Monthly Archives: December 2020

Our most-read articles of 2020

Compiled by Bethany Bray December 28, 2020

It has been a year like no other, bringing upheaval and uncertainty to professional counselors and their clients alike. It’s no wonder that many of 2020’s most-read articles at CT Online were on topics related to the COVID-19 pandemic and racial injustice. Other popular articles focused on helping clients with relationship issues, anxiety, obsessive-compulsive disorder and other mental health diagnoses. Pieces that put a spotlight on practitioner confidentiality, compassion fatigue and other professional issues also attracted strong reader interest.

More than 150 articles were posted at in 2020. This year marks the first time that a majority of the top 10 most-read articles were online exclusives that did not appear in Counseling Today’s print magazine.

Some of the top search terms that brought people to the site included self-care for counselors, empathy fatigue, polyvagal theory, “Self-care for the activist counselor,” trauma-informed counseling and counselor burnout.


What were counselors reading in 2020?

Here are the most-read articles posted in 2020 at

  1. Uncovering the root cause of mother-daughter conflict” (Member Insights article, January magazine)
  2. Recovering from the trauma of infidelity” (feature article, April magazine)
  3. How do counselors support clients during the coronavirus pandemic?” (online exclusive posted in April)
  4. The historical roots of racial disparities in the mental health system” (online exclusive posted in May)
  5. Hey, Siri: Did you break confidentiality, or did I?” (online exclusive posted in January)
  6. Deconstructing anxiety” (Knowledge Share, January magazine)
  7. Solution-focused tools to help school counselors in a pandemic” (online exclusive posted in September)
  8. Helping clients rebuild after separation or divorce” (online exclusive posted in March)
  9. Overcoming free-time boredom during COVID-19: Combining a home-based optimal leisure lifestyle with behavioral activation” (online exclusive posted in July)
  10. Living with — and beyond — OCD” (cover story, February magazine)
  11. Black mental health matters” (cover story, August magazine)
  12. A note of encouragement for counseling students during COVID-19” (online exclusive posted in April)
  13. Counseling’s evolution under COVID-19” (cover story, June magazine)
  14. Grappling with compassion fatigue” (feature article, September magazine)
  15. The revised meaning of self-care in the wake of COVID-19” (online exclusive posted in August)
  16. Bouncing back from ‘failure’ as a counselor” (feature article, March magazine)
  17. Adjustment disorder in the time of COVID-19” (online exclusive posted in April)
  18. Can you hear me now? Ways to reduce sound transfer between rooms” (online exclusive posted in February)
  19. Engaging avoidant teens” (Knowledge Share, May magazine)
  20. Putting first responders’ mental health on the front lines” (feature article, July magazine)




What was your favorite article of 2020? What would you like to see Counseling Today and CT Online cover in 2021?

Leave a reply in the comment section below, or email us at



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Grief and the COVID-19 pandemic

By Sophia Caudle December 21, 2020

The COVID-19 pandemic has triggered everyone around the world at the same time. The most common feelings people are reporting are fear, anxiety and loneliness, often with no clear pathway to feeling grounded again because of the uncertain nature of the pandemic’s timeline.

Unacknowledged grief is also being triggered for people during the pandemic. For example, a 22-year-old male client has been experiencing flare-ups with his obsessive-compulsive disorder, and his generalized anxiety and sex addiction have been triggered since the beginning of the pandemic. However, after guiding his therapeutic work into his deep, original grief, which he describes as not feeling connected or nurtured by his parents, he is now more effectively understanding and processing his grief, and his symptoms referenced above have drastically reduced. I have seen this pattern with many clients who experience reduced daily triggers after digging deep into their original grief work.

When grief is triggered (especially when we are unaware of our grief being triggered), it can create an intensity attached to the feeling we are currently identifying, because it traces back to our original grief. What I have termed “original grief” is the perceived awareness of our earliest emotional woundings, and when this gets tapped into, whatever we are currently dealing with seems exponentially more severe.

Original grief typically is formed during the first five years of life, when we are most vulnerable to being shaped by life’s circumstances. The foundational emotion attached to the pandemic is grief, and grief — if not acknowledged, felt and addressed — will continue to trigger more easily identifiable emotions such as fear, anxiety, depression, and whatever other feelings and reactions typically present for people in a crisis.

