Monthly Archives: May 2017

Opioid SOS

By Laurie Meyers May 31, 2017

During a single afternoon this past August, 26 people overdosed on opioids in Huntington, a small city in West Virginia with a population of approximately 50,000. Bolstered by naloxone — an opioid antidote that often can revive overdose victims who have stopped breathing — and too much practice in overdose scenarios, police and paramedics were able to save all 26 people. However, the danger of overdosing is so great — and so common — that many of those 26 individuals are likely to overdose again, some fatally.

Scenes of opioid overdoses are playing out again and again in cities, towns and rural areas across the United States. So many Americans are in thrall to opioids — which encompass both prescription pain relievers and the illegal drug heroin — that the Centers for Disease Control and Prevention (CDC) has declared opioid abuse an epidemic. According to the CDC, in 2015 (the latest year data were collected) more than 33,000 Americans died from opioid overdoses, a number that is quadruple the rate of deaths in 1999. In fact, from 2000 to 2015, more than half a million deaths were attributed to opioid overdose. West Virginia, New Hampshire, Kentucky, Ohio and Rhode Island are the states with the highest rates of opioid deaths, but no state, no socioeconomic status and no racial or ethnic group can claim to remain untouched by the opioid epidemic.

“We’re in danger of losing a generation,” asserted Carol Smith at an April congressional briefing on Capitol Hill sponsored by the American Counseling Association to raise awareness about the opioid epidemic and the role professional counselors can play in stemming the tide. Smith, a member of ACA and a past president of the West Virginia Counseling Association, is a counseling professor and the coordinator of the violence, loss and trauma certificate of studies at Marshall University — which happens to be located in Huntington.

Birth of an epidemic

The CDC numbers show that the opioid epidemic has been gathering steam for a long time. Public awareness of the epidemic has grown gradually with media reports of more fatal overdoses, including the startling 2016 death of music legend Prince by overdose from nonprescribed fentanyl. More than a year later, the full story is not yet known, but the singer and musician had reportedly been taking prescription opioids for chronic pain for many years, which put him at risk for developing an addiction.

In fact, for many of the people who become addicted to opioids, this is how it begins — with a prescription for painkillers. According to the CDC, prescriptions for opioids in the U.S. have quadrupled since the year 2000, despite there being no corresponding overall increase in the amount of pain that Americans report. Experts say a combination of factors has driven the sharp rise in opioid prescriptions. In the late 1990s, in a push to improve pain management, the medical community began considering pain a fifth vital sign, along with body temperature, pulse rate, respiration rate and blood pressure. The prescription drug OxyContin debuted in 1996 and was marketed as less addictive than other opioids. Research that has since been discredited asserted that patients in severe pain had a low tendency to become addicted to opioids.

“That was simply not true,” says Kirk Bowden, a licensed professional counselor (LPC) and ACA fellow in Phoenix who has specialized in addictions for almost 30 years. “They found that [severe pain] patients did start to become addicted — very early on. You can become addicted even if you follow the physician’s directions.”

Experts say that certain populations are particularly at risk for becoming addicted to opioids, including individuals who have a history of trauma, mental illness or other substance abuse. Medical professionals such as doctors, nurses, dentists and veterinarians are at increased risk because they have easy access to opioids through their work. Those in the military are also at greater risk because they are so often treated for pain.

As Smith points out, opioids are particularly addictive because of the effect they have on a person’s mind and body. “We are all biologically vulnerable,” she says.

Opioids attach to opioid receptors in the body to reduce the sensation to pain. As they do this, they cause physical changes in the body’s own opioid system. Over time, the body may become physically dependent on opioids. Even a weeklong prescription for opioids can cause withdrawal at cessation. In addition, opioids affect the brain’s reward system and can cause a feeling of euphoria. This combination of effects means that long-term use is itself a risk factor for physical dependence and addiction. A study reported in the March 17 issue of the CDC’s Morbidity and Mortality Weekly Report found that in patients prescribed opioids for the first time, the likelihood of them still being on the opioid within a year’s time increased after just six days of use and then again at 31 days.

Unfortunately, Smith Says, doctors and dentists commonly prescribe 30-, 60- or 90-day supplies of opioids to help patients alleviate instances of even short-term pain, such as the removal of wisdom teeth.

Some people who become addicted while on painkillers turn to heroin once their prescription runs out or when other opioids become too expensive, says ACA member Kevin Doyle, an LPC who has a private practice that specializes in group work for clients who have substance use disorders. It is becoming more common for heroin to be mixed with fentanyl, which is a much stronger opioid. Frequently, he notes, users either don’t know about the fentanyl or misjudge the dose and end up overdosing.

Addiction as a lifelong illness

There is a common misconception, not just on the part of the average person but also by many health professionals, that “getting sober” (clearing the body of the addictive substance) and recovery are the same thing. Nothing could be further from the truth, say substance abuse experts.

All of the counseling professionals interviewed for this article say that the standard for addiction treatment for both inpatient and outpatient programs is typically 30 days to get biologically clean. Clients are then sent back into their home environments, where they can easily become addicted again in the absence of follow-up support.

“You hear numbers about treatment programs that have outrageous treatment success rates, like 98 percent, but they don’t say where people are five years later,” Bowden notes. “People new to [addiction and recovery] don’t realize how addiction encompasses your whole life. … Long-term support is critical.”

ACA member Larry Ashley, an LPC with more than 40 years in the field of addictions, agrees. He says that as hard as getting “sober” or physically clean may be, it is actually the easiest part of recovery. “Recovery is a lifestyle change,” he says. “It’s important that people understand the difference between sobriety and recovery.”

Smith adds that addiction is most often treated like an acute disease when it is actually a chronic one, and the challenges don’t just stem from staying off the substance.

Doyle agrees. “There is a tendency to think of this [addiction treatment] as a single episode — that once you take care of that, we are done,” he says. “But, unfortunately, it’s a lifelong disease, and like any other disease, there may be episodes when a person doesn’t take as good of care of themselves as [other times]. I tell the client upfront, ‘We don’t see a cure, but this is something that can be managed.’”

The cost of not seeking help for addiction is high, and the opioid epidemic has been particularly devastating. ACA member Rick Carroll, a counselor who helped develop the substance abuse certification program at Lindsey Wilson College, has seen many people lose everything to opioids. And like a bomb blast, the destruction from addiction is not limited to the person hooked on opioids — it spreads outward.

