flashbacks [starts at 03:06 mins]

Managing triggers and flashbacks is crucial for working with clients who have experienced trauma. In this section, Rory and Ken explore the mechanisms behind trauma responses and how counsellors can help clients manage and reduce distress caused by these experiences.

Key points discussed include:

• What Are Triggers?
  • Triggers are stimuli – such as sounds, smells, images, bodily sensations, or emotions – that remind a client of a past traumatic event and activate a distressing response.
  • These triggers can be conscious or unconscious, meaning clients might not always recognise what has set off their reaction.
• Understanding Flashbacks
  • Flashbacks pull a client back into the past, making them re-experience their trauma as though it is happening in the present.
  • This can be accompanied by emotional regression, where clients may revert to a childlike state in their speech or body language.
• Helping Clients Identify Triggers
  • Therapists can support clients by identifying potential triggers before they become overwhelming.
  • Trigger journals are a useful tool to help clients recognise patterns and gain greater self-awareness.
• Techniques for Managing Triggers and Flashbacks
  • Grounding Techniques: These help bring the client back to the present moment, e.g. the 5-4-3-2-1 Method.
  • Breathing Techniques: Encouraging deep, calm breathing to slow the physiological stress response.
  • Physical Movement: Stretching, standing up, or walking to interrupt the trigger response.
  • Developing a Coping Plan: Creating self-soothing strategies, such as listening to music, using a weighted blanket, or engaging in a creative activity.

Key Practice Tip:

If a client regularly experiences triggers or flashbacks, therapists should incorporate trauma-informed practices into their approach to ensure a safe and supportive therapeutic environment.

Selective Mutism [starts at 29:35 mins]

In ‘Practice Matters’, Rory speaks with Dr. Antje Bothin, author of Annika and the Treasure of Iceland, about selective mutism – a condition where individuals experience extreme anxiety when speaking in certain situations.

The key points discussed include:

• What is Selective Mutism?
  • A phobia of speaking caused by anxiety, often leading individuals to experience a freeze response in social settings.
  • People with selective mutism may speak comfortably in some environments (e.g. at home) but struggle in others (e.g. school, therapy).
• Recognising Selective Mutism in Clients
  • Clients may remain silent in certain situations while appearing confident in others.
  • Some individuals exhibit high-profile selective mutism, where they completely stop speaking, while others display low-profile selective mutism, where they respond with one-word answers or gestures.
• How Therapists Can Support Clients
  • Avoid pressuring clients to speak—instead, create a safe and accepting environment.
  • Use Alternative Communication Methods:
    • Start with closed-ended questions (yes/no answers) before gradually encouraging more open-ended responses.
    • Allow clients to write responses or use nonverbal gestures.
  • The Sliding-In Technique:
    • Gradually introduce the therapist into the conversation by first having the client speak to a trusted person, then slowly integrating the therapist.

Key Practice Tip:

Understanding selective mutism is crucial for counsellors who work with neurodivergent or anxious clients. Therapists should consider specialised training or reading resources such as The Selective Mutism Resource Manual by Maggie Johnson and Alison Wintgens.

Key points from the conversation include:

• Breaking stereotypes – Addressing common misconceptions about autistic professionals in therapy.
• Masking and burnout – How masking neurodivergent traits in a professional setting can lead to exhaustion.
• Client relationships – How self-disclosure and a neurodivergent perspective can enhance therapeutic connection.
• Workplace accommodations – The importance of reasonable adjustments to support autistic therapists in practice.
• Neurodivergent therapists can bring unique strengths to therapy, including deep empathy and creative engagement techniques.

Key Practice Tip:

Understanding selective mutism is crucial for counsellors who work with neurodivergent or anxious clients. Therapists should consider specialised training or reading resources such as The Selective Mutism Resource Manual by Maggie Johnson and Alison Wintgens.

Ideal Client Load for Student Counsellors [starts at 53:15 mins]

In Student Services, Rory and Ken discuss the ideal client load for student counsellors in placement. Many students wonder how many clients they should take on to meet the required placement hours without becoming overwhelmed.

Key points discussed include:

• Start Slowly
  • Begin with one client to adjust to real-world counselling dynamics.
  • The shift from peer practice to working with real clients can be a big adjustment, so pacing yourself is important.
• Supervision and Ethical Considerations
  • More clients mean increased supervision requirements, which come with time and cost considerations.
  • Some students rush to complete their hours, but burnout and emotional overwhelm can occur if they take on too much too soon.
• Gradual Increase in Client Load
  • After your first client session, reflect with your supervisor before taking on more.
  • Consider your own emotional resilience – some clients may bring challenging material, so ensure you have time to process sessions fully.
  • Keep in mind that not all scheduled clients will attend—around 30% of client sessions may result in non-attendance.

Key Practice Tip:

It’s not a race – each student’s journey is different. Prioritise quality over quantity to ensure you gain the best learning experience while maintaining self-care.

Links and Resources

Counselling Skills Academy

Advanced Certificate in Counselling Supervision

Basic Counselling Skills: A Student Guide

Counsellor CPD

Counselling Study Resource

Counselling Theory in Practice: A Student Guide

Counselling Tutor Shop

Facebook group

Website

Online and Telephone Counselling: A Practitioner’s Guide

Online and Telephone Counselling Course