The COVID-19 pandemic is a perfect example of how understanding the different types of grief, especially original grief, can be helpful to us when we experience current daily triggers, because our deep grief awareness can better inform the tools we implement to ground ourselves.

Traditional grief

The most easily identifiable grief that the pandemic is creating for people is traditional grief. Traditional grief is the grief we feel when someone dies. For many of us, traditional grief is the only type of grief of which we are aware. Most of us are aware of acknowledging grief for ourselves or others only in the event of death and dying, and the biggest fear related to COVID-19 is the possibility of getting sick and that either we or a loved one will die.

According to the tracking website Worldometer, as of Dec. 13, more than 305,000 Americans had died from COVID-19, and there have been approximately 1.6 million deaths around the world. When we see the numbers of deaths related to COVID-19 around the globe, it is easy to become overwhelmed by fear and anxiety. It is also easy to think that if we or a loved one contracts COVID-19, death is inevitable.

Ambiguous grief

Another type of grief that is widely prevalent during the time of COVID-19 is what I term “ambiguous grief.” Ambiguous grief is the grief felt when a relationship ends or when we lose a loved one in our life who is still living. Ambiguous grief is also felt when we lose something important to us or when we have the awareness of something important that we never had. According to Pauline Boss, the principal theorist of the concept of ambiguous loss, the grief experienced during ambiguous grief can be ongoing because there is no closure as there is with traditional grief.

During the pandemic, ambiguous grief has certainly been ongoing for many of us. Most of us have lost relationships, lost in-person connections and lost our ability to move around our communities. Most people do not realize that the primary emotion being triggered in them is ambiguous grief, and typically, if we do not know what we are feeling and where it comes from, then we cannot effectively address it. People may believe that they are feeling anxious, scared or lonely when, in reality, their deep grief is being triggered and the felt awareness is anxiety and fear. Also, because there is no real sense of when the pandemic will be over and no sense of a projected closure date, ambiguous grief is constantly present and creating ongoing insecurities for many people.

The pandemic is triggering many types of ambiguous grief. The ambiguous grief I am seeing most often is the grief felt from the loss of daily interactions with others because of physical distancing. This has created a sense of feeling isolated and lonely for so many people. The interactions we are missing can involve either significant relationships or random interactions with people we do not know well at all. For instance, a simple conversation with the checkout person at the grocery store or a simple chat with a stranger in a park can serve as a type of spontaneous connection. For many of us, these interactions are no longer occurring or occurring much less frequently.

Live human interaction is sorely missed during this time, and our brains are noticing the loss of connection. As John Bowlby, the renowned attachment theorist, acknowledged, humans are hard-wired to connect, and the pandemic has removed person-to-person connection for many people. Some people who live alone or who are in other isolating living circumstances have not had a face-to-face conversation or felt a hug from another person in months, and this is tapping into their deepest sense of original grief aloneness.

For instance, my client “Charles” has not left his apartment in over eight months because of his fear of COVID-19 and his other health concerns. Charles lives alone and has not attended in-person Alcoholics Anonymous meetings since the pandemic began. Charles has also not experienced human touch in over eight months, and he describes feeling the effects of that unfortunate reality as “constant loneliness and depression.” Charles is experiencing deep grief around the loss of the ways he used to connect with others in a face-to-face manner.

Another type of ambiguous grief most of us are feeling is sadness around the loss of our “normal” way of living life. We used to be able to leave our homes and grocery shop, go to work, attend school, attend spiritual gatherings and socialize without thinking that our health could be in jeopardy. Now, these ways of living have either been stripped from us, or we must take extra safety precautions to do them at all. So many regular activities have been lost to us since the onset of the pandemic: marriage ceremonies, funerals, graduations, birthday parties, going away celebrations, sporting events, competitions of most kinds, and many types of intimacy.

Most of us took many of life’s daily activities for granted before the pandemic. Now, we are feeling ambiguous grief because much of what we used to do is not possible at this time. We are feeling a loss of our freedom to connect and move about in society.

Physical distancing during COVID-19 has forced us to set up intentional connections with others rather than relying on spontaneous connections if we want to feel emotionally healthy and maintain healthy relationships. Intentional connections during COVID-19 are exactly what they sound like — ways of meeting with others that we discuss and agree upon ahead of time. So, rather than communicating and deciding what fun activity we are going to do, we are actually planning with whom, as well as how, we want to connect in a safe manner.