In fact, the fallout from opioid abuse is what spurred the state of Kentucky, where the main campus of Lindsey Wilson College is located, to fund Carroll’s certification program. Currently, 1 in 4 babies born in Kentucky is diagnosed with neonatal abstinence syndrome — a range of physical problems that result from being exposed to opioids in the womb. The babies and mothers receive any needed addiction treatment and health care at the hospital, but there is also a need for clinicians who can help mothers cope with bonding and other family issues while undergoing detox.

Carroll also does parental assessments in Virginia for social services and the local court system. He sees many parents who have lost their children to foster care because of opioid abuse and estimates that a third of these clients will never regain custody of their children.

Many problems associated with addiction cannot be addressed with a 30-day program because recovery involves rebuilding a life, say the counselors interviewed for this article. In many instances, these clients have a lot to “relearn,” Carroll says.

“In our program, we talk about meeting people where they are at,” he says. “Which stage of change are they in? Do they say that they have a [substance abuse] problem? Where are they in recognizing the problem?”

People often take substances such as opioids as a way to cope, so counselors can help these clients by teaching them healthy coping skills, Carroll says. This starts by teaching them to be mindful and pay attention to their emotions, particularly becoming aware of when they are experiencing negative emotions such as anxiety and depression. Journaling can be helpful as a kind of daily log of thoughts and feelings, says Carroll, adding that some clients feel more connected to their emotions when they write them down.

As clients learn to be mindful of their emotions, they also need to be presented with new ways to cope, Carroll says. Among the tools he shares with clients are relaxation techniques and systematic desensitization. Carroll says that counselors should talk to clients about the events and everyday situations that are most stressful for them and have them practice breathing and other relaxation techniques that they can continue to use on their own. Counselors can also teach clients how to better deal with conflict through role-play and empty chair exercises, he says.

People who struggle with addiction are also often dealing with significant cognitive distortions, such as thinking that they are damaged goods, Carroll explains. Counselors can help clients examine these beliefs to see either that the beliefs aren’t valid or to clearly identify problems that clients can work on.

It is also important for counselors to understand the dynamics of these clients’ family systems, Carroll says. In some cases, family relationships have been broken or the client’s family members are struggling with addiction themselves. In either case, the client is faced with a lack of support and a potentially triggering environment, he says.

Carroll advises the use of genograms to explore family dynamics, looking in particular for toxic relationships or indications of a multigenerational history of substance abuse or mental illness. Through the use of genograms, “clients can see the roots [of their difficulties] and ask, ‘What can I create in my life right now to break the cycle?’” Carroll says.

Ashley, who also specializes in combat trauma, says that clients struggling against addiction also need to learn different ways to alter their consciousness and feel good. “People who have been addicted for a long time don’t know how to have fun,” he says. Ashley advises asking these clients about the activities that they used to enjoy and encouraging them to find or rediscover hobbies because they need alternatives to getting high.

“Exercise is good as long as they don’t overdo it,” he says. “Reading, bowling, going for a walk, art — it just depends. If you never had any experience [with hobbies], you have to try. If it doesn’t work, keep on trying.”

Ashley says clients also need to develop a plan to stay sober. These plans address elements such as how to stay away from situations or people that trigger or encourage substance use and abuse, how to handle stress and other emotions without opioids or other drugs, what to do when the urge to use strikes and how to occupy the time that previously went to scoring and taking drugs. Although counselors can assist clients with these plans, Ashley says it is equally important that they help clients find additional support through avenues such as group therapy, 12-step support meetings and other treatment programs if necessary.

Carroll agrees. “Counselors need to work closely with other health providers, medical professionals, social workers and school personnel,” he says. “It’s very imperative that you don’t work within a bubble. Get the individual the best help that you can.”

Necessary knowledge

Counselors can serve as a vital source of support for clients in recovery, but many practitioners have little or no training in addictions work. Bowden firmly believes that counselors need intensive training to work with those struggling with addictions.

Smith asserts that the grip of the opioid epidemic is so strong that all counselors must learn how to work with these clients. Likewise, counselors who specialize in substance abuse issues note that all practitioners will encounter clients who are struggling with addiction, even if addiction isn’t the presenting issue. Smith adds that clients may not reveal substance abuse problems right away, meaning that by the time the subject of addiction comes up, a therapeutic bond likely will have been established already with the counselor.

That is not to suggest, however, that the proper training isn’t important. Counselors should seek out additional courses on addictions work, either locally or online. Bowden and Ashley urge counselors to undergo supervision and to find a specialist with whom they can work. Counselors can also get involved with professional organizations such as the International Association of Addictions & Offender Counselors, a division of ACA.

“No matter what your practice is based on, most of your people are going to have addiction issues, whether obvious or not,” Ashley says. “So get to know people in the 12-step community. Look in the Yellow Pages or go online and Google ‘support groups,’ including options that aren’t [connected to] AA [Alcoholics Anonymous].”

When working with individuals who are battling addiction, Smith says, counselors also shouldn’t forget to simply call on the fundamentals of counseling. “A person needs to know that they are in safe company, with someone who is empathetic and who understands at least a little bit what they are going through and is willing to act as a guide.”

 

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Larry Ashley, Kirk Bowden, Kevin Doyle and Carol Smith each served as panelists (along with Dr. Melinda Campopiano of the federal Substance Abuse and Mental Health Services Administration) at the congressional briefing on opioid abuse in April that was sponsored by ACA. For a report on that briefing, read the online exclusive, “‘We’re in danger of losing a generation,’” by Bethany Bray at CT Online (ct.counseling.org).

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association.

