Monthly Archives: September 2020

School counseling in the time of the coronavirus

By Laurie Meyers September 28, 2020

“School counselor” is a deceptively simple title. In reality, school counselors play many roles, including social and emotional educator, academic adviser, conflict mediator, wellness coach, mental health therapist, student champion, educational collaborator and family liaison.

Now, with the advent of the pandemic caused by the novel coronavirus, many school counselors have become connectors and comforters-in-chief — not just to students but to parents and school staff.

Last spring, schools began closing in response to the pandemic. According to Education Week, 48 states; four U.S. territories; Washington, D.C.; and the Department of Defense Education Activity eventually ordered or recommended school closures affecting at least 50.8 million public school students. Suddenly, students, families, counselors, teachers and administrators all had to find a way to virtually re-create their in-person school routines. This already-challenging shift was complicated by the significant number of students who lacked access to high-speed internet or desktop, laptop or tablet computers.

Even before the pandemic, civil rights and education groups had been decrying what they had dubbed the “homework gap” because many teachers were increasingly assigning work that required internet access. Already at a disadvantage, these disenfranchised students — many of whom were Black, Indigenous or people of color (BIPOC) — now faced being completely locked out of school academic activities for the rest of the year.

According to “Students of Color Caught in the Homework Gap,” a recent report by organizations that include the Alliance for Excellent Education and the National Urban League, when the wave of school closures occurred, 16.9 million children lacked high-speed home internet access (a number that included 1 in 3 BIPOC families), and 7.3 million did not have a computer or tablet. Many schools spent the spring and summer scrambling to provide devices and internet access to students — a task that was still incomplete going into the new school year. Stories of students struggling to keep up with online instruction on cell phones are still not uncommon.

In addition, when the economy took a nosedive as the coronavirus spread, it made it hard to focus on anything but survival for many families. But even financially secure families found it challenging to provide the ideal learning environment as — in many cases — parents working from home with multiple children wrestled with carving out a physical space and a time for each person to be online. Students missed getting to see their friends and participating in extracurricular activities. Sports seasons were canceled. The theater curtains never went up on school plays. Rites of passage such as prom and graduation ceremonies largely fell by the wayside.

And now it is fall, meaning a brand new school year. Even so, in many parts of the country, the football fields and stands will remain empty, the marching band instruments will stay silent and there will be no homecoming dances. Things are decidedly not back to normal. For that matter, there is relatively widespread belief that “normal” will never return. No one knows what the future will hold.

So, it’s not surprising that parents, students and school personnel are all feeling stressed and overwhelmed. Continuing to hold classes online while simultaneously ensuring that students and families have the needed technological resources — or, in some cases, the absolute basics, such as enough food to eat — continues to be a team effort.

Because safeguarding the mental, emotional and physical welfare of students is the essence of what school counselors do, these professionals have typically been at the center of the problem-solving process since the arrival of the coronavirus. They have conducted check-in phone calls to make sure students had the necessary equipment and internet access; helped parents (or grandparents) with technological troubleshooting; arranged for families in need to receive gift cards and community resources; responded to requests from teachers to find out why students weren’t showing up for online class (and then worked to resolve whatever the barrier was); reassured stressed-out parents; coached families on how to set up a structured school day; made mental health referrals for students in crisis; and provided moral support to teachers, administrators and each other. All while finding ways to continue offering academic guidance, focusing on students’ emotional and social learning, and giving specific support to children who were struggling with various personal and school-related issues.

Counseling Today spoke to several school counselors at the end of the 2019-2020 school year and as they prepared for the new 2020 fall semester to learn more about the challenges of performing their jobs in the midst of a pandemic.

 

Linda Colón
Counselor for prekindergarten and kindergarten students, Bancroft Elementary School, Washington, D.C.

Bancroft is a Title I school (i.e., a facility that receives financial assistance due to a high population of students from families with low incomes) with a majority Latinx student body that also includes children of Ethiopian immigrants. Many of the families in the district live in poverty and often share relatively small living quarters with extended family.

Under normal circumstances, American Counseling Association member Linda Colón gives Bancroft’s youngest students their earliest lessons in social and emotional learning. By observing (and joining) students at play, reading aloud to them, incorporating toys, conversing with puppets and showing self-produced videos, Colón teaches prekindergartners and kindergartners basic social skills and how to recognize and regulate their emotions.

Getting to know students’ families and getting them invested in their children’s learning has always been an integral part of Colón’s counseling approach. She says that she’s “planting a seed” of awareness about the importance of education and attendance from an early age. Colón meets with parents to answer questions and, if requested, gives them advice on how to reinforce the social and emotional lessons that their children are learning.

Another benefit of establishing a relationship with families — and checking in regularly via phone or in person (during nonpandemic times) — is that Colón can get a better sense of the problems with which the families might be struggling. If they trust the counselors and teachers, she says, they will be more likely to reach out if they need help addressing emotional or mental health problems or accessing vital resources such as food and shelter.

Colón has been finding new ways to stay connected to her students and their families since March, when schools across the metropolitan region shut their doors and transitioned to online learning to finish out the school year because of the coronavirus. Schools in Washington, D.C., opted to begin the new year virtually as well, with an option to reevaluate in November.

“We can’t just say, ‘This isn’t going to work,’” Colón says. “We have to figure it out. We owe it to the kids.”

Before in-person learning ceased completely in March, Colón, knowing that the children were feeling anxious, created a lesson centered on “claiming strategies.” She reminded the children that when they were really afraid, it was helpful to talk about it, and she provided them with some age-appropriate safety information.

But the most important piece was the practical activity: washing hands. “We want to keep the germs away, so we wash our hands for 20 seconds,” Colón told the children, reinforcing the statement with videos and puppet demonstrations of hand-washing.

Colón also made videos so that the children’s social and emotional learning could continue virtually. The videos covered topics such as keeping a positive mindset, practicing breathing techniques and exercising mindfulness.

Colón also spoke to some of her students and their families one-on-one, either on the phone or via Microsoft Meetings, to find out how they were coping, to offer a sympathetic ear to stressed-out parents and to provide a reassuring presence for anxious children. She has given her phone number to parents and encouraged them to call or text her if they need help. As distance learning continues, she has been encouraging teachers to reach out as much as possible too. In addition, Colón has worked directly with parents to help solve technological problems.

This year, one of her initiatives is to help parents find a way to provide a space for children to take a break from their surroundings — a relaxation bubble. Many of her students live in small spaces, so the “bubble” might be something as simple and small as a blanket draped over a chair to make a mini tent.

Even at a young age, children are more aware of what is going on around them than most people realize, Colón says. They know that people are sick and dying, and at this age, children are less able to process the fear, which leaves them at risk of getting stuck in fight-or-flight mode. When they are at school, they can see their friends on the playground and have other opportunities to get away, but at home, exposure to trauma — even if only through the television — may be inescapable.

Activities such as drawing, watching a fun video or escaping to their relaxation bubble can help relieve the agitation, Colón says. The staff at Colón’s school has requested that markers, crayons and paper be sent to all the families.

Research also shows that when people are experiencing trauma, simply making a connection with a sympathetic presence can help, Colón says. So, she believes that keeping in contact with students and families is one of the most important things school staff can do right now.

“It’s finding a way to establish that connectedness,” she says. “When you’re in school, you’re waving to them [students and families], saying ‘Hi, good morning,’ singing a silly song. You’re doing something to make a connection that doesn’t have anything to do with academics.”

“I think our [school counseling] services are needed more than ever,” Colón says. “We’re the ones who are getting the pulse [of the community].”

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Natasha Griffith
Counselor for first through sixth grades and homeless coordinator, Dorothy I. Height Elementary School, Washington, D.C.