COVID-19 has forced many people to make decisions about who they want in their inner circle of social connections. People who are being responsible and observing Centers for Disease Control and Prevention recommendations have chosen a short list of friends they can trust to socialize with during this time. Some relationships are blossoming, and some are deteriorating.

Living in isolation is difficult for many people, and not everyone can handle conscious connection for safety purposes. The removal of spontaneous interactions has required many of us to pivot and create new ways of connecting. Zoom, FaceTime, Skype and many other platforms have been used frequently during the pandemic in efforts to connect. Among those who have been able to transition into intentional connection during COVID-19, most are doing fine, but among those who are stuck in their original grief and not knowing how to create intentional connections, many are not doing well. In March, a commentary in QJM: An International Journal of Medicine predicted heightened isolation-related mental health impacts such as depression, anxiety and posttraumatic stress, which have already been identified during the pandemic in China. Furthermore, literature from Jiang Du and colleagues with the Drug Abuse Treatment Department at the Shanghai Mental Health Center suggests that those with substance use disorders and addictions are particularly sensitive to stress and have increased potential for maladaptive coping styles during periods of isolation related to the pandemic. Finally, according to research published by Brad Boserup, Mark McKenney and Adel Elkbuli in The American Journal of Emergency Medicine, relationship issues and domestic violence are trending upward globally following stay-at-home orders, quarantines and social isolation.

As noted, people in addiction recovery may be especially triggered during the pandemic because shelter-in-place regulations require disconnection, and addiction recovery is about learning how to connect. One of the main components of addiction recovery is learning how to have healthy relationships and connect deeply with others. When in-person therapy sessions, in-person group therapy, in-person 12-step meetings, etc., are removed from the recovery plan, it can be difficult for people to pivot and learn connection via teletherapy or video meetings, particularly when connecting was a challenge before the pandemic. Some people in recovery have transitioned nicely to video meetings, but for those who have not, recovery may be at a standstill, or they may be at greater risk of relapse.

Fortunately, some people in addiction recovery have used the extra time to do more recovery work and more self-care while acknowledging their grief, and this has provided an opportunity for further growth. Grief awareness and the use of recovery tools to intentionally connect are critical to sobriety and recovery. I facilitate two meetings on the global addiction recovery website In The Rooms. One meeting is for codependency, grief and relationships, and attendance at this meeting has doubled during the pandemic. I also created a coronavirus support meeting every Monday on In The Rooms, and for eight months, we have had more than 100 attendees participate. In fact, the entire website has doubled in membership since the pandemic began. People in recovery are trying to find various methods of connection because in-person meetings are not possible at this time.

Original grief

I believe the different types of grief created by the pandemic are also connecting back to people’s original grief and, therefore, increasing the intensity of emotions. As stated previously, I have identified original grief as the grief felt with the perceived awareness of our earliest emotional woundings. I believe that whenever we feel highly activated or charged, our original grief is being tapped into by whatever current trigger is occurring in the moment.

Jaak Panksepp’s research in his text Affective Neuroscience states that grief and social bonding are related together in the mammalian brain. A lack of social bonding, or a feeling of loneliness, is also what we feel when we feel grief. Grief is the experienced and felt loss of a lack of social bonding.

Essentially, all grief is connected not only in our brains, but also in our feelings and in our bodies. A current feeling related to grief, sadness or aloneness is going to track back to our original grief and make today’s feelings more intense or charged. In this way, original grief is being tapped into during the pandemic because at some point, we are feeling fear, anxiety, aloneness or loss. And because the trigger is safety-related and there is a possibility of sickness or death, the depth of the grief is beyond today’s situation; it actually connects back to the deepest and most disturbing grief we have ever experienced. Stated differently, our original grief is being tapped into daily due to the pandemic’s daily triggering of fear, loneliness and uncertainty.

A specific example of how daily triggers can connect back to one’s original grief is in the case of abandonment. During the pandemic, if one is feeling isolated and lonely, and if one’s original grief involves abandonment by parents or other primary attachment figures, then the current feeling of loneliness will connect back to early childhood abandonment, and that feeling will be more intense. This can also be the case if physical or emotional safety is a part of our original grief, because both are being triggered due to COVID-19.