Counseling Today (ct.counseling.org)

Practice briefs (counseling.org/knowledge-center/practice-briefs)

  • “Opioid Use Disorder” by Rachel M. O’Neill
  • “Substance Abuse and Addictive Disorders” by Gerald A. Juhnke & Kathryn L. Henderson
  • “Chronic Pain Counseling” by Stephanie T. Burns

Books (counseling.org/publications/bookstore)

Podcasts (counseling.org/knowledge-center/podcasts)

  • “The Latest on Addiction Counseling, Co-Occurring has Replaced Dual-Diagnosis and Why is Crack so Addictive Anyway?” with Ford Brooks and Bill McHenry

ACA divisions

  • International Association of Addictions & Offender Counselors (iaaoc.org)

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The Counseling Connoisseur: Free time: Vacationing and well-being

By Cheryl Fisher

 

My schedule is abysmal. I methodically pluck each hour and consume it with some obligation. At the end of my day, my free time is as nonexistent and barren as a sweet-corn field in October. — Cheryl Fisher

 

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Exams are graded. Grades are finally posted. Commencement pomp and circumstance has been observed. I am now able to turn my attention to my much neglected home, garden and family life. Closets and drawers burst with the abundance of unseasonal attire, while young seedlings choke on interloping weeds. I vaguely remember the names of my husband and my canine companion, who both have remained loyal and supportive during these past hectic months.

My closets need space to make room for a warmer climate wardrobe. My seedlings need space to grow to their full capacity. My husband and I need space to reconnect and reclaim the richness of our relationship. We need to make space and time for us!

 

Take back time

The concepts of overwork and “poverty of time” are explored and examined by like-minded professionals at the annual Time Matters: The National Take Back Your Time Conference. These individuals strive to bring life-work balance into practice through discussion and strategy by hosting experts in the field such as historian and author Benjamin Hunnicutt.

Hunnicutt, in his book Free Time: The Forgotten American Dream, challenges that “progress, once defined as more of the good things in life as well as more free time to enjoy them, has come to be understood only as economic growth and more work, forevermore.” He suggests that recommitting to the forgotten American Dream will promote enriched family life and provide more opportunity to “enjoy nature, friendship and the adventures of the mind and of the spirit.”

This sounds great … but how do we do it?

 

Simplify

The most singular thing to do to increase time is to simplify. By minimizing the materialism in one’s life, a person takes back not only time but energy and economy by investing in priority-only possessions, people and protocols. Attending to one or two goals or commitments at a time allows for more full engagement and success. Focusing on positive thoughts reduces ruminating negative feedback loops. Unplugging from digital communication affords solace. Taking steps to simplify life allows for the cultivation of free time.

 

Free time: Benefits of vacation

Recently, I found myself thinking, “I can’t wait until the weekend so that I can get some work done.” Seriously! I was planning to use my weekend to catch up from the workweek.

It was at that point I realized that I needed a vacation. Vacations help to rejuvenate and rehabilitate us from overexposure to demanding schedules and work environments. Here are a few benefits to making the most of our free time.

1) Vacations reduce stress. The American Psychological Association found that vacations reduce stress by removing people from the stressors identified in the workplace. This was similarly found in a Canadian study that examined the role of vacation for 900 lawyers who reported a sense of rejuvenation from the temporary reprieve from their stressful work environments.

2) Vacations reduce heart disease. A Multiple Risk Factor Intervention Trial for the Prevention of Coronary Heart Disease found that in 12,000 men with high risk for coronary disease, those who took regular vacations reduced their chance of a heart attack by 21 percent. Furthermore, the largest and longest running study, the Farmington Study, found that taking routine vacations significantly decreased the risks of heart disease in both men and women.

3) Vacations decrease depression. A study conducted by Marshall Clinic found that taking regular vacations appears to increase positive emotions and buffer the effects of depression. A similar finding emerged from the University of Pittsburgh’s Mind-Body Study.

4) Vacations may make you thinner. The Mind-Body Study additionally found that taking vacations decreased blood pressure and decreased waistlines. These appear to be related to increased activity levels, a decrease in cortisol and a decrease in stress eating.

5) Vacations improve relationships and sex life. Spending time with loved ones and sharing experiences appears to have a positive effect on the bonding experienced in relationships, Furthermore, lower cortisol levels are believed to promote a positive feedback loop in the brain and increase levels of sex hormones such as testosterone, contributing to an increase of libido. Therefore, people report feeling more easily aroused and experiencing higher levels of sexual satisfaction while on vacation.

 

Conclusion

In an effort to resume balance, and with a renewed sense of conviction to self-care, I take the vacation pledge borrowed from Take Back Your Time (repeat after me):

 

I HEREBY PLEDGE:

To not add to the 429 million days of unused paid time off last year.

To promise to vacation so that I can lead a happier, healthier life.

To recharge, refuel and refresh by taking all the vacation time I have earned.

To ignore my voicemail, email and text messages for days on end.

To reduce my stress, improve my health and nurture my relationships by vacationing on a regular basis.

To return to my regularly scheduled life glowing, smiling and doing a little happy dance.

 

And so it begins … Happy summer!

 

 

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For more on the logistics and responsibilities involved in stepping away from a counseling practice for a much-needed break, see Cheryl Fisher’s archive column “Break away: Five vacation hacks for the responsible counselor

 

 

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Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland, and a visiting full-time faculty member in the Pastoral Counseling Department at Loyola University Maryland. Her current research examines sexuality and spirituality in young women with advanced breast cancer. She is working on a book titled Homegrown Psychotherapy: Scientifically Based Organic Practicesthat speaks to nature-based wisdom. Contact her at cyfisherphd@gmail.com.

 

 

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

 

Nonprofit News: Edible ‘offices’: Adding beauty to your program while helping the hungry

By “Doc Warren” Corson III May 26, 2017

Multitasking is a way of life for many of us, although it would appear that with ever-shrinking budgets, counselors in nonprofit settings have made a true art of it. We can no longer afford to do something that only covers one area. Instead we need to reach deeper to do more with less.

Thankfully, there is a way to mix therapy, education, recreation, nature, beautification, nutrition and holistic health — planting a vegetable garden. The best part? The effort requires little in the way of money for startup and even less in future years.

 

What is needed

  • South-facing areas: windows, pathways, greenways (anyplace that gets direct sunlight daily)
  • Access to water
  • Planting space: garden areas, pots, planters or anything that can hold soil and seeds. Be creative. We once used a windowsill and gallon milk jugs with the tops cut off.
  • Basic tools: Depending on the size and scope of the project, you might need common gardening tools or nothing more than the ability to open a bag of soil. For larger areas, you will want a hoe, garden shovel, watering can or garden hose, and clippers.
  • Seeds
  • Fertilizer
  • Storage area for tools, supplies and vegetables
  • Patience

 

How it’s done

All you need is a basic desire to plant and grow vegetables. If you use non-GMO (genetically modified organism) and nonhybrid seeds, you can collect seeds from the vegetables you grow for use in future planting. This allows for minimal startup and sustainability costs. (Note: GMO seeds can be controversial, and at times you are not allowed to collect and save the seeds because of arcane laws. Hybrid seeds are poor choices for saving because they are made from a blend of plants, and the resulting seeds are unpredictable.) If space allows, you can compost any nonedible or spoiled greens. Reusing this compost limits the need to purchase supplemental fertilizers.