Height is also a Title I school, with many of its families living at or below the poverty level. Most of the students are Black — primarily first-generation Ethiopian. Approximately 20 to 30 percent of students are Latinx.

“I think this year, I’ll feel proud and accomplished if I can master Microsoft Teams and have whole class sessions,” says ACA member Natasha Griffith, whose school — like Colón’s — will be all virtual until at least November. She has modest goals for kicking off the school year, including holding a few smaller group sessions with students in fourth through sixth grades. Griffith’s role as the school’s homeless coordinator — which involves helping families in transitional housing find financial and community resources — can make that goal challenging. “I have to focus on the barriers that children and their parents face,” she says.

Griffith says she and her co-workers “hit the ground running” last spring when school buildings closed, distributing gift cards from the city’s public services department and money from a GoFundMe campaign to the neediest families and making sure that students had computers. But there will be an ongoing need for assistance during the current school year. In fact, although Griffith wasn’t officially working over the summer, she heard from families in search of additional gift cards and did some interpreting for the school’s technology contact, who doesn’t speak Spanish. Most of the students received computers or iPads in the spring, but stable internet access was a persistent problem, so the school has been setting families up with mobile hotspot devices (routers connected to a cellular data network that provides Wi-Fi connectivity).

Griffith will also continue to call families to check in on students who aren’t showing up online. If their absence is due to technological problems, she will make sure they get the resources they need. If the absence is because the students and families aren’t adapting well to virtual learning, then Griffith will do her best to help them navigate the unfamiliar territory and highlight how important it is for students to participate so that they don’t fall behind. “So many students weren’t participating [last spring],” she says. Even if families aren’t experiencing technological difficulties, many of them still aren’t sold on virtual learning, Griffith says.

Unfortunately, as is the case in many communities across the country, there will be cases in which Griffith isn’t able to get in touch with families. The counseling staff at Height does work closely with a social worker from Washington’s department of public health who is responsible for connecting families with resources, and Griffith says that she has been able to accomplish a lot. Even so, the reality is that educational continuity is incredibly difficult for schools to provide during the pandemic.

As she did last spring, Griffith will continue to help bridge the gap between parents and teachers. Many parents are feeling overwhelmed, and coping with online learning is yet another source of frustration for them. Griffith provides a listening ear and works toward helping families see that the school staff is there to help, not to judge. She is also concentrating on developing lesson plans that help students navigate the virtual landscape and encouraging them to ask for help when they need it.

Another challenge Griffith is facing is that she has no designated “classroom time” online. To present lessons, she has to be flexible and grab any spare time that teachers have in their class schedules. To supplement, she is planning on developing videos covering the social and emotional learning topics that make up the core part of her counseling curriculum, including managing anger, building self-esteem, learning to identify emotions, developing resilience and using tools for academic success. She has been rearranging her apartment to carve out a space for filming. The videos will be posted on Microsoft Teams for the students to access on demand.

In the spring, Griffith created a few virtual “lunch bunches” for small groups of students. She and the children would play games such as self-care bingo; squares included actions such as taking a shower, eating breakfast, listening to your body, taking a break, meditating, calling a friend and saying something good about yourself. She would also ask students about what they were doing outside of their classroom lessons. “It gave them a place to talk about missing their friends,” she says. “It was also something social that wasn’t related to school.”

Griffith is starting up the virtual lunches again during the current school year. She would also like to find a way to virtually re-create the in-person restorative circles that she used to hold in school. The activity, which usually involved 20-22 students, was focused on building community. Griffith would ask open-ended questions (usually focused on having respect for fellow students) and present students with a talking piece to pass around the circle. Students could choose to keep the piece and speak, or pass it on.

“I think restorative circles work well because they allow students to express their feelings about various social and emotional learning topics,” she says. “It allows students to take ownership and be an involved participant in the classroom community.”

Griffith will continue to connect with students any way she can while her school is held online, but she believes there is no substitute for face-to-face interaction. “Especially for these kids,” she says. “Saying in person, ‘You’ve got this. You can do this.’ That’s what I live for as a school counselor … [to] make a difference and tell them they matter.”

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Judy Trigiani
Counselor for kindergarten through sixth grades, Spring Hill Elementary School, McLean, Virginia.

Spring Hill has a large population of international students, many of them the children of diplomats and business people from around the world. Some of these families temporarily relocated to their home countries to wait out the pandemic and have not yet returned to the U.S.

The plan for ACA member Judy Trigiani’s school district is to operate exclusively online through at least the first quarter of the school year and then to reevaluate. But as Trigiani noted at the end of the prior school year, one of the biggest burdens of the pandemic for people is not knowing when it will end. Or, in the case of schools, when bringing students back in person will not carry the threat of widespread community spread. “We are trying to plan for the unknown. We don’t know when we’ll go back yet,” Trigiani says.

In the meantime, Trigiani and the rest of the staff at Spring Hill continue to try to keep things as “normal” as possible. Traditionally, the school’s year starts with an open house and a new family and student orientation. This year is no exception; however, the events will all be virtual. Families and students will connect via Blackboard Collaborate, where staff will introduce themselves and talk about the school community, scheduling and resources available to parents. A question-and-answer session will follow. The school is also hosting town hall meetings and a kindergarten orientation to present new resources and answer questions.

This year, there will also be a technology orientation to demonstrate Blackboard features such as the icons for accessing the microphone and video and “raising” your hand; how to magnify the screen; agreeing, disagreeing and reacting to the teacher and fellow students with emojis; and where to find the chat box, Trigiani says. The technology orientation will also cover some of the other programs the school will be using. Blackboard Collaborate enables staff to post videos and PowerPoints and share their screens. The tech session will also demonstrate how to access the website and the asynchronous learning area (video sessions that students can watch on their own schedule). Trigiani has also been preparing PowerPoint presentations for parents on topics such as setting up their children’s workspaces and how to talk to children about COVID-19.

Trigiani and the rest of the counseling staff will continue to visit the virtual classrooms every morning to check in and say, “We’re here if you need anything.” There are 18 classrooms per counselor, and counselors go into one classroom each day, she explains. Sometimes, they conduct a lesson. Other times, Trigiani will show up early just to chat with the kids, asking them to use the emojis to let her know how they are doing. If a student expresses distress or Trigiani hears or sees something that causes her concern, she meets with the student individually online and works to address the issue.

Individual counseling, social skills instruction, school counseling programs, parent meetings, the identification and sharing of resources — all of the normal work of school counselors also continues virtually. In addition, Trigiani works with parents who are struggling to cope with their children’s behavioral, social and emotional issues. If necessary, the counseling staff makes referrals to outside mental health resources.

The key, Trigiani says, is something that one of her former bosses used to say: “Keep your community and people informed, and stay as positive and flexible as you can.”

Trigiani believes that technology will continue to become more and more critical to school counseling, even after schools decide to return to the in-person model. Not only will retaining a virtual element allow medically fragile students better access to education, but it will also help counselors prepare students for 21st-century jobs by enabling them to give students training in online social skills, Trigiani asserts.

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Randi Vogel
Counselor for sixth grade, Thomas Pyle Middle School, Bethesda, Maryland.

Pyle also has a significant number of international students, which means that the student population is somewhat transitory.

“This pandemic has really brought to light the social-emotional needs of our students,” ACA member Randi Vogel says. “Even students who we considered very solid are having difficulties.”

In the spring, several students who were already struggling with mental health issues deteriorated further with the loss of a structured school environment and ended up needing to be hospitalized, she says. But even students who had no history of mental health issues were experiencing anxiety and stress.

After school moved online, Vogel and her team put out an announcement on the school portal that they were available via email and Zoom. They also sent out regular surveys asking students how they were feeling, if they needed anything or whether they just wanted to share.

