Monthly Archives: August 2020

Using apps to promote client safety

By Marissa Gray and Victoria Kress August 12, 2020

Daily, professional counselors work with clients who live in unsafe situations involving exposure to violent and exploitative relationships. These unsafe situations might include experiencing partner violence or being the victim of child abuse or human/sex trafficking.

Especially now, during the coronavirus pandemic, partner violence and child abuse are on the rise. Clients are at a heightened risk of violence during the pandemic because of increased stress (which can exacerbate violence), isolation from support systems, and more time spent in close quarters with potentially abusive family members.

When working with clients who are being victimized, counselors have an obligation to promote these individuals’ safety. While perpetrators often use technology against clients to control and further victimize them, recent technology apps have been developed that can help counselors facilitate client safety. We will discuss several of these apps in this article.

Harnessing technology to empower clients

Many client safety concerns must be considered in counseling. First, technology is often used by perpetrators as an additional vehicle for abuse. Technology outlets provide perpetrators with opportunities to antagonize, stalk and ultimately continue abusing and exploiting their victims. Technology that can be used to perpetuate abuse includes tracking devices, location-enabled applications on cellphones, cameras, microphones, social media apps and even simplistic communication methods such as abusive text messages, emails and phone calls.

Clients are often forced to surrender their devices completely, especially if their technology use is being monitored by their abuser or if their number is in any way known by their abuser. Clients might consider changing their phone numbers and presence on social media, but this can be difficult, expensive and time-consuming.

Although taking steps to maintain digital — and, thus, physical — safety involves placing thick boundaries around technology use, it is important to realize the role that technology can also play in supporting survivors’ safety, autonomy and empowerment, all of which are crucial factors in a trauma-informed counseling approach. Counselors can work with clients to maintain their desired level of digital connection while also encouraging them to take measures to be safe.

Overview of apps for client safety

Several apps exist that can offer crucial support and assistance to clients. These apps are free and are compatible with iOS and Android devices, meaning they are widely accessible regardless of the devices clients use. These apps can be powerful and empowering resources. They are particularly helpful for those in violent relationships and for trafficking survivors seeking to extricate themselves from unsafe relationships. They can also empower clients who have been sexually abused or assaulted, as well as those looking to enhance their safety “just in case.”

All of these apps can be easily incorporated into clinical practice. For example, counselors can support survivors in setting up and configuring these apps and talk with clients about how best to use these apps to promote their safety. For many survivors, these apps can be a small step on the long road toward rehabilitating a sense of personal safety. Thus, counselors can play a crucial role in supporting survivors as they process the tangled emotions that accompany the steps of starting to feel safe again.

In this way, the use of technology via apps is an interactive and engaging intervention that can help empower survivors. By incorporating these safety apps into counseling, clinicians can help survivors begin to feel, perhaps for the first time, that they are worthy of protection and deserve to feel safe.

myPlan

Safety plans are an important part of counseling when working with clients in unsafe relationships. Historically, counselors have developed written safety plans on paper with clients, but these can be dangerous because abusers can discover them, and this may invite violence.

One app that can be useful in developing electronic safety plans is myPlan. This app allows clients to craft safety plans and keep them stored in the cloud of their devices. Plans are saved in the app itself, which is then backed up in the cloud, making it difficult for perpetrators/abusers to access.

On this app, individual survivors respond to several brief questions (automatically generated by the app) regarding their relationship and situation. The app then produces a safety plan tailored to the specific needs of the survivor, based on the responses the person provided to the questions.

Use of this app puts a more secure and technologically advanced spin on safety planning. Keeping safety plans in the cloud allows clients to have immediate access to their plans. In addition, this app connects survivors with local resources, live chats with advocates (trained volunteer advocates working with loveisrespect.org) and even emergency medical/shelter options. The live chat option provides real-time support for survivors that can complement and enhance the safety plan.

Noonlight (formerly SafeTrek)

Noonlight allows individuals to call emergency services without having to dial 911 or make any sudden motions that could alert the abuser that the person is seeking help. In actively unsafe situations, this app can save lives. The app can be especially useful for clients who remain in harm’s way or continue to have contact with their abusers.

Noonlight allows users to simply hold the phone in their pocket, purse or another location that is not suspicious. The app comes equipped with a large safety button that, when gently touched, gives real-time notification to local emergency services to send help. The app is location enabled and holds an individual’s data to pass along to law enforcement in the event that the individual is unable to speak, text or otherwise seek help.

This app can prove especially useful for individuals who are being restrained or are unable to verbally communicate their distress. Furthermore, it helps to provide peace of mind and a sense of empowerment to clients. If an individual is at risk of ongoing abuse, this app can assist them in acquiring emergency assistance.

Aspire News

Another app helpful for clients affected by unsafe situations or ongoing abuse is Aspire News. In the event that a client’s phone is being monitored, this app appears as an ordinary news app with daily headlines, weather reports and so on. Embedded in the “Help” section of the app, however, are emergency contacts, resources, and information on shelters and other supportive services offered to those affected by abuse. The app is location enabled, meaning that it can tailor resources for wherever the client is at that particular moment.

Although this app is geared mainly toward clients affected by relationship violence, it can be equally useful when working with clients in other unsafe situations. It may be especially helpful to those being trafficked because these individuals are moved around frequently and may not be aware of local resources or shelters where they can go for assistance. Aspire News can connect these individuals with resources wherever they go, regardless of their familiarity with the area.

Many resources in the app target survivors of intimate partner violence and sex trafficking, but they also service those experiencing sexual abuse or exploitation. Aspire News connects clients with resources such as shelters, food and hygiene pantries, case management, law enforcement and even counseling. Aspire News may be a helpful app to provide to any client concerned about an abuser searching their phones or punishing them for seeking help.

bSafe

The relatively new bSafe personal safety app offers a variety of helpful tools and resources. It provides specific supports to clients who may be enduring ongoing abusive situations and wish to record or gather evidence against their abusers. The evidence can then be saved to the cloud so that it cannot be destroyed.

The bSafe app has both audio and video recording capabilities (the form used is selected by the app’s user) to capture whatever abusive act may be occurring. The app also offers the ability to livestream an abusive incident or assault as it is occurring. All of these evidentiary recordings can be saved to the cloud to ensure that they are not lost or destroyed by an abuser, even if the abuser destroys the device itself. The app also forwards the footage or recording to trusted people whom the client has previously identified and included on their emergency contact list.

