Tag Archives: Depression

The tangible effects of invisible illness

By Cathy L. Pederson and Greta Hochstetler Mayer April 26, 2016

A variety of invisible illnesses can greatly impact both the physical and mental health of individuals. Some of these illnesses are debilitating, preventing participation in the normal activities of daily living. Examples include chronic fatigue syndrome/myalgic encephalomyelitis, Ehlers–Danlos syndrome, fibromyalgia, lupus, Lyme disease, multiple sclerosis, myasthenia gravis, postural orthostatic tachycardia syndrome (POTS), regional complex pain syndrome and Sjogren’s syndrome.

These disorders disproportionately affect women and are not well understood by the health care Branding-Images_invisibleestablishment or the general community. Lack of understanding can lead to feelings of alienation and hopelessness for those suffering from these disorders.

Such was the case for Natalie (case study used with permission). Seemingly overnight, she transformed from a vivacious teenager at the top of her eighth-grade class to being virtually bedridden with fatigue, dizziness and chest pain. She visited a series of doctors in search of relief. A few months later, at age 15, Natalie’s life changed forever when she was diagnosed with POTS and Ehlers–Danlos syndrome, neither of which is curable or easily managed medically.

POTS is a disorder of the autonomic nervous system in which blood pressure, heart rate, blood vessel and pupil diameter, peristaltic movements of the digestive tract and body temperature are affected. Natalie’s Ehlers–Danlos syndrome caused additional pain — her connective tissues were weak and her joints would easily dislocate. During her freshman year of high school, Natalie was bound to a wheelchair. But as a sophomore, her dizziness and other symptoms were better controlled, so she went roller-skating with friends. She broke her wrist and injured her neck that evening, and her fall triggered debilitating migraines.

Although not widely studied, rates of suicide are believed to be higher in people with chronic or terminal illness. It is unclear if physical illness alone leads to risk of suicide or whether having an illness increases the chances of developing depression or hopelessness, which then increases suicide risk.

Painful, chronic illnesses and illnesses that interfere with a person’s everyday functioning are believed to be risk factors for suicide, especially among older adults. Some illnesses associated with increased suicide risk are AIDS, certain forms of cancer, Huntington’s disease and multiple sclerosis.

Risk of suicide is often linked with co-occurring mood, anxiety and substance use disorders in this population. However, people with invisible illnesses may not necessarily be clinically depressed or anxious; instead they may feel hopeless about their prognosis, experience real and anticipated future losses, and suffer from chronic pain — all of which are potent risk factors for suicide. The basic science of these individuals’ physical condition is not well understood, which makes developing medications to treat them difficult. Most treatments are aimed at individual symptoms rather than the root cause of the problem.

It takes Natalie three times more energy than normal just to stand because of her POTS. Even making minor movements around the house and engaging in daily routines, including eating meals and showering, can be exhausting for her and increase her symptoms. Her quality of life is similar to those with congestive heart failure or chronic obstructive pulmonary disease.

At 16, Natalie endured weeklong hospitalizations for headaches and other POTS symptoms. Medications didn’t offer relief. An honor student, Natalie missed more than 70 days of school during the last half of her sophomore year. She was no better by the end of her junior year and eventually dropped out of high school. She was behind in her work and struggled to complete projects and tests that would have been easy for her when she was healthy. “It was heartbreaking,” said Natalie’s mother about seeing her daughter transform from high achiever to high school dropout.

Natalie’s family had done everything right. They took her to see physicians, followed all prescribed treatment regimens, put her in counseling and supported her through her illness. Unfortunately, medical help was evasive and mental health care was marginal. Over time, Natalie’s friends drifted away. She couldn’t be physically active, participate in community events or hold a job. Eventually, she confronted insidious suicidal thoughts.

Working with those who are chronically ill

Many chronic illnesses are not terminal conditions, but they can severely impact a person’s quality of life for decades. For example, imagine that you have POTS. You feel lightheaded every time that you stand, and you faint several times per day. You experience neuropathic pain that feels like bees stinging your arms and legs. Hot flashes arrive without warning, and you begin to sweat. Despite possessing above-average intelligence, you have difficulty concentrating and analyzing problems. Simply taking a shower drains your energy, and it doesn’t replenish itself. Your physical isolation and illness create feelings of being misunderstood and not belonging.

These feelings only increase when you finally venture out of the house. People congratulate you on your “recovery.” Friends tell you how good you look. Distant relatives offer advice about how to get better. Even worse, you are bullied, called a faker or are the target of other derogatory comments. Your boss suggests that you would feel better if you only ate right and exercised. Even your spouse says, “Just get over it!”

Counselors should not fall into these traps when working with these clients. For someone who is chronically ill, even hearing “you look good” might be equivalent to “I don’t believe that you are really sick.” Normal niceties take on special meaning and ring hollow for those with chronic illnesses.

