Monthly Archives: May 2020

Affirming all shades of the rainbow

By Laurie Meyers May 27, 2020

Licensed professional counselor (LPC) Laura Brackett’s specialties include counseling LGBTQ+ individuals. A frequent complaint she hears from her clients is that those outside of the LGBTQ+ community — including some mental health practitioners — see it as one big, happy family that shares all of the same problems and concerns.

This is, of course, not the case. “There can be deep and painful divides between the various groups that make up this community,” says Brackett, an American Counseling Association member who practices and is the director of community engagement at Change Inc. in St. Louis.

That is especially true for marginalized communities within the LGBTQ+ population. For example, American society has made significant progress in accepting differences in sexual or “affectional” identity but remains distinctly uncomfortable with alternate gender expressions such as transgender and nonbinary, says ACA member Christian Chan, an assistant professor in the Department of Counseling and Educational Development at the University of North Carolina Greensboro. People can generally grasp (even if in some cases only reluctantly) being gay, lesbian or bisexual as being about whom one chooses to love. However, the idea of someone being assigned the wrong gender at birth or a person rejecting that they must choose the binary of either male or female undermines deeply held notions of what constitutes a person’s identity, explains Chan, whose research interests include intersectionality and issues affecting queer people of color.

Even the LGBTQ+ community tends to prioritize affectional identity over gender identity, says Chan, a member of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (ALGBTIC), a division of ACA. For too long, there has been a hierarchy of whose needs matter, he asserts, and transgender people — particularly women of color — have been at the bottom.

“Mental health providers are not really culturally responsive to the needs of [diverse] communities — particularly communities that have multiple identities,” he says. Even counselors who are affirming of LGBTQ+ clients don’t always take the time to consider clients’ intersecting identities and how those identities affect their mental health needs, Chan adds.

When transitioning is not an option

LPC Jessica Jarman Hayes says the transgender clients she counsels are often not out and almost “sneaking themselves into therapy.” Hayes, whose Columbia, South Carolina, practice specializes in LGBTQ+ issues, explains that being transgender anywhere in the surrounding area is just not accepted. If anyone in the communities where her clients live learned that these individuals are struggling with their true identity as a transgender woman or man, her clients would lose everything, she says. If married, their spouses would leave them and take their children. Their families, friends and neighbors would reject them, leaving them with no social support. The need for secrecy is so great that it can be challenging for these clients to even schedule appointments with Hayes.

Other of Hayes’ clients live out in isolated areas of South Carolina’s Low Country. They cannot easily get to her office, so their only option is teletherapy, sometimes from a car in the parking lot of a grocery store because they have no safe space available to them at home.

“It reminds me a lot of when I was working in domestic violence,” says Hayes, who is also a volunteer at the Harriet Hancock LGBT Center in Columbia. “You just have to be there to support them, sometimes for years, when they finally reach a place in which it [denying their identity] is no longer acceptable, and then come up with a plan to get out of Dodge.”

Violence is an ever-present threat for people who identify as transgender and gender nonconforming or “nonbinary.” According to the Human Rights Campaign report “Violence Against the Transgender and Gender Non-Conforming Community in 2020,” at least 26 individuals who were transgender or gender nonconforming were murdered in 2019. Most of the victims were African American women.

As the report notes, “These victims were killed by acquaintances, partners or strangers, some of whom have been arrested and charged, while others have yet to be identified. Some of these cases involve clear anti-transgender bias. In others, the victim’s transgender status may have put them at risk in other ways, such as forcing them into unemployment, poverty, homelessness and/or survival sex work.”

Hayes says the fear of violent retribution is another reason, in addition to fear of losing family and friends, that her transgender clients feel unable to express their identities in any way. One client hid underwear in a wall in the house, and their spouse gave them a severe beating when they discovered it, Hayes says.

There is no protection for the abused in these cases because the local police do not take such incidents seriously, according to Hayes. This lack of concern is present even when a juvenile is involved, she says, recounting the story of a suicide hotline call from a transgender teen that got routed her way. The teenager was actively suicidal and in danger. The father had found girls’ clothing and had severely beaten the teen. Hayes called the police and made it clear this was a domestic violence incident involving child abuse and a victim who was actively suicidal.

“The police went in there and teamed up with the dad,” Hayes says. “They said, ‘If you would just stop pretending to be a girl, your dad wouldn’t have to do this.’”

For a time, the girl was able to maintain touch with Hayes by using a self-wiping app on her cell phone to avoid being detected. Hayes called the police repeatedly, but they continued to refuse to take action. Eventually, the father discovered the girl was making calls and took her phone, her computer and his computer out of the house so that she had no means of reaching out. Hayes and other volunteers at the Hancock Center have done their best to check on the teen’s welfare since losing contact but have been unsuccessful. Her school has been ordered not to give out any information, and the local police aren’t providing any help. A Columbia-area police officer has agreed to keep his ears open for any news, but thus far the Hancock Center hasn’t heard anything.

In search of support

Closeted transgender women (i.e., people presenting as men, in accordance with their assigned gender at birth, but who secretly self-identify as women) who are discovered are at risk of violence not just from spouses but, potentially, the spouse’s family, Hayes says. “This is seen as an act of great betrayal.”

Hayes recommends that all of her transgender clients use the time after their phone sessions with her (or any other time they have 15-20 minutes of private time) to connect with virtual support groups. She wants clients to find at least one “safety buddy” to whom they can reach out if they just need to talk or if something serious is going on. She also makes sure that all clients have the transgender peer support and crisis hotline number (Trans Lifeline: 877-565-8860).

Hayes also uses radical acceptance to help her clients cope with the inability to embrace their true identities. “OK,” she tells clients, “we can radically accept that this situation really sucks and is really uncomfortable, but we have to accept that we are in danger of losing a job or family, even if we never come out but someone else finds out.”

Hayes urges her transgender clients always to have a go-bag packed, but recommending places for refuge is a challenge. A few domestic violence shelters in Georgia are trans-affirming, but they are a significant car ride away. The Columbia area has some homeless shelters that will accept transgender individuals. Still, these are not always great options because some of them are run by religious organizations that require those seeking refuge to read “applicable” Bible verses. Hayes generally encourages clients to think of relatives with whom they could stay. Clients don’t necessarily need to explain the whole story of what is happening — just that they need to get away, Hayes says.

In an environment in which wearing gender-affirming underwear or painting one’s toenails can have devastating consequences, Hayes acknowledges that it is incredibly challenging to help make her clients’ situations more livable. Even so, she has found a few small ways for her transgender and nonbinary clients to explore their identities, including gaming, an environment in which having avatars of different or no fixed gender is common.

Another outlet she suggests — but only if clients believe their phones are safe from scrutiny — is the social media platform Tumblr, which is very graphics-oriented and functions a bit like a cross between Facebook and Twitter. Users can set up an account and post or follow others who share art, graphics, GIFs and other visual content. Crucially for Hayes’ clients, it’s also possible to search content without registering. Why is this an affirming outlet? Because Tumblr is a hive for many kinds of interests, including fashion, design, décor and art. Hayes tells her clients to use the platform to explore what their “aesthetic” (personal style) would look like if they had complete freedom, encompassing not just their appearance but also their surroundings. 

Hayes began her career counseling domestic violence survivors in the Miami area, where the shelters are transgender and LGB affirming and intimate partner violence between gay men or a trans woman and cisgender man is taken seriously by the legal system. Although Hayes, who considers herself a member of the LGBTQA+ community, has been in South Carolina for several years, she is still sometimes surprised by the virulence of the hatred many in the area feel toward transgender and other queer people. She echoes Chan in saying that although different affectional orientations are now more tolerated (even if sometimes grudgingly) in some quarters, alternative gender expression is still largely viewed as unacceptable. She believes there also remains significant transphobia within the LGBTQ+ community itself, which leaves her transgender clients with very few resources for social support.   

Family struggles

When ACA member Bethany Novotny moved from Pittsburgh to Johnson City, Tennessee, to begin teaching as an assistant professor of human services at Eastern Tennessee State University (ETSU), she wasn’t sure how friendly her new surroundings would be to those identifying as LGBTQ+. Novotny, who went on to start a local lesbian dine-out group, was pleased to find that Johnson City had a robust LGBTQ+ community and that it and the university were a haven among the surrounding Appalachian towns for queer young adults.

Over time, Novotny, who is an LPC in Pennsylvania, found that students viewed her as a safe and sympathetic person to talk to. That rapport, her desire to help transgender and nonbinary students, and Novotny’s friendship with staff at the campus counseling center led to her taking over ETSU’s transgender support group, now called ASPECTS — Aligning Support, Pride, Education and Community for Transgender Students. The group originally included only students who had been referred by the campus counseling center. But Novotny opened it up to all transgender and gender-nonconforming students because she feels they have unique challenges apart from the rest of the queer community. “People are more afraid [discussing alternative gender expression] than they are when we talk about sexual orientation,” she notes.

Novotny supervises while students lead the group, which meets once a week. The students share practical information such as where they can go to receive hormone therapy and find affirmative health care providers. Obtaining these services usually requires traveling to either Knoxville, Tennessee, or Asheville, North Carolina, which is a challenge, especially for those students who don’t have cars. Novotny says the group often works together to make sure members get rides when necessary.

Not surprisingly, acceptance is a constant topic in the group, Novotny says. The students feel safe — many for the first time in their lives — at ETSU, but they still have to navigate family and community attitudes when they go home on breaks.

“We would talk about coping skills [before breaks],” Novotny says. “Sometimes they would choose to stay with a friend or another family member. I would remind them to have a crisis plan — making sure if things got bad, they knew what to do.” A crisis plan resembles a suicide safety plan, with a list of local and campus resources, shelter locations and the number for the national suicide hotline.