For clients who choose not to report their abuse, it can still be empowering for them to know they have evidence to document the trauma they have survived. This leaves the door open for them to report their abuse in the future if they so choose. Accruing such evidence may also help clients feel heard and believed concerning their lived experiences within an abusive relationship. The evidence gathered by the bSafe app may also assist clients in obtaining protective orders against their abusers or perpetrators.

In addition, the app can automatically alert contacts to call 911. The app is location enabled, meaning that it equips trusted social supports with the individual’s location in the event that the individual is in distress and unable to call for help themselves. The app also offers an SOS button and a “fake call” service, further allowing survivors to reach out for support during an abusive situation without pinging the radar of a perpetrator who may notice or monitor cellphone usage. By simply pressing the button, individuals are able to notify emergency services to send help immediately through use of the app’s location-enabled technology.

National Human Trafficking Hotline

Safety planning is crucial when working with clients who have experienced sex trafficking. These clients may be at ongoing risk as various abusers and pimps attempt to wrangle these individuals back into a life of exploitation. As counselors, we can empower this specific population with knowledge of ways to maintain safety during the recovery process.

The National Human Trafficking Hotline has recently begun offering more advanced and accessible options for individuals to use. The hotline provides a plethora of resources and assistance to help clients keep themselves safe. One such resource is the BeFree Textline; individuals can reach out for assistance by texting “HELP” to 233733 in the event they cannot speak freely in the presence of their traffickers or johns. This text line is a powerful resource to share with clients because it offers a great deal of support.

Crisis Text Line

The Crisis Text Line (CTL) can be reached by texting 741741. Callers are then connected with a trained crisis counselor. The CTL is a valid resource for all clients but has immense value for those impacted by relationship violence, trafficking or sexual abuse.

Given that the CTL communication occurs over text, many clients may find it less threatening, or perhaps less noticeable to their perpetrator, to connect with an advocate. The CTL will then connect clients with appropriate referrals and resources that they can use to find support and maintain their personal safety.

Empowering survivors with technology

The aforementioned resources offer examples of apps and other tools that can support clients in their ongoing struggle to maintain safety. Technology can play a unique and emerging role when we work with these resilient clients as counselors. These apps and text tools demonstrate recent advancements in technology that can foster support, safety planning and healing for clients.

Use of these tools is one small way to remind clients that they are indeed worthy of protection, safety, peace and healing. As counselors, we have the privilege of walking alongside these clients in their brave and unique recovery journeys. These technological nuggets provide resources to empower clients while helping to preserve their safety, dignity and healing resilience.

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Marissa Gray is a licensed professional counselor working at Youth Intensive Services in Youngstown, Ohio. She provides trauma counseling to those who have been involved in the sex trafficking industry. Contact her at mgray@youthintensiveservices.com.

Victoria Kress is a professor at Youngstown State University. She is a licensed professional clinical counselor and supervisor, national certified counselor and certified clinical mental health counselor. She has published extensively on many topics related to counselor practice, particularly regarding work with abuse and trauma survivors. Contact her at victoriaEkress@gmail.com.

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

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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.

Encountering and addressing racism as a multiracial counselor

By Michelle Fielder and Lisa Compton August 11, 2020

It was a simple question, “How are you doing?” that started us on a path of discovery. I (Lisa) wanted to check in with Michelle, my teaching assistant, after racial tensions consumed the news. George Floyd had just been killed, and the media were focused on his death, the shooting death of Ahmaud Arbery, and the outcry for justice for the African American community.

Michelle was initially numb, unsure of how to articulate the different thoughts and feelings the recent events had triggered for her. I could tell she needed a break from our usual academic work, so I assigned a reflective activity to give her space for introspection.

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The events brought to my (Michelle’s) mind a comment that actor Will Smith had previously made on a late-night television show: “Racism is not getting worse; it’s getting filmed.”

As my ideas began to crystallize, Lisa and I began to share our perspectives on the sobering current events. The result was a rich dialogue between us — raw, authentic and refreshingly open.

What follows is an excerpt from our discussion. We hope that it will stimulate other discussions and encourage counselors to not fear engaging in dialogue about race. We believe that such open communication will help us to better understand one another and the reality of systemic issues, to identify our blind spots and areas for growth, to improve our care for clients and to move our profession forward.

Racism at first glance

Lisa: Michelle, you told me how triggering the recent acts of racism in America and subsequent protests have been for you. Could you share some of your background?

Michelle: I was born to an African American father and a Japanese mother around the civil unrest and well-publicized riots of 1968. The United States was embroiled in an unpopular war in Vietnam, and racial tensions at home were an additional black eye on our status as a world leader. It is sobering to consider that the institutionalized racism which led to the widespread violence and destruction of many cities, including Washington, Chicago and Baltimore, has not been eliminated over my lifetime.

My first understanding of racism occurred when I was in the first grade. My mother would meet me after school each day to walk the mile or so back to our house. One day, a white pickup truck pulled alongside us, and two Caucasian men started yelling racial epithets and throwing beer bottles at us. My mother grabbed me and ran into a nearby park where they could not follow in their vehicle.

My mother reported the incident to the police, but it was not investigated, and the matter was dropped. It was not until several years later that I understood what transpired that day and the reality that the very notion of my existence was abhorrent to someone simply based on how I looked.

The path to becoming a counselor

Lisa: That must have been a terrifying experience for you. What impact did your childhood have on your career path as a professional counselor?

Michelle: I became driven to prove my value and worth to society through academic and athletic achievement. When it came time to apply to college, I wanted to mark the “other” box because, back then, “multiracial” was not an option.

My mother surprisingly challenged my decision: “Michelle, whether you like it or not, the world is going to look at the color of your skin and decide that you’re African American. Why not show them you are also kind, driven, intelligent and talented? It doesn’t have to be either-or.”

My mother’s advice empowered me to look beyond my neighborhood and the typical path of my peers, which was community college or service and retail jobs. I applied to the United States Naval Academy and was accepted into the 10th class that allowed women. As a midshipman, it was not lost on me that there were few black or brown faces, and I was often reminded that there were 20 other applicants for everyone who was accepted, so I had to make my presence count.

I found my follow-on experience in the Marine Corps to be a great example of inclusion, as we all worked together toward a common mission. There were not black, white, brown or yellow Marines — we were all “green.” As an intelligence officer, I became adept at understanding the human nature of our enemies and advising appropriate responses to conflict. This intuitiveness and desire to bring healing to suffering led me straight to my next career as a professional counselor.

Experiencing racism with clients

Lisa: Have you experienced racism in your interactions with clients and, if so, how have you managed it?