One girl replied that she needed a Chromebook laptop to keep up with her school assignments. Another student said, “I miss you — and I fell and broke my arm.” Some students expressed that they just really wanted to talk, so Vogel and her team connected with them individually via video chats.

The surveys also asked students what they were doing to take care of themselves and to whom they had reached out. Every time that Vogel spoke to a student, she would ask them what they were doing for themselves.

Vogel’s district is starting the new school year with virtual-only instruction and will reassess in November. Although many students may have initially enjoyed the novelty of learning from home, that sentiment generally seems to have worn off, Vogel says. “I have heard from several parents and students that they truly miss the school experience — chatting in the halls with their friends, switching classes, the cafeteria, after-school activities, the bus rides to and from school.”

Although her school can’t re-create those experiences, the days will be more structured and organized for students this year, she says. There will be more live and interactive instruction, in contrast to this past spring, when teachers primarily gave lessons via “asynchronous learning,” which involved using previously recorded videos that students would watch on their own. Teachers then offered online “office hours” to field follow-up questions.

“Parents definitely want more ‘live’ instruction and for more of the day to mimic what occurs in the building,” Vogel says. Although this may help virtual lessons to feel more like regular class, she anticipates that students will have difficulty being on their screens for so many hours, despite the breaks that have been built into the schedule.

“We, as counselors, will continue to reach out to our students to see how we can help them virtually,” she says. “This might look like lunch bunches or initiating one-on-one Zoom calls as check-ins.”

Vogel says her counseling department really prided itself on always being available to students during the day. In fact, they had several students who were issued “flash passes” so they could come to the counseling office anytime they needed a break. “Once we are back in the building, I expect that to resume,” she says. “However, it is much more challenging to establish relationships with middle schoolers via Zoom.”

Because so many students are struggling or just need a little extra help coping, Vogel and her colleagues will be incorporating more mindfulness and stress-reduction activities and class meetings into the virtual day for students. “I think it will be very beneficial to have the students hear from one another how they are managing and that they are not alone with their feelings,” she says.

 

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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)

ACA School Counselor Connection (counseling.org/membership/aca-and-you/school-counselors/school-counselor)

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

Books & DVDs (imis.counseling.org/store)

Books

  • A School Counselor’s Guide to Small Groups: Coordination, Leadership, and Assessment edited by Sarah I . Springer, Lauren J. Moss, Nader Manavizadeh and Ashley Pugliese
  • Critical Incidents in School Counseling, Third Edition, by Tarrell Awe Agahe Portman, Chris Wood and Heather J. Fye
  • Developing and Managing Your School Guidance and Counseling Program, Fifth Edition, by Norman C. Gysbers and Patricia Henderson
  • Solution-Focused Counseling in Schools, Third Edition, by John J. Murphy

DVDs

  • Acute and Severe Behavior Problems presented by Dave Scott
  • Bullying in Schools: Six Methods of Intervention presented by Ken Rigby
  • Managing Conflict in Schools: A New Approach to Disciplinary Offense presented by John Winslade
  • Quality Circle Time in the Secondary School presented by Jenny Mosley

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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.

Helping clients develop a healthy relationship with social media

By Bethany Bray September 24, 2020

When a user opens Facebook, Twitter or many other social media platforms, there is a slight delay before an icon illuminates to indicate that the person has a notification, signaling that someone has liked or interacted with one of the user’s posts.

That moment of delay is purposely designed into social media apps to create an alluring cycle of anticipation and reward, according to Amanda L. Giordano, a licensed professional counselor (LPC) whose main area of research is behavioral addictions, including addictions to technology and social media. “Social media is made to be irresistible. It taps into the pleasure centers of the brain. It’s designed to keep you on it as long as it can,” says Giordano, an associate professor at the University of Georgia. “They operate from the variable ratio reinforcement scenario. That’s the most powerful reinforcement schedule there is. [Social media’s draw] is like gambling, knowing that there could be a big payout at any time, so you keep playing. Users know that they’re going to get some kind of reward, but they don’t know when it’s coming. There is a strong dopamine response [to that].”

That drive to seek the rewards that are triggered by social media can lead to compulsive and problematic use. But by providing psychoeducation about the ways that social media platforms are designed to affect neural pathways, counselors can help clients achieve a healthy balance with their social media use, says Giordano, a member of the American Counseling Association. This is especially true with child and adolescent clients, who are digital natives who have been exposed to technology all of their lives but may not yet possess the maturity to recognize the control that social media can exert over them, she adds.

Providing psychoeducation is just one of many ways that counselors can assist clients in flipping their perspectives and using social media to get what they want out of the experience rather than vice versa. Taking simple actions such as changing a smartphone’s color scheme to gray scale can render Facebook’s notification icon — a red bell — less powerful, Giordano notes.

“By becoming aware of all of that, and understanding how social media is tapping into some of these more primitive brain responses, clients can be empowered by the knowledge and take more control over their use,” she says.

Part of life

According to the Pew Research Center, 72% of American adults use at least one social media site “to connect with one another, engage with news content, share information and entertain themselves.” Pew found that those ages 18-29 had the highest usage at 90%, followed by 30- to 49-year-olds at 82%, 50- to 64-year-olds at 69%, and those 65 and older at 40%.

Pew’s data collection in early 2019 found that more than half of adults who used Instagram, YouTube or Snapchat visited those sites at least once per day. Facebook was pinpointed as the most popular social media site, with 69% of adults using the social networking platform. In addition, 74% of Facebook users visited the site daily.

These statistics point to a hard-to-ignore conclusion: Social media is a very real part of the fabric of people’s lives today. Regardless of counselors’ personal feelings about social media — whether they view its impact and influence as a net positive or a net negative — they must do their best to understand it and the role it plays in their clients’ lives.

Don’t discount the positives

Social media use can factor into any number of presenting issues and challenges that clients bring to counseling, from relationship friction discussed in couples counseling to self-esteem or body image issues in clients who struggle with perfectionism, eating disorders, social anxiety or other conditions. The COVID-19 pandemic has added another layer to this issue, as many people are quarantined or otherwise spending more time at home, feeling isolated and turning to social media to find connection or quell boredom.

As it relates to their clients’ lives, professional counselors may first think of the potential negative implications of social media use. However, the counselors interviewed for this article emphasize that there are both good and bad aspects of social media use. And for many people, the pluses can far outweigh the minuses.

“It’s an area that many counselors shy away from. … A lot of times, it feels like folks demonize social media. There are a lot of ways to keep from using it in an unhealthy way and to use it to your benefit,” says Kertesha B. Riley, a career coach at the University of Tennessee’s Center for Career Development and Academic Exploration, where she is working on a doctorate in counselor education. “There are hundreds and thousands of examples where social media is not a good thing at all, but I don’t let that outweigh the good that can come from it.”

Riley is active on Twitter, using the platform to stay up to date professionally, follow leaders in the field and forge connections. In the realm of career counseling, social media sites such as LinkedIn can play an integral role in clients’ job searches, Riley says, adding that she often talks with her clients about leveraging social media to enhance their career development. Creating posts with hashtags such as #jobs and #hireme can catch the attention of potential employers, while clients can follow hashtags within their own industries to stay abreast of trends or connect with colleagues.

“It can help [clients] to stay in the know and connect with people, but also further their career goals in a way that propels them a lot quicker than without [using social media],” says Riley, a member of ACA. “For networking, follow leaders and movers and shakers in your industry, and see who they follow. See what gets you noticed on this platform, and in your field.”

Social media can also serve as a tool to find and connect with professionals with whom clients relate, Riley notes. “Especially for those who are having feelings of doubt or mention that they’re not seeing people who look like them in the field, they can follow people they admire and identify with.”