For most people, a doctor’s visit will result in control of their illness and restoration of their health. This isn’t true for many individuals suffering from chronic, invisible illnesses. Not only are they grieving their loss of health because of their physical condition but, often, they also feel dismissed and even traumatized by their health care practitioners.

Many with chronic illness feel ignored or abandoned by doctors and nurses. Some individuals have even been told to stop fainting or to bring down their heart rate, as if they are making choices meant to curry attention. Many physicians aren’t educated about these debilitating illnesses, and specialists in these fields often have waiting lists that are years long. Imagine how such repeated, negative experiences might erode hope for recovery and lead to suicidal thinking. What is a patient to do? In the case of those with POTS, the incidence of mental illness is the same as is found in the general population. The seemingly paranoid behavior these individuals demonstrate related to their health can be the result of medical mistreatment and neglect, and it is often justified and understandable.

Sadly, invisible illness can put even the strongest relationships in jeopardy. As days turn to months and years, the constancy of chronic illness can wear on marriages, friendships and family relationships. Missed holidays, birthdays and other social events leave loved ones feeling betrayed and wondering if the person who is chronically ill could make more of an effort to be present. Friends and family members often doubt whether their loved one is sick. Some acquaintances become confrontational with the person who is chronically ill, whereas others turn passive-aggressive. Because a person’s hair doesn’t fall out with chronic fatigue syndrome, no skin lesions appear with multiple sclerosis and no significant weight loss takes place with fibromyalgia, it is easy to forget the internal battles being waged every day by those with chronic illness.

Counseling professionals are well-positioned to address the fallout of living with chronic illness. Counseling can provide something that those with chronic illness who are feeling suicidal desperately need but are often missing — a safe place where they can be heard, validated and comforted. Most important, counselors are particularly skilled at uncovering suicide risk, advocating for underserved populations and providing clinical management of complex cases.

In Natalie’s case, she was depressed from grieving her loss of physicality, friends and school. She had found some relief through the use of an antidepressant and went to counseling regularly. In the midst of a flare, her physician switched Natalie to Prozac, which she had taken previously, without considering the fact that it might increase suicidal ideation in teenagers. Natalie never mentioned the suicidal thoughts to her family or doctor. Shortly after titrating to 30 milligrams, the 17-year-old attempted suicide.

Consider physical illness part of the problem

Many people with debilitating and invisible chronic illnesses are told that it is all in their heads. As a counselor, you may be the first person who truly listens and tries to understand what is happening in the individual’s life. Don’t be afraid to suggest that someone who has especially dry mouth and eyes (Sjogren’s syndrome), fainting episodes and difficulty thinking (POTS), debilitating fatigue that can’t be attributed to known causes (chronic fatigue syndrome/myalgia encephalomyelitis, POTS, fibromyalgia, lupus) or chronic pain (complex regional pain syndrome, fibromyalgia, POTS) should get a thorough checkup with a good physician.

Consider working collaboratively with these physicians as a multidisciplinary team. Recommend someone who is a knowledgeable problem-solver to investigate underlying physical causes for the person’s anxiety or depression. In addition, assess regularly for suicide risk, especially during transitions in levels of care, and take all warning signs and risk factors seriously. Labeling a person’s symptoms as part of a recognized disorder will often be a great relief to the person psychologically.

Physical limitations and their effect on counseling

As a result of chronic illness, routine activities can cause debilitating fatigue. Standing, walking, showering, riding in the car and even attempting to focus on a conversation can quickly exhaust those with chronic illness. As their fatigue increases, brain fog also tends to increase.

As counselors, it is important to understand and recognize the effort it takes for these clients to walk through your office door. Offering small encouragements will reinforce the proactive effort they have taken to maintain their mental health and improve their quality of life.

Also note that many people with invisible illness are particularly sensitive to light, noises and smells. This is particularly true when they are flaring. Simple gestures such as closing the blinds or turning off fluorescent lights may help them conserve their energy for their work with you. Similarly, avoiding the use of candles, strong scents or incense can be helpful.

Differentiating the physical from the psychological

When working with clients who are chronically ill, differentiating their physical issues from their psychological issues can be difficult. Consulting with knowledgeable health care specialists is essential. Taking the time to learn about a client’s chronic illness can greatly increase empathy, provide authentic understanding and help in guiding the person to proper medical care.

Counselors should be aware that the coping skills people use to deal with symptoms of chronic illness can look like warning signs for depression or suicide. For example, coping skills to manage many invisible illnesses, such as staying in bed and avoiding the shower, may be unrelated to depression or risk of suicide.

In addition, dysregulation of the autonomic nervous system causes surges of norepinephrine that can lead to insomnia, anxiety or panic attacks. A person’s lack of appetite can be related to gastroparesis (paralysis of the stomach) or other digestive motility issues. Debilitating fatigue and difficulty focusing/concentrating are also common problems connected to many invisible illnesses.