Michelle: Depending on how I wear my hair, it has apparently been difficult for others to determine my race. Over my lifetime, I have been mistaken for Filipino, Puerto Rican, Thai/Burmese, South Korean and Samoan.

As a licensed professional counselor, I have had clients decline to meet with me because I was not pale enough for their liking or not dark enough “to understand their experience.” Several clients have made racially disparaging comments about African Americans or Asian groups in my presence because they were unaware of my multiracial background. One Caucasian client made the flip comment, “She [a Hispanic friend] is so stupid. What did she expect dating a Black guy? They’re all dogs and can’t keep a job!”

Those comments were spoken so casually that it is not hard to imagine that worse was being said in other settings. It is a sad reminder that racial prejudice and stereotyping are still at the forefront of some people’s minds. Sad because such views prevent the speaker from seeing the potential good aspects of another race and benefiting from their culture. Sad because such divisiveness prevents unity that could make us stronger as neighbors, co-workers or fellow journeyers on this path through life. My identity is not the “little mongrel” girl who had to hide in a park, nor are those individuals being described the sum of those demeaning or devaluing statements. We can and need to do better.

Early in my career, I had a Caucasian client tell me he hated “Black people.” I was quite surprised, and it must have shown on my face because he immediately added, “But you’re all right. You’re not like the other ones I’ve met.”

As you can imagine, I was angry at his audacity and saddened by his views, but I knew based on where he was in treatment that it was not the time to get into a heated debate about his racial beliefs. However, I realized that his sharing of those ideas with me indicated that he felt safe to do so in my presence and that I had been entrusted with a variable that I had not known about him previously. While I was offended by his remark, I remember thinking, “Stay focused on the client. This is not about me; it’s about the client.”

I am going to be judged, fairly and unfairly, but I choose to live in a manner to be a credit to my race rather than a detractor. I also recognize that every instance of racism is a learning opportunity — for me to better understand how the other person came to their beliefs and for clients to perhaps expand their views to see past a person’s appearance to their character. We are all a product of our genetics, nurturing, environment and experience. A client’s life may have taught them to hate, but if we, as counselors, do not believe in the potential for people to change and grow, we are in the wrong profession.

Racism can come in many forms. It can be overt or covert, generational or situational, and institutional or individual. As counselors, we need to be prepared for however it manifests and to recognize that some people are not even aware of how hurtful their beliefs are until they are uttered out loud and someone checks them on it. When working with clients, I have come to recognize that racism is often based on fear, and the more information the client is willing to learn about the object of their fear, the less impact it has. Working with a client’s racist remarks takes the same unconditional positive regard that you would give any client, and it is an opportunity to model healthy self-concept and emotional regulation.

So, take the client I mentioned previously who stated that he hated Black people. For this interview, I will call him “John.” When John made that statement, I did not react to his remarks, but I was able to work with him later in therapy surrounding some of his distorted schemas when he was ready. The following are some practical suggestions for working with clients who show signs of racism:

1) It’s not about you. (Do not personalize clients’ racist remarks).

Me: “It sounds like there are anger and pain behind that statement. Tell me about the Black people you’ve previously met.”

John: “Well, they make me sick. They’re lazy. They lie around doing drugs and collecting a welfare check while I bust my butt working all the time.”

2) Gently challenge any overgeneralizations.

Me: “Who are ‘they’? Are you talking about specific people you know?”

John: “No, you know what I mean. Just Black people.”

Me: “I know some Black people, but they don’t do drugs and they have jobs.”

John: “I know they’re not all like that. Like I said, you’re all right because I know you work for a living.”

Me: “So you don’t hate all Black people, just the Black people who are uneducated or unemployed?”

John: “Yeah, I guess.”

3) Help clients clarify their feelings.

Me: “Some might take your response as jealousy rather than hatred. You work hard, but they get by without working. Would you consider jealousy to be a better word?”

John: “No! I’m not jealous of those Black people. Shoot, I’m way better than them. I’m financially secure with a good job and a house. There’s nothing to be jealous of.”

Me: “You do work hard and have a lot going for you. So, why are you comparing yourself to them?”

John: “I’m not! They’re a drain on society. They could be doing as well as I am if they would just apply themselves.”

Me: “So, help me understand. If there is no comparison in your eyes, why do you even care?”

John: “Because my taxpayer dollars are going to finance their lifestyle.”

Me: “Actually, your and my tax dollars are going to finance a lot of things, like the military, Social Security and the national debt. Do you hate them too?”

John: “No, that’s just stupid. Of course I don’t hate the military. They’re necessary for our nation’s defense. It’s just our precious resources should only be used on important things that benefit all of society.”

Me: “If hate is too strong, or not the right word, what is a better way to describe how you feel?”

John: “I guess you could say I’m frustrated.”

4) Help clients clarify their beliefs.

Me: “OK, you are frustrated with some uneducated or unemployed Black people.”

John: “Yeah, because they’re on welfare.”

Me: “I also know a lot of people on welfare — White, Black, Hispanic, etc. Are you frustrated with them as well?”

John [staring at me]: “I know what you’re doing. No, I’m not frustrated with all of them. You are just twisting things around.”

5) Follow up with psychoeducation.

Me: “I’m just trying to understand what you believe and why you believe it. Words matter, and I hope you can see there is a big difference between ‘I hate Black people’ and ‘I’m frustrated with what I believe is the misuse of taxpayer money.’

Some people are where they are due to a lack of nurturing, growing up in an unsafe environment or even traumatic experiences. But when you are hindered by those things, which are outside of your control, and the color of your skin habitually prevents others from seeing you as a person or recognizing your worth, it is hard to have hope of living any other way.

We all have biases — because of our genetics, nurturing, environment and experiences — that can incite our emotions and distort our thinking. Racism occurs when we start believing those distortions about an entire group of people without considering individual differences. It may be easy to blame an entire group of people in a situation, but it is much more helpful to honestly examine why we feel the way we do and, when in our power, to do something about it.

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Having an open conversation about race with a client is possible, but counselors must consider the client’s readiness and make sure the discussion is integral to the context of the client’s presenting issue. The counseling office is not a bully pulpit, nor is it a place for counselors to get their own emotional needs met. However, when a client is ready and open to discuss the subject, counselors should be ready to “go there” while maintaining empathy and without allowing countertransference to interfere with their effectiveness.

Experiencing racism within the profession

Lisa: Thank you for sharing your experiences and such practical suggestions for working with clients. I think we are often caught off guard by comments made during sessions, and it is very helpful to think ahead of time about what to do in those situations. In addition to interactions with clients, have you experienced racism within our professional field?