As a Black doctoral student, this is the case for Riley. Although she doesn’t have many Black colleagues at her university, she follows and interacts with many Black doctoral students and professors via social media.

ACA member Jordan Elliott saw how social media could play a beneficial role in her work as a residential counselor at a treatment facility for women with substance use disorders. Many of the women at the facility had extensive trauma histories. Elliott, an LPC intern and licensed chemical dependency counselor in San Antonio, often worked with clients to create social media plans for after they were discharged. In many cases, this included joining social media groups and following pages with others in recovery.

These connections helped the women support each other and keep moving forward in their recovery after discharge, Elliott says. If a friend began to relapse, they would often recognize the signs in the person’s social media posts — or lack of posts — and reach out to check on one another.

“They often found intense connections with each other once in treatment. They were already drawn to connect with each other, and they wanted to continue that after they were discharged,” recalls Elliott, a doctoral student in counselor education at the University of Texas at San Antonio (UTSA). “This was huge for them, to stay in contact with one another through social media. … Social media has such a healing capability because it helps people connect and stay connected with each other.”

“When working with clients who have experienced extreme disconnection, via addiction, loss and grief, trauma or other ways, think of the power [social media] can have to bring people together and find connection,” Elliott continues. “In counseling, the relationship is key — we are relational creatures and drawn to connect. Think of how social media can be a connective intervention for clients.”

Getting up to speed

Counselors who aren’t familiar or comfortable with social media should think of it as “just one more way to connect with clients,” Elliott says.

“It’s our responsibility to keep up with it and how it is changing. It can be difficult to keep up with everything, but take that initiative to educate yourself on these platforms as much as you can,” Elliott urges. “For counselors who don’t feel as comfortable with technology, think of it as a creative intervention [to reach clients], and it might not be as intimidating.”

Giordano agrees, noting that counselors have a duty to bring themselves up to speed on social media to better help their clients. Having even a basic knowledge of the different platforms and their varying attributes will help practitioners ask the right questions to connect with clients,
she says.

“The best way is to ask clients, ‘What does it [a particular social media platform] do for you? Escape boredom? Find identity? Connect with peers?’ It’s really important to have a nonjudgmental view of it because, in large part, people have a good experience and find benefits,” Giordano says.

Counselors who want to learn more about social media can begin by doing an internet search on the different platforms and the terms they hear clients using in session. In some cases, counselors might want to consider creating a profile themselves so that they can log in and explore a platform further. Erin Mason, an LPC and assistant professor at Georgia State University, notes that some of the school counselors she knows have created TikTok accounts to better understand the video-sharing platform that is particularly popular among teens and young adults.

Mason, an ACA member, has maintained an active presence on Twitter, professionally, for nine years. She says it helps her stay up to date on trends and developments in the field of school counseling.

Riley recommends that counselors “stay open-minded and talk with someone in your personal or professional life who does use social media. Talk with your clients. Ask what draws them to it and what are some challenges that they’ve encountered. Hearing some firsthand perspective can help pull the wall down against social media,” she says. “[Social media] is a living, breathing, evolving entity, and because of that, there’s a place for everyone if you choose to look for it.

“If a client really loves TikTok, have them walk you through it: What do they like about it? What makes a good video [post]? What do they engage with the most? This helps open them up and tells you a lot about why and how they engage. … It gives you a better idea about their motivation, their mindset and their personality based on the type of platform and how they engage [with it].”

When it becomes a problem

There are no uniform diagnostic criteria for social media addiction, either in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or through the World Health Organization or other agencies, Giordano notes. However, she says, it is estimated that between 5% and 10% of adults have a “problematic relationship” with social media — a prevalence that is comparable with most other behavioral addictions.

“What we know is that it’s prevalent among adolescents, adults and young adults across the globe,” Giordano says. “In the United States, researchers have found that almost 10% of undergrads have social media dependence.”

With that in mind, Giordano urges counselor clinicians to complete thorough assessments of clients’ relationships with social media. The frequency and amount of time they spend on the platforms are good places to start, but there are many more nuanced indicators to consider. Giordano recommends that practitioners check in with all adolescent and adult clients about their motives for engaging with social media, their compulsivity levels, how social media use affects their moods and the emotions that they associate with it. For example, does it disrupt their sleep cycles? Do they experience envy, a lack of belonging or self-loathing?

“When the client is not on social media, do they have an urge to check it? Are they craving it? Do they have FOMO [fear of missing out]? Is it creating anxiety when they’re not on it?” asks Giordano, co-author of an upcoming article on cyberbullying and adolescent social media use that will appear in the Journal of Child and Adolescent Counseling.

Practitioners should note that using social media while driving is a red flag that can indicate social media addiction, Giordano adds. There is also a documented link between social media use and nonsuicidal self-injury — so much so that many of the major platforms have created guidelines for banning photos and posts that glorify self-injury, she says.

Overall, people with poor regulation skills are at higher risk for social media addiction, Giordano says, whereas those who have healthy regulation skills are better able to self-regulate their emotions rather than relying on social media to manage their moods. Counselors should listen for the hallmarks of addiction in the ways that clients describe their social media use, she says. Among the possible warning signs are:

  • When clients’ social media use becomes compulsive and they find themselves checking it when they didn’t plan to
  • When clients have a loss of control, staying on social media longer than they intended
  • When clients continue to engage in the behavior even after experiencing negative consequences such as cyberbullying, family or relational conflict over their social media use, or disruptive sleep patterns

Practitioners can use several assessment tools and questionnaires to screen clients for social media addiction, Giordano notes. More information on these tools can be found in “Investigating psychometric properties of social media addiction measures among adolescents,” an article that Giordano co-wrote with Joshua C. Watson and Elizabeth A. Prosek for the October issue of the Journal of Counseling & Development.

Elliott emphasizes the importance of assessing each client individually because what a healthy relationship with social media looks like will differ for each person. “One client could say that they only use social media six hours per day — but they used to use it for 12. Shift your perspective to meet them where they’re at with their social media use, and don’t pathologize it. … Don’t have a set idea of what it would or should look like, thinking you know what’s best for them. Let them be the judge of how they interact with these platforms instead of us placing our perceptions on them,” says Elliott, who co-presented a session with Stacy Speedlin titled “Healing the Brave New World: Resolving Trauma Issues for Millennials Using Social Media” (available at aca.digitellinc.com/aca/sessions/18482/view) at the ACA 2019 Conference & Expo in New Orleans.

For Riley, a general indicator that a client has an unhealthy relationship with social media is when its use begins to interfere with the person’s daily life and functioning. If clients talk about choosing activities because they might result in posts or photos that will garner likes or attention on social media, that should prompt further questioning from the counselor, she says.

“It’s not as simple as the amount of time you spend on [social media]. That can be an indicator, but not necessarily. … Right now, with everyone at home [because of COVID-19], use will be higher,” Riley says. “If it’s impacting the time you [the client] are spending on self-care, or time with loved ones, being in nature or in your community, and you’re finding it’s taking time away from the things you want to do, then it might be approaching an unhealthy relationship. … Asking [clients] about their time spent on social media is a way to start the conversation. But from there, flesh out what is behind that. What is compelling them to spend so much time on social media?”

Cold turkey isn’t the answer

A recommendation that clients delete their social media accounts or discontinue their use altogether may be appropriate for the small percentage of individuals who truly struggle with social media addiction, Giordano says, but it might not be helpful — or even possible — for many other clients.

“There are a lot of benefits to social media, from building relationships and social connectivity to advocacy,” Giordano says. “The answer is not to stop using social media. The answer is for clients to take more control of their social media use so they’re not just going along with whatever impulses they have but [instead] being intentional.”