Once, a student who had started taking hormones decided that they should come out to their family on break. The group talked it through for several weeks beforehand, Novotny says. The student’s parents did not take the coming out announcement well, and the student was forced to seek shelter with a cousin. The cousin turned out to be very supportive and even helped the student come out to their grandmother, which they never thought possible, Novotny recounts. All too often, however, students would return to school without getting any affirmation from their families.

Although revealing oneself as transgender is particularly challenging, coming out to family and friends isn’t easy for anyone in the LGBTQ+ community. Even among families who want to support and affirm their loved ones, the coming out process can be a difficult transition, Brackett says. Some family members — often parents in particular — grieve letting go of the future they had envisioned for their loved one, she adds. “That’s not to say that they reject their family member’s future as an LGBTQ+ person, simply that they may need to adjust the specifics of what that future may be. Maybe the vision was of a son who [would have] a wife and children, and now that vision needs to be adjusted to [having] a husband instead of a wife,” Brackett says.

In other cases, families fear their loved one will become an entirely different person, she says. Brackett explains to families that although changes in expression and personality are very likely, it isn’t a foregone conclusion that in coming out, their loved one will undergo a complete transformation.

“Even when there are substantial changes, I try to remind families that the person they knew was possibly more of a mask than they want to accept,” she explains. “This person is now trying to discover who they really are, and that process will take time. It’s important to be patient, be curious, be respectful, and [for families to] find their own support.”

Novotny says many of her group members have parents who struggle because they perceive the transition of their child’s gender expression — from the one the student was assigned at birth to their true gender — as an alteration that has transformed their child into someone they don’t recognize. This comes in part from a lack of exposure to and understanding of what being transgender means.

One student’s mother couldn’t even grasp the concept, telling her child, “You have a penis, so you’re a boy,” Novotny recounts. “The student was trying to communicate to [their] mom, ‘I’m still the same person. I’ve actually been this person the whole time, and you don’t see that. I am trying to share something scary and vulnerable with you.’” At the student’s request, Novotny helped them talk to their mother.

“I always respond first with empathy,” Novotny says. “I know that what they [parents] are going through is difficult, and I don’t want to minimize or dismiss their feelings. It’s all about meeting them where they are, even though sometimes I want to shake them and scream at how horrible they are being. I also worked to affirm the love and support that it took for mom to show up in my office that day. The fact that she was there was huge. She was willing to talk even though she didn’t understand, and I wanted both mom and my student to recognize what a big step that was.”

Novotny listened to the mother’s concerns and helped correct misinformation by inserting “tidbits of information that might help mom put the puzzle pieces together. I did this very gently and only where appropriate because I did not want to come off as though I was lecturing her,” Novotny says. “As an educator, I know how important it is to plant seeds. We may not always see that come to fruition, but it is so important to plant those seeds gently. … I also try to communicate to parents that they don’t need to fully understand to provide support, love, affirmation and acceptance.”

In some cases, the family conflict isn’t rooted in a lack of understanding but something more fundamental. Brackett, like Novotny, tackles these struggles with understanding and empathy.

“I seek to understand what their resistance or hostility is connected to and move from there,” she says. “Working with a family that has deeply rooted religious beliefs that condemn sexual or gender minorities is drastically different from working with a family that is afraid of the changes that may occur within their family system. At times it can be necessary to have these discussions without the LGBTQ+ family member present in order to not only protect them from hearing this process in its most raw form, but also to allow the family space to be open about what they are feeling. Additionally, recommending outside support groups or resources can help alleviate some of the misinformation and isolation the family may carry.”

Families also fear the treatment their loved one might experience in the outside world. “Will they be bullied or ignored or even physically hurt or killed?” Brackett says about some of the common concerns families voice. “Will they suffer mental anguish and be at higher risk for addiction or suicide?” 

“It’s important for families to remember that a huge protective factor for members of the LGBTQ+ community is the presence of a supportive family,” Brackett asserts. “When working with family members in this place of fear, I try to highlight for them the power they have in creating a safe and loving environment for their loved one. While a mother can’t make the world safe for her gender-nonconforming child, she can at least work to ensure that she is safe for them.”

The process of coming out

In some cultures, such as those Hayes’ clients live in, as well as other racial and ethnic communities, coming out may be dangerous to the LGBTQ+ individual and perhaps to their family. Or an LGBTQ+ person may have some family members who would support their coming out but others who would not be affirmative or accepting. Some individuals choose to honor both their LGBTQ+ identity and their familial or cultural identity by coming out only to certain family members or friends.

“I frame coming out as an ongoing process and remind my clients that the need for a grand unveiling isn’t necessary unless it’s important to them,” Brackett says. “Often, I see my clients come out by degrees, starting with the safest people or environments first to gain support. By identifying safe people and thinking through the possible outcomes of coming out, the client can begin to amass protective factors they need as they go through the process. Deciding not to come out to people they identify as unsafe or unnecessary doesn’t have to be framed as a betrayal to their identity, though it’s an understandable reaction. It can also be framed as a means of protecting themselves. They are not required to disclose information that puts them at risk.”

With any major life change, there is grief at whatever is lost, and this is very true in people who are negotiating the ways in which they want or don’t want to be publicly out, Brackett continues. “Being rejected by a family member or important institution like a religious community or friend group can be devastating,” she says. “Gentleness, empathy and nonjudgmental discussions are important in allowing clients the freedom to connect with the impact coming out is having on them. Holding the grief is important, but so is guiding them toward creation of a new life and support system: ‘Yes, this is horrible and heartbreaking. Is there someone who has acted differently or where you’ve felt acceptance?’”

Counselors can help clients build a new support system by working with them to change their concept of family, says ACA member Leah Polk, a licensed clinical social worker and clinical director at Change Inc. in St. Louis. Clients are not limited to their families of origin; they can assemble ones of their own choosing, she emphasizes. So, even though their families of origin may have set a priority on traditional scripts or rituals, the families they choose can be inclusive and view each member as inherently valuable, says Polk, whose specialties include LGBTQ+ issues. 

“The important part here is that the client gets to spend time identifying what is most important and valuable to them as it relates to family,” she explains. “They are able to map out how they establish family and gain reliable reflections that emphasize what they like about themselves.”

Peer support for transgender youth and young adults

Laura Boyd Farmer, an LPC whose specialties include affirmative LGBTQ+ counseling, helped found a peer group for youth and teenagers 10 years ago in the Roanoke, Virginia, area. She and other area professionals saw a need among the area’s LGBTQ+ youth, who were frequently ostracized and bullied and had little family support. “Our intention was to create a safe and supportive space,” says Farmer, a member of ALGBTIC. Farmer and others sat with teens in the area and asked them what they needed and what kind of support would be helpful. The result was Youth SAGA (Sexuality & Gender Alliance) of Roanoke.

“The kids created the name,” Farmer says. “They were very passionate that they wanted this to be a group for queer-identified kids, but also for anyone who was affirming of gender and sexuality diversity.”

SAGA meets twice a month, and there are always two leaders with mental health experience (Farmer and three volunteers take turns serving as the two leads). Meeting times are posted on Facebook, and the group gathers in public spaces such as coffeehouses, libraries and bookstores so that teenagers who are not out to their families will have a ready-made excuse to drop in.

The group follows two basic rules: Respect participants’ chosen identities, names and pronouns, and give everyone time to talk. Group members are also asked not to talk about what goes on at meetings outside of SAGA. All of the participants are so invested in preserving a place where they can find and give support that there has never been an issue with breaking confidentiality, according to Farmer.

The structure of each meeting depends on the size of the group. If only a few teens are present that week, the session is relatively informal, with group members simply discussing what is going on in their lives. With larger groups, leaders pass out pieces of paper so participants can write down any topics they would like the group to cover. The group leaders put all the pieces of paper in a bowl, which is then passed around. Each person removes a piece of paper and reads out the topic for discussion.

Topics range from concerns such as “My parents don’t want me to transition and I don’t know what to do” and “I don’t know how to come out to a family member” to the practicalities of expressing gender identity. The group has covered logistical questions about the physical and hormonal aspects of transition, as well as ways that youth can present themselves in a way that affirms their gender expression when their families are not letting them transition. The teens also ask each other about how to find good chest binders and affordable makeup.

Dealing with bullies and finding allies are also common topics, Farmer says. She recounts an approach to bullying that she thought was particularly effective: “This trans youth shared that he found the best way to deal with bullies was to choose a direct statement to respond with and to use it repeatedly,” Farmer explains. “For example, when a bully would say to this youth that he was really a ‘she’ and just confused, the youth would reply, ‘That sounds like a you problem.’ This kid also had his friends use the same response when they heard anyone say anything unkind about him or toward him. I loved this approach because it puts responsibility back on the bully to educate themselves, like holding up a mirror for them to see that whatever mean things they are saying are actually about them, not the person they are trying to bully.”

Sometimes the group features outside speakers. For example, because the intersection of religion with sexual and gender identity is a common concern in southwest Virginia, Farmer had a pastor lead a discussion on how spirituality and sexuality intersect. The pastor also talked about what the Scriptures actually say (and don’t say) about the topic and gave the group recommendations for discussing the topic with family.

Farmer emphasizes that SAGA is not a therapy group but rather peer-based support. Because discussions about sexual and gender identity sometimes include topics such as trauma that can be triggering for others, she and her co-leaders have developed a signal that group members can use if they are being triggered. If someone puts a hand on their heart, it is a signal for the leaders to gently and respectfully move the discussion away from the current topic. Farmer and the other leaders are careful to check in afterward to see whether the teen who brought up the topic wants to continue the discussion privately.