Michelle: Sure. I once had a colleague tell me that she was no longer going to take Medicaid clients because they were “all Black, unemployed and unmarried with a gang of kids.” Another colleague commented that the Black clients brought their kids in for testing for attention-deficit/hyperactivity disorder “just so they can get a check.” These were seasoned professionals who had been seeing clients for many years.

Lisa: How disappointing to hear such comments from your peers. As a Caucasian, I have noticed that many of my White colleagues feel content in knowing that they do not personally hold prejudiced feelings against others. However, I realize that a lack of personal hate does not do enough to confront systemic racism. What can we do as a profession to make progress and move forward in this area?

Michelle: The first thing is to stop apologizing. I cannot speak for all people of color, but we are not looking for apologies. Now, let me caveat that: I always advise my clients to “own what’s yours.” If you personally contributed in any way to the oppression of a person of color, then apologize to that person. Otherwise, a blanket apology often indicates that someone does not understand the nature of institutional racism.

Secondly, ask, listen, learn and act. We will never solve the problem if we do not understand the nature of the problem. Ask people of color about their experiences. You may be surprised how many instances of racism — such as inappropriate comments or jokes in the workplace — individuals have had to push aside or ignore. Question formal processes at work that have been in place for a long time because “that’s the way we’ve always done things” attitudes can indicate tacit approval of an oppressive infrastructure (e.g., not taking Medicaid clients because it does not pay as well as commercial insurance).

Listen to the conversations being held when people of color are not in the room. They may be an indication of an undercurrent of racism (e.g., gossip or complaining regarding people of color) that needs to be exposed.

Learn by reading books, listening to podcasts or subscribing to YouTube channels by people of color.

Act by speaking up when you hear racist comments or when you see acts of discrimination. Be willing to get involved with faith organizations, social justice movements and causes of people of color (e.g., speaking at a city council meeting about trauma-informed care for African American neighborhoods or joining a peaceful march). Lastly, help affect the future of the counseling profession. Become a supervisor and share the wisdom you learn about institutional racism and the need to work with people of color to fix the system.

Thirdly, for supervisors, it is important to recognize that our supervisees are coming from different backgrounds and are at different levels of multicultural competence. I hold an initial interview with my supervisees to get a sense of their goals, strengths and weaknesses. Included in this interview is a question about their ethnicity, nurturing, environment and experience as it pertains to working with race and other marginalized groups. The answer is usually, “I had a multicultural awareness class as part of my master’s degree.” I take that to mean that they do not know what they do not know, so the onus is then on the supervisor to prepare counselors-in-training in this area of competency.

I take a developmental approach with supervision and challenge supervisees to take multicultural considerations into account as they approach each client and their diagnosis. Our discussions also include case studies tailored to increase their ability to recognize their own biases and blind spots.

These past weeks, with all of the media coverage of the racial unrest, have offered a rich environment for my supervisees to learn about institutional racism and to ask questions about social justice for their clients. It is not just a multicultural issue but also an ethical one. So, I try to ensure that my supervisees are not only comfortable working with people of diverse backgrounds but also willing to admit their own areas of cultural ignorance and work toward increasing their knowledge.

Connecting multicultural competency and trauma-informed care

Lisa: Is there any other area where we can look for change?

Michelle: All professional counseling organizations have submitted statements of support to the current nonviolent protests and offered ways to help support the victims of racial trauma. This is a great start to addressing the issue. However, if we want to make a difference, we need to reevaluate the profession’s approach to multicultural and trauma-informed education because they go hand in hand.

Most counseling programs have one mandatory multicultural class and may offer some trauma electives. However, multicultural competency should be infused throughout the program, and trauma-informed care should be a required part of every curriculum. Recognizing that the design of the master’s programs is toward clinical competency as determined by face-to-face hours, how well do practicum and internships expose and evaluate multicultural and trauma care competencies? Your new book, Preparing for Trauma Work in Clinical Mental Health, addresses concepts such as historical trauma, disenfranchised grief, advocacy and ethnic identity strength and would really fill this curriculum void.

For provisional and licensed counselors, in the same way that ethics continuing education is required every year, multicultural and trauma refresher training should be required on an annual basis to ensure that counselors are maintaining the best practices. To obtain licensure, counselors should demonstrate competency in working with diverse clients and various trauma backgrounds. In addition, all professional counselors should take an active role in advocacy work on behalf of their clients and in their communities.

Just as the color of my skin is going to be subconsciously noted by the people I meet, similar experiences are happening to our clients of color, most of whom have lived with some form of oppression during their lifetime. Counselors need to be prepared to approach multicultural considerations in trauma-informed care to understand how to appropriately establish strong therapeutic alliances with clients and enhance safety and stabilization. This is a herald’s call for counselors to change the way we approach the effects of institutionalized racism if we truly want to be agents of change.

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Michelle Fielder is a licensed professional counselor and approved clinical supervisor in private practice. She is also a doctoral candidate in the counselor education and supervision program at Regent University. Contact her at michfi3@mail.regent.edu.

Lisa Compton is a certified trauma treatment specialist and full-time faculty at Regent University. Contact her at lisacom@regent.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.

A climbable mountain: Quitting smoking and managing mental health

By Bethany Bray August 10, 2020

For people with a preexisting mental health condition, quitting smoking can seem like climbing two mountains at once.

Managing a mental health condition is a daily — sometimes moment-by-moment — challenge, and smoking is often used as a coping mechanism. Understandably, people with mental health conditions who smoke often fear that taking away that source of comfort could send them into a tailspin.

“That was the way I always seemed to manage my stress: Sit down, light a cigarette, and it would make my brain think, ‘It’s going to be OK.’ But in reality, it’s not,” says Rebecca M.* a Florida resident and participant in the Centers for Disease Control and Prevention (CDC)’s Tips from Former Smokers campaign who lives with depression.

Rebecca smoked her last cigarette in 2010. She quit smoking for good — and found balance in her life — with the support of a professional counselor. In hindsight, smoking only made her depression worse, Rebecca acknowledges.

For many people, mental health and smoking go hand-in-hand — you can’t fix one without addressing the other, she asserts.

“Wanting to be healthy, mentally, while smoking is impossible. After I quit, I was able to look at the world with a completely different mindset,” Rebecca says. “Smoking affects every aspect of your life — family relationships, work life, home life. It’s just a cloud. … When I see people who are struggling with mental health [while smoking], I have deep compassion for them. You want so desperately to get better, but with smoking, it’s like taking two steps forward and two steps back.”