Counselor clinicians should also keep in mind that social media may be part of a client’s livelihood, adds Mason, so it would not be feasible for the person to quit the platforms entirely.

The same holds true in the realm of addictions recovery, notes Elliott, who counsels mostly adult clients at UTSA’s Sarabia Family Counseling Center, which offers free community services. Deleting one’s accounts would mean severing contact with those who support them during recovery. Social media “is often their lifeline to each other,” she says. “Say they relapse. It’s so important to have that network that they can plug back into. If they’ve deleted all their accounts, how are they going to do that?”

“I think the best way to help someone learn to have a healthy relationship with social media is [for them] to use it,” agrees Riley. “There can be instances where it can be helpful for clients to step back for a time, but for me it’s important to help them engage with it in a healthy way, and that’s not as easy if you go cold turkey.”

“I have a love-hate relationship with this idea, but social media is ingrained in our society,” Riley continues. “Not using it is lessening your engagement with the world, especially for those in rural or isolated areas. It’s a way to see the world without leaving your ZIP code and engage and learn from those who aren’t around you.”

Getting to the why

Researchers from Harvard University, in a November 2019 study published in Health Education & Behavior, found that routine use of social media could have positive health outcomes on social well-being, mental health and self-rated health. At the same time, researchers found that having an emotional connection to social media use could generate negative health outcomes, such as increased anxiety, depression, loneliness and FOMO.

Having a healthy relationship with social media involves understanding why one uses the platforms, and counselors can play a key role in helping clients explore that perspective. It’s most important for clients to decide on and create their own goals rather than counselors making suggestions, Giordano stresses.

“They probably already have people in their life telling them that they spend too much time on social media, so that’s not helpful to say. Instead, help them find their own motives for making change. From there, come from a nonjudgmental stance [and] use the client’s own motivation for making change rather than just imposing rules,” she says.

Giordano finds motivational interviewing and cognitive behavioral techniques helpful when engaging in this work with clients, but she says that counselors can adapt whatever framework they prefer to address this issue.

Practitioners can start by helping clients “give voice” to the pros and cons of their social media use. Giordano suggests asking clients in session why they use it, what they like about it and what they wish they could get out of it.

Giordano notes that research studies on the function of social media in people’s lives have pinpointed that people turn to it to meet three main needs:

  • The need to belong
  • The need for self-presentation
  • The need for emotion regulation or mood modification

She suggests that practitioners ask clients about their thoughts and beliefs prior to using social media, during social media use and after social media use. Then, listen for language that could indicate deeper issues or maladaptive core beliefs that might be motivating clients’ behavior. For example, a client who struggles with self-esteem may mention feeling inadequate or self-critical if they don’t post a witty response to a friend’s post.

Elliott emphasizes that the client should be the driver in this process. “I’m a huge advocate for meeting clients where they’re at. If they’re presenting with negative side effects of social media or an unhealthy relationship with it, ask them about their relationship, what is its role in their life and how is it affecting them. Enhance that conversation instead of challenging it head-on. [If you say], ‘It sounds like you’re addicted to social media,’ that’s not going to help. Fall back on motivational interviewing techniques to have them evaluate what it is giving to them versus taking from them.

“Social media is good because you get to choose who you’re connected to. There’s so much freedom. A counselor can help with flipping that perspective: [Clients] have control of who they’re friends with and what they might see in their feed.”

Perspective shift

Counselors can help clients move toward intentionality and control over their social media use. A good way to start this process is to prompt clients to talk about what social media gives them and what it takes from them — and how or whether they’d like to change those benchmarks, Elliott says.

Elliott recalls one client with whom she worked at the residential treatment center in San Antonio. Social media was a prevalent part of the woman’s life, and she had more than 1,000 “friends” on Facebook.

Clients were not allowed to have cellphones while they were in recovery treatment. As this particular client neared discharge, Elliott allowed her to turn on her phone — for the first time in two months — as part of creating a social media plan in a session.

Elliott sat with the client as she went through her social media contact lists, blocking, unfollowing and severing ties with people who had previously been part of her life of substance abuse. Many of them had sent her messages, knowing full well she was in a recovery program, to ask her to contact them once she was out.

“If she had looked at those messages at the beginning of her treatment, she might not have stayed. There were a lot of unhealthy people in her life,” Elliott says. “It was a really important exercise to do. In hindsight, I can’t imagine what would have happened if we didn’t address this together. Would she have left treatment, turned on her phone and been bombarded with all these messages?”

Instead, in session, Elliott and the client talked about setting boundaries with social media and processed each friend decision together. They talked about why she wanted to block some people and unfollow yet remain connected with others — those to whom she could be a help, Elliott recalls.

The client also was able to add women from the treatment program to her social media accounts. This greatly broadened her pool of friends, adding people of different ages and backgrounds. The process represented “a complete reframe” for the woman as she exerted control over her social media and decided what role she wanted it to play in her life and her healing moving forward, Elliott says.

This process was often part of creating social media plans with clients at the facility, Elliott says. She served as a support as clients deleted or began to follow accounts, set boundaries and rethought their social media use.

For example, if a client followed a page that glorified drug use, such as the account of an artist or musician, Elliott and the client would process that choice together. “I would talk it through with them: ‘How will it affect you to see that? If so, what are you going to do about it?’ We would evaluate which of these things [the people and pages the client followed] are worth it to them and which things aren’t, as well as knowing their triggers and making a plan for if they were triggered by social media. For example, ‘What if you go on to social media and find that someone has passed away [from an overdose]?’ I would talk all of that through with clients.”

Setting boundaries

Exerting control over one’s relationship with social media often involves setting boundaries and limits. Counselor clinicians can support clients in this process by helping them create a social media plan in counseling sessions. Giordano says this can be particularly helpful for adolescent clients, who may benefit from writing down parameters to which they can refer back outside of sessions.

Social media plans should delineate specific times that clients do not want to use social media, such as during mealtimes, while driving, right after waking up in the mornings or within two hours of going to bed at night, says Giordano, who is writing a book on behavioral addictions that is slated to be published next year. Part of a client’s social media plan might include deciding not to engage in phubbing, a term for when people are glued to their smartphones while gathered together with others — in essence, snubbing people in favor of their phone.

Offering psychoeducation about the triggering aspects of social media can also be helpful during this process, Giordano says. For example, discussing the brain’s dopamine response to a phone’s notification alerts might lead clients to deactivate the notifications for their social media apps. Similarly, explaining how the blue light emitted from digital screens can disrupt sleep cycles might prompt some clients to set a goal of putting their phones in another room when they sleep, thus removing the temptation to check it while in bed.

There are also numerous apps and programs available that limit the amount of time a user can spend on a particular website, including social media. Giordano recommends an app called Offtime, whereas Mason uses Freedom, which is available both as an app and a Chrome plugin. In both cases, the user selects the amount of time they’d like to allow themselves to use certain sites each day, or they have the option to block sites entirely.

“One of the things that makes social media so different from reading a book or watching a movie is that a book and a movie have a set end. With social media, you can scroll without end, so you have to be intentional,” Giordano says. “Clients and counselors can decide [as part of making a social media plan] to only use social media when the results are positive and to do emotional check-ins on how using social media is making them feel.”

 

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Social media and youth: Taking a proactive role as a counselor

For counselors who work with young clients or in school settings, part of staying up to date with social media includes becoming knowledgeable about cyberbullying, says Erin Mason, an assistant professor at Georgia State University.

Cyberbullying, or harassment via digital means, including through social media, is a complex topic. It can take place both during and outside of the school day and both on and outside of school property. In school settings, the responsibilities of counselors and administrators regarding cyberbullying can vary significantly from school to school, as can the consequences imposed on students, notes Mason, who was previously a school counselor.