At the same time, it is important to remember that individuals with chronic illnesses that involve functional impairment and chronic pain are at greater risk for suicide, so warning signs such as suicidal thoughts and threats, previous suicide attempts and hopelessness must be taken seriously. In Natalie’s case, she had confided her suicidal thoughts to her counselor. Unfortunately, her parents and doctors were unaware of the extent of Natalie’s overwhelming emotional pain until she attempted suicide.

Follow-up care after hospitalization is critical

Pursuing inpatient hospitalization for people at serious risk of suicide can be a life-saving step. However, the current health care environment poses challenges to accessing timely, quality care when needed, even for those at imminent risk for suicide. Inpatient stays are difficult to secure, and lengths of stay are minimal at best.

Individuals often transition from an inpatient level of care to outpatient settings before their stabilization, and this is not easy for individuals with chronic illness or their families. In addition, being hospitalized for mental health problems can be further stigmatizing and demoralizing for the person with chronic illness.

The period immediately following hospital discharge is particularly dangerous for people at risk for suicide. Counselors operating from a multidisciplinary framework can mitigate this risk (with permission of the person with chronic illness) by coordinating care with hospital staff, medical specialists and key family members.

Providing continuity of care also helps with stabilization, engagement and retention in aftercare. Long-term counseling is necessary to strengthen the person’s reasons for living and to uncover the problematic situations and underlying psychological vulnerabilities that led to the suicidal crisis.

“After 12 inpatient days and nine partial hospitalization days, I’m starting to feel confident that she is on the road to recovery,” Natalie’s mother reported. Natalie’s medications were changed, and she passed the GED test in lieu of her high school diploma. She is now on the road toward college. We hope that sharing her story can help to prevent suicide attempts in other young adults with chronic illness.

 

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Cathy L. Pederson holds a doctorate in physiology and neurobiology. She is a professor of biology at Wittenberg University and founder of Standing Up to POTS (standinguptopots.org). Contact her at cpederson@wittenberg.edu.

Greta Hochstetler Mayer holds a doctorate in counselor education and is a licensed professional counselor. She is the CEO and initiated suicide prevention coalitions for the Mental Health & Recovery Board of Clark, Greene and Madison Counties in Ohio. Contact her at greta@mhrb.org.

Letters to the editor: ct@counseling.org

 

Validating the quarter-life crisis

By Lynne Shallcross April 22, 2016

More than a decade ago in the song “Why Georgia,” musician John Mayer put words to a phenomenon that many 20-somethings sense all too well.

“I rent a room and I fill the spaces with/ Wood in places to make it feel like home/ But all I feel’s alone/ It might be a quarter-life crisis/ Or just the stirring in my soul/ Either way I wonder sometimes/ About the outcome/ Of a still verdictless life/ Am I living it right?”

Despite its inclusion in a hit pop song, the quarter-life crisis isn’t always taken seriously by society at large. “Nobody questions the midlife crisis,” points out Cyrus Williams, an associate professor in the Branding-Images_quarter-lifeSchool of Psychology and Counseling at Regent University, but the same isn’t always true of the quarter-life crisis, which Williams defines as a period of significant life and career transitions for young adults between the ages of roughly 22 and 30.

“As a culture, we all think that age 25 is the best stage of your life — these folks are happy, they’re doing everything they want and it’s a great time of life,” says Williams, an American Counseling Association member who has been studying and speaking about the quarter-life crisis for more than five years.

In the counseling session, however, the quarter-life crisis — a developmental time period of potentially high anxiety — needs to be given the same level of respect and attention as the midlife crisis rather than being dismissed out of hand, Williams says. “We really need to acknowledge and not minimize this time period,” he emphasizes.

Decisions, decisions, decisions

In their early 20s, many young adults are graduating from college and find themselves faced with a deluge of life transitions, Williams explains. There are choices and changes swirling around them in almost every major area of life.

They are deciding where to live, whether moving to their own apartment (or a shared living space) in a new city or back into their parents’ home. They want to pursue a career but sometimes find themselves stuck in entry-level jobs that don’t pay their bills or student loans. They wonder whether they should already be in a committed relationship headed toward marriage and a family. They question whether and how they will develop new friendships while hanging on to old ones from their high school or college days.

All of those issues can lead to feelings of anxiety, fear, instability and an existential crisis of “Who am I?” Williams says. “There are too many choices, too many decisions to make, and it’s scary,” he says.

This time in life can also dredge up self-doubt, says Melissa Nelson, a doctoral candidate in counselor education and supervision at Regent University who has been researching the quarter-life crisis with Williams. For example, some young adults might see that a peer has landed a successful job and become financially stable and start wondering why they haven’t been able to follow the same timetable. This can make young adults question themselves, their decisions and their abilities, says Nelson, a member of ACA. “Did I major in the right thing? Is there something wrong with me?”