“The beauty of this group is that I don’t have to know the answers,” Farmer says. “The kids are sharing their wisdom with others. It’s a beautiful thing to witness.”

Providing affirmative counseling

Even professional clinical counselors who have experience with the LGBTQ+ community may have biases and blind spots, say the practitioners Counseling Today interviewed for this article. Brackett and Polk offer some suggestions for counselors who want to make sure they are offering affirmative counseling to LGBTQ+ clients.

“The first thing I recommend is self-reflection on how you are connected to the LGBTQ+ community outside of being a clinician,” Brackett says. “Understanding your own involvement and comfort within the LGBTQ+ community will help you be present with these clients in an authentic way.”

She suggests that counselors ask themselves the following:

  • Are you a member of the LGBTQ+ community? If so, what elements do you connect to versus what elements do you find yourself separated from? Are there parts of the queer community that you (consciously or unconsciously) avoid or dislike? If so, why? Do you feel like you “belong,” and how does that impact your willingness to connect with others in the community? How do your opinions change if the race, ethnicity, income, gender or gender presentation of the person changes?
  • If you don’t consider yourself part of the LGBTQ+ community, how open and connected are you to people within it? Do you seek out or seek to avoid places or events that are heavily attended by the queer community? How comfortable do you feel when you are in those spaces? How do your opinions change if the race, ethnicity, income, gender or gender presentation of the person changes?

“Remember that there are generalized experiences, and then there are your client’s experiences,” Brackett continues. “Trust your client to tell you their reality. It may align with your own experiences or general narrative you have of the LGBTQ+ community, but it may not. Your goal is to be present with them where they are, as they are.”

Polk has some additional suggestions:

  • Allow the client to determine the pace. It is not the counselor’s job to set an agenda for coming out or transitioning.
  • Frequently reassess goals in therapy. What the client needs when they enter therapy is often not the same as what they need after eight to 10 sessions have taken place.
  • Monitor for clients’ sense of safety and agency. For example, ask them how their relationships are and how they experience safety in an environmental context (e.g., employment, social events, political environment).
  • Continue to scan and assess for co-occurring disorders such as substance abuse. Individuals who identify as LGBTQ+ tend to have a disproportionate number of stressors that could lead to comorbid emotional and mental health concerns.

“Additionally, I would suggest some form of participation in LGBTQ+-affirming communities,” Polk says. “For example, attend a support group, view LGBTQ+ art [and] film, or read literature written by queer authors. Ask to interview LGBTQ+ counselors, or seek out LGBTQ+-specific supervision and psychotherapy training. Finally, perform a self-assessment of your own attitudes and biases of LGBTQ+ people to determine your growing edges in counseling.”

Brackett offers a closing thought: “If you find that you are uncomfortable with LGBTQ+ clients or are concerned about your ability to work with this population, seek out clinical supervision, and engage in your own therapy.”

 

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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)

Books (counseling.org/publications/bookstore)

  • Affirmative Counseling With LGBTQI+ People edited by Misty M. Ginicola, Cheri Smith and Joel M. Filmore
  • Casebook for Counseling LGBT Persons and Their Families edited by Sari H. Dworkin and Mark Pope
  • Group Counseling With LGBTQI Persons by Kristopher M. Goodrich and Melissa Luke

Continuing Professional Development: LGBTQ (aca.digitellinc.com/aca/specialties/137/view)

  • “Transgender — Moving From Awareness to Advocacy” with Becca Smith
  • “Affirming Counseling Practice With Queer People of Color: From Margins to Center” with Adrienne N. Erby and Christian D. Chan
  • “Resiliency Factors of Trans-College Students: Implications for Professional Counselors and Higher Education Professionals” with Jane E. Rheineck and Matthew Lonski
  • “Lesbian, Gay, Bisexual, Transgender and Queer Youth: Family Acceptance and Emotional Development” with Julie Basulto
  • “The Counseling Experiences of Transgender and Gender Nonconforming Clients” by Rafe Julian McCullough, Lindy K. Parker, Cory Viehl, Catharina Chang, Thomas M. Murphy and Franco Dispenza

ACA Mental Health Resources (counseling.org/knowledge-center/mental-health-resources/self-care-resources)

  • LGBTQ
  • Grief and loss

Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (algbtic.org)

 

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Laurie Meyers is a senior writer for Counseling Today. Contact her at lmeyers@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.

Voice of Experience: Knowledge is a coping skill

By Gregory K. Moffatt May 26, 2020

In 1994, I built my house in a tiny little village in Georgia. Back then, a neighboring town not even 10 miles away counted as a long-distance telephone call. At the time, nearly all cell phone companies charged by the minute. My phone plan gave me 10 minutes a month for $60. There was no Skype, Zoom or videoconferencing, and the internet was still something that many people didn’t have in their homes. In fact, many people in 1994 didn’t have a computer in their homes.

In 2003, when I was in India, I paid over $80 for a 15-minute telephone call home. Today I could talk as long as I want for free. We could go back further in time, and some of you would remember hand-dug wells, outhouses, coal stoves and homes with no electricity. I can.

The point here is that we are so fortunate. We couldn’t have managed the coronavirus 20 years ago as easily as we are managing it today.

Things are not as bleak as they might seem in light of COVID-19. I think of this coronavirus event as “The Great Interruption.” I take it seriously, but at the same time, I don’t regard it as the end of the world.

Part of coping with stress is knowledge. Think of a traffic jam. It is frustrating if everyone is stopped on the highway and you don’t know why. But if you receive information that there is an accident ahead that will take 30 minutes to clear, that knowledge helps you manage your stress. You can now make plans, and you have a hint of control.

Here is what we know about the COVID-19 virus:

  • It is one of many similar viruses that we have faced before; we will face others in the future.
  • It is transmitted through the air and via contact. Isolation and physical distancing can help lower risk of contracting and spreading the virus.
  • The time the virus can survive exposed to air varies depending on the type of surface it is on: metal (5 days), plastic (2-3 days), cardboard (only 24 hours — yeah Amazon.com).
  • It is currently thought that 1 in 4 carriers may be asymptomatic. On average, people are contagious for 48 hours before symptoms appear, but that can extend up to 14 days.
  • The fatality rate for COVID-19 remains a source of debate, but in general, the rate is low (about 2%). Vulnerability and age are significant factors. Among young people, the death rate is practically zero. Those 60 and older account for the majority of deaths (by far) from COVID-19, with those who are 80-plus the majority among that group.

I use this knowledge in hopes of putting this virus into perspective. It is very contagious, but so is the flu.

Nonstop news coverage of every new case, every celebrity and every athlete who has it, as well as the “experts” telling us all the terrible things that might happen, has created an impression of plague. One ridiculous teaser line I heard said, “Coming up next, an interview with an actual survivor!” Like approximately 98% of the people who get it?

We’ll get through this. Here are some ways we can manage our stress and that of our clients as we work through this pandemic.

First, we need to be aware that any stressful event magnifies pre-existing conditions — addictions, relationship troubles, anxiety, etc.

Second, self-monitor. I hate change, and this situation has caused me to change almost everything. Repeatedly throughout the week, I have to self-monitor, recognize my rising stress or frustrations, and manage them.

Third, don’t stop your daily routines unless you have to. If you shop for groceries on Fridays, shop for groceries on Fridays.

If you are a parent, keep an open dialogue with your children that is age appropriate. Help them manage their fears and anxieties.

Identify specific stressors of this isolation. I’m an extreme introvert. Staying home hasn’t caused me any stress, but for extroverts, the lack of socialization can be very stressful. Seeing people wearing masks everywhere can also subconsciously cause fear and anxiety.

Eat right, sleep right, and get plenty of exercise. If you are a regular reader of my work, you will recognize this as Moffatt’s Mantra.

Find the positive in the situation. We have lots of time with family or time to learn a new skill. Plus, no traffic and much less driving! I normally divide my time between three offices. This virus has returned to me almost 10 extra hours a week that I normally would have been on the road.

Finally, take it a day at a time and shut off the TV. We’ve had enough gloomy news.

 

 

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Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.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.

Coping with the (ongoing) stress of COVID-19

By Lindsey Phillips May 21, 2020

The COVID-19 pandemic is affecting everyone differently. Some are coping with the loss of a job. Some are risking their lives caring for those who are sick. And others find themselves deeply contemplating existential questions of mortality and the meaning of life.

The pandemic could also be compounding underlying mental health issues for some clients, notes Robert Haynes, a member of the American Counseling Association. For instance, clients who were already battling depression or obsessive-compulsive disorder may now be dealing with a significant amount of anxiety and stress on top of that related to COVID-19. Those confronted with social injustices because of their race, ethnicity, sexual orientation or disability may also be more affected, he adds.

“People are going to be all over the spectrum as far as how they’re doing, what they’re doing and how it’s affecting them,” Haynes says. “Don’t assume anything, even if you’ve been working with a client for some time. This [pandemic] may be a huge setback for them.”

Many people have not dealt with this level of stress before, and some are having newfound anxieties, which can be jarring, says Shainna Ali, a licensed mental health counselor (LMHC) in Orlando, Florida. The pandemic may also uncover an unaddressed mental health concern that could benefit from counseling, she adds.

People’s ability to cope with stressful events has been and will continue to be tested by the COVID-19 pandemic. During this time when mental health is moving to the forefront of the public’s consciousness, professional clinical counselors are in a prime position to help clients cope with uncertainty and loss, build resilience, adjust their coping strategies and self-care routines, and identify their individual and community strengths. And counselors, of course, can best help their clients by remembering to also take care of themselves during this challenging time.

Coping with uncertainty

Uncertainty surrounds this global crisis. No one is quite sure what to expect or what the next day will hold. The uncertainty, fear and unknown with COVID-19 creates the perfect formula for anxiety, says Haynes, co-author, with Michelle Muratori, of the recently published ACA book Coping Skills for a Stressful World: A Workbook for Counselors and Clients.