Mason recommends that counselors visit Common Sense Media (commonsensemedia.org) to stay updated on the latest trends in social media and its use among children and adolescents. The site’s many resources include detailed descriptions and ratings of TV shows, movies, apps, video games and other media for parents and educators.

Mason emphasizes that counselors need to take a proactive role — rather than a punitive one — when it comes to cyberbullying. Efforts should go toward fostering a healthy school culture that includes a focus on positive social-emotional behavior, she says.

“Counselors need to be really vigilant about what’s trending at their schools. Sometimes the trends start in schools and then filter out and become problems in lots of places [in the community],” Mason says. “This is where partnerships are really important — partnering with other school staff, local police and families, and making sure everyone’s on the same page with what’s happening.”

In a trend that was brought to Mason’s attention by one of her graduate students, a problem arose at a school where students were exchanging and sharing messages via Google Docs. The students would type a message and change the font color to white so that any parent or school staff person who intercepted the document would just see a blank page. This method was a way to conceal cyberbullying among students, Mason says.

“Kids figure out the workarounds, ways to trick the system or at least trick the adults,” Mason says. “It’s a lot for educators to stay on top of, and it’s a lot for families to stay on top of.”

On the flip side of the coin, Mason says she has seen social media used as a positive tool in schools. One of her colleagues was running a small group for female students in high school that was focused on empowerment, confidence and positive body image. She created a Pinterest board, and the teens were able to “pin” inspiring quotes and positive messages to share with one another. This activity bolstered the group’s cohesion, Mason says. The young women would add to the board outside of sessions, and the group would discuss the posts when they met in person.

“Some of this comes down to generational differences, and I wonder if over time we will see more of a shift in understanding how social media and these kinds of tools can be helpful, because they are so integrated in people’s lives,” Mason says. “Over time, the negatives won’t diminish, but the advantages will begin to outweigh the negatives, and counselors have a role to play in that — with families and in school settings. We need to be thinking about how social media can contribute positively to school environments.”

 

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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)

ACA Code of Ethics (counseling.org/resources/aca-code-of-ethics)

  • Section H: Distance Counseling, Technology and Social Media

Continuing education

 

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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.

Using existential-humanistic psychotherapy in the treatment of COVID-19 survivors

By Audrey Karabiyik September 22, 2020

To say 2020 has been an unusual year would be quite an understatement. As a collective human society, we have all experienced significant alterations to our once normal lives. One factor, COVID-19, has played the predominant role in this process, and some individuals have been affected more than others.

My personal experience with COVID-19 has prompted me to write this article so that my fellow counselors will have guidelines for helping other COVID-19 survivors. It is important to note that no evidence-based therapy practices are currently available as the pandemic continues to unfold. Before this, we had not experienced a worldwide pandemic in 100 years.

What is existential-humanistic psychotherapy?

Existential-humanistic psychotherapy helps clients discover their own uniqueness through acquiring a greater awareness of themselves and the world around them. The therapist assists clients by teaching them to see their resistance so that they can have a more meaningful existence. Clients are free to explore which aspects of their lives support their journey and which can be discarded to live a fuller existence. This approach avoids labeling and diagnosing, so the focus can be placed on self-searching and meaning.

There are five key goals in existential-humanistic psychotherapy.

  • Develop the capacity for self-awareness and understanding the ramifications of freedom of choice
  • Create a personal identity and be present for quality relationships
  • Search for the meaning, purpose, values and beliefs of life
  • Accept normal anxiety as a natural condition of living
  • Become aware of death and nonexistence

Where to begin

The COVID-19 symptomology and experience are unique to each individual, so it is important for existential-humanistic psychotherapists to encompass a number of traits.

The therapeutic alliance must be established during the initial visit. First, by adopting an I-Thou relationship with the client, you establish a relationship in which the client is the authority of their personal illness experience and life. Second, by providing unconditional positive regard, your acceptance and support will allow the client the important opportunity to share their subjective experience and reflect upon it. Third, by utilizing empathy, you will permit your client the freedom to share a fuller range of feelings and emotions with you, thus creating a space to deepen their authenticity.

Stages for COVID-19 exploration

Stage One: Life before COVID-19. This is an excellent entry point to begin the I-Thou therapy relationship. The client will start to gain an understanding of your existential-humanistic style.

Simultaneously, you have the important opportunity to explore your client’s communication style and level of expressiveness. You will acquire an understanding of your client’s typical lifestyle, level of functioning, and what values and beliefs existed for them prior to the COVID-19 pandemic. Additionally, you can establish the client’s goals and what they wish to achieve during therapy.

Questions that may be of help could include:

  • Who were you living with?
  • What was your typical day?
  • Were you actively employed? How important was your job to you?
  • How did you spend your free time?
  • How was your general health?
  • Did you take time for yourself?
  • What was your “normal”?
  • What did you value most at that time?

My normal was living with my husband and son. My husband had endured six months of cancer treatments in another country the year before, and we were finally able to live together again. I was working in a counseling capacity. Our spare time was usually spent being with family and friends, traveling and enjoying our personal hobbies. 

Stage Two: Understanding the client’s early illness. In this stage, each client recalls and shares their unique symptomology and experience. At this point, your client may have greater comfort in the therapeutic relationship as a result of you engaging in active listening and empathetic techniques. You teach the client to explore their problem to develop insight by sharing physiological and psychological feelings related to their early illness.

Questions that may be of help could include:

  • How did the disease manifest itself?
  • What were your early symptoms?
  • Where do you think you came into contact with the disease?
  • When did you realize you were seriously ill?
  • What action did you take to address your illness?
  • What were you thinking and feeling about your symptoms?
  • What were your concerns at that time?

My symptoms — dizziness, cough, a heightened sense of smell, kidney pain and extreme fatigue — started in late March. My doctor prescribed an antibiotic and suggested I avoid the emergency room because it was believed that all in-house patients were positive for COVID-19 at that time, and if I did not have COVID-19, I would surely acquire it when I arrived. (It was days later that I understood her logic).

So, I spent a few days in bed, sleeping most of the time. I made every attempt to avoid the kitchen because the cooking odors were overwhelming to me. I had a desire to indulge in very hot baths, but each one seemed to make me weaker than the one before. I was feeling unsettled at this point because of the inconvenience of missing work. I also had feelings of fear that things would worsen. 

Stage Three: Determining the client’s level of illness. This stage involves the realization of a more serious illness, worsening symptoms and the eventual need for a higher level of care. Ideally, your client will be able to express a broadening range of feelings and thoughts as they reveal how they came to terms with their level of illness. As the therapist, you can begin to introduce the concept of freedom of choice in their decision-making.

Questions that may be of help could include:

  • How long had you been sick by this point?
  • What were your worsening symptoms at this time?
  • What made you decide to seek additional care?
  • How did you discover that you actually had COVID-19?
  • How long were you in the hospital?
  • What were you thinking and feeling when you realized what was happening?
  • What were your concerns at that time?

As part of four days of deepening symptoms, I had ceased all eating and drinking. I was unable to consume anything, mostly due to my heightened olfactory symptoms. Simultaneously, I was beginning an insidious decline in my ability to oxygenate my lungs, so I finally had my husband take me for the inevitable drive to the emergency room.

We were met outside the hospital by a front-line health care worker in complete personal protective equipment. My husband was required to leave before I was permitted to enter the emergency room. In these early days of the pandemic, with only a limited number of cases being discussed in the media, the seriousness of the disease was not yet widely known, but the possibility existed that I might never see my husband again. Although we had both experienced the fear and sadness of my husband leaving for cancer testing and eventual diagnosis the prior year, I believe we both inherently knew that my departure was unlike anything we had encountered before.