It isn’t uncommon for clients in their 20s to present in the counseling session with feelings of depression and anxiety, says Katherine Hermann, an assistant professor in the Department of Counselor Education at the University of Louisiana at Lafayette. The idea of leaving a close-knit community, whether the town where someone grew up or the circle of friends an individual developed at college, can be isolating, says Hermann, who has presented on transitions in adulthood. The search for a romantic partner can also feel isolating and provoke anxiety, she points out.

Young adults in this stage may also feel a sense of betrayal, Williams says. Many of these individuals have grown up being told by parents, teachers and others that if they follow the rules and check all the boxes they’re instructed to, life will work out as it is supposed to. When things don’t fall into place that seamlessly, Williams says, these young adults feel lied to.

In such cases, Williams says, it can be helpful if counselors talk through those feelings of betrayal with clients, allowing them to express why things feel unfair and then working together to move forward past those feelings.

All of the anxious feelings that are normally experienced at this time of life can be exacerbated by social media, Williams adds. For instance, on Facebook and Instagram, people tend to post messages and photos documenting only their best experiences, which doesn’t translate to a realistic account of life. “That is one of the things that other generations didn’t have to deal with,” Williams says. “They [didn’t] have to have this in their face every day of ‘Wow, my friend is having a great life and I’m not.’”

Nelson agrees. It is easy for people in this stage of life to get caught up in comparing themselves to peers who post photos or messages related to career success, romantic adventures or starting a family. “What does that mean for an individual who doesn’t have those things yet?” Nelson asks.

One key is for counselors to talk with these clients about how social media rarely shows the day-to-day reality of people’s lives, Williams says. That simple action can help young adults begin to put things in the proper perspective, he adds.

Keep your ‘therapeutic antennae up’

With all those choices and transitions hurtling toward young adults in rapid succession, how can counselors help most? “I wish there was a magic answer,” says Hermann, a member of ACA. Short of that, developing a strong therapeutic relationship is perhaps most important, she says, along with gathering and attempting to understand the perspective of the client as much as possible.

“I think having your therapeutic antennae up is one of the most important things,” says Hermann, who adds that the client’s presenting problem isn’t always the real problem. Get to know these clients and work on the issues they present with, she says, but also be open and attentive to exploring other issues of which they may not even be aware.

Counselors should also know that these clients aren’t afraid to walk through your door, Williams says. “This generation is not like generations in the past,” he explains. “There’s not a stigma involved in mental health issues [with them]. They’ll come in to your office and they’re like, ‘Listen, I’m stressed out, I’m anxious. I need some help.’”

In return, Williams says that he stands ready to help these clients identify what they are experiencing. He specifically uses the term quarter-life crisis with young adult clients because he says it is empowering for them to hear a phrase that defines their experience. “It’s liberating for them,” Williams says. “They’re like, ‘Holy crap. OK. I get it. This is what I’m going through right now.’ So normalizing this is very important.”

Nelson agrees, adding that 20-somethings are reading magazine articles and self-help books on this topic as a way of finding support and normalizing their experience. “If we as counselors and therapists don’t do the same in normalizing this and recognizing this,” Nelson says, “then we’re not providing the comprehensive services that we need [to].”

Even if career counseling is not a counselor’s specialty, being well-versed in career counseling topics is imperative when working with these clients, Nelson says, because career issues are intricately tied to many other areas of life, from identity to finances to relationships. For example, Nelson says, paying for a house or paying for child care is tied to family and partner relationships, but it is also dependent on career decisions. That means that even if a counselor doesn’t specialize in career or academic counseling, it is critical to have a basic understanding of those areas of counseling, she says.

On the flip side, Nelson says, career counselors might have young adult clients come in for help writing résumés, only to discover that their parents are pressuring them to create the “perfect” résumé in order to find the “perfect” job. Or perhaps a counselor working with a couple in premarital counseling might find that one member of the couple is struggling with career and financial worries. Nelson suggests that counselors try to look holistically at everything going on in these clients’ lives.

Williams points out that, of course, not every 20-something is going to experience a full-blown “crisis.” But the potential is there for these various life transitions to lead to crisis if young adults don’t have the coping skills and supports in place to weather changes in a healthy way, he says.

Counselors would be wise to do assessments with these clients at the outset of counseling, Williams says, especially to help determine whether they might be experiencing clinical depression or anxiety. Then, he says, counselors should hear these clients out and try to understand where they’re coming from.

Williams often explores existential questions such as “Who am I?” and “What do I want to do with my life?” with clients in this age group. He also reminds these clients that the answer to what they want to do with their lives doesn’t necessarily have to be related to their jobs; a job can pay the bills without necessarily “satisfying” or defining every aspect of the person. Williams prefers a holistic perspective, asking clients to think about what things in life make them happy, bring them meaning and help them make sense of the world.

No one right approach

When working with clients on quarter-life crisis issues, Williams suggests that practitioners remember to keep the counseling brief. Although these clients tend to be more willing than generations past to seek out counseling, they also generally want a faster route to a solution, not years of sessions, he observes.