As an example, one of my clients, “Colleen,” experienced abandonment by her father in her early teen years. Her experience was horrid and included lack of food and utilities. In addition, Colleen’s mother was so distraught after Colleen’s father left home that she abandoned Colleen emotionally. So, Colleen has always reported feeling deep aloneness.

During the pandemic, Colleen’s abandonment schema has been triggered again because of the constant isolation. Colleen feels like she has been abandoned and forgotten by the world. In her treatment, we are using this time to dive deep into her original grief, which she reports as, “I do not matter to anyone, not even my parents, who are supposed to love me.”

Treating Collen’s original grief is also soothing her current sadness about feeling alone and forgotten during the pandemic because both are connected in her social bonding neural pathway. Conversely, if we addressed only Colleen’s current feelings about COVID-19 and loneliness, we would not be addressing all that affects her because her original grief would continue to be tapped into. Thus, it would serve as an unknown trigger for her loneliness. In this way, knowing our original grief can be a very empowering process for identifying and treating not only our foundational aloneness, but also the current triggers that we experience as adults.

This unprecedented and difficult time in our world is certainly a trigger for most of us. If we can be aware of some of the deeper feelings underneath, like the various kinds of grief we are experiencing, then we can be more self-aware and take active steps to heal our ultimate trigger of original grief. The deep grief awareness of original grief can empower us to heal not only our foundational pain but also the current triggers introduced by the ongoing pandemic.



Related reading, from Counseling Today columnist Cheryl Fisher: “Counseling Connoisseur: Death and bereavement during COVID-19


Sophia Caudle is a licensed clinical mental health counselor with three private practices in North Carolina. She specializes in sex addiction, sex therapy, and ambiguous and original grief. She conceptualized ambiguous grief via her work with partners of sex addicts, as partners experience the grief regarding the loss of their partner after learning of the double life of sex addiction. Contact her at for more information about ambiguous grief and original grief, or to schedule your High Speed Grief Breakthrough Intensive.


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

Counseling Connoisseur: Holidays 2020

By Cheryl Fisher December 16, 2020

“This is the season when people of all faiths and cultures are pushing back against the planetary darkness. We string bulbs, ignite bonfires, and light candles. And we sing.” —Anita Diamant

The holiday season is upon us, and navigating tradition with safety during the pandemic has proven challenging. The current dramatic surge of COVID-19 infections has resulted in a return to greater restrictions and fewer opportunities to safely meet with family and friends. The U.S. Centers for Disease Control (CDC) has recommended avoiding inside gatherings that include anyone outside our immediate household. An alternative is to gather outdoors, but the weather in colder climes makes this more difficult. This reduced ability to gather with loved ones may make this winter seem particularly dark. Yet, we are resilient, and, as we are reminded, this is a season that is about bringing light into darkness at its core.

Traditional winter holidays

Hanukkah, also known as the Festival of Lights, is an eight-day Jewish celebration marking the rededication of the Temple in Jerusalem by the Maccabees after their victory over the Syrians. Upon entering the Temple for battle, the Maccabees immediately relit the ner tamid (eternal light) with a small amount of oil that should only have lasted a day. Miraculously, it lasted eight days. Celebrants mark this by lighting one candle on each of the eight nights of the holiday.

Kwanzaa is an African American celebration of family and community that lasts from December 26 to January 1. The holiday honors seven principles: unity, self-determination, collective work and responsibility, cooperative economics, purpose, creativity, and faith. The Candlelighting Ceremony is central to Kwanzaa and takes place at time when all family members are gathered. Seven candles — representing the seven principles — are placed in the Kinara (candleholder). Beginning on the 26th, one candle is lit each day.

Diwali is a five-day Hindu festival beginning on the 15th day of the month of Kartika (sometime during October or November on the Gregorian calendar). Also known as the “row of lights” it symbolizes good triumphing over evil and light over darkness and is celebrated with music, dance and lights.

Advent is the season in which many Christian denominations prepare for the birth of Jesus Christ with prayers of anticipation and for peace and hope. Advent begins four Sundays before Christmas. Part of the observance centers on the Advent wreath, which has five candles; one lit on each of the four Sundays and one in the center to be lit on Christmas Day.

The Winter Solstice is the first day of winter and the longest night of the year. Many of the elements of modern winter holidays are drawn from traditions in past celebrations of the solstice. Numerous cultures continue to celebrate this day with various rituals, including the lighting of candles, bonfires, or the burning of a Yule log to celebrate the eventual return of the sun following the coming time of darkness.