Stage Four: What were the client’s experiences during their care? While this stage addresses what was happening physiologically with the client, it is also giving birth to several key existential concepts for early exploration. As COVID-19 patients spend time in the required isolative ICU, anxiety rises and universal themes such as freedom of choice, isolation, meaningless and death are thrust upon them, becoming inescapable.

First is exploring the meaning of illness itself while having to grapple with giving up control. Second is finding meaning in the aloneness they are experiencing. Some clients may find that this is the first time in their life they have ever been alone or had an opportunity to focus solely on themselves. Third is finding meaning in the emptiness of their surroundings. Fourth is dealing with finding meaning in life itself and coming to terms with potential death.

You (as the therapist) can openly discuss the reality of death at this stage. Active listening and unconditional positive regard are of the utmost importance during this stage because this is where the transformation ultimately begins. The client deserves to have the complete freedom to share all of their thoughts, memories and feelings, no matter how irrational they may seem to you.

Questions that may be of help could include:

  • Did you understand what was happening medically?
  • What were your emotions during early care?
  • Was this your first experience with emergency care?
  • How did you feel when you realized that you had to give up full control to the medical staff?
  • What treatments did you receive?
  • Did you require the use of a ventilator?
  • What was your length of stay?
  • What emotions and feelings came into play? Were you frightened? Bored?
  • How did you feel being all alone?
  • What were you thinking and feeling when you realized what was happening?
  • What were your concerns at that time?
  • Did you think you were going to die?
  • How did you deal with that thought?
  • Did you draw any conclusions?

During my first career, I spent many years as a front-line health care worker. Therefore, in the hospital setting, I was returning to my roots and was fully aware of what was happening. With that said, too much knowledge can also prove frightening. I was quickly made aware of the gravity of the situation, and I was well aware that the best approach was to instantly give up control so the staff could make every effort to save my life.

I spent the next two weeks in ICU, continuously receiving 15 different medications, mostly intravenously, and 24-hour-a-day oxygen therapy, as well as undergoing many venous blood and several arterial gas tests and portable chest X-rays. My oxygen levels were very low and not responding to treatment.

The realization had long since set in for me that I would not have visitors and that death was a possibility. My entire focus went to one thing: continuing to inhale and exhale repeatedly, even as COVID-19 played tricks to convince me to stop breathing. A ventilator was considered, but I knew there would be an 85% chance of never breathing on my own again. Each labored breath represented many things — avoiding the ventilator, returning to the presence of my husband and son, lying in my own comfortable bed, not dying alone.

Despite my desires to return home, I spent many hours in the ICU contemplating the life I had lived and the possibility of death. I reconciled my life with God and was in a place of total peace. I came to terms with all of the relationships in my life, feeling sorry for those individuals incapable of making true connection. I was filled with extreme gratitude for what I had been provided throughout my life, including family, special friendships and the ability to connect with others.  

Stage Five: Post-hospital healing and meaning. Checking out of the hospital left me with immense hope. I had achieved what I had set out to do there. At this point, I was still on oxygen 24 hours a day and was able to walk about 24 feet before exhaustion set it. Because little information was available, the doctors required me to quarantine alone for another week, then another. I came to the realization that all one can do for the sick or terminally ill is to provide sustenance and let the person know they are loved.

Two weeks alone in my bedroom and my perspective had changed again. My wonderful bed had become my new prison. But, finally, I was set free of isolation and able to experience smiles, laughter, human touch, hugs and togetherness again.

Stage six: Where do we go from here? Certain clients will benefit from cognitive behavior therapy at this point to explore any distortions that may exist and will become content with their progress, thus ending their therapy at this time.

Others, having been given the opportunity to unleash their personal COVID-19 journey, will begin to open to possibilities for the future. First, you can explore anxiety with the client. You can provide psychoeducation to help the client understand the purpose of anxiety and to distinguish between existential, normal and neurotic anxiety. You can then explore how freedom of choice is used in decision-making and relates to the future and discuss the reality of death in greater detail. Introduction of Maslow’s hierarchy and self-actualization can provide the client psychoeducation to increase their self-awareness in the present and give them a road map for the future.

Questions for possible exploration can include the following:

  • Do you see yourself differently since your illness?
  • What things did you learn about yourself?
  • Are you more comfortable with yourself at this time?
  • Have your values or beliefs changed in any way?
  • Have your thoughts or fears changed related to death?
  • Are there any changes you would like to make in your life?
  • How would you like to spend your time in the future?
  • Will you handle situations differently?

Lingering COVID-19 symptoms, including bouts of low energy, occasional low oxygens levels and the unfortunate loss of a great deal of hair, still plague me. However, they are insignificant compared with my desire to help recovering COVID-19 survivors and front-line workers find meaning in their personal experiences.

 

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I would like to thank Ayala Winer and Arlene Gordon for their gentle guidance in encouraging me to share my story.

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Audrey Karabiyik is a graduate of Nova Southeastern University and is currently a registered mental health counselor intern in Florida. She is starting several COVID-19 groups geared toward survivors, front-line workers and others wishing to process the “new normal.” She is associated with Systemic Solutions Counseling Center in Plantation, Florida. Contact her at AudreyKarabiyik@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.

ACA online event encourages conversation about counselor stressors

By Bethany Bray September 21, 2020

“How can I to continue to hold hope for my clients while I feel like I’m drowning?”

“How can I confront colleagues who commit microaggressions in client sessions?”

“What advice do you have for students whose professors and textbooks do not address multiculturalism?”

These were among the many challenging — and honest — questions raised during “Our Community Gathers: A Conversation With Counselors About Mental Health in 2020,” an online forum the American Counseling Association held Sept. 17 to facilitate professionals connecting with one another and sharing concerns. Much of the discussion from panelists and attendees alike focused not just on the additional stress that counselors and clients have been experiencing throughout the COVID-19 pandemic but also on the trauma, grief and exhaustion raised by recent social turmoil tied to systemic racism in America.

The online event, which was sponsored by the ACA Foundation, drew more than 400 attendees, including ACA members and nonmembers.

“This event is all about you,” said ACA President Sue Pressman as she opened the Zoom session. “Each day it feels like the very fabric of our society is unraveling. The work we do for clients and students is so important, [and] frankly speaking, counselors are needed more now than ever. I could never be more proud to be a counselor. At the same time, counselors are in crisis and in need of support. … Care and compassion for our colleagues is important and can be quite powerful, and this is one of the reasons for this event.”

S. Kent Butler

S. Kent Butler, ACA president-elect, served as the forum’s moderator, while Pressman gave opening and closing remarks. The event panel included several past ACA presidents and leaders from across the counseling profession, including Beverly O’Bryant, Courtland Lee, Gerald Corey, Ebony White, Mark Scholl, Anneliese Singh and Selma Yznaga.

The panelists were open and honest about how they too have been struggling recently. They urged attendees to focus on practicing self-care, taking breaks and staying aware of the body’s signals that one is becoming overwhelmed. They opened the session by talking about the necessity for counselors to seek their own counseling.

White said that counselors are “secret keepers” and noted the importance of processing the pain they carry for others in their own counseling sessions. At the same time, it can be a challenge for Black practitioners and other counselors of color to find a practitioner who looks like them because a majority of counselors are white. This is a barrier that is also shared, of course, by clients of color when they seek counseling.

“Even still in the year 2020, right now, as a Ph.D., LPC [licensed professional counselor], Black counselor who has a [professional] group of people I’m connected to, I’m having trouble finding a Black woman counselor, right now in this moment,” said White, an assistant clinical professor at Drexel University in Philadelphia. “This continues to be an obstacle, particularly for people of color, and it needs to be addressed.”