“They come to counseling, but they don’t stay in counseling,” Williams says. Brief, solution-focused and existential approaches are often the best alternatives with these clients, he says. At the same time, many young adult clients aren’t afraid of doing work toward arriving at the solution, he adds, so counselors shouldn’t hesitate to suggest books for them to read, questions for them to ponder or other homework for them to do between sessions.

When deciding which interventions to use with these clients, Nelson suggests that counselors familiarize themselves with the literature on evidence-based practices related to life transitions, such as the school-to-work transition or the transition of becoming a family. Because the quarter-life crisis is a newer area of study that hasn’t yet been extensively researched, Nelson says it is hard to pronounce whether one counseling approach would be more effective than another. She believes almost any evidence-based approach can be effective with these clients, although she tends to lean toward existential-based approaches.

Williams came up with an intervention that he calls the “NEEDS” approach. The “N” stands for normalize, which all three counselors interviewed for this article highly recommend trying to do with clients confronting a quarter-life crisis.

The first “E” stands for empower. Williams says counselors can do this by arming these clients with anything from books to YouTube videos that will help them feel less alone and more confident that what they are experiencing is real.

The second “E” stands for taking an existentially focused approach. Williams says this involves helping clients explore who they are, what their calling is and the “why” behind it. For example, if young adult clients are focused on landing a particular job or moving out of their parents’ house, Williams will ask them to examine the “why” behind those desires.

The “D” stands for a developmental approach, in which Williams encourages clients to explore the “long continuum” of their lives, and also the decision-making skills that are required at this time in life. The decisions that 20-somethings make can have consequences that extend into their later years, he points out. For example, some young adults make the decision to run up their credit card debt so they can rush to move out of their parents’ home, while others decide to get married and have children before they are truly ready.

The “S” stands for screening and assessment, which Williams says is a must in determining whether clients are experiencing a normal transition or if their experience has crossed over into crisis mode.

Prevention where possible

Although counselors must be prepared to help 20-somethings who already find themselves in the midst of a quarter-life crisis, Nelson says practitioners should be thinking with a preventive mindset whenever possible. For example, she says, counselors who work with college students can help those students better prepare for what lies ahead by engaging them in exercises to build their self-esteem and raising their awareness of the challenging decisions and transitions that might pop up in the near future.

University counseling centers might be able to offer graduating students continued career counseling services until they land jobs, Nelson says. If such services aren’t feasible, she suggests that college counselors ensure that their clients who are graduating leave the school equipped with referral sources. She encourages college counselors to add website resources for recent graduates “who are feeling the heat of the quarter-life crisis.”

Nelson says counselors must do what they can to arm graduating students with the tools they need before they actually need them. “Getting the information out there and the resources out there before it becomes a problem is really important,” she says.

In preparing to work with clients on issues related to the quarter-life crisis, Nelson says it is crucial for counselors to be aware of changing cultural dynamics. For example, she says, counselors should understand how social media can further complicate life transitions for young adults and how changes in unemployment rates and student loan rates can have “very real implications” during an already frightening time period for 20-somethings.

Counselors who desire to work with young adult clients should read more about this generation, Williams says. Understand what makes them culturally unique, what is significant to them and what has shaped their lives. Among the resources that Williams suggests is the 2001 book Quarterlife Crisis: The Unique Challenges of Life in Your Twenties by Alexandra Robbins and Abby Wilner.

“Cultural shifts of parenting style and expectations are one of the greatest mitigating factors in understanding millennials,” Williams says. “Concepts such as positive reinforcement rather than punishment, or self-esteem building rather than tough love, became popular during the millennials’ formative years. Millennials were revered by parents and sheltered from the world, developing unrealistic expectations of self and never learning skills necessary for survival in the ‘real world.’ Often they have been sheltered so much that they have not been allowed to learn to survive on
their own.”

“In addition to the confounding dynamics such as parental influence, millennials have come to age during a period of significant corporate downsizing, unemployment, underemployment and outsourcing,” Williams continues. “The estimated unemployment rates for young adults are more than double that of overall unemployment rates. As a result, young adults face increased financial stressors, often resulting in an inability to pay student loans, save for retirement or maintain independent living. It is estimated that approximately 44 percent of recent college graduates are currently experiencing underemployment, working in fields and positions in which they are overqualified. Like many other generations, work is a crucial aspect of one’s identity and expression of self. Consequently, when employment aspirations and ideals are not met, crises of personal identity may result.”

Hermann agrees. “Understanding the culture of this population will be important to sustained treatment success,” she says. “I think a systemic perspective is very important, and understanding the individual within [his or her] environment, especially as it pertains to relationships — family of origin, intimate, social, professional — is imperative to treatment.”

Hermann recommends two journals published by ACA divisions to counselors who might be working with this population. One is Adultspan Journal (published by the Association for Adult Development and Aging), which includes topics relevant to young adults. The other is the Journal of Creativity in Mental Health (published by the Association for Creativity in Counseling) “because of the innovative, therapeutic applications that engage and challenge clients to think differently,” she says.