Starting the program can take many paths. It can involve simply recruiting a few interested staff members, or it can involve putting out a call to the community (including those whom your nonprofit serves) to look for volunteers. I recommend having a key point person to supply basic information to interested participants. This includes educating them on how this effort ties into positive mental and physical health. The point person will also provide basic training.

Have folks commit to an activity either on a one-time basis or as an ongoing chore. A feeling of ownership will help develop their sense of belonging to the greater community. It can also help to build self-esteem, responsibility and confidence.

 

What to do with the products

Some nonprofits sell the vegetables they grow as a fundraiser. Others simply share the vegetables with those who participated in the project, and still others share with the volunteers and with the greater community. There is no right answer.

 

Case study

Here at Pillwillop Therapeutic Farm, we elected to go big with our community growing program by making field areas open to volunteers. The idea was that we could educate on nutrition, share what is harvested with volunteers and those in need, and add a small “take what you need, leave what you can” farm stand.

The first few years were marked with both successes and challenges (broccoli remains my greatest foe, as we have yet to have any real success with it). Starting with a few shovels in the dirt and water collected by hand from a nearby brook, we regularly invested in programming as possible. Applying for competitive grants and other income resources led to a $10,000 “Seeds of Change” grant, as well as other grants, which enabled us to expand our offerings greatly.

We invested thousands of dollars and thousands of man-hours to build infrastructure such as year-round water access to some fields, seasonal access to others and drip irrigation with timers to help preserve water and reduce labor. We also built two large greenhouses (“seasonal high tunnels” in government nomenclature), complete with lights, power outlets and several ADA-compliant planting beds.

We put periodic calls out for volunteers and tried to have volunteers take on leadership roles whenever possible. By modifying our planting processes, we were able to include those who are normally excluded from such programming, including older adults, those with disabilities and those who have allergies to the sun (lighting allows for nighttime planting, care and harvesting). The greenhouses, though unheated, allow for nine to 10 months of garden programming in our area of New England. In fact, April marked our first opportunity of the year to harvest cold-weather crops. We have had limited harvesting go into December.

All told, we have received very positive feedback from volunteers and the community at large. We have helped provide high-quality organic food to those who otherwise would not have access to it and have helped inspire other programs and individuals to start pocket-garden centers and personal plots. We have also seen the emergence of a real community where once there was only unused land.

 

Results

Results will vary of course, but with a little effort, some time, minimal money and community involvement, you may find that adding beauty to your nonprofit counseling program will not only help the hungry but also fill a need in your program and community.

My advice? Start as small as you need. A few cups on a windowsill in an inner-city office might lead to a rooftop garden or other community garden program.

 

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Here are some links to gardening resources for those who are interested:

  • seedsofchange.com — We have used this company’s seeds and were fortunate to win a competitive grant from them. They appear to be very community minded, and their prices are fair.
  • seedsavers.org — We just discovered this company, and this is our first year using their seeds. We were very impressed with their commitment to seed saving and promoting education on seed saving and gardening practices. You would think that educating about and promoting seed saving would be contrary to a company that sells seeds, and it is, but their greater mission is to help folks be self-sufficient and to also promote education, gardening etc.
  • johnnyseeds.com — I haven’t ordered from this company myself because I already had sources, but many of our garden friends swear by them and the quality of their seeds.
  • reimerseeds.com — I have read some negative reviews online, but in the three or so years that we have ordered tomato seeds from this company, we have had nothing but good experiences. They came highly recommended by a local commercial gardener.

This list is not meant to be exhaustive, nor is it an endorsement. There are many other great seed companies out there. It is important to explore seeds and companies to see what works best for you in terms of customer service and results in your particular environment and soil type.

 

 

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Dr. Warren Corson III

“Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, and clinical and executive director of Community Counseling Centers of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). Contact him at docwarren@docwarren.org. Additional resources related to nonprofit design, documentation and related information can be found at docwarren.org/supervisionservices/resourcesforclinicians.html.

 

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Living with anxiety

By Bethany Bray May 24, 2017

Anxiety disorders are the most common mental illness in the United States, affecting 18 percent of the adult population, or more than 40 million people, according to the National Institutes of Health. Among adolescents the prevalence is even higher: 25 percent of youth ages 13 to 18 live with some type of anxiety disorder.

Anxiety disorders are often coupled with sleeplessness, depression, panic attacks, racing thoughts, headaches or other physical issues. Anxiety can run in families and be a lifelong challenge that spills over into all facets of life, from relationships and parenting to the workplace.

The good news is that anxiety disorders are manageable, and counselors have a plethora of tools to help clients lessen the impact of anxiety. Caitlyn McKinzie Bennett, a licensed mental health counselor, says she regularly talks this through with her clients at her private practice in Orlando, Florida. She often uses an analogy of ocean waves with clients: Anxiety comes in waves, and managing the disorder means learning coping tools and strategies to help surf those waves rather than expecting the waves to disappear entirely.

“Anxiety can be a long-term thing,” says Bennett, who is also a doctoral student in counselor education at the University of Central Florida. “With clients, I try and explain that [anxiety] is the body’s response that something’s not right — based off of what’s happened to you [such as past trauma] or what’s happening currently. Then we can work to accept it, cope and be happier in your life. Some things you can’t necessarily get rid of in their entirety, and that’s OK. It’s learning to be you and have a fulfilling life with anxiety, where you’re able to feel anxious and [still] be productive and be a mother, a student, a partner. I try and normalize that [anxiety is] going to come and go. It’s OK, and it’s human.”

Anxiety doesn’t happen in isolation

Everyone experiences anxiety from time to time, such as worry over an upcoming work responsibility, school exam or first date. Anxiety disorders, however, are marked by worry and racing thoughts that become debilitating and interfere with everyday functioning.