In the family

Rebecca says she was “born into a family of smokers.” Growing up, all of her friends and family smoked, so it seemed natural for her to start smoking as a teenager.

She quit smoking for the first time in 2002. However, she started smoking again seven months later as she was going through a divorce and struggling with intense emotions and stress, she recalls.

Throughout this period, she met with several different counselors to help her manage her depression. She had an “aha!” moment in 2009 when her first grandchild was born; she knew then she wanted to quit smoking for good.

“When my oldest grandson was born, it made me stop and think about life in a different perspective. At that time, I reached out to find another counselor, to learn from past mistakes and learn a new way of life,” says Rebecca.

After smoking for more than three decades, she quit fully in 2010, roughly one year after setting the intention, seeking counseling, and going through “some intense self-reflection,” she says. “I was thinking about how I’m a grandmother now, and where do I want to be [in life]? I had a desperate desire to live a healthy lifestyle, and what can I do to get there?”

“Counseling gave me a sounding board, someone I could trust who could give me trusted answers,” Rebecca says.

Since quitting, she says, she has had to examine some friendships with close friends and even family members who continue to smoke. “If they’re not healthy for you, supportive of your healthy lifestyle, it’s important to make those changes as well,” she says. “It was a perspective shift: It’s the difference between being born into a life that you don’t get to choose and choosing the life that you want to live.”

The climb

Professional counselors can help clients meet life’s challenges with an approach based on leveraging the client’s existing strengths. For Rebecca, this included her intention to be a healthy example to her grandson. Practitioners have an arsenal of tools that can help clients make life changes and reach their goals, including smoking cessation.

Rebecca’s counselor helped her establish a self-care routine that includes exercise (she now runs regularly) and meditation. She has come to realize that she needed to exchange one unhealthy behavior, smoking, with a healthy behavior, exercise.

“Nothing will go well unless you take care of yourself first. Counseling taught me how to take care of myself first,” she says.

“[Quitting successfully] is about teaching people about the tools they need. When they are faced with a situation that may make them uncomfortable, or trigger a panic attack or need for a cigarette, they have to have [coping] tools ready and available. For me, it’s been exercise, staying grounded, and focusing on what I can control. I’m [continuing to] educate myself and learn as much as I can so that I can give myself the best self-care I can,” she says.

Most importantly, Rebecca’s counselor helped her accept that her depression, her tobacco dependency, and “all of this was not my fault,” she says.

“I don’t think I could have quit without counseling. I didn’t have the knowledge to do it on my own,” says Rebecca, who turned 63 this summer. “It’s essential to get someone [a mental health professional] who can help you walk this path to healthy living. It’s a path, a journey. It’s one step at a time, one day at a time, sometimes one moment at a time, but it’s empowering. It’s doable, and it feels amazing.”

Rebecca M. has exchanged one unhealthy behavior, smoking, with a healthy behavior, exercise. After smoking for more than three decades, she quit fully in 2010. Photo courtesy of the CDC’s Tips from Former Smokers campaign.

Ten years after quitting smoking, Rebecca’s mental health is good, but she acknowledges that she has to work at it every day. In addition to exercising regularly, she meditates often and tries to approach each day with an attitude of gratefulness, especially for things like a walk on the beach or video chats with her grandsons.

“I’m grateful for every one of those little moments I get,” she says. “It feels wonderful to climb that mountain. … It’s so empowering to be able to overcome tobacco use. There is a lot of life left [after cigarettes], even if you think there’s not.”

Counselors as allies

Professional counselors are particularly suited to help clients quit smoking because the profession has an array of tools focused on behavior modification. Instead of focusing on the health consequences of smoking — as a medical professional might — counselors can instead help clients focus on why they want to quit and how they can leverage their own strength to achieve that goal.

Practitioners also use a holistic perspective to help clients. For example, if a client turns to smoking in social situations because of anxiety, a counselor would help the client address the root cause, finding ways to cope with social anxiety. Similarly, if a client smokes to escape the negative thoughts that can be a constant companion of anxiety, depression, obsessive-compulsive disorder or other mental health conditions, a counselor can equip the individual with techniques to quiet their inner critic.

Read more about the many ways that professional counselor clinicians can support clients on their journeys in the Counseling Today article “What counselors can do to help clients stop smoking.”

In addition to counseling, Rebecca encourages people to use the plethora of tobacco cessation resources offered by the CDC.

“It’s OK to seek help,” she urges. “[Counselors and other professionals] want to see you succeed. You have it in you to succeed. That success is within you; you just have to learn to be kind to yourself and be loving to yourself. That, more than anything, was what I had to learn: to give myself the love that I give others.”

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For support to quit smoking, including free coaching, a free quit plan, educational materials and referrals to local resources, call 1-800-QUIT-NOW (1-800-784-8669).

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*Rebecca M.’s last name has been omitted for privacy reasons.

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Resources

From Counseling Today: “What counselors can do to help clients stop smoking”

Find a professional counselor in your local area through the link here: counseling.org/aca-community/learn-about-counseling/what-is-counseling/find-a-counselor

CDC’s Tips from Former Smokers campaign: cdc.gov/ tips

Rebecca M’s page: cdc.gov/tobacco/campaign/tips/stories/rebecca.html

CDC page on quitting smoking: cdc.gov/quit

Additional CDC resources on addressing tobacco use in individuals with behavioral health conditions:

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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.

Identifying and addressing competing attachments with couples

By Anabelle Bugatti August 6, 2020

Couples come to counseling for a variety of reasons, and therapists are tasked with understanding the nature of couples’ concerns and offering helpful tools. Sometimes, as therapists, we might hear one partner complain about the things the other partner is doing and, often, these things may seem very trivial. We might also hear clients complain of conflict that centers on a lack of emotional availability on the part of their partner, coupled with their partner escaping or turning elsewhere to de-stress, to get needs met or for emotional sharing.

For example, one person might say, “My partner is always on their phone” or “My husband always takes work calls even during family time” or “My wife shares our fights with her friends” or “My partner would rather play video games than be with me.” Then there are statements that are less trivial, such as, “I think my spouse is having an affair.”

Anything that erodes the security of the bond between partners and creates distress can be seen as a threat to the relationship. The resulting distress must not be viewed as trivial, regardless of how small and harmless the situation may appear on the surface.