Expert wisdom

To help counselors better prepare to work with clients undergoing a quarter-life crisis, Counseling Today asked these experts to weigh in with their best advice and guidance. Here are their top tips.

  • Don’t minimize the quarter-life crisis, Nelson says. “Far too often, that’s one of the reasons that an individual is there [in counseling] in the first place.” In many cases, parents, peers or co-workers have minimized what these 20-somethings are experiencing, which only ends up increasing the pressure on them, Nelson says.
  • Do focus on wellness, decision-making and the future, Williams says, not pathology.
  • Don’t make assumptions, Hermann says. “Every client has a different past and goals for the future. Focus on the individual,” she says. Although counselors develop models and frameworks to understand patterns, “every person is a unique human,” Hermann reminds her colleagues.
  • Do your research, Nelson says. Become aware of factors outside of your counseling specialty or area of practice that may be affecting young adults. “Awareness is half the battle,” she says.
  • Do make it clear to these clients that this is short-term counseling, Williams says, “because you lose Generation Y if you are going to ask them to come back for 15 sessions. They really need to see the end from the beginning.”
  • Don’t rely solely on clinical intuition, Williams adds. “I love the fact that we are intuitive, but we have instruments and science out there that can help us,” he says.
  • Do consider group therapy. “If you are working in a setting that has the ability to utilize group therapy and group counseling interventions, I would say go for it,” Nelson says. “I think that group counseling can really help that process of normalizing the crisis [and] developing a support network for individuals beyond their counselors.”
  • Do take the time to explore the individual’s relationships, including family relationships, intimate relationships, friendships and work relationships, Hermann says. “This exploration will give counselors an understanding of the individual and also the depth and capacity of [his or her] support group. In addition, so many of the changes that occur during this developmental period are connected to changes in relationships, so having a complete understanding of the relational aspects of an individual can be helpful in understanding and focusing a treatment plan.”
  • Do encourage these clients to address their relationship with their parents, Williams says. It is a relationship that has likely changed now that these young adults are in their 20s, but it is a relationship and an influence that has long been paramount to them, he says.
  • Do normalize the crisis, Nelson says. Point clients toward books or other resources to help them recognize that they are not alone in experiencing these struggles and challenges.
  • Do explore identity development with clients, Hermann says. What is meaningful to them, and how do they create meaning?
  • Do give these clients resources, books to read and homework to do, Williams says. They are typically used to being on the computer and doing research, so they are likely to engage in the homework related to their own counseling, he says.
  • Do ask questions and then address any issues that become apparent from the answers, Nelson says. “Is it stressful to pay your student loans each month? Is it stressful to be pressured by your parents to be married and to have children, and how are you dealing with that?” Nelson suggests asking. “I don’t think that counselors need to be afraid and shy away from addressing the quarter-life crisis.”

 

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To contact the individuals interviewed for this article, email:

 

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Lynne Shallcross, a former associate editor and senior writer at Counseling Today, works for Kaiser Health News as a web producer. Contact her at lshallcross@gmail.com.

Letters to the editor: ct@counseling.org

Laumann: Finding the courage to be authentic

By Bethany Bray April 2, 2016

Silken Laumann is a world-class rower and three-time Olympic medalist. But she says that isn’t the hardest and most important work she has done in her life.

“The most incredible journey I’ve been on is the internal one – the journey of the soul,” says Laumann, a Canadian author, speaker and advocate. “It takes courage to become who you really

Silken Laumann speaks at ACA's 2016 Conference & Expo in Montréal. Photo by Paul Sakuma

Silken Laumann speaks at ACA’s 2016 Conference & Expo in Montréal. Photo by Paul Sakuma

are. … We are given the opportunity to go deep within ourselves. It’s the greatest opportunity we can ever take.”

Laumann shared her story with approximately 2,500 professional counselors in a heartfelt keynote address this morning at the American Counseling Association Conference & Expo in Montréal.

Laumann became a household name in Canada — and, for many Canadians, the very embodiment of courage — when she overcame a severe injury to win a bronze medal in single sculls at the 1992 Olympic Games in Barcelona. Ten weeks before the Olympics, Laumann’s leg was shattered when another sculling boat collided with hers during a warm-up run.

In addition to her comeback win in 1992, Laumann had previously won a bronze medal in double sculls at the 1984 Olympics in Los Angeles and would go on to win a silver medal in single sculls at the 1996 Olympics in Atlanta. She was also chosen to carry Canada’s flag during the closing ceremonies of the 1992 games.

In this morning’s keynote, Laumann was open about her struggles with anxiety and depression, which she treats with a combination of medication and counseling.

After her Olympic days were over, she led a life that, from the outside, looked like she had it all together as a mother and public persona, Laumann says.