“It’s a normal part of life to experience occasional anxiety,” writes the Anxiety and Depression Association of America on its website (ADAA.org). “But you may experience anxiety that is persistent, seemingly uncontrollable and overwhelming. If it’s an excessive, irrational dread of everyday situations, it can be disabling. When anxiety interferes with daily activities, you may have an anxiety disorder.”

A number of related issues fall under the heading of anxiety disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), including specific phobia, panic disorder, separation anxiety disorder, social anxiety disorder, generalized anxiety disorder and others. According to the DSM-5, anxiety disorders “include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat.”

Racing thoughts, rumination and overthinking possibilities — from social interactions to decision-making — are central to anxiety. In addition, people with anxiety often struggle with insomnia or sleeplessness and physical symptoms such as a racing heart, sweaty palms and headaches, says Bennett, an American Counseling Association member who is currently leading a study for her doctoral dissertation on the effects of neurofeedback training on college students with anxiety. Adolescents sometimes turn to self-harming behaviors such as cutting or hair pulling to cope with anxiety. In adults and adolescents, anxiety can manifest in physiological issues such as stomachaches or irritable bowel syndrome. Although adults may channel their anxiety into physical problems, they’re also generally much more capable than adolescents and children of identifying and articulating the anxious thoughts, ruminations and social struggles that they’re facing, Bennett says.

Bennett worked with a 14-year-old female client whose anxiety had manifested as the behaviors of obsessive-compulsive disorder (OCD), including avoiding the number six, leaving her closet door open a certain way and struggling with crossing thresholds. Bennett worked with the client to identify her triggers and find coping mechanisms, such as connecting with friends and her Christian faith.

“A big part of her improvement was creating the awareness of what was happening,” Bennett says. “Typically there’s a large, irrational fear. With her, she was afraid that her mom was going to die. She would focus on it so much that it would cause her to start the [OCD] behavior. … For her, it felt so real. It was so scary for her that she felt compelled to do these behaviors to keep her mom alive, so to speak.”

Bennett worked with the young client to confront her fears in small doses through exposure therapy, such as listening to a song at volume level six and talking through how she felt afterward. This method allowed Bennett to first address the client’s OCD behaviors and then — once trust was built and the client had progressed — move on to work through the bigger, deeper issue of her fear of her mother’s death.

“It helped her to feel safe enough and have the confidence to work through some smaller things and move on to work on bigger things,” Bennett says. “For her it was talking it out, normalizing that for her and drawing attention to [her anxious behaviors].”

Christopher Pisarik is an associate professor in the Division of Academic Enhancement at the University of Georgia and a licensed professional counselor (LPC) who works with students in need of academic support. He says that stress and irregular sleep and eating patterns — which are often ubiquitous parts of college life — can go hand in hand with anxiety.

“Sleep is a big one — if they’re just not sleeping, or sleeping too much,” says Pisarik, who also treats many college-age clients at his private practice in Athens, Georgia. “This is really, really common — clients who can’t get to bed until 4 a.m., and then they can’t get to class, and it snowballs. Their thoughts just race with worry. … Sleep seems to be a big diagnostic indicator [for anxiety], and not being able to go to bed. [I ask clients,] ‘What are you thinking about, and can you stop thinking about this? Is that what’s keeping you from getting back to sleep?’ They get tired and fatigued, and it’s perpetuated.”

In addition, anxiety is often coupled with — or is an outgrowth of — other mental illnesses, most commonly depression. Counselors will need to treat a client’s anxiety alongside other diagnoses, Bennett says. For example, a client with schizophrenia will have hallucinations that provoke extreme anxiety. If the counselor doesn’t address the client’s anxiety, those symptoms will get worse, explains Bennett.

“Depression and anxiety are like brother and sister,” she adds. “They play off of each other and exacerbate the symptoms. You need to work through both. I don’t think I’ve ever worked with anyone who solely experienced anxiety.”

Stephanie Kuhn, an ACA member and LPC at the Anxiety Treatment Center of Greater Chicago, agrees. She regularly sees client anxiety paired with other issues such as specific phobias, insomnia, chronic pain issues, depression, panic disorders and OCD.

“It’s never really one thing,” Kuhn says. “It’s never just anxiety.”

Pumping the brakes on racing thoughts

The first step for many people who struggle with anxiety is to create awareness of their thoughts and then learn to manage those thoughts with a counselor’s help. Although the strategy of identifying negative self-talk and addressing one’s thoughts is old hat to most counselors, it may be an entirely new concept for some people, especially younger clients, says Pisarik, an ACA member who uses cognitive behavior therapy (CBT) in his private practice. Clients with anxiety often polarize, exaggerate or catastrophize details in their minds as they ruminate over them, he explains.

“Even being able to identify anxious thoughts is big,” Pisarik says. “They just assume it’s normal to walk around [feeling] anxious because of these thoughts. … It gives them a language and a real usable and rudimentary skill they can use in the moment when they’re walking in [to a stressful exam]. They can identify that their inner narrative isn’t healthy.”

For example, a college student might come to a counselor expressing worry about an upcoming exam in a class that he or she needs to pass for a major in pre-med. The student might have allowed negative and catastrophic thoughts to snowball: “If I get a C on this test, I will never get into medical school, which will derail my entire career plan and make my parents angry and disappointed.”

“For … a student who is 20 years old and [still] learning to think critically, it would be easy to blow everything out of proportion and catastrophize everything,” Pisarik says. “I am really big on helping them understand negative thinking and false cognitions, and getting them to self-monitor and renarrate [their unhealthy thoughts].”

Following the CBT approach, Pisarik says he would talk such clients through their thought patterns to identify and restructure their negative thoughts about the exam. He would also suggest that they focus on and remind themselves of prior successes, such as other exams or classes in which they earned A’s and B’s.

“I would try and systematically educate the client [about] what type of thinking that is,” Pisarik continues. “There are many doctors out there who got C’s and got into medical school, and probably [who] got C’s in medical school. I will explain that they are catastrophizing this … [and] try and get them to think about it in a different way, evaluate it carefully and create a different narrative about it. Are there people who have gotten C’s and gotten into medical school? If it stops you from getting into medical school, would that be the worst thing in the world?”

“It takes a consistent effort to practice and challenge one’s thinking,” adds Pisarik, who co-authored the article “A Phenomenological Study of Career Anxiety Among College Students.” The article will be published in the December issue of The Career Development Quarterly, the journal of the National Career Development Association, a division of ACA.