A common response to this uncertainty is trying to seek control, Ali says. Throughout this pandemic, Ali, owner of Integrated Counseling Solutions, has constantly been reminding clients, “Manage what you can. Release what you can’t.” Fixating on what you can’t control leads only to rumination, but focusing on what you can manage is one way of coping with a stressful situation, she says.

For example, an adult client might worry about their parents and how well they are isolating during the pandemic. The client may want to visit their parents but also fear making them sick. Ali would advise this client to find another way to check on them (one that aligns with the Centers for Disease Control and Prevention guidelines) such as calling or doing a video chat.

“Focusing on what we can control might help us to feel more grounded,” says Muratori, a senior counselor at the Center for Talented Youth and a faculty associate in the school of education at Johns Hopkins University in Baltimore. Counselors can help clients set small, achievable goals and take time to reflect on what they have accomplished each day. For example, clients can ask themselves, “What is one thing I can do today to move toward accomplishing my goals?”

People can also control the type and amount of information they consume. As Stephanie Dailey, an assistant professor of counseling at George Mason University, points out, overexposure to media tends to increase people’s levels of distress, fear and anxiety during disaster situations, regardless of whether they were involved in the crisis.

“Accurate and timely information is important,” says Dailey, a licensed professional counselor in Virginia. “But if a client is constantly on social media and is accessing sensationalized or erroneous information, it’s going to undermine their mental health.” She advises counselors to inquire about how much access (or overaccess) to information clients might have.

Coping with loss

Not all loss is obvious. A couple mourn the cancellation of their vacation plans. A high school senior is upset because he won’t be able to experience graduation with his friends. A young child misses her first Broadway show. Neighbors are no longer able to relax and celebrate the end of a workweek by having dinner with one another in their homes on Friday night. Baseball fans lament the start of the season being postponed.

Loss is upsetting because it highlights what we no longer have or what we could have had, explains Ali, a member of ACA. She helps clients more fully understand what they are truly mourning and validates their appropriate emotional responses to the loss, such as sadness, anger and frustration. But she also helps clients see possibilities for experiencing gratitude even in the midst of loss.

For example, if a client is upset about not being able to get married when originally planned, Ali first reassures the client that feeling that way is OK. She may then ask the client to think about something for which they are grateful. The client may respond, “I still have my partner.”

Ali, author of The Self-Love Workbook and the blog A Modern Mentality (hosted by Psychology Today), finds gratitude a particularly valuable coping skill currently because “right now, it’s really easy to get distracted by the negative.” Encouraging clients to be grateful and to look for the positive isn’t meant to undermine or minimize negative emotions, she asserts. Rather, it deters clients from ruminating on the negative. 

Ali might also ask the client upset about their postponed wedding, “How can you still honor what you have?” This question would help the client refocus their energy on what can be managed (such as revising their wedding plans or planning an at-home date night) rather than wrestling with what is beyond their control, she explains.

Building resilience

Haynes and Muratori say that resilience is one of the key components of being able to cope with stressful events. Some people incorrectly assume that resilience is innate, but it can be learned, asserts Haynes, a clinical psychologist and producer of psychology video programs for Borderline Productions. “Resilience is more what you do than it is who you are,” he explains. And like any other skill, it grows stronger with practice.

Counseling techniques that help clients connect with others, adjust their thinking and beliefs, become more optimistic and flexible, practice self-care, attend to the spiritual dimension of life or promote self-compassion can bolster resilience, Haynes says.

In Coping Skills for a Stressful World, Haynes and Muratori share an exercise for strengthening client resilience. It involves clients tracking their reactions to stressful events for a period of two weeks and asking themselves some questions: What did they feel and think about the situation? What actions did they take to resolve the crisis? How effective were those actions? What did they learn? The exercise encourages clients to consider their own strengths and the ways they already cope with stressors. Clients come to the realization that they can use these same tools that they already possess when facing future crises, Haynes and Muratori explain. (The use of out-of-session exercises and activities such as this one is a major focus of their workbook.)

Ali works with clients to create their own toolkits of general self-care and coping skills that may be helpful during difficult times. It is important that people establish a general self-care practice rather than waiting to focus on coping skills during a crisis, Ali notes. She says that everyone’s coping skills during a stressful event will look different, but she advises clients (and counselors) to break into their “emergency coping kit” and find activities that help them manage stress.

Dailey, an ACA member who specializes in disaster mental health, finds ways to tap into her clients’ strengths to promote resilience and coping. If a client enjoys art, for example, Dailey may recommend painting or drawing as a possible coping tool. If a client is a natural helper, Dailey might have them brainstorm ways they could support others during the COVID-19 crisis, such as making masks or volunteering virtually. Spiritual or religious practices also provide an enormous amount of strength for some clients, she adds.

“Communities and individuals are innately resilient,” says Dailey, co-author of the 2014 article “Shelter-in-place and mental health: An analogue study of well-being and distress” for the Journal of Emergency Management. “Everyone has strengths, and this crisis can be an opportunity to find those strengths.”

As Muratori, an ACA member, points out, learning coping skills and resilience is not just something that will help clients get through the current COVID-19 crisis. It will also prepare them for future crises, large or small.

Adjusting coping and self-care strategies

“One of the skills in being resilient is also having some flexibility,” Muratori says. That is particularly relevant now because the COVID-19 pandemic has forced people to constantly shift and reshift their schedules while also creating new routines.

It is natural for people going through challenging times to engage in rigid thinking such as “I can’t stand this,” Muratori says. She advises counselors to remind clients that they are standing this; they are adapting and adjusting.

Many of Ali’s clients thrive with routine, but those routines have repeatedly been disrupted by physical distancing, quarantine and gradual reentry. Some of her clients were used to having a clear distinction between their home lives and work lives, so being forced to work from home has created new challenges for them around establishing and maintaining boundaries.

Ali works with these clients to recognize their personal boundaries and to establish some sort of new routine for themselves. She encourages clients to use a semistructured routine, in which they set their intentions for the day but also remain flexible to accommodate new circumstances as they arise.

Dailey also advises clients to maintain a regular routine as much as possible. She encourages them to focus on the basics, such as waking up, showering, eating and going to bed at the usual times.

Ali says that social connectivity remains an important coping strategy during the COVID-19 pandemic. “Social distancing and social isolation are not the same,” she emphasizes. Ali advises clients to think of creative ways to continue meeting their social needs. For example, if clients previously coped with a stressful workweek by going out to dinner with friends, perhaps they could consider hosting a virtual dinner party.

Likewise, clients may need to adjust their self-care regimens right now. After first defining self-care, Ali says, counselors can help clients brainstorm self-care techniques that have worked for them in the past and then look at how they can adapt those strategies (if necessary) to work in an environment of physical distancing or gradual reentry. For example, if a client previously coped with stress by going to the gym, how could they still fulfill that need while gyms are closed? Could they take a remote fitness class or go for a run instead? (For more on this topic, read Ali’s ACA blog post “Self-care & social distancing: Helping clients adjust during COVID-19” at tinyurl.com/ACAMemberBlogAli.)

“Any tools that will support relaxation are really critical at this time,” Dailey emphasizes. She finds mindfulness an effective technique for helping clients regulate their emotions because it encourages them to pause for a moment and let their bodies catch up with their brains. In turn, emotion regulation helps clients successfully manage their symptoms, maintain focus for day-to-day problem-solving and attend to physical needs such as eating, sleeping and taking the proper medications, Dailey says. Clients can journal, go for walks, spend time outside, exercise, meditate, do breathing exercises or do grounding exercises to manage their anxiety, she adds.

Counselors can also play a role in making self-care fun. To help boost self-care, Ali challenges clients (and herself) to combine various coping strategies. For example, a client could livestream a fitness class with a friend, or a family could do a gratitude reflection together at dinner.

Coping as a community

Muratori says that the COVID-19 pandemic exemplifies communal shared trauma — a traumatic event that affects an entire community directly, indirectly or vicariously. The good news is that community members are finding ways to support one another.

In Dailey’s community, neighbors stood on their porches one night and clapped into empty space to show their support for health care workers. They also placed stuffed bears with hearts on the chests in their windows to show their love for one another. Members of Haynes’ neighborhood also placed stuffed bears in their windows so children could go on a “bear hunt.”

Counselors can encourage clients to look around their communities and notice these resilient acts, Dailey says.

Ali specializes in individual mental health counseling, so her clients typically come to her to work on their own individual concerns. But since the COVID-19 crisis began, Ali has noticed that her clients are also showing more concern for the mental health of those around them, including family members, friends and neighbors.

Ali’s clients are also passing along their coping skills to others. One client noticed a roommate was anxious and suggested that they color together because coloring had previously helped the client manage stress.

Some of Ali’s other clients have been modeling the coping and communication skills they learned in counseling for their children at home. This includes using “I” statements, taking breaks and practicing self-care.

Ali also found a way to use her expertise to serve her community. Ali noticed a pattern of heightened stress among people in her life (herself included) because of the pandemic, but as a counselor, she also knew that this reaction was normal. She realized, however, that others in her community might not understand the emotions they were experiencing or know how to cope with the increased stress.

“This [pandemic] is not just exacerbating mental health concerns for people who are in counseling. This is also highlighting mental health problems for people who are not in counseling,” she says.

Of course, Ali couldn’t provide counseling to her entire community, so she and two other LMHCs, Candice Conroy and Sanya Matani, started offering a free virtual lesson to help people better understand and cope with the stress they might be experiencing because of COVID-19. The three LMHCs made it clear that the lesson wasn’t a substitute for counseling and provided resources for people to seek professional help.