Celebrations that center on light span the globe. They mark the eventual return of the sun, new beginnings and the embrace of family. Amidst the pandemic that has dominated this year, it is more important than ever to find ways to keep those celebrations alive. Here are four things to consider when planning your holidays.

Manage expectations

While we have become more accustomed to limiting our social activities, it is important to recognize that this year’s holiday experience may be quite different than years gone by. Gatherings (if any) are much smaller and more subdued. Lean into the difference. Plan for the change.

Order in — One of my brothers usually hosts our grand Thanksgiving feast. This year, because we are honoring the recommendation to limit gatherings, each family will host its own meal. As I am a vegetarian and no one in the family trusts my ability to cook a turkey, I have ordered our turkey dinner from a local market so that my husband can get his fill of turkey and gravy while I prepare (and enjoy) my signature side dishes and desserts.

Drive-by desserts — Although we will not share a meal together, I am preparing my father-in-law’s delicious pumpkin custard pie and bringing it to the assisted living facility where he resides. We can gather outside his bedroom window for a few moments, enjoy a piece of pie and savor the precious time we have together.

Zoom gathering — While we all have Zoom fatigue, we are still so fortunate to have the opportunity to see loved ones in “real-time.” Zoom during your mealtime. FaceTime while taking an after-meal walk. Enjoy a phone call during coffee and dessert. Connect with your loved ones.

Traditions matter

Now, more than ever it is important to connect to that which solidifies our identity and heritage. Traditions matter!

Decorate — Holiday decorations are part of the experience and this year we are motivated to deck the halls sooner in the season. Trees are trimmed. Outdoor lights are hung. Neighborhoods are having decorating contests to ignite neighborhood engagement. Host your own virtual tree trimming party. Create an environment that welcomes celebration and holiday cheer.

Create socially distanced adventures — What activities are traditions in your family? Do you sing holiday songs? Do you have a jigsaw puzzle around which family gathers informally, placing puzzle pieces while sharing stories together? Borrowed from a creative neighbor of mine, I have initiated a Family Jigsaw Puzzle Frenzy. I sent each family the same puzzle. When everyone has received it, we will join on Zoom and officially begin the frenzy of puzzle making. Over the holidays, family members chronicle their progress with pictures and videos. Awards for the first puzzle completed, the last savored, the funniest photo or most memorable puzzle moment will be presented. The most important part of this endeavor is that families recognize that while we cannot be physically together, we can still engage in merriment together while apart. Be creative!

Cook holiday foods — Every year I make my mother-in-law’s famous gingerbread recipe for my husband and his family. She has long been deceased, but this recipe is reminiscent of a time when my mother-in-law was present, the family was all together, and the holiday magic was infused with the aromatic spices. This year, care packages of these yummy cookies will be gifted as a reminder of a simpler time and in hope of our gatherings soon to come.

Make music — Music soothes and inspires. Turn on those holiday tunes and let them ring. Sing out loud. Zoom in family and friends for a holiday sing-along. Do drive by caroling in your neighborhood. Allow the magic of music to be part of your holidays.

Connect — This is the year for holiday cards and letters. Bring out beautiful stationary. Write the annual family letters. Slip a teabag into a card and invite the receiver to share teatime with you. If you would prefer not to send paper cards, consider ecards or video greetings. Call people you think about but have not talked to in eons. Text “just thinking of you” random messages.

Journey within

The holidays are a perfect time for reflection and contemplation. Follow nature’s lead and allow yourself time to journey within.

Meditate — Take time to quiet your mind and experience stillness. Breath in the calm and exhale anything that is not serving you. Create an internal space for the holiday light to shine brightly.

Be in gratitude — Cultivating an attitude of gratitude is powerful. This year has offered many challenges. Despite these obstacles, are there things for which you are thankful? For example, in these trying times, I am incredibly grateful for the comfort of my home, food on my table and a warm bed at night.  Additionally, as a counselor, I have been able to resort to telehealth and continue to see my clients without fail. I am incredibly grateful for the work that I am privileged to do.

Journal — This is a great season to take pen to paper and write down thoughts from the year. Review the challenges, perhaps the losses and honor your emotions about these concerns. Note how resilient you are to have survived, possibly thrived the difficulties that 2020 has presented. Describe how you have navigated this unprecedented year and savor your resiliency.