CBT works well for anxiety because “it lets people see that their own thinking and their behaviors are not productive for the way they want to live or the life they’re living right now,” says Kuhn, who uses both CBT and exposure therapy with her clients at the Anxiety Treatment Center of Greater Chicago. “It’s giving people an outside perspective — getting them to look at their own thoughts and behaviors objectively rather than letting those anxious thoughts take over everything, making it harder to function.”

One way Kuhn works with clients on challenging their unhealthy thoughts is by asking them to identify the best, worst and most likely outcomes of situations they are ruminating over. “I ask, ‘Would [the outcome] matter in a week, a month or a year from now?’ Typically the answer is no,” Kuhn says. “After we go through that, we reframe the original thought [and] transform it into something more rational, more realistic.”

Both Pisarik and Kuhn encourage their clients to keep thought logs to track anxious thoughts and the situations that triggered them. This exercise increases self-awareness, helps identify triggers and creates an opportunity to discuss how the client might change the negative narrative.

“Writing helps a lot because it slows people’s minds down, and they can go back and read about it,” Kuhn says. “Creating that awareness is the only way to understand yourself, understand what you’re worried about and be able to accept it and push it away.”

In addition to using thought logs, Pisarik gives his clients a list of automatic negative thoughts, or ANTs, to check themselves against. The collection lists the most common types of unhealthy, anxious thoughts and types of thinking, including catastrophizing and either-or thinking (polarizing).

Kuhn has a particular phrase that she often repeats with clients: “Handle it.” She acknowledges that it’s not the most empathic of mantras, but it does help to focus on the manageability of anxiety. With clients, she works toward a goal of “being able to sit with the uncomfortableness [of anxious thoughts] and tolerate the stress.”

Kuhn says her style when working with clients matches her personality: “Let’s go forward and hit our fears hard instead of tiptoeing around them.”

Exposure therapy, which introduces things in small, controlled increments in session that make a client anxious, is another good way to focus on handling anxiety, Kuhn adds. Whether the scenario is a fear of speaking up in class or a fear of being rejected by a loved one, exposure therapy can help clients learn to live with the issue and the anxious feelings that come with it.

“When I talk to people about ‘handling it,’ it’s creating that awareness and understanding [of] themselves that they’re able to manage or take on more than they think they can,” Kuhn says. “Anxiety a lot of the time makes us believe that we can’t handle the tiniest things. That’s why our body has created or learned how to respond to things in an overactive or hypersensitive way.” This is most commonly experienced in our fight-or-flight response, she says.

Managing worry and taming anxiety

From CBT and mindfulness to a focus on wellness and coping strategies, professional counselors have a wide range of tools to help clients who struggle with anxiety. Here are some ideas and techniques that can be particularly useful.

> Controlling the controllables. Kuhn says it can be helpful for clients to talk through and identify what is out of their control during situations that make them anxious. “A lot of times, anxious clients want control over everything, and that’s just not realistic,” Kuhn says. “It’s important to go over what’s controllable and what’s not. That creates awareness and a pathway to reevaluate [their] own thinking and behavior. I like to call it ‘controlling the controllables.’ I talk with clients about this a lot.”

Kuhn often uses an exercise with clients in which she draws a target with concentric circles. Things that clients can control, such as their own thoughts and behaviors, go in the center circle. Things that they partially control, such as their emotions or what they focus on sometimes, go in the middle ring. Things that are out of their control, such as what other people think or do, go in the outside circle. In a simpler alternative, Kuhn draws a center line down a piece of paper and works with clients to list what is and isn’t in their control in situations that make them anxious.

> Creating common ground. Kuhn says she also talks openly with clients about how common anxiety is, alerting them that they are among literally millions of Americans who are battling the same challenge. “I let them know they are not alone. It creates a universality,” Kuhn says. “To let people know that they’re not the only ones suffering like this can help. … It does create a common ground for people not to feel ashamed of [their anxiety] or feel like they can’t talk to someone about it. Just creating that education typically makes people feel a ton better.”

> Acknowledging and naming worry. Journaling and making lists to document anxious thoughts can help clients address and reframe the everyday rumination that accompanies anxiety. Kuhn offers two variations on this intervention: worry time and the worry tree.

With “worry time,” clients set aside a dedicated amount of time (Kuhn suggests 30 minutes) every day to write down any anxious thoughts that are troubling them. Clients don’t need to engage in long-form writing to complete this exercise, Kuhn says. Making a bulleted list or jotting thoughts down on sticky notes will work just as well. When the designated time is up, clients put all the notes in a box or container that they have set aside for this purpose. This action signifies that they are leaving those thoughts behind and can move on with the day.

“They have to leave those thoughts or sticky notes there and be done with them,” she says. “Obviously more [anxious] thoughts will come, but you have to remind yourself to leave them behind.”

With Kuhn’s “worry tree” intervention, clients create a flowchart of their anxious thoughts. With each item, clients ask themselves whether their worry is productive or unproductive (see image, below). “Is it something that you can actually do something about?” Kuhn asks. “If it’s unproductive, then you need to just let it go. Do something you enjoy or focus on something else to reset [your mind].”

 

> Mind-body focus and exercise. Mindfulness, meditation and other calming interventions can be particularly helpful for clients with anxiety. Kuhn recommends the smartphone app Pacifica, which prompts users with breathing, relaxation and mindfulness exercises, for both practitioners and clients. Kuhn, who has a background in sports counseling, and Pisarik, who is a runner himself, also prescribe exercise to anxious clients. Exercise boosts serotonin, a neurotransmitter connected to feelings of well-being, and comes with a host of other wellness benefits. In addition, exercise allows a person to get outdoors or disengage from work and home activities and other people for a brief period to “have time to hear your thoughts and challenge them,” Pisarik says. “You have to hear your thoughts if you’re going to challenge them.”

> The butterfly hug. Beth Patterson, an ACA member and LPC with a private practice in Denver, teaches deep breathing exercises to anxious clients to help them become grounded, focusing on the flow of energy through the body. She also recommends the “butterfly hug” technique. With this technique, clients cross their arms across their chests, just below the collarbone, with both feet planted firmly on the floor.