A rival to the relationship

A competing attachment is a threat to secure bonding in which one person in a relationship turns away from the relationship and toward someone or something else to get their emotional or attachment needs met. This is often experienced by their partner as a rival to their relationship — someone or something with which they have to compete for their sweetheart’s time
and attention.

Some of these emotional investments or activities on the part of one of the partners may actually be counterfeit attachments. These attachments are an attempt to mimic the fulfillment of comfort, soothing and belonging needs that a secure relationship would typically provide. It is usually the other partner (not the partner engaging in the competing attachment) who initially complains of distress.

The person participating in the competing attachment may or may not be aware that they are turning elsewhere to get their emotional and attachment needs met. This may largely depend on their own attachment style and level of emotional intelligence. Those engaging in the competing attachment are sometimes aware of what they are doing but may try to deny the impact this has on their partner or relationship.

Depending on the type of competing attachment (what or whom a person turns out to) and the frequency (how often they’re turning out), their partner can be left feeling frustrated, jealous, hurt and disconnected. The more often this occurs, the more distressed the relationship may become. The attachment bond may then start to shift from secure to insecure, or a romantic attachment bond that was already insecure can have that insecurity amplified. Additionally, relationship satisfaction decreases as a relationship becomes distressed by a competing attachment.

Research currently shows a connection between competing attachments and insecure attachment relationships. However, it is unknown whether one causes the other or if an already insecure bond or insecurely attached person might be more vulnerable to developing or experiencing a competing attachment.

While different types of competing attachments tend to pose different levels of threat to a relationship, there is a clear connection between a partner’s concern of competing attachment and their romantic attachment security and relationship satisfaction. In a study conducted for my dissertation research, it was revealed that the more a competing attachment increases, the more the attachment security within the relationship decreases. As attachment security decreases, the more relationship satisfaction also decreases.

Competing attachments constitute a counterfeit attachment in which one partner turns outside of the marriage or relationship and toward something or someone else for escape, soothing, comfort or attention as a substitute for unmet attachment needs. Competing attachments can include addictions, affairs, gaming systems, smart phones, family members or anything else that might lead a spouse or partner to feel it necessary to compete with this “other” for the attachment bond with their partner.

Competing attachments vs. hobbies

It is important to distinguish the difference between a competing attachment and a hobby. Obviously, not everything that someone turns to outside of a relationship will constitute a competing attachment. Clients may have healthy attachments with other people or things that do not violate the boundaries of the romantic attachment relationship between two people and that do not create a feeling of competition for emotional time, attention or affection.

In general, hobbies do not threaten relationships because there are some emotional boundaries involved. Typically, hobbies are engaged in for general enjoyment rather than as an escape or as an alternative to the benefits of their romantic partner. Hobbies do hold the potential of turning into a competing attachment, although this doesn’t usually happen in securely attached people or relationships.

In my clinical practice, I have often heard female partners voice feeling the threat of competing attachment because their partners come home from work most nights and neglect to spend even a little bit of quality time connecting. Instead, they go straight to their gaming systems and play for hours until it’s time to put the children to bed or turn in for the night. Part of what contributes to the sense of a competing attachment is if one partner regularly turns to this “other” before they turn to their own partner or more frequently than they turn to their own partner.

Types of competing attachments

Research has yet to explore every type of competing attachment individually or their respective impact on relationship security and satisfaction, in part because new forms of competing attachment pop up and develop over time. In addition, competing attachments and their impacts can vary culturally. However, a few specific types of competing attachment have been linked to decreases in relationship security and satisfaction.

Addiction

Research on addiction and attachment helps explain how disrupted early life attachment bonds and adaptive mechanisms can, if left untreated, become barriers to emotional flexibility and bonding in adult romantic relationships. When emotional regulation and soothing have not been taught in the context of attachment bonds with a loved one, it can leave the individual more vulnerable to turning to a substance as a means of soothing and escape. On a fundamental level, failed attachment to a primary attachment figure creates alternative attachment to survival mechanisms and defenses. This eventually transitions into attachments to substances or other compulsive behaviors in an attempt to find comfort, soothing, safety, protection and security.

Substances are shown to have analgesic (pain blocking) effects that aid in the numbing out of emotionally painful experiences and situations. Individuals with addiction lack the ability to internally self-regulate their emotions. They frequently turn to substances or compulsions to regulate their feelings of pain or distressing emotional experiences. Nonchemical processes such as pornography and gambling are demonstrated to have similar effects to chemical substances on the brain and can be used by a person to achieve the same effect.

The more frequently someone turns to addictive behaviors to meet their attachment needs, the less often they will seek connection with others. The addiction eventually starts to become a substitute for human connection. Over time, this builds into a false sense of connection, or a counterfeit attachment, because a true and secure attachment bond involves a reciprocal relationship.

In romantic relationships, the consequences for the partner who is not addicted is that they are left emotionally (and, often, physically) alone to deal with emotional distress and the stresses of daily living. Additionally, it is hard to build a secure and satisfying connection with a partner who is not emotionally present, engaged or accessible because of their addiction, especially if the addiction negatively alters the person’s mood. The result is a relationship that is higher in conflict, less emotionally engaged, more unstable or insecure, and less satisfying.

Social media, gaming, smart phones

With the advancement and availability of new technology, the types and frequency of competing attachments have also changed. Internet addiction is a general term used to encompass a wide variety of online behaviors that are problematic for individuals and relationships. For example, addiction to Facebook, Twitter or Instagram has been cited as being intrusive in relationships and is associated with relationship dissatisfaction. Technoference is a term applied to the interference of technology in relationships, including romantic relationships. Another trending term is phubbing, or phone snubbing. This describes when a person turns their attention to a smart phone instead of to their romantic partner or others in a social or personal setting.

As cell phones and gaming systems have morphed from simple electronic devices to devices that encourage participation and interaction online, live human interactions have decreased. Online adult gamers have described sacrificing major aspects of their lives to maintain their online gaming status. Romantic partners report that technologies such as gaming and smart phones frequently interrupt quality time and connection, reduce instances of going to bed together at night, and affect the amount of time spent together on leisure activities. In other words, these partners feel that their relationship has taken a back seat to online gaming activity.

Those who have been phubbed report feeling that their romantic partner favors a virtual world over time and connection with them, thus sending an implicit message about what their partner values most. This has become so problematic in romantic relationships that support groups have been created for “gaming widows” suffering from technoference. Additionally, interviews have revealed that technoference lowers relationship satisfaction and increases conflict between romantic partners.