However, “there were some signs that all was not well in my little perfect world,” she says. “In my life, at that time, help was for people with bigger problems – weaker people. Boy, did I have a lot to learn.”

It was a counselor, Laumann says, who pulled her from rock bottom — a crisis moment years ago when she was harboring so much internal rage that she had thoughts about lashing out and harming her children during a moment of uncontrolled anger.

Laumann says counseling gave her the confidence to eventually be (and show compassion for) her authentic self rather than trying to guard and live up to her polished public persona. Counseling also helped her come to terms with her story, including her troubled childhood, and learn to heal, she says.

Laumann always understood that what happened in her childhood – growing up with a mother who

Photo by Bethany Bray/Counseling Today

Photo by Bethany Bray/Counseling Today

was unpredictable and threatening at times – “wasn’t right,” she says. But it didn’t fully click until her counselor asked her how she would feel if her own daughter, Kate, was in that situation.

Finding self-compassion and love for her authentic self “transformed everything,” including her relationship with her children, Laumann says.

“My kids have an authentic person [for a mother] now,” she says. “I felt like I was putting on the mask of a mother [before].”

Laumann credited counseling with breaking the cycle of abuse that runs in her family. What if a counselor had not been there at her rock-bottom moment, she asked the audience of counselors.

“I am deeply grateful for this profession,” Laumann told the crowd. “We need to make counseling available to everyone who needs it.”

Laumann represented Canada for 13 years in international competitions and was inducted into Canada’s Sports Hall of Fame in 1998.

She is married with four children, including a stepdaughter, Kilee, who is profoundly autistic. In addition to participating in author events and speaking engagements, Laumann engages in a significant amount of advocacy work, including fundraising for autism causes with her husband, David Patchell-Evans.

After her keynote, Laumann met with counselors and signed copies of her 2014 memoir, Unsinkable.

 

 

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Learn more about Silken Laumann and her advocacy work at silkenlaumann.com

 

Related reading: See Counseling Today’s profile of Laumann: wp.me/p2BxKN-491

 

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ACA’s 2016 conference, held in partnership with the Canadian Counselling and Psychotherapy Association, runs through April 3.

See more photos of ACA’s 2016 Conference and Expo at flickr.com/photos/23682700@N04/

 

Interested in Live Streaming the 2016 Conference to earn 15 CEs? Go to counseling.org/conference/montreal-aca-2016/livestreaming

 

Silken Laumann receives a gift from Natasha Caverley, president of the Canadian Counselling and Psychotherapy Association (CCPA), after her keynote on April 2. Photo by Bethany Bray/Counseling Today

Silken Laumann receives a thank you gift from Natasha Caverley, president of the Canadian Counselling and Psychotherapy Association (CCPA), after her keynote on April 2. Photo by Bethany Bray/Counseling Today

 

 

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

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

Talk therapy less effective for depression than once thought

By Bethany Bray December 2, 2015

No one – especially professional counselors – would dispute the fact that psychotherapy is an effective way to help people deal with depression. However, a recent study claims that the benefits of traditional “talk therapy” are less effective than once thought.

According to the co-authors of a recent peer-reviewed article in the Public Library of Science’s PLOS ONE journal, the benefits of psychotherapy treatment for depression have been historically overestimated by roughly 25 percent because studies with negative results often go unpublished, thus skewing the data pool.

This same overestimation occurs with data about the effectiveness of antidepressant drugs used in the treatment of depression. This, too, is due to “publication bias,” say the article’s authors, a cohort of professionals in neuroscience and psychology departments at universities in the Netherlands and the United States.

“Our findings indicate that psychological treatment is efficacious and specific, but, as is the case for antidepressants, less than the published literature conveys,” the authors write in the study’s conclusion. “Clinicians, guidelines developers and decision-makers should be aware of [the] overestimated effects of the predominant treatments for major depressive disorder.”

Depression is one of the most common mental illnesses in the United States, affecting more than 6 percent of American adults, according to the National Institutes of Health.

 

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View the full PLOS ONE journal article at bit.ly/1L6N83u

 

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Related reading: See Counseling Today’s August cover story “Treating depression and anxiety

 

 

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

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook: facebook.com/CounselingToday

Counseling, football, recovery and triumph

By Bethany Bray September 28, 2015

In a life of ups and downs, football has been a constant for Chris Harris, a 34-year old limited licensed professional counselor (LLPC).

Among the struggles Harris has faced was a battle with severe depression that threatened to derail his life at a young age. Football served as a saving grace for him during some of his darkest periods — times when life didn’t seem worth living.

Chris Harris, LLPC

Chris Harris, LLPC

Harris’ example of how football can change lives for the better was featured in the National Football League’s “Together We Make Football” campaign in 2013. He was one of 10 finalists from across the United States featured in nationally televised video clips on Thanksgiving Day.