Clients tap themselves gently, alternating between their right and left hands. This motion introduces bilateral stimulation, the rhythmic left-right patterns that are used in eye movement desensitization and reprocessing. “It’s phenomenally self-soothing,” Patterson says. “Doing that with deep breathing really helps with anxiety. I love the idea that you’re hugging yourself. Even just doing that helps.”

> Walk it out. Along with deep breathing and grounding, Patterson also recommends walking and movement for clients who are feeling anxious. She instructs clients to focus on the feeling of each foot hitting the ground instead of their anxious thoughts. As with the butterfly hug, this action creates bilateral stimulation, Patterson notes.

Bennett also uses walking as a way to help clients refocus their thoughts. She will take clients out of the office during a session for a “mindful walk” up and down the block. During the walk, they talk about what they’re sensing, from the sunshine to the breeze to the smell of flowers. Bennett says this allows her to work with clients “in the moment,” recognizing and refocusing anxious thoughts as they come. Afterward, they process and talk through the experience back in the office.

“It’s a lesson that [anxious] thoughts are going to come up for you, and you can refocus on your sense of touch or hearing,” Bennett says. “Thoughts will come up, and it’s really easy to attach to those thoughts and become anxious, but we can acknowledge the thought, be accepting of it in the moment and refocus. Change and connection can come that way.”

> This is not that. Clients commonly transfer anxiety-provoking personal issues onto relationships or situations in other facets of life, including the workplace, Patterson says. For example, Patterson worked with a client who had a very domineering, controlling mother, and this client felt triggered by a female boss in her workplace. Patterson introduced the client to the mantra “this is not that,” and they worked on reframing the anxiety the client experienced when she felt her boss was being controlling.

“She had to work through it in a beneficial and compassionate way for herself and really remember ‘this is not that,’” Patterson says. “Our minds are brilliant, but they’re binary computers. When something happens, it will immediately associate it with something else it knows. If a co-worker is being overly competitive, it might trigger feelings about sibling rivalry. This [mantra] offers a great opportunity to work through family-of-origin issues [with clients] when you see them replicated in the workplace.”

> Abstain from negativity. Another empowering tool clients can use is to become conscious of and then avoid unhealthy or toxic situations and people who trigger their anxiety, Pisarik says. He advises clients to “stay away from groups of people or individuals who they know will engage in negative self-talk or negativity. If you’re feeling anxious already, the last thing you want to do is to go and talk to that toxic person.”

Similarly, he commonly advises anxious students to avoid waiting outside the room where they’re about to take a big exam, surrounded by 30 classmates who might be saying that they are going to fail, they didn’t study enough, they don’t feel prepared and so on. Counselors can coach anxious clients to think ahead and prepare ways to remove themselves from these types of situations, regroup and redirect their thinking, Pisarik says.

> Lifestyle choices. Counselors can also educate clients on the connection between anxiety and lifestyle choices such as sleep patterns, exercise and diet, Pisarik says. For young clients especially, this also includes social media use, he notes.

Pisarik says he frequently talks with his college-age clients about their alcohol consumption, drug use, irregular diet and other aspects of the modern university experience. “The lifestyle of a college student is absolutely conducive to generating anxiety,” he says. “While they are college students, I get that — their job is to have fun and sleep whenever [they] want. But building some sort of healthy routine is important, [including] getting enough sleep and making sure they eat well. I tell them to try and maintain the diet they had at home. … If you’re struggling with anxiety to begin with, any one of those [elements] can add to it, and those are really easy fixes.”

For Bennett, conversations with clients about lifestyle also include questions about smoking and caffeine use. Both tobacco and caffeine can make a person shaky or make his or her heart and mind race, which can trigger or exacerbate anxiety, she points out.

In addition to social media use, Pisarik also asks clients about their social engagement, such as participating in sports or other hobbies. Clients who struggle with anxiety often isolate themselves, he notes, so he works with them to identify social outlets, from volunteering to joining a school club. This sense of connection can reduce anxiety, he says.

> Narrative therapy and externalization. Patterson finds narrative therapy helpful when working with clients with anxiety because it allows them to externalize what they’re feeling. When clients uses phrases such as “I am worried” or “I am anxious,” Patterson will gently redirect them by saying, “No, you’re Susan, and you have a problem called worry.”

“Externalize the problem,” Patterson explains to clients. “Externalize it and dis-identify it. See it outside of yourself. … ‘I can deal with that because it’s not who I am.’ … If you’re carrying it around as if it’s you, you can’t do anything about it. The truth of the matter is, it’s not you.”

Counselors can also help clients with anxiety to focus on a time in their lives when they faced a similar challenge and got through it, Patterson says. She asks clients questions to help them probe deeper. For example: How did you handle that challenge? What worked, and what didn’t work?

 

Working with clients on medication

Anti-anxiety medications are commonly prescribed in the United States. Their prevalence means that counselors are likely to encounter clients who are taking medication to control their anxiety symptoms.

Regardless of their feelings about the use of psychotropic medications, practitioners must treat and support clients who are taking such medications the same as they would any other client, Kuhn says. “I never treat someone differently based on their medication. They get the same CBT therapy that anyone else would get,” she says, adding that the most important thing is to ensure that clients don’t feel judged by the counselor.

Kuhn has seen anti-anxiety medications work well for some clients. “It can take that little edge off that they need to get through the day and be able to function,” she says. At the same time, she also has clients who express a desire to be able to stop taking their medication eventually.

Pisarik notes that for anti-anxiety medication to work well, clients must remember to take it faithfully, keep track of how it makes them feel and schedule the repeated appointments needed to monitor and adjust dosage levels. Each of these elements can pose a challenge to college-age clients. “It’s a lot of work, and [college students] often lack the discipline and time to get it right,” Pisarik says.

Bennett agrees, suggesting that even though professional counselors are not the ones prescribing medications, they still need to discuss and explore medication use with their clients. She also stresses that practitioners should be knowledgeable about the different kinds of medications that clients may be taking and their possible side effects.

Bennett sometimes conducts conference calls with her clients and the medical professionals who are prescribing them medications so that she can help clients ask questions and otherwise be a support to them. “We [counselors] don’t prescribe, but at the same time it’s very important to collaborate with whoever is prescribing the [client’s] medication,” she says. “Be supportive and involve the client in conversations: How long have you taken it? Have you noticed any side effects? Has it been helping? Talk about how often they’re supposed to take it and if they’re adhering to that. There can be stigma about taking medications, so it’s important to normalize it. … It’s comforting too for the client to know that you’re on their side, and part of that is collaboration [about medication].”