Pornography

Pornography is unique in that it can encompass two different types of competing attachments: addiction and infidelity (since many romantic partners view pornography as a form of infidelity). Often, the partner who is addicted turns to pornography as a source of stress release or to soothe feelings of shame and disconnection in the romantic relationship.

Research into the experiences of those partners who are not addicted to pornography shows that they often feel in competition with the pornography or the actors in the pornographic material. The turning outside of the relationship to an addiction has also been shown to have a negative effect on the security of the relationship bond and the level of relationship satisfaction.

Affairs and infidelity

Being unfaithful in a romantic relationship (infidelity) is considered one of the most potent threats to romantic attachment security and relationship satisfaction. Infidelity is one of the leading causes of divorce and one of the leading threats of competing attachment.

Unlike other forms of competing attachment, this particular form may need to occur only once for the partner to consider it a competing attachment. What constitutes appropriate or inappropriate behavior with someone outside of the relationship can take on different meanings for different people. For some, a one-time nonsexual encounter in which their partner turns to another may be acceptable, whereas others may find small flirtations that do not result in sexual intercourse unacceptable. For others, finding inappropriate, provocative or sexual pictures or messages exchanged between their partner and someone else may constitute infidelity. The definition of infidelity depends on how the couple delineates the boundaries of their relationship and how they define cheating.

Infidelity, even if only perceived, has the power to undermine the trust, security and satisfaction of the love relationship. Behaviors on social media that violate relational boundaries are also associated with relational insecurity and lower levels of relationship satisfaction.

Factors such as attachment security and satisfaction have been demonstrated to be both consequences and causes of infidelity. Those with secure attachment are less likely to engage in infidelity-related behaviors. There is also a link between attachment avoidance and interest in other partners, as well as strong associations between attachment insecurity and infidelity in relationships. Unmet attachment needs and low levels of relationship satisfaction may contribute to people seeking connection and sex outside of their primary love relationship.

Rival relationships

Outside or “rival” relationships may not constitute or result in infidelity, but they can still be experienced as competing attachments to the romantic bond. A rival relationship may be any nonromantic relationship that a partner has with another person outside of their love relationship, especially if the outside person is perceived as being attractive. This could be a friend of the opposite sex. Even family members can become competing attachments in some relationships.

In rival relationships, one partner may consistently turn out to a friend or family member to discuss private emotional topics, seek comfort or validation, or share friendly connections that are not shared with their partner or spouse within the love relationship. Another example may be a partner who exchanges text messages, emails or phone calls or engages in private get-togethers with another person outside of the love relationship, particularly if their romantic partner is not invited to take part. The romantic partner may feel like they are being left out of or are on the outside of a friendship or relationship that their partner has.

In therapy, clients might complain about their partner’s closest friend of the opposite gender or an intrusive in-law whom their spouse frequently turns to for advice and emotional support. Rival relationships that involve family members, usually described by clients as “intrusive” family members, are associated with a weaker couple identity and are demonstrated to predict the quality of the couple’s bond.

Interestingly, even in cultures in which men are expected to maintain a strong alliance with their mothers after getting married, wives in these marriages often complain about feeling like they are competing with their mothers-in-law for their place in the family unit. An example might be a husband who frequently puts his mother first by meeting her every need, even after he marries. This type of competing attachment often goes unnoticed. Society tends to dismiss enmeshed mother-son relationships as being potentially problematic, despite the consequences to the son’s marriage or romantic relationship. I am not referring here to a healthy attachment bond between a mother and a son but rather to an unhealthy form of attachment (insecure bonding) that results in the failure of either person to securely and appropriately transition parts of their attachment role when necessary.

Importance to clinical practice

In each of these types of competing attachment, there exists a common link with attachment security (or lack thereof) and relationship satisfaction. As professional therapists, we know that science is clear about the importance of human attachment bonds across the life span. Primary attachment figures were initially considered important for infants and children. However, these roles were later recognized as being important for all humans at all stages, including those with whom we formulate strong romantic attachment relationships as adults.

Each person will have a different attachment style that is classified as either secure or insecure. These attachment strategies are typically stable over time. However, attachment relationship bonds can be defined separately from individuals, also as either secure or insecure. Additionally, there is plasticity in adult attachment relationships. They can shift from secure to insecure and vice versa. In romantic relationships, distress can occur when the security of the attachment relationship is threatened. This is important for therapists to understand as they work with their clients to help them shift from insecure to secure bonding and to build safe and satisfying relationships.

Competing attachments threaten the security and satisfaction of romantic attachment relationships and can become pivotal moments that redefine a couple’s relationship as unsafe. This can additionally create an impasse to relational trust and stability, both of which can negatively affect relational satisfaction. Anything that threatens the stability and satisfaction of an attachment bond is important for clinicians to know about so that they can be prepared to intervene.

Not all things that someone turns to outside of the love relationship qualify as competing attachments. To constitute a competing attachment, it must cross certain boundaries or thresholds that result in distress. If a competing attachment does exist in a relationship and is causing distress, then the relationship satisfaction will start to go down. The less secure the bond becomes between the couple and the less satisfying the relationship is, the more risk exists of the relationship becoming broken. Attachment security is strongly associated with relationship satisfaction. Both attachment security and relationship satisfaction are also important factors in relationship longevity and personal health. Relational satisfaction should remain relatively high and stable over time for most couples in securely attached relationships.

Attachment science offers a guidepost for treatment strategies and interventions for couples who come to therapy reporting the presence of competing attachment.

Treatment recommendations

If a couple comes to your practice complaining of a competing attachment or hinting at the possibility of one, consider asking a few assessment questions. These questions are based off of the Competing Attachment Scale that I created with emotionally focused therapy trainer Rebecca Jorgensen and UCLA professor Rory Reid in 2015 for my dissertation study.

1) Have you experienced in the past or do you currently experience a sense of competition with the activities or relationships in which your partner engages?

2) Do you feel like your partner turns elsewhere outside of the relationship to have their needs met rather than turning to you?

3) Do you feel hurt, bothered or upset by this?

4) Do you feel like this has been a problem in your relationship, created a lot of conflict or affected your ability to get close with or have a healthy bond with your partner?

Also consider the following treatment recommendations for couples reporting distress due to a competing attachment:

Clearly identify and understand how the competing attachment is part of a couple’s relational system (their negative interaction pattern or cycle).
Identify the competing attachment as an alternative (and ineffective) way of coping with/not dealing with emotional distress or not getting needs met (maladaptive behavior).
Help couples turn toward each other as secure bases/safe havens to help co-regulate moments of emotional distress.
Help couples find alternative ways of coping with emotional dysregulation that don’t create relational distress or violate relationship boundaries.
Help couples identify their emotional/attachment needs and be able to ask for these needs to be met in their relationship.