Coping as a counselor

Haynes and Muratori express concerns about the stress levels counselors might experience throughout the pandemic and even after the initial threat subsides. “They need to take care of themselves better than they ever have before,” insists Haynes, author of Take Control of Life’s Crises Today! A Practical Guide.

Counselors need to apply the same coping strategies and tools to themselves that they give to clients, Haynes says. These include getting proper sleep, exercising, connecting with others, taking breaks, processing their emotions, turning off the news and getting outside.

Ali acknowledges that she has been feeling the stress of handling her own anxieties and concerns about the pandemic while also maintaining her current caseload. At first, the pandemic was the main topic for all of her clients, but this is evolving, she says. Now that most of her clients have adjusted to a new routine, they are again discussing their primary concerns that originally brought them to counseling. Still, Ali thinks it is important to do a quick check-in with her clients about how they are coping with the ongoing stress of COVID-19.

Self-care becomes even more important for counselors when sessions all deal with the same topic, giving clinicians few breaks to escape from it, Ali says. She has been coping with her stress by journaling, doing yoga, dancing, walking her dog, practicing mindfulness, reading, doing video chats and exercising.

Counselors need to remember that they are affected (whether directly or indirectly) by this pandemic too. Before the pandemic, most of Ali’s clients used traditional counseling, but with physical distancing rules in place, they now mainly use telebehavioral health. Ali acknowledges that staring at a screen for long periods of time has been taxing for her.

Taking breaks from the screen and using a semistructured schedule for both her personal and work schedules have been helpful coping strategies for her. When she feels particularly overwhelmed, she also practices a “digital detox,” putting her digital devices away for a day and focusing on her self-care to find her equilibrium. If a complete digital detox seems intimidating to counselors or clients, she encourages them to create small, manageable digital boundaries such as stepping away from their devices for a few hours or setting a timer to minimize their use of electronics.

For counselors in private practice, isolation can be another pronounced risk during the pandemic, Haynes points out. He highly recommends that counselors seek out colleagues for consultation, support and supervision during this stressful time.

Much like counselors advise their clients to look for individual and community strengths, clinicians can listen for examples of clients’ resilience, Dailey says. This may result in vicarious resilience, a concept developed by Pilar Hernandez-Wolfe, David Gangsei and David Engstrom in which therapists experience their own personal growth by witnessing and recognizing the growth of their clients.

Adjusting to a new normal

Even after the number of COVID-19 cases subsides, life won’t just go back to normal. The reentry process is going to upset people’s routines all over again, Haynes predicts. For that reason, he and Muratori advise that counselors prepare to take a more directive stance with some clients and focus on their life skills during the transition back toward a “new normal.”

Counselors may need to provide clients with guidelines, instructions or demonstrations, or they may have to model or teach clients new skills, Haynes and Muratori say. For instance, some clients who have been laid off may need help filing for unemployment, conducting a job search or applying for new jobs. Others may need guidance on how to safely reenter their workplace or physically interact with family, friends and community members for the first time in months.

Counselors will also have to help clients manage expectations, Dailey says. For example, many clients may now be dreaming of returning to work, but when that finally happens, they could very well find themselves stuck in meetings again and wondering what their kids are doing at home. Likewise, parents feeling impatient about their children returning to school may have forgotten what the old morning struggle was like to get everyone off to school and work on time.

Adjusting back to something resembling the previously normal routine as stay-at-home orders are lifted will take time. Dailey thinks the adjustment will come in phases. People returning to work will be one round of adjustments. Then there will be another adjustment period as schools attempt to reopen in the fall. 

It is also important to note that clients won’t just be going back to “work as normal,” Dailey says. Even if they return to the same job and the same physical work location, things promise to be different in the wake of COVID-19. These differences may cause some clients to feel relief, whereas others will experience a new round of anxiety and fear.

Dailey compares these adjustment phases to a flipbook. Everybody has their own unique story with the pandemic, and every page of the flipbook represents a new experience, a new adjustment. Counselors can help clients process and cope with these adjustments by “flipping” through their stories, stopping at certain points, and assessing how the clients reacted and coped with that part of their story. The tools they used to cope — making art, meditating, sewing, exercising — are ones they can use again in the future as they adjust to a new phase, Dailey says.

The COVID-19 pandemic possesses the potential to change the counseling field and how professional counselors work with clients now and in the future, Haynes says. Since the turn of the century, it’s true that the United States has experienced major crises such as 9/11, large-scale natural disasters and the Great Recession, but, as Haynes points out, there hadn’t been a crisis on a global scale like a world war until COVID-19. This experience could shift the focus more toward prevention and preparation (both for individuals and for systems on a national level) for future crises, he says.

Adjusting to this new normal doesn’t have to be all negative. Once we reenter society after the threat of COVID-19 subsides, we will be able to celebrate regaining some of our old coping strategies as well as the acquisition or discovery of new strengths along the way.

Counselors are in position to help clients gain greater perspective and self-awareness while coping with the stress and loss that the pandemic has introduced, Ali says. To aid in that process, she sometimes asks clients who have already adjusted and are successfully coping with this stress and loss, “What are you learning during this time?”

In asking that question, Ali has found that several of her clients now understand how the coping skills they previously learned in counseling have helped them handle this stressful moment in history.

How we cope with the stressors of COVID-19 can tell us a lot about ourselves, Ali says. While it may be unpleasant, we can use these times as learned lessons that will help us continue to adapt and manage stressors in the future.

But for now, just take a deep breath.

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.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.

Counseling’s evolution under COVID-19

By Bethany Bray May 20, 2020

Under a shelter-in-place order, are professional counselors considered essential workers?

What if a client’s insurance covers in-person therapy but doesn’t cover video or telephone sessions?

Are Skype, WhatsApp or Zoom compliant with health privacy laws?

My employer expects me to continue seeing clients in person, but I’m not comfortable with the health risk that entails. What can I do?

This spring, worried practitioners flooded the American Counseling Association’s on-staff ethics specialists with these and many, many other questions as the new coronavirus that causes COVID-19 gradually became a concern and then — very rapidly — upended the landscape of daily living across the United States. The past three-plus months have presented a steep learning curve for professional counselors, especially with the pandemic causing disruptions and difficulties with something at the heart of their work: connecting with people.

Many counselors in clinical settings responded to these new realities by ceasing in-person interactions and quickly getting up to speed to offer client sessions via telebehavioral health. Most school counselors and counselor educators found themselves negotiating unplanned extended breaks or even abrupt halts to their school years in early spring. Many of these professionals navigated a similar scramble to that of their clinical counseling colleagues, having to adopt and use new technologies so they could continue supporting and teaching students online.

In addition to those challenges, the economy took a dramatic downturn, causing many counselors to wrestle with financial worries and even job uncertainty. Despite the widely reported rise in mental health concerns connected to or exacerbated by the COVID-19 pandemic, some counselors are facing income loss because of a decrease in clients. That’s due in part to many clients experiencing financial struggles of their own, including loss of insurance.

Under the strain of adjusting to this new normal, counselors say they have experienced a flood of emotions, from stress, worry and fear to vulnerability and frustration. At the same time, professional counselors are finding silver linings, such as learning the heights of their own strength and flexibility.

“It’s exhausting,” acknowledges Andrea Morganstein, a licensed professional counselor (LPC) and owner of a solo private practice in West Chester, Pennsylvania. When interviewed in mid-April, she had shifted her entire client caseload to sessions via telebehavioral health. “It’s been a constant evolution,” she says.

Morganstein says she has been relying on the support of her professional peer consulting group, which has been meeting virtually more frequently throughout the spring. In addition, she says her new self-care routine of taking a walk every morning at 7 helps her to anchor her day and maintain a stable schedule, including observing regular mealtimes and bedtime.

“I’m not scared of the virus. I try to take the approach that if there’s nothing to worry about right now, there’s no productive reason to take on extra worry. [But] at times, I’m not feeling good about myself and getting down on myself about not being able to manage everything and get enough work done,” she says. “I’ve learned about how much I was taking for granted in terms of the day-to-day social contact that I had [before the pandemic] and that it’s so important that it’s worth putting in the extra energy that is needed now to maintain those relationships and feelings of connection.”

As this article was being written in April, there were still many questions about how COVID-19 might affect the counseling profession over the long run. Will counselors rush back to offer in-person sessions as soon as possible — and will clients rush back to schedule them — after becoming more comfortable with online therapy? Will some of the emergency measures that offered flexibility regarding regulation of telebehavioral health spur change for the future? Will a mental health pandemic follow the COVID-19 pandemic as some experts predict?

Only time will tell. In the meantime, professional counselors will continue to do what they do best: supporting their clients and students, regardless of setting or circumstance.

Navigating the learning curve

Morganstein had set up the office at her practice so that she and the client sat perpendicular to each other during sessions. The comfort of that arrangement went missing when Morganstein shifted to offering sessions exclusively via video and phone in mid-March.

In addition to learning and adjusting to the technical piece of telebehavioral health, including a new web camera that initially caused extreme frustration, the medium forced Morganstein  and her clients to be “eyeball to eyeball” for video sessions. Some of her clients who struggle with self-esteem also expressed discomfort at seeing themselves for the duration of their sessions in the little video box in the corner of the screen.

When sitting with clients in her office, Morganstein often uses her own body language and positioning to help clients feel more comfortable during moments of silence or when struggling with difficult emotions. That subtle strategy is harder to deploy with telebehavioral health sessions. Although, as time has gone on, Morganstein has adjusted to sit farther away from the camera to bring more emphasis to her upper-body language and less to her face, she says.