In the NFL’s three-minute video, Harris explained how football had been a lifesaver for him, in addition to providing him with an opportunity to become a leader and peer counselor on a newly established club team at Oakland University in Michigan.

When he was younger, “I couldn’t see myself living to even be 20 [years old],” Harris says, citing his struggles with alcohol addiction, depression and fitting in with peers. “Anytime I got really down, football would come knocking. That’s why I love football.”

Harris says football will always be a central part of his life, even though his playing days may be behind him. He graduated from Oakland University this year with a master’s degree in counseling.

Harris wants to build a platform from which he can reach people who are wrestling with some of the issues he has struggled with, including depression, anger, alcoholism, bullying and finding focus and direction in life.

He has established a private practice and hopes to eventually specialize in sports counseling and youth development and mentoring. He would also like to become a public speaker.

“I’ve always had a natural passion for helping people,” he says. “With my personal experience with mental illness and trauma, I know how that impacts people. … I have a passion to be a bridge builder.”

When Harris speaks about the potential for recovery and triumph, it’s personal. Counselors should never underestimate the power of growth and development to change a person’s life, he says.

“Even if a client doesn’t see it in that moment, have the vision of them yourself growing and developing to achieve the life that they want for themselves,” he says. “As a counselor, make sure you maintain that vision of them getting healthy, recovering and achieving the triumph that they would like, because it is possible.”

 

‘I would have never imagined myself being here’

The 6-foot-5-inch Harris played football as a youngster growing up in Detroit. At age 19, he made the roster of the Motor City Cougars and played semi-professionally for four years.

ChrisHarris_1Playing with the Motor City Cougars pulled him out of a downward spiral he fell into after high school, including a bout of depression, alcohol dependency and grief over the death of his grandfather.

He fell into another dark depression in 2009 when he was six months shy of earning an undergraduate degree in social work at Wayne State University in Detroit.

Although his 2009 mental health crisis was as a breakdown, it also marked a breakthrough for him, Harris says. Since that time, he has been able to rise above his struggles and make a 180-degree turn, he says.

He has completed bachelor’s and master’s degrees at Oakland University, where he also was a leader on the school’s club-level football team.

“At my darkest time, I would have never imagined myself being here,” says Harris, a national certified counselor (NCC). “But guess what? I did the work, I sacrificed, I made the decisions, and it happened. I know it sounds cliché, but if I can do it, anybody can do it.”

Harris is starting a yearlong internship this fall with Michigan College Access Network, an organization that works to boost the percentage of Michigan residents who go to college. The organization places particular focus on students from families with low incomes and students who would be the first in their families to seek postsecondary education. Harris will be working in a local high school, where he will advise students on everything from choosing a college or academic major to applying for financial aid.

James Hansen, a professor and coordinator of the mental health specialization within Oakland University’s counseling department, describes Harris as a bright, warm, accepting and curious person.

“He glows with those qualities, and his clients will certainly benefit from that, as [will] the others in the counseling profession he encounters,” says Hansen, who is a member of the American Counseling Association.

“I admire his courage,” Hansen says of his former student. “His own journey informs his empathy and his ability to be an excellent helper. … He has a sincere desire to help others. I admire what he’s gone through.”

 

Trust and team building, on and off the field

Much like football, counseling is based on building relationships and trust with those you work with, says Harris. The relational aspect of counseling is what ultimately drew him to the profession, he says.

“[Counseling] has techniques and theories. However, it’s all about the relationship, the therapeutic alliance,” he says. “I feel in my heart that it’s the truth – relational health is central.”

As a counselor, Harris would like to work with athletes – a natural fit with his personal experience and with the profession’s relational approach.

“I understand the mentality of an athlete,” he says. “The same things that make them successful on the field of play can get them in trouble off the field – aggression, being strong, being a leader. It’s difficult for athletes to channel that in the right way. You can’t get rid of it (anger, competitiveness, etc.). It’s what you do when you’re angry that gets these people in trouble. I’d like to use my experience as a platform.”

Athletes are hard-wired to understand the give-and-take, trust and relationships that are part of being a tight-knit team, Harris explains. Counselors can leverage these skills when working with clients who are athletes, he adds.

Athletes will especially understand and respond when given a finite task or job to do, Harris says, because that’s what they’re used to in team sports. For example, athletes are used to having to go home and learn their playbook, he says. In counseling, this could translate to the “homework” assignments that counselors often give to clients, such as journaling or communication exercises.

“In sports, you’re used to a script [or playbook], following directions and doing your job,” Harris says. “If [a counselor] can sit down with an athlete, or anyone, and lay the foundation for the relationship to gain and earn their trust – after that, your counseling skills, the ability to sense patterns, read body language, etc., will benefit.”

“Counselors should listen first. Listen to your client speak about what inspires them, what drives them and what they desire,” he says. “Once you’re comfortable and know the client well enough, then you can begin to engage them from that perspective. Bring their struggle back to their strengths.”

 

 

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

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook: facebook.com/CounselingToday