Keep the faith

The holidays are also a time to lean into one’s beliefs and understandings around hope, peace, and community.

Read inspirational words — Minimize listening to and watching information that promotes fear and division. Focus on literature and media that are encouraging and unifying. Sacred texts, inspirational podcasts, positive and hopeful movies can plant seeds of hope and renewal.

Pay it forward — Alfred Adler knew the value of social interest in overall well-being. Consider sending a care package to first responders. Order a meal to be delivered to local emergency room staff. Pay for a stranger’s coffee in the drive-through line. For example, I have taken home-baked cookies and treats to the local fire and police departments and leave Starbucks gift cards for the postal and delivery workers over the holiday. It does not need to be costly. Volunteer at an animal shelter. Randomly rake your neighbor’s front lawn. Shovel the snow (yes, we are already seeing snow in some areas) from the sidewalk in front of another’s home. Create a neighborhood swap by setting up a table in front of your yard and inviting neighbors to take or borrow your used books, puzzles or games.

Be the change — If you want peace, promote unity and connectedness. Invite conversations with those who differ in your beliefs or understandings. Listen with an open mind and heart and hold the space for differences to be tolerated. If you want hope, cultivate a positive presence with inspirational words and actions. Sponsor a family or child in need. Use your personal power to advocate for those whose voices may be marginalized.


This year has been difficult. It has posed many obstacles to endure. However, it has also allowed us to tap into our skillset around patience and innovation. It has allowed opportunities for us to demonstrate kindness and generosity. It has promoted the development of resiliency. This holiday season, use those skills to ignite the flame of hope and love. To quote author Hamilton Wright Mabie, “Blessed is the season which engages the whole world in a conspiracy of love.”

From my family to yours, Happy Holidays!



Related reading from Cheryl Fisher:

The Counseling Connoisseur: Enjoying the holidays by letting go of expectations”

“The Counseling Connoisseur: Cultivating silence in a noisy world”


Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is director and assistant professor for Alliant International University California School of Professional Psychology’s online MA in Clinical Counseling.  Her research interests include examining sexuality and spirituality in young women with advanced breast cancer; nature-informed therapy; and geek therapy. She may be contacted at




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: Intake: Avoid wasting paper — and clients’ time

By Gregory K. Moffatt December 14, 2020

If I were a teacher at any level other than the collegiate level, I would want to be a kindergarten or pre-K teacher like my wife. Over the years, I have spent hours in her classroom reading to children and helping her with the joys of managing her young students.

I especially love watching children being exposed to a formal educational experience for the first time at the beginning of a school year. That pre-K year is the foundation on which the rest of the child’s academic life will be built. If that experience is positive, the child is much more likely to enjoy the learning process in future years.

Internship for graduate students is sort of the adult equivalent of kindergarten in the counseling field. These students are mature adults, of course, but new clinicians are walking into the clinical world for the first time. In their faces I can see the same excitement, nervousness and fear that my wife sees in her students at the beginning of every fall. I love it.

As a supervisor, I’m in a unique position with my interns because I take on only one intern each year and, since I direct our counseling program, I can run it any way I want to. That gives me plenty of latitude and daily one-on-one personal mentorship time with interns, plus the freedom to expose them to the field however I see fit.

I enjoy supervision of postgrads, but what I absolutely love is watching new counselors actually begin to practice what they have previously only heard about in the classroom. Witnessing their development from those first weeks in sessions with clients to graduation months later is always a pleasure.

During our year together, we examine every aspect of the counseling process in detail — intake, assessment, rapport building, treatment planning, record-keeping, ethics, risk management, the law, termination, just to name a few. But one of the many things I do — and I doubt most other interns experience this — is help my interns develop their own intake forms and processes. I have never talked to any clinician who, during internship, didn’t simply have intake processes provided for them. Their job was to then simply follow orders.

Once clinicians move into regular practice, they either adopt some version of the forms they have always been told to use or they use forms provided to them by the hospital or clinic where they are working. This means that most clinicians never have to really think about the intake process. They just do what they have been told and simply assume this is the best way to do it.

Most counselors consider quality-of-life issues when suggesting that clients change behaviors, pursue medical treatment options or engage in other interventions. But I doubt most clinicians ever give a second thought to the intake process as a quality-of-life question because they have never been forced to do so.