“The biggest thing for me has been the use of silence. I have been finding that sitting in silence in telehealth feels different — more anxious and less comfortable for me,” says Morganstein, a member of ACA. “In exploring that, I realized when there’s silence on a video or phone call in the social realm, it’s a cue to say goodbye; we’ve said all we need to. But in therapy, I will often use silence to give the client space to think or process [a question or topic] or think through a new idea that’s coming to them. You can see it in their body language, that they’re ‘getting it’ and seeing a concept. It’s much harder, in my experience anyway, to do that in telehealth.”

“I’m finding instead that in my own internal experience with telehealth, my brain is telling me that I should be doing something — I should be keeping this conversation going and doing something to fill this space. It shifts the role that I typically inhabit in counseling,” Morganstein continues. “At some point, I do think it would be helpful to put it on the table and say [to the client], ‘Gosh, this feels different. Here’s a time that I would [normally] sit here quietly and let you think. What is this feeling like for you?’”

Morganstein says she is trying to stay mindful that as different as this new normal feels for her, it feels just as different for her clients. As the weeks pass, she continues to look for ways to shift her approach and re-create the warmth and openness she strives for during in-person sessions.

She lives in a townhouse with her spouse and children, so she has set up a section of her bedroom to conduct video therapy sessions. She has staged a section of wall to mimic an office setting, complete with a plant, a lamp and a canvas print. “I refer to it as ‘my home office’ to my clients. But it’s my bedroom, and I can’t leave confidential files lying around. That’s the part I’m finding very stressful,” Morganstein says.

Morganstein says the shift to telebehavioral health has also caused her to adjust the methods she uses with clients. In person, she often writes on a whiteboard in her office during sessions to illustrate a topic. “I find that [now] I am encouraging my clients to do a little bit of [in-session] journaling themselves, when normally I wouldn’t have slowed down to have them do it,” Morganstein says. “I’m finding it to be powerful and will bring it more into my in-person work. … I’ve learned that I should have clients write things down more on their own, in their [own] words. At the end of the session, they’re more likely to internalize what we just talked about when their brain had to do the work to construct it and put it on paper.”

On the minus side of the ledger, Morganstein says the exposure component of the social skills work she does with clients with attention-deficit/hyperactivity disorder has “ground to a halt” because clients aren’t leaving their homes. She is also finding that in-depth counseling work such as processing trauma is being put on hold because clients need to focus on more immediate needs such as dealing with the stress of going to the grocery store or, for school-age clients, mourning the loss of school activities and graduation celebrations.

“Doing trauma work temporarily leaves clients more vulnerable,” Morganstein points out. “Now is not the time to leave people feeling more vulnerable or emotionally exhausted.”

Morganstein also believes some clients have taken her off of a pedestal after watching her operate outside of her typical office environment — and she is comfortable with that. Seeing her struggle with technology at times or hearing her dog bark occasionally during sessions has allowed more opportunities for her clients to see her in a new light. “It’s OK to be human with your clients,” she stresses.

Morganstein recalls one session — or rather, an attempted session — scheduled with a middle school-age client in the early weeks after switching to telebehavioral health. Morganstein had sent the client’s mother a link to connect on the video platform she uses. When it came time for the session, Morganstein couldn’t get either the microphone or camera on her computer to work. She knew she needed help from her husband — “my IT guy,” she jokes — but counseling ethics regarding confidentiality dictated that her husband should not see the client, who was visible on the video feed. The client’s mother offered suggestions, staying online with Morganstein as she tried to problem-solve, but after 25 minutes, Morganstein gave up and ended up rescheduling the session.

What could have been a frustrating or angering situation for both parties actually ended up improving Morganstein’s relationship with her young client’s mother. The client was relatively new to Morganstein’s practice, and before this incident, the mother had been a little nervous and somewhat guarded around Morganstein. After witnessing Morganstein in a vulnerable situation, the mother seemed to feel much more comfortable around her, even making the occasional joke, and their relationship has grown since that time, Morganstein reports.

Practicing what you preach

Licensed mental health counselor Stacey Brown closed her Fort Myers, Florida, group counseling practice and began offering client sessions via phone and video on March 13, well before many practitioners in her area were doing so. It was becoming clear to Brown how easily the COVID-19 virus could spread, and knowing the number of clients who came through her office in an average week, she followed her gut instincts that Friday and made an impromptu decision to cease in-person sessions. “It just felt like the right thing to do,” Brown recalls.

Since then, Brown has been able to keep a full schedule of client sessions while working from home. She has found that a majority of her clients prefer telephone sessions. To retain focus during sessions and maintain some privacy from family members or others with whom they live, Brown’s clients have talked to her while sitting in a parked car, taking a walk or even floating on a raft in a backyard pool.

“All of my clients’ [presenting] issues are still happening, so they need support — or need even more. When people are forced to be by themselves, they have to deal with themselves. A lot of our talk [in sessions] has been on how to deal with ourselves,” Brown says. “For me, when you’re with somebody [a client in session], you need to really be with somebody. You need to be 100 percent present. You can’t go into a session with preconceived notions. That really messes you up. You can’t go into a session and think, ‘Today we’re going to talk about her mother.’ … Over the phone, it’s the same — sitting and really listening and concentrating. I really feel like I can be right there with them, and it’s turning out OK.”

Client struggles with anxiety, trauma and grief have intensified since the outbreak of the new coronavirus, says Brown, a clinical supervisor and ACA member. In addition to using cognitive behavior therapy and other methods, Brown has found it helpful to emphasize calming techniques such as breath work and meditation with clients. She has also ramped up conversations and check-ins about how well clients are sleeping, engaging in self-care, staying hydrated and eating — some of the foundations of Maslow’s hierarchy of human needs.

Wellness practices can help counselors and clients alike process and digest emotions, just as the body digests food, Brown says. “Now is not the time to do just counseling or just therapy,” she says. “Ask your clients if they’re having neck and shoulder pain, or how are they sleeping and what are they eating. Everyone is ramped up right now, and we need to take care of our bodies. Talk about stretches and relieving tension and the difference between shallow breathing and deep breathing. Remember the mind-body connection.”

As the pandemic continues to affect counselors’ work, Brown emphasizes that practitioners — now more than ever — need to heed the guidance they give their own clients: Don’t forget the importance of self-care, and find ways to move away from rigid and one-dimensional thinking.

“If we’re upset because things aren’t the way they are supposed to be, we will only get madder and more closed off. See this change as an opportunity, a chance to be creative and flexible,” she says. “You have to nurture yourself and find balance. This includes turning off the news, if needed. Take the same advice you give your clients [to] be aware when your anxiety is rising.”

Likewise, counselors often encourage clients to be intentional about their life choices and the goals they set. The same guidance applies to practitioners themselves, especially during times of crisis, Brown asserts. Brown, who is certified to teach yoga and meditation, has found ways to diversify her work and supplement her income from counseling. In addition to offering meditation and yoga instruction, she paints and sells her artwork, writes, and supervises counselors-in-training.

From Brown’s perspective, the business side of counseling is a lot like a tennis match. When your opponent is about to serve you the ball in tennis, she explains, you don’t know where it will go, so you have to be agile and “springy” in order to run and meet the ball. So too with running a business: You have to think ahead and be both prepared and flexible when challenges arise.

“Counselors can’t just sit in their office and see people anymore; they need to diversify and have multiple income streams. We can’t just be awesome clinicians; we have to be awesome business people as well,” she says. “We have to practice what we preach — and this is the challenge, always. If you’re constantly in the box, then that’s where you’re going to stay. … If you’re always reactive, then you’re going to have some trouble with your business. If you’re intentional and manifest what you want, then you’ll be fine.”

Professionally, Brown says these past few months have presented her with lessons in creativity, patience, gratitude and self-trust. Even though she loves her office setting, she is thinking of continuing to offer telebehavioral health from home one day per week after the COVID-19 pandemic subsides.

“This has given me time for self-examination and time to reflect and confer with others on how they’re running their businesses,” Brown says. “Aside from the health fears, it has been a rejuvenating time for me because of the creativity element. When I was in the office, I was all zoomed in on day-to-day activities. Now I have been able to zoom out and see things from the big[ger] picture. It’s different somehow. … It’s helping me to refresh my perspective and stay curious on how to do this and how to grow my business to be sustainable to attain my ultimate goal: to help people.”

Emphasizing safety

Linda Diaz-Murphy has been doing play therapy with young clients via telebehavioral health ever since New Jersey enacted a shelter-in-place order in March. Parents and youngsters alike have easily adapted to the medium, she says. A parent or caregiver is always present during the session, and young clients use a combination of their own toys and play therapy items such as sand trays that Diaz-Murphy previously sent home with families.

Even when delivered via telebehavioral health, Diaz-Murphy says, the focus of play therapy remains the same: building clients’ sense of safety and developing their coping skills and strategies. This includes talking about and processing emotions as young clients draw or create scenes with figurines.

“We use whatever resources they have,” says Diaz-Murphy, an LPC and registered play therapist whose private practice in Leonia, New Jersey, is 15 minutes away from the George Washington Bridge leading into and out of New York City. “One child likes to cook [using a play kitchen] and feed everyone in his family. We used to do that in the office, and now we’re doing that in teletherapy. We’re continuing to do the same things in the home as we do in the office, which is really amazing. Nothing has really changed except the location.”

Diaz-Murphy has also been emphasizing safety with her adult clients in the form of extra outreach. As soon as she switched to telebehavioral health, Diaz-Murphy increased her communication with clients, checking in regularly (once or twice per week) via phone or text message. She has let her entire caseload know that she is available for extra sessions or even “just to talk,” although she limits client phone calls outside of sessions to 30 minutes.

“It’s more than I would usually do, but this is important,” Diaz-Murphy says. “Years ago we called it proximity control, but it is just being there for [clients], helping them feel safe and know that you’re there to help.” It also involves staying close with and being available for clients without being too intrusive, she explains.