 

See the person, not the anxiety

Given how common anxiety disorders are, it’s likely that any counselor’s caseload will be filled with clients presenting with symptoms of anxiety. It is important, however, for counselors to treat each client as an individual and to tailor the therapeutic approach to meet that client’s unique needs, Bennett emphasizes.

Building trust and a healthy therapeutic relationship are key in treating anxiety because clients can feel very vulnerable as they talk about what makes them anxious, Bennett points out. That is why it is critical to get to know these clients as individuals rather than through the lens of their anxiety.

“Don’t assume that because they’re anxious, they’re going to think and behave like other people with anxiety,” Bennett says. “Meet them where they are and find out what’s most effective for them based off of their interests. It can be empowering for clients to integrate their own interests and life experiences into the therapeutic process. Not only does this create buy-in for the client, but it can also help in creating a safe space to begin exploring the vulnerabilities that come along with anxiety. … Hear their story, find their strengths and give them a voice in the process. It’s important to honor them as individuals.”

 

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To contact the counselors interviewed for this article, email:

 

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Bethany Bray is a staff writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Teaching counselor education curriculum in a ‘new reality’

By Suzanne A. Whitehead May 19, 2017

I love my job, my calling, as a counselor educator, and I take my role and passion as a graduate student advocate, public innovator and social justice change agent to heart every single day. As Mahatma Gandhi once said, “Be the change you wish to see in the world.”

His words are my mantra in life. Each one of us touches the hearts of so many others and, thus, the very future.

But teaching in these uncertain, turbulent times has been challenging to say the least. A powerful, yet almost silent and unspoken subtle change has occurred in my classrooms. It almost feels like a gray mist or cloud that is not seen but clearly felt.

I have never tried to be political with my students or to discuss politics in the classes that I teach. I don’t believe in it. Just because a professor has a “captive audience” in a class and CAN speak his or her mind doesn’t mean that one should. I don’t shy away from state, national or global issues because they are often pertinent to the material we discuss. Still, I don’t offer my own political opinion on these issues, mostly out of respect, but also because I feel it’s the right thing to do.

I care a great deal about my students. I can see the concern and worry in their eyes. They are more unsettled than normal, and the mood is palpable. Approximately 80 percent of my students are Hispanic and bilingual. They share an immense pride in their heritage, culture and family systems. I honor their commitment to their communities, their livelihoods and this country that they dearly love.

My students bring in reports of their own counselees in schools and agencies who share stories of intense fear, anxiety and pain at the idea that they, or their parents, could be deported. We have a lot of “Dreamer” students (children of undocumented immigrants) at my university and many of these children and families in our surrounding communities. Their understandable angst is powerful, heart-wrenching and compelling.

 

Teaching in these challenging times

And now we are asked to continue to teach our students as though nothing has changed in our world. No matter how one voted (or chose not to vote) in our nation’s most recent election, one thing is for certain: It has been an incredibly acrimonious, divisive and challenging time for our entire country. I have my opinions, but they are not for me to share them with my students. Yet they share theirs, every day. They have to because it affects their lives, their families and the clients they serve.

Other counselor educators who are struggling with these same issues may be wondering: How do we respond in a caring, empathic, yet ambiguous, way and not take sides?

The danger in “taking sides” is that even if I find great personal solace in doing so, I may also inadvertently destroy a student’s belief that each person has a right to free speech and to believe as he or she sees fit. In my bully pulpit ramblings, I could possibly (even if unintentionally) insult or even scar a student who may hold vastly different opinions from my own. That would be inexcusable. That serves no one except for my own selfish gain.

 

What we can do

It tugs at my heartstrings, but the only conclusion I can see is to treat this situation as a counselor would with any client. We must be confident, genuine, caring and willing to listen. We need to share that we understand students’ (and their clients’) fears and concerns. We express great empathy for what they are experiencing and model, summarize and validate their honest emotions, using an overall person-centered approach from Carl Rogers.

This isn’t always easy with a large number of students on one’s caseload. I never want to appear disingenuous. I just keep telling them, and myself, that their feelings, and those of their clients, are real, significant and truly matter. I will not judge; that is not my purpose as an educator. And I will not just gloss over everything with the proverbial, “It will all be just fine” message, to assuage their fears and my own discomfort.

All we can do is let them know how much we care and then use our own therapeutic orientations that we hold dear to help them and their clients. For example, in using a brief solution-focused therapeutic approach (Steve de Shazer), they can explore their options and what they believe IS within their power to influence, and develop effective ways to cope and move forward. These are all productive ways of handling and making sense of difficult times. The basic tenets of Viktor Frankl’s logotherapy seem useful here as well — finding purpose and meaning, even within one’s suffering and turmoil, and a reason to keep going.

 

Wellness for counselor educators

It is also more evident than ever that we as counselor educators need to take the time for wellness and coping strategies for our own mental well-being. It is one thing to conduct site visits and observations to see each of my students working with children, adolescents and adults. I too hear their stories firsthand and feel great empathy for their situations. But now, we also hear the same concerns from our students in our classes, and it is hard not to feel their pain intensely.

I reach out to my professional colleagues for feedback and interaction. I value the unwavering support of my family and friends and cherish their input now more than ever. And I have become intensely aware of where my own “head” is at — and my emotions — and utilize my coping strategies to the fullest. I consciously try to “check my ego and attitude” at the door before I step into the classroom and hold fast to the belief that I am here to instruct, teach, lead and inspire. The American Counseling Association’s values and code of ethical conduct are bedrocks of sanity to hold dear.

I am guessing that things will continue to be tricky for many of us in the coming months and years. As educators, we need to help each other through these very different times and circumstances. Knowing that the counseling profession is strong, and that our colleagues are always there for us, brings great comfort and resoluteness. My fervent hope is that it brings the same to each of you.

“Carpe diem,” dear colleagues.

 

 

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Suzanne A. Whitehead is a licensed mental health counselor and assistant professor of counselor education at California State University, Stanislaus. Contact her at sawhitehead7@gmail.com or swhitehead1@csustan.edu.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.