It is always a good idea for counselors to seek out therapy, but especially so now, agreed Lee, a professor in the counselor education program at the Washington, D.C., campus of the Chicago School of Professional Psychology. “Dealing with this [clients’] intense pain constantly is really going to get to us,” he said.

Lee, a past president of ACA and the Association for Multicultural Counseling and Development, emphasized the importance of resting and only taking on work and tasks that are personally important to individual counselors. He said that was a lesson he learned acutely and personally after his wife, Vivian, passed away suddenly earlier this year.

“What’s not important is sitting in front of a computer all day and having my phone in my hand all the time. Tonight was important to me; that’s why I’m here,” Lee said. “Find what gives you meaning, what’s sacred to you. You’ve got to find ways to take rest.”

White suggested that counselors consider “the bare minimum” amount of time they want to devote to self-care and make sure to hit that mark. For her, that’s 1% of her day. “Dedicate that portion of your day to something that is self-care. Whether that’s for prayer, dancing, drinking wine, whatever it takes,” she said.

Corey and Scholl urged attendees to consider all facets of wellness — physical, social, spiritual, emotional, cognitive, etc. — and focus on areas they find depleted, seeking activities that rejuvenate. For Corey, that includes doing Pilates; for Scholl, it’s enjoying naps that aren’t restricted to “power naps.” Scholl also is intentional about engaging in activities to connect with his Native American heritage, including attending Native gatherings and reading works by Native authors.

“One of the things that I’ve learned is that wellness doesn’t just happen, it takes discipline,” agreed Yznaga. “I have to plan for it, be deliberate. … For anyone who is thinking, ‘I’m not well and I cannot be well,’ yes you can, but you have to work at it.”

Attendees of Our Community Gathers flooded the platform’s chat queue with questions and comments throughout the session. Many posted websites and resources they thought others might find helpful and exchanged email addresses to continue conversations offline.

Panelists stayed online for more than three hours, until 10:30 p.m. Eastern, to answer questions and share ideas with attendees. Judging by the level of engagement the event garnered, counselors found the dialogue sorely needed.

One attendee asked for guidance on how to respond when a client makes a racist statement or uses offensive language in a counseling session. The panelists stressed the importance of responding to clients with honesty in these situations.

“It’s your responsibility to manage that tension in the room,” said White, who noted that counselors are doing a disservice to the client if they let a client’s statement go by without challenging it in session even as another dialogue that disagrees with the client plays silently in their heads.

Confrontation can be a therapeutic tool, White added.

Lee emphasized the term “broaching” in his response and the importance of broaching the subject to help clients un-learn words and perspectives that may have been ingrained in their culture and upbringing.

“Counseling is supposed to be an educative process,” Lee said. “Counselors often skip by teachable moments, but you can’t let them slide by.” When a client expresses a racist view in session, “Broach it and use it as a teachable moment,” he advised.

“We can be authentic and confrontational and still be respectful, even though it’s tough,” agreed Corey, an ACA fellow and professor emeritus of human services and counseling at California State University, Fullerton.

In such an instance, Corey said he would respond to the client by saying, “What I’m hearing you say is X. Let’s talk about it.” Afterward, it would be helpful for the counselor to seek out a mentor or colleague to debrief with and find support, he said.

Several panelists noted that the United States is in the midst of a cultural shift that brings opportunity for the counseling profession.

“Let’s try and take advantage of this moment and show the country what we have to offer, to destigmatize mental health and teach people how we [counselors] can help,” said Yznaga, an associate professor at the University of Texas Rio Grande Valley.

Lee remarked that he never thought he’d witness Confederate monuments taken down in his lifetime or the professional football team in Washington, D.C., change its name.

“We are at an inflection point that I have never seen,” Lee said. “This is much different than the [civil rights movement of the] 1960s. The ‘60s opened the door and made tremendous progress, but this era … It’s beyond just a teachable moment at this point; it’s an opportunity that we haven’t had before. If counselors are agents of social change and social justice, we need to get out there and fill the learning gap.”

 

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Resources

Continue the conversation

ACA will hold a virtual event on racial injustice and policy reform Oct. 14 at 2 p.m. (Eastern). The moderator for the event will be Aisha Mills, CNN and MSNBC political commentator.

Be on the lookout for registration information in ACA’s Member Minute newsletter, or email advocacy@counseling.org to share your interest in attending.

Counseling Today articles on related topics

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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.

Voice of Experience: The miracle of 28 days

By Gregory K. Moffatt September 17, 2020

When I began my life as a mental health worker well over 30 years ago, the words “managed care” weren’t even a blip on the radar. Almost everyone had personal insurance. People who had an HMO were mostly factory workers, and to have an HMO or a PPO was generally not regarded as a good thing. Otherwise, you could go to whatever doctor you wanted, there were no “referrals,” and both physicians and counselors had immense latitude in the first few weeks of treatment.

In those days, there was a joke in our profession that went something like this: “How long does it take to treat [fill in the blank with any issue]?”

The answer: “Twenty-eight days.”

The reason for 28 days is that insurance companies would reimburse for up to 28 days of treatment — even in-patient care — without question. After that, lots of other documentation was required. So, miraculously, in-patient care was often — you guessed it — 28 days.

Of course, no responsible therapist planned their treatments based on that 28-day ceiling, but we had tons of latitude on treatment plans. But the late 1980s brought us major changes in health care. Managed care (HMOs and PPOs) changed the way we did business. I was too new in the field to have an opinion at that time, but I remember the outrage among my supervisors and other veteran counselors.

In retrospect, the change in how insurance worked actually helped us (forced us?) to become better in how we provided services. For example, brief solution-focused therapy, which was something that didn’t exist when I was a graduate student, is a result of this change.

You may be asking yourself whether there is a point to this interesting trip down memory lane. Well, I think we may be seeing something just like I described above happening right now.

Americans are innovative. I am confident that the coronavirus pandemic has created a scenario that will permanently change much of our culture. In the 1980s, therapists didn’t have to think about being “brief” or efficient, but the rise of managed care forced our hands, and we got better because of it.

This virus has forced us into telemental health and other ways of offering services that, prior to March of this year, we didn’t have to think about unless we wanted to. I have encouraged all of my supervisees to pursue the telemental health credential in our state, and I have done so myself, both as a clinician and supervisor, but I suspect that lots of veteran therapists just didn’t want to mess with a new modality.

Imagine that. Once again, here is something that we were forced to do that we should have been doing already because it provides options and helps our clients. In my early years, I learned to be efficient — to do in one session what my teachers might have had the luxury of doing in five or 10 sessions. I did things efficiently because managed care forced me to do so. But shouldn’t we have been doing that anyway?

I’m not belittling my predecessors. My teachers and supervisors didn’t have to do something they weren’t accustomed to doing, so they only did it if they felt like it. Now I’m realizing that this current pandemic is changing the way we do business, and that change isn’t going away when the virus eventually fades away. I predict that some of our clients will never choose to go back to the way it was. And maybe they shouldn’t. Young therapists will probably look back on this time in history and say, “Why did my teachers need a virus to get them to routinely offer services that benefited their clients? Crazy!”

This will also affect me as a college professor. My students undoubtedly will be asking, “Why do I have to come to the classroom?” long after the pandemic is history.

My clients will be asking something similar: “Why do I have to drive all the way across Atlanta and deal with traffic every week when I can see you from the quiet of my home office (in my slippers and jammies) if I wish?”

So, in our very near future, I suspect that graduate programs will not offer telemental health as an optional certification. Instead, programs will be adjusted to provide telemental health as an expected option for clients who fit well with this modality.

If any of you reading this are holding your breath until things “get back to normal,” don’t hold your breath any longer. We have a new normal, and this will almost certainly, in some ways, be very good for us, good for the counseling profession and, most importantly, good for our clients.

 

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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.