One of Diaz-Murphy’s clients, an adult man who lives alone and is geographically separated from his family, had a relative die of COVID-19 in April. Initially, he was hesitant to use telebehavioral health, but Diaz-Murphy continued to stay in touch with him via text message. Eventually, he agreed to participate in a counseling session over the telephone. Now they are in contact roughly twice per week, and the client is reaching out to her instead of the other way around, which Diaz-Murphy views as a very positive development.

“What is important for me, especially during this coronavirus crisis, is to always be honest [with clients], share my limitations, discuss options, think of safety first, be patient, offer reassurance, speak in hopeful tones and use hopeful language, remain in the present and think of the future, make myself available, and remember [that] my presence is important,” Diaz-Murphy says.

Diaz-Murphy has completed extensive training in disaster mental health and is a crisis response counselor. She has drawn on that knowledge this spring, she says, adjusting her approach to meet her clients’ needs as anxieties swelled and so much was unknown. Part of her own coping strategy during the pandemic has been to continue learning. She recently completed a training on offering disaster mental health and crisis counseling over the phone, including best practices on strategies and language to use.

A little humor can also go a long way when anxiety is swelling, Diaz-Murphy says. During the toilet paper buying frenzy (and ensuing shortage) that accompanied the first several weeks of COVID-19 in the United States, she found a website that calculated how much toilet paper each household would need to make it through quarantine. She shared the site with a few clients to lighten the mood.

“It’s a source of humor, but [there’s] also a reality that people are afraid that others will take resources and there won’t be enough left. It’s the same with food. This [toilet paper calculator] puts things into perspective for people, and then it helps in other ways,” says Diaz-Murphy, a member of ACA.

Most of all, she has focused on making sure her clients have appropriate self-care and coping mechanisms in place to deal with the worry and uncertainty that have accompanied the pandemic.

In times of crisis, professional counselors must remember to trust themselves and fall back on their core counseling skills: empathy, communication and listening. “You want [clients] to be in control and feel empowered,” she says. “Behave the same way that you would in the office: Don’t panic, stay calm, and treat your clients with respect. Let them know that they can manage this, and give them the tools to manage.”

Finding connection on camera

Chris McClure still drives to her Manassas, Virginia, private practice to conduct telebehavioral health sessions, even though clients are no longer coming in. Sitting in the same chair and being in the same space where she used to conduct in-person counseling helps her to focus and “switch gears” from the personal to the professional, says McClure, an LPC and a member of ACA.

She also thinks it is important to retain that familiar setting for her clients. When Counseling Today interviewed her in April, McClure was working to set up her laptop so that clients would see her at the same angle and with the same backdrop as if they were sitting in the client chair in her office.

She admits that she is still struggling to strike the right balance while using telebehavioral health. Initially, she felt too detached and too “pulled away” from clients through video. Sometimes she feels that she has to “project my empathy larger than life” to get through to clients.

“Video doesn’t feel very intimate, and therapy is a very intimate interaction,” McClure says. “It can be kind of intrusive. I am coming into a client’s home, and some are uncomfortable with that.”

McClure also tries to use her facial expressions to connect more with clients. The human brain is hard-wired to recognize emotions in others’ faces, so clients can pick up subtle cues, she says. “If they can see us looking reasonably calm and conveying very soothing messages, then they are better able to handle their anxiety,” she says.

When clients express discomfort about using video for counseling sessions, such as remarking that their home is messy or apologizing for family members who wander into the screen, McClure acknowledges that adjusting to the new medium is hard. To further validate their feelings and set clients at ease, she sometimes remarks that it would be difficult for her to “let someone in” to her home and that she is grateful for their hospitality. Complimenting something that she sees on camera, such as a pet or a piece of art on the wall, can also help, she notes. With clients who still seem a little uncomfortable, McClure revisits the topic in future sessions to help them continue to adjust.

“For most clients, after a time, they forget that they’re not in the office and just focus on me. Others are more aware of the limitations of it,” McClure says. “I’m very much a perfectionist and very much a caretaker, and I want this to be as comfortable and smooth for clients as possible. I’m very much aware when things are missing. [But] I do think that it’s possible to get there with this technology.”

One particular challenge McClure has noted while using telebehavioral health is picking up on clients’ nonverbal cues — something she says comes as second nature to her in person. Recently, she was conducting a session with a client, and the image quality and delay of the video feed made it difficult for McClure to recognize that the client was on the verge of crying until tears were streaming down his face.

“I’m working overtime to listen for those subtle cues in their voice. After almost 30 years [as a counselor], a lot of that is second nature, autopilot, and [now] I have to bring that up to a more conscious level of listening,” she says. “When you’re together with a [client], you can notice the slightest twitch of an eyelid or small facial movements that can convey so much, especially when people are trying to hide their emotions.”

At the same time, McClure acknowledges that her clients are expressing more basic needs right now, such as managing anxiety and getting enough sleep, which aren’t as dependent on nonverbal cues, or at least not at such a deep level as other counseling topics might involve. “It would be exaggerating to say that people are regressing [in therapy], but there is some truth to that. Some of what I’m doing is crisis management,” McClure says.

So much has felt like a moving target as the COVID-19 pandemic continues to unfold and new information becomes available, McClure notes. She has been trying to find a balance between staying informed and limiting her exposure to the news.

“I see a lot of [clients] with anxiety, and I’m trained to help them with [distinguishing between] rational fears and irrational fears, and it’s been very unclear between those two. I have some people who are absolutely terrified and don’t want to leave their homes, and others who think we’re overreacting. It’s hard to feel like I, as a counselor, have an authoritative message when there’s so much mixed information out there. … I think the vast majority of Americans are feeling a considerable amount of anxiety. This [virus] is a substantial threat to our way of life, our well-being, both health and economic.”

McClure has completed a number of trainings on telebehavioral health over the course of her career, although she didn’t use it much until the COVID-19 pandemic hit. She plans to seek more continuing education to keep adjusting to the medium. Eventually, she’d like to transition to semiretirement and be able to counsel clients via telebehavioral health while traveling.

“I’m excited by the possibility that a lot more people are going to get comfortable and used to [telebehavioral health],” McClure says. “Part of the reason I’ve been interested in distance counseling is that there are a lot of underserved populations [that could benefit]. I specialize in working with transgender clients and clients with gender concerns, and there are not that many practitioners who are genuinely trained and qualified to work with these clients once you’re past major cities. There are huge parts of [my] state that are just not well served on certain issues. I really like the idea that a client could get really quality therapy, even if there’s not a therapist within 50 miles. … Hopefully some of the temporary things that have happened during this [pandemic] will stay in place and [result in] positive change.”

‘We’re stronger than we think’

Celine Monif has a private practice near the junction of two states, Iowa and Nebraska, that have not enacted shelter-in-place orders. That has created a sticky situation, Monif says, because she can only suggest telebehavioral health and encourage her clients to use it. The other option would be to voluntarily close her office, but Monif is unwilling to do that because it would disrupt or suspend treatment for clients who are unable to use telebehavioral health. For those who opt to continue with in-person sessions, she has been seeing clients at her Bellevue, Nebraska, office, spacing out sessions so that no two clients cross paths and risk infecting each other.

“It’s been a heavy mix of demand and resistance to go to telehealth, which would not happen in a shelter-in-place state,” Monif says. “Some [clients] are coming in because this is their safe space, and they don’t feel they would get the [needed] privacy or freedom to talk freely at home.”

Monif, an ACA member, holds two licenses. She is a licensed mental health practitioner in Nebraska and a licensed mental health counselor in Iowa. She estimates that roughly one-third of her caseload continues to come in for in-person sessions. Some of these clients simply aren’t comfortable with telebehavioral health technology. For others, it poses logistical challenges. For example, one of Monif’s teenage clients continues to come to the office for in-person sessions because she doesn’t have a cell phone of her own and her large family has only one computer to share between them.

To minimize the risk of infection, Monif has been sanitizing her office and waiting room after every client, taking her temperature each morning, washing her hands regularly, and opening the door for each client so they don’t have to touch the doorknob. She has also posted a sign on her office door asking that people who are sick or have a fever not enter.

Monif admits that she has experienced a roller coaster of emotions this spring. “Because it’s the Midwest and we’re not the epicenter of the virus, we still have a percentage of people who are not taking this as seriously as they probably need to. This can be frustrating,” she says. “But at same time, there’s compassion. I understand about their fears or hesitancy to give up the safe space of my office. I understand the anxiety and feel a lot of compassion for them. … My emotions fluctuate so quickly throughout the day.”

In the past, Monif typically accommodated one or two pro bono clients at any given time to help those who couldn’t afford counseling or had lost their insurance coverage. With the recent economic downturn in the wake of COVID-19, that number has increased, with Monif offering pro bono sessions for several clients who have lost jobs or been furloughed.

“It would be unethical for me to stop [treatment] and not try and help them,” she says. “My husband and I are both working and will be OK for the near future. We have that luxury, so I will continue [to offer pro bono services].”

A trained volunteer for Nebraska’s Critical Incident Stress Management program, a statewide team that offers mental health debriefing for first responders after major incidents, Monif is also offering free sessions for first responders who need counseling.

The counseling profession’s swift and unexpected pivot to telebehavioral health this spring has revealed a few challenges that will need to be addressed for the long term. For example, there have been mixed messages concerning which telebehavioral health platforms are compliant with health privacy laws. Professional counselors need clearer guidelines both from licensing boards and insurance companies, Monif says.

“[Practitioners] in my area often have clients across state lines, and there’s some confusion on what our license allows. It’s a new territory,” Monif says. “When everything comes out, we’re going to have a little bit to unravel. … It used to be that online therapists were a specialty, and now it will be more of the norm. There will be a huge influx of providers who provide online therapy.”