Isn’t it irritating when you go to a doctor for the first time, fill out pages and pages of forms (many of which ask repeatedly for the same information) and then, when you see the physician in the examining room, you hear, “So, what brings you here today?”

Do you not find yourself wondering, “Well, I just spent 30 minutes writing that down for you. If you’re beginning by asking me why I’m here, why did I have to spend all that time filling out paperwork?”

During our first few weeks of supervision, I help interns think through this process. THE question is this: What is essential for you to know when you see a client for the first time? Some things are inescapable — HIPAA forms and informed consent, for example. But beyond that, what is critical? If it isn’t essential, then maybe it shouldn’t be a part of your intake paperwork.

My short-version intake form is only one page. In my practice, I need to know the child’s name, contact information, legal guardian and presenting issue. This is oversimplified but, generally, that is all that is critical for me. I have a longer form that I use if I know the case may go to court or if it involves an evaluation for a school or foster care system, but many of my clients don’t fall under those two situations. Anything that matters beyond the information captured on my short form will eventually come up in therapy.

So, I’m suggesting that you examine your paperwork. If we are going to ask a client to do something — complete homework, see a physician, change life habits or, yes, even fill out pieces of paper — we need to have a good reason for it.


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


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.

Paths to wellness

By Rebekah Lemmons December 9, 2020

I have been working in the mental health field since 2010, and in that time, the topic of wellness has come up often across an array of settings. In my professional counseling roles as an instructor, supervisor, trainer, consultant, therapist and manager, I have witnessed a growing need for wellness practices. And as I have learned more about the impacts of stress on the brain, I have come to better understand the necessity of all professional counselors having strong wellness practices.

Counselor wellness is essential to providing quality services to our clients. I have been able to observe counselors with strong self-care practices who balance boundaries well and maintain strong professional helping relationships with their clients. I have also witnessed the opposite end of the spectrum, in which therapy progress is hindered due to counselor issues such as burnout, compassion fatigue, vicarious trauma and overcommitment to myriad duties.

The dynamic nature of wellness

Wellness and burnout are not mutually exclusive. Instead, they operate more on a continuum. So, rather than viewing counselors as “burned out” or “not burned out,” we should understand that many counselors oscillate between various levels of wellness and burnout. It is common to see many professional counselors cycle back and forth between varying stages of wellness and burnout. A particular therapist might present with symptoms of burnout during a specific period of time but be well and maintaining strong self-care practices during another period of time. Because of the dynamic nature of wellness, counselors need to revisit this topic frequently.

The theme of self-care has become a hot topic over the past decade. From articles and books on how to promote self-care to ways to address burnout, the professional helping fields have been inundated with information on burnout, compassion fatigue, vicarious trauma and associated subjects. Even with these themes being more openly discussed in graduate programs and across supervision settings, many counselors could still benefit from practical strategies designed to increase overall mental health and well-being.

One way to provide such information is within the framework of a practical model. Some models found in current counseling articles do address self-care components. However, models could more holistically include self-care components that tie into larger wellness frameworks as an area of growth. Many clinicians verbalize an array of variables that inhibit effective self-care practices. On that basis, I have conducted qualitative research to identify themes related to what gets in the way of wellness. From interviews with master’s-level counselors, I have learned the importance of expanding wellness models to include the array of factors that contribute to self-care or a lack thereof.

A proposed wellness model

From this research in 2019, I and my fellow researcher, Steve Zanskas, developed a three-tiered model for self-care that identifies levels of responsibility targeted at providing an integrative way to increase the effectiveness of wellness pursuits. This model looks at wellness accountability through the lens of individual, supervisory and organizational responsibility. This mirrors feedback provided during interviews with 77 counselors discussing what helps and what hinders their self-care.

This model also provides practical approaches to increasing our awareness of the self-care domains that influence wellness. The model was titled Paths to Wellness based on the idea that wellness pursuits are similar to a journey with many roads leading to the same destination. When we view wellness as a journey, we are able to acknowledge the individuality of self-care pursuits and the layers of wellness that can help to buffer negative professional hazards.