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For more information on adult attachment research, or to find clinical training in your area, visit the websites of the International Center for Excellence in Emotionally Focused Therapy and its founder, Sue Johnson.

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Anabelle Bugatti is a licensed marriage and family therapist with a private practice in Las Vegas. She is a certified emotionally focused supervisor and therapist and is the president of the Southern Nevada Community for Emotionally Focused Therapy. She has a doctorate in marriage and family therapy from Northcentral University. Her new book, Using Relentless Empathy in Therapeutic Relationships: Connecting With Challenging and Resistant Clients, is slated for release at the end of the year. Contact her at anabellebugattimft@gmail.com.

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

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

The revised meaning of self-care in the wake of COVID-19

By Scott Gleeson August 4, 2020

Practicing proper self-care is often the prescription that professional counselors will share with their clients to help manage life stressors and mental health symptoms during their day-to-day lives.

That emphasis has taken on new meaning over the past several months as self-care routines have been offset by quarantining measures from the COVID-19 pandemic. Suddenly, sleeping patterns were thrown off by newfound anxiety. Routine pleasures such as listening to a podcast or playlist during the morning and evening commute disappeared as working from home became the new norm. With gyms closed, people were forced to adjust their exercise routines and workout habits. Typical avenues of social escape — restaurants, movie theaters, salons — were also closed. Even parks and hikes were off-limits in some states for a time.

In spite of the limitations, self-care has never been more meaningful given the conditions that people found (and, in some cases, still find) themselves in. Stephanie Burns, an associate psychology education professor and coordinator of the clinical mental health counseling program at Western Michigan University, says the unprecedented times prompted unprecedented human responses.

“Two things were happening at once for clients coming into therapy: They were going through their own already-existing struggles of depression and anxiety. Then there’s the trauma from what this crisis brought. Trauma is really about anything providing discomfort or distress to where an individual feels overwhelmed. It’s not something as obvious as getting hit by a car. Consciously, you can think some of this doesn’t bother you. But in the subconscious mind, trauma can exist. Everyone lost something from COVID. People lost jobs, loved ones and, by and large, their daily lives.”

On the positive side, the pandemic’s conditions have presented new opportunities for self-care for many people — with extra time at home for projects such as painting, playing music and experimenting with cooking and baking, more quality time with pets, additional emotional space to journal and a renewed premium on daily walks.

“There’s such a protective element to our routine, and our emotions get caught up in that pattern,” says Eric Beeson, president of the American Mental Health Counselors Association. “By being at home for several months, we had to readjust by finding normal in the abnormal. Normal had to be reconceptualized.”

That concept of normal was flipped upside down for clinicians too. The same focus on self-care needs to extend to therapists in their own lives and can be a unique blind spot, according to experts. Burns says she often reminds her counseling students that self-care works both ways and to practice what they’re so often taught to preach to clients.

“As counselors, when aspects of the client start matching you, then we run the risk of aligning with them and assuming what’s working for us is working for them,” says Burns, a member of the American Counseling Association. “Because of COVID, we were all going through the trauma and the grief process of our everyday lives at the same time. We cannot as clinicians expect to not be impacted by all this at the exact same time on a personal level. Then we add the extra layer of vicarious trauma from clients with intensified needs where we take on their pain. That all adds up to extra layers that cannot be neglected.”

“There’s been an overall shift in how we think about self-care as clinicians,” Litherland says. “Particularly during COVID, we should be asking ourselves, ‘How can I meaningfully and effectively engage in clinical work? Personally and professionally, am I able to buffer any side effect of burnout and compassion fatigue?’ Maybe we need 15-20 minutes in between each client because of our added pressures. Pace certainly matters for us because the speed of life right now feels fast.”
Gideon Litherland, a licensed clinical professional counselor at Veduta Consulting in Chicago and a Ph.D. candidate at Oregon State University researching supervision effectiveness, says emotional pace is an area for clinicians to pay attention to in working with clients.

Litherland adds that with the heavy increase in telehealth sessions during the pandemic, self-care has become even more integral. “The volume can take its toll,” he says. “Particularly when we’re connecting through a computer screen, a video monitor, it’s a different mode of attending for us. We’re working harder to extract more information from limited data. The sessions might be doable, but the wealth and richness aren’t as easy to pick up as in person.”

Carol Park, CEO and founder of the virtual platform company Thera-LINK, says telehealth was already on the rise before the coronavirus pandemic. But shelter-in-place orders prompted a huge increase and reliability on digital therapy. The benefits for both clinicians and clients can be widespread, but Park notes that she’s found treating virtual sessions slightly different than in-person sessions can be helpful for clinicians’ self-care.

“People who were having struggles pre-COVID, now they were needing connection even more,” Park says. “Telehealth really has filled that void for clients. For therapists, it’s important to know that you’re not quite getting that neuroconnectivity element. You sort of lose that sixth sense. As a therapist myself, I’ll leave feeling a little bit more depleted. You work a little bit harder.”

As states have started to gradually open up establishments and shelter-in-place orders have lifted around the country, private practices and therapy businesses are also opening their doors. With some clients returning to work, that gradual adjustment can be mended in the therapy room.

“I think one of the most important things is being gentle with ourselves, accepting that things are different,” Litherland says. “We’ve all been through something. We have to look at what previously worked for us and feel out how it fits into a new reality.”

Beeson, who is also a licensed professional counselor in West Virginia and a professor at Northwestern’s Family Institute, says the initial concept of easing back into day-to-day life as a clinician (mirroring the process many clients were experiencing) was interrupted by current events. The killing of George Floyd while in the custody of Minneapolis police officers sparked nationwide protests and, from Beeson’s perspective, put a renewed focus on clinicians’ roles being about more than just sitting in the counselor’s chair.

“When you look at wellness models, they’ve become accentuated more now,” Beeson says. “Continued racism and violence and health care disparity have always been there. But they’re highlighted more now. So, my sense of getting back to normal might be more cannonball-like considering the sense of urgency I feel in my role as a professional counselor, leader and person. Sometimes that sense of purpose can be part of our self-care too. As we come back to our daily lives, things have changed. There’s a need to collaborate and come together now more than ever.”

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Scott Gleeson is a licensed professional counselor at DG Counseling in Downers Grove, Illinois, and Chicago. Contact him at scottmgleeson@gmail.com.

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