“If there’s a silver lining to this,” she continues, “I’m hoping this helps raise the awareness that this [telebehavioral health] is something we need. It’s an essential service. People need access, and right now it’s an imperfect system, and we need to work on it.”

The fallout from COVID-19 has ushered in an opportunity (even if unwanted) to learn and see things from a new perspective, Monif says. She has witnessed counselors in her area rise to the occasion and rearrange their entire practice to work online, all while caring for family and dealing with both the personal and professional stressors of the coronavirus pandemic.

“I have learned that if I have to adjust quickly, I can,” Monif says. “I went from having zero telehealth clients to [those clients being a major] part of my caseload in seven days. I learned that we’re all in the same boat and we don’t have the answers, but we’re learning as we go. This threw us all off-kilter, and we’re still day by day, [but] we’re all so adaptable, and that’s great to see. … We’re stronger than we think, [but] we also need to make sure we’re taking care of ourselves. Find a balance between managing your own emotions, taking care of family, and being responsible for clients and helping them. Find that balance, and you’ll be OK.”


Identifying potential in crisis

Although the COVID-19 pandemic has forced some unexpected changes to the way professional counselors are working, it has also brought immense potential for practitioners to flex their outreach and advocacy muscles, says David E. Jones, an LPC in the Cincinnati area.

Counselors are well suited to help with the many needs that have arisen alongside COVID-19, from the anxiety and isolation that can accompany shelter-in-place mandates to the distress and burnout felt among health care workers and first responders, says Jones, an ACA member and assistant professor in the Department of Counselor Education and Family Studies at Liberty University.

“There is a chance of having a mental health pandemic after all of this. What are we [counselors] doing? What can we do? What should we do to help our communities? What are we going to do six months from now, beyond just our individual clients?” asks Jones. “Part of this is getting outside our walls of one-on-one thinking and coming together as a profession and collaborating across professions to address at-risk populations and structural disparities. We need to be collaborating with public officials and sitting at those tables for long-term planning and thinking of the mental health aftermath.”

Jones urges counselors to take their role as advocates seriously and to think about how they can reach across disciplines to address mental health in their communities. This could include collaborating with local organizations, schools and even houses of worship, but it should involve thinking outside the four walls of the counseling office, he emphasizes.

“Show up at town hall meetings or sit down with local politicians. Offer to go to your local firehouse and talk about mental health first aid. Or send them a letter and offer to have coffee with them and offer your insights,” suggests Jones, who was a public health researcher, including time spent as an infectious disease epidemiologist, before switching careers to become a professional counselor. “It doesn’t have to be a huge elaborate thing, but it’s a drop of water in a pond, and if you have a lot of people putting a drop of water in, it’s going to ripple and make a difference.”

For example, there will be immense need for career and employment counseling in the coming months, with millions of Americans being unemployed or underemployed. Counselors could host community workshops focused on learning job search and interview skills, seeking job training or studying for the General Educational Development exam.

“Counselors have so many points of contact to make a difference, [including] schools, parents and other nonprofits. Who do you know that could make a difference? Go and speak at groups, provide psychoeducation [about mental health], and shine light on local resources. We need to get out of our silos and work across professions. There’s connection points that can be made, and sometimes you just have to think outside the box to make them.”

In the wake of the coronavirus crisis, there is great potential to expand the counseling profession’s reach and impact while meeting needs in counselors’ communities, Jones stresses.

“During a time like this, we get a chance to reflect on who we are. And that’s a good time to make us pause and look at things that are working, and things that aren’t working, and have a potential place to effect change,” Jones says. “You can focus on the distressing part of this, or you can introduce yourself to fellow counselors in town and ask if they need anything. It’s time to reflect and be more person-centered than we were before.”

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Professional resources

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

Encouraging T-shaped thinking in the counseling profession

By John McCarthy May 18, 2020

I thought it was a most ridiculous assignment. The instructor of my Introduction to Counseling course in 1988 asked us to write, of all things, a book report. “Make sure the book has nothing to do with counseling,” he directed.

I was incredulous. “My first class in counseling, and he’s asking us to do a fifth-grade assignment?” I wanted to learn everything I could about counseling, especially in an initial course, and a book report was not on my anticipated list of important things to do.

Years later, I realized that it was a brilliant stroke by the professor, and in 2020, I believe it could well be a portal to the future of the counseling profession. With a strong interest in creativity, I now realize the impetus of the assignment. The instructor wanted us novice students to know things outside of counseling. Go learn about Portuguese history, quilting or the evolution of vacuum cleaners.

The assignment concerned creativity and, in retrospect, was aimed at helping us counselors-in-training with our creative “shape.” Creativity involves being a “T-shaped” person, a term originating from a well-known design firm named IDEO. The T-shape idea entails a person knowing a great deal about a specific discipline and having a breadth of knowledge in other fields. It is not a matter of being an expert in only one area, represented by the vertical line in the T, but also being able to draw from other arenas, as represented by the horizonal line.

In her 2009 book What I Wish I Knew When I Was 20: A Crash Course on Making Your Place in the World, Tina Seelig related the importance of developing T-shaped thinkers in directing the Stanford Technology Ventures Program. The aim was straightforward: Students would have an extensive knowledge base in one discipline, perhaps science or engineering, along with, in this case, innovation and entrepreneurship.

It is the combination skills that can be central to creativity. Incidentally, it is these skills that represent the C (combination) in the commonly cited SCAMPER acronym of creativity. Linking ideas from counseling with web design, political science or chemistry can lead to innovative solutions in any number of roles that counselors play, including as consultants, crisis responders or group facilitators.

In her book, Seelig also observed, “Life presents everyone with many opportunities to experiment and recombine our skills and passions in new and surprising ways.” T-shaped thinkers can draw from other parts of their knowledge base in that recombining process to formulate more creative solutions to challenges.

Radical collaboration

The T metaphor isn’t just about individual counselors though. It also concerns our counseling profession and, in my opinion, how it can be strengthened in the coming years. Yes, integrated care is critical to counseling, but I believe that interprofessional partnership extends beyond this model.

“We believe in radical collaboration.” The last two words caught my eye as I read the “We’re glad you’re here!” brochure during a recent visit to the Hasso Plattner Institute of Design at Stanford University. Also known as the “d.school,” this internationally recognized institute offers students from an array of disciplines — including engineering, law, business and medicine — the opportunity to deepen their creative skills and gain design competencies toward solving complicated dilemmas.

The same brochure posed thought-provoking questions, one of which fits the notion of “radical collaboration” and the future of the counseling profession: Choose two diverse occupations and list ways that they could work together to answer a challenge in the real world. If counselors were chosen as one of the occupations, imagine the potential life-changing ideas that could be sparked in partnering with oceanographers, mathematicians or cybersecurity specialists. Imagine how social justice, advocacy and consultation could be integrated. Imagine how such an adventure could result in even more creative T-shaped counselors-in-training and professional counselors.

Work involving the search terms “interprofessional” and “counselor” would appear to be limited, although the topic has been discussed in the literature for at least 30 years. Elizabeth Mellin, Brandon Hunt and Lindsey Nichols conducted questionnaire-based research among counselors in 2011 that included a discussion on interprofessional collaboration. In a 2016 study, Christianne Fowler and Kaprea Hoquee (nee Johnson) described a one-day standardized patient experience among students in counseling, nursing and dental hygiene programs. In research published last year, Kaprea Johnson surveyed students in counseling, along with those in dental hygiene, nursing and physical therapy programs, and concluded that counseling students were as receptive as the students in health care programs regarding interprofessional training.

Examples of interprofessional interaction are seen in related mental health arenas. Last year, the American Psychological Association announced that it would be partnering with medicine, pharmacy, nursing and other areas to oversee organizational accreditation for interprofessional continuing education. According to the article announcing this recent development, the move was viewed as a benefit to the field, especially in relation to the amount and caliber of continuing education possibilities. A second instance is Robert Morris University’s Access to Interprofessional Mental Health Education program, which aims in part to train psychiatric mental health nurse practitioners to offer care as part of an interprofessional team.

Identity is central to our counseling profession, and T-encouraged initiatives with other domains can make us better as a whole, broadening our collaboration with — and increasing our visibility by — other fields. Continuing education regulations could be modified to include domains outside of counseling. Imagine counseling conferences with people from other areas such as pharmacy, dentistry, media relations, medicine, computer science and the design industry. Presentations by counselors in tandem with dietitians, architects and TV producers could deepen our knowledge bases and foster further cross-disciplinary collaboration.

Programmatic standards could be adjusted to encourage (or perhaps even require) counseling students to take at least one elective outside of the department. They could learn about the future of health care in a medical curriculum, about correctional reform in other countries in a criminology program, or about sustainability in an engineering course.

T-shaped efforts at the professional level would deepen our collective cultural competency and contribute to our collective mindfulness. Kio Stark devoted a 2016 book to talking with strangers, and her message aligns with the present-moment orientation that counseling espouses. “When you interact with a stranger,” she wrote, “you’re not in your own head, you’re not on autopilot from here to there. You are present in the moment. And to be present is to feel alive.”

Developing cross-disciplinary tentacles can aid our future. T-shaped counselors and a T-shaped profession can broaden our scope, charge innovative ideas, emphasize wellness and deepen counseling’s visibility.

Counseling is a holistic, collaborative approach. Let’s extend the letter T in encouraging creative counselors and, ultimately, an innovative counseling profession.

The letter of tomorrow is T. Now let’s all go read some books.

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John McCarthy is a professor in the Department of Counseling at Indiana University of Pennsylvania. Contact him at jmccarth@iup.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.