Career Counseling during the Establishment Stage Derailed by a Child’s Medical Crisis

By Mary Rose Tichar

Caryn and her husband are both 30 years old. They share an enthusiasm for their work and often talk about how they will support one another in their pursuit of professional development, such as graduate school, certifications, licensures, and even moving to a new city for employment opportunities. They are energized and excited.

Caryn is pregnant with her third child. At 22 weeks, the baby is diagnosed with a critical and congenital disease. The baby will need surgery within 48 hours of birth. The hospital that can best treat their child is 250 miles away. Caryn and her husband decide to relocate their family for the birth and first surgery. While this scenario may sound extreme, it is reality for some adults who seek the dual responsibility of establishing their families and their careers.

A sick child can upset the equilibrium of a family and a career. Career goals will often shift to include the best medical care possible. A flexible work schedule becomes a priority. And working parents are likely to miss important meetings and opportunities for advancement while attending to their child’s medical appointments. Shrouding all this is a preoccupation of an unknown future. Parents may become vulnerable to fear, anger, anxiety, and depression. Now, career goals seem less important than their child’s medical care.

A Sense of Self and Shattered Dreams

Engaging in professional development during the Establishment Stage offers young professionals ways to seek opportunities for increased responsibility and professional advancement (Sharf, 2002). A child’s medical crisis during this time, however, disrupts and disorganizes work values, career goals, and life missions.

Throughout their children’s medical crises, parents commonly experience the sense of losing one’s identity. Dr. Ronnie Janoff-Bullman’s (2010) theory of Shattered Assumptions explains how grief and trauma can shatter a sense of self, and that it may take a long time to come to know that self in the wake of trauma and grief. How do you guide your clients’ careers when their children’s’ serious illnesses dominate their life stories?

Counseling Clients through Altered Life Stories

As a career counselor, you have the knowledge of career development theories and understand how a crisis affects self-concept, and you are attuned to the multi-faceted nature of a crisis that includes the social, emotional, intellectual, and spiritual dimensions. You are also adept at how to weave a wider sense of self into the career life of the parent.

Using those skills and talents, your role while counseling parents of very sick children is to:


Planning Your Career Counseling Sessions

Some topics will specifically help you guide clients through their most urgent career concerns, but keep in mind your ethical obligations (e.g., make a referral to a marriage therapist if necessary).

While being mindful of your role and skills, here are seven career counseling topics to employ that offer clients effective ways to move forward in the Establishment Stage and work through their children’s medical crises:

  1. Devise strategies to foster supportive work relationships. What do your clients want their bosses, colleagues, and their clients to know about the crisis? This is an ongoing conversation as parents encounter a variety of responses.
  2. Consider the role of work amidst your clients’ crises: Is it a healthy escape or an escape from reality?
  3. Reflect on how these crises expand your clients’ beliefs and schemas as a way to help them cope in their “new normal.”
  4. Be mindful of how clients’ personal strengths, gifts, and natural talents can be utilized, even if it means taking jobs with fewer responsibilities. That can be okay and is not threatening to the future of a career.
  5. Identify skills learned during crises and how clients can use them in their present careers or jobs.
  6. Use narrative therapy for making meaning of clients’ crises and integrating their resulting experiences into their lives and careers.
  7. Help clients maintain a focus of self-identity through assessments such as Clifton StrengthsFinder® and the Myers Briggs Type Indicator®.


Assess Your Helping Skills and Resources

Practitioners who face clients with seriously ill children may need additional training and resources. Reaching out to experienced colleagues is another ethically-responsible action (Makela & Perlus, 2017).

The worksheet, “Your Personal Narrative—The story you tell yourself, about yourself” will be presented at the NCDA Global Career Development conference in Houston in June (Presentation #210). Clients who have completed this worksheet report feeling enlightened and encouraged on how what causes them the most pain can also provide insight about their greatest strengths, relative to their career life. By documenting their strengths and talents, values, and goals, clients come to know the intrinsic values of their strengths gained through their children’s medical crises.

While much has changed, the core of who these young, career-oriented clients are has not changed. Prompting clients to acknowledge this can bring a small sense of equilibrium to their daily lives.




Janoff-Bullman, R. (2010). Shattered Assumptions. NY:NY, The Free Press.

Makela, J. P., & Perlus, J. G. (2017). A case study approach to ethics in career development, 2nd edition. Broken Arrow, OK: National Career Development Association.

Sharf, Richard S. (2002). Applying Career Development Theory to Counseling. Pacific Grove, CA: Brooks/Cole.



Mary Rose Tichar lives in Cleveland, OH. She will present “Career counseling for parents of children with a chronic or terminal illness” at the NCDA 2019 conference. She is a licensed career counselor, an NCDA Certified Career Counselor, and founder of InsideOut Career Direction, LLC. Her counseling includes parents of children with chronic or terminal illness. She created the worksheet, “Your Personal Narrative—The story you tell yourself, about yourself.” Mary Rose has over 20 years’ experience of helping individuals identify their talent and connect to the world of work. Her ability to cultivate talent for job effectiveness, combined with her strengths-based approach, guides individuals toward a purposeful and meaningful life at work. You can reach Mary Rose through her website at https://insideoutcareer.com or email at mrtichar@insideoutcareer.com.


Printer-Friendly Version


Carol Van Rhein    on Thursday 06/06/2019 at 11:22 AM

I am unable to attend the conference but I feel that the worksheet, “Your Personal Narrative—The story you tell yourself, about yourself” would be very helpful in working with many of my clients. Where can I learn more about this?

Carol Van Rhein, M.Ed., NCC, PLPC, CRC, CCC, BC-TMH
Vision Specialist in Vocational Rehabilitation
Senior Vocational Rehabilitation Counselor
Rehabilitation Services for the Blind

Linda Greenfield   on Thursday 06/06/2019 at 05:08 PM

I am also unable to attend the conference but would love to learn more about your work and your worksheet. Thank you so much!

Mary Rose Tichar   on Friday 06/14/2019 at 10:54 PM

I am happy to share the worksheet and the slides of the presentation with you after the conference. Please send an email to remind me of your request after June 29 and I will send the documents to your email. Thank you very much!

Disclaimer: The opinions expressed in the comments shown above are those of the individual comment authors and do not reflect the views or opinions of this organization.