Wellness domain: Individual level of responsibility

Practical wellness check-in:

  • What makes me feel recharged?
  • What stresses me?
  • Where do I feel stress in my body?
  • What recharging activities do I need to do when certain stressors occur?
  • Do I have a balance of self-care activities across various domains (physical, emotional, intellectual, financial, social, etc.)?
  • What can I do to increase balance among my self-care domains?
  • Do my values as a person align with the work I am doing?
  • Does my job overall give me a sense of satisfaction?
  • What job factors are increasing or decreasing my overall wellness?
  • What changes can I implement to help me become present and peaceful?
  • What resources and supports do I need to make these changes?
  • Do I have regular check-ins with myself to reflect and make needed adjustments to my wellness plans?

Wellness domain: Supervisory level of responsibility

Practical wellness check-in:

  • Does my supervisor practice self-care and model overall wellness?
  • Does my supervisor discuss self-care and check in on my overall wellness?
  • Does my supervisor respect my individual self-care needs and support my self-care endeavors?
  • Does my supervisor support the use of vacation, sick leave and other paid time off?
  • Does my supervisor provide coverage for time off?
  • Does my supervisor provide a positive work environment?
  • Does my supervisor facilitate teamwork and a positive team culture?
  • Does my supervisor support time off for mental health?

Wellness domain: Organizational level of responsibility

Practical wellness check-in:

  • Does my organization provide paid time off for vacations or hobbies?
  • Does my company provide resources to staff for growth and development?
  • Does my company encourage a positive work culture?
  • Does my company regularly obtain and utilize employee feedback?
  • Do leaders communicate openly and honestly with employees?
  • Does my company care about me as an individual?
  • Does my company promote work-life balance?
  • Does my company provide benefits related to wellness activities (gym reimbursements, health coverage, paid sick time, employee assistance programs)?
  • Does my company have policies and processes in place specifically targeted to promote wellness?

Model usage

The Paths to Wellness model can be used across counselor roles and functions by clinicians, supervisors, counselor educators and organizational leadership. Benefits of this model include use as an assessment and evaluation tool as well as a resource for reflection on further wellness development.

Counselors can use this model as a tool for evaluating their own levels of wellness, helping to inform them of both weak and strong areas related to self-care. In alignment with this, this framework can empower professionals to strategically weigh the benefits and drawbacks of their choices on their overall wellness to make the best decisions for their own self-care at that moment in time.

In the professional realm, counselors could use this evaluation tool when they are asked to consider a new position or added role opportunities or when considering a move to a different employer. New professionals could use it as they decide where to begin their work. The tool can help counselors evaluate how a potential new role or task might affect their self-care and wellness pursuits across individual, supervisory and organizational domains. Such evaluations can provide counselors with a framework to make decisions that align with their wellness goals.

Supervisors can use this tool both at the individual level for themselves and at the supervisory level. The supervisory level aims to assess the current level of wellness modeling and promotion they are providing to their supervisees. The counseling profession regularly promotes supervision and consultation as a positive way to buffer negative client impacts associated with burnout and a lack of overall counselor wellness. The level to which supervision assesses for and positively addresses needs related to self-care and wellness may greatly influence the gains from attending regular supervision.

For supervisors within agencies, this model can help to facilitate increased worker satisfaction by allowing supervisors to better understand and address individual differences that occur within staff groups. This promotes an approach of all staff receiving what they need to support their wellness versus using an “equality standpoint” that provides all staff with the same resources regardless of individual need area.

Organizational leaders can use this model as a screening tool to evaluate the potential wellness impacts associated with each agency policy, process and procedure. Leaders can then advocate for specific policies that better foster employee wellness.

Ideally, policies and procedures would be designed based on feedback gathered directly from agency employees. Regular check-ins with employees and program evaluations designed to get specific responses can provide leaders with employee perspectives. These perspectives can then be used to update and revise wellness-related measures. Furthermore, leaders can model wellness pursuits to help infuse a wellness focus into the fabric of their organizations. This may include leaders showing that it is truly OK to take breaks, set boundaries with time off and maintain healthy habits.

Through agency, employee and supervisory collaboration, wellness gains are possible. Integration across these domains is vital to the successful implementation of self-care pursuits. Because of the dynamic and complex nature of counselor roles and demands, wellness endeavors and need areas should be evaluated often. The Paths to Wellness model serves as one approach that can facilitate wellness promotion and integration. Furthermore, the model can be added to current wellness strategies or used along with other self-care assessments.

With awareness and accountability across individual and systemic levels, wellness cultures are developed. These cultures then begin to thrive as wellness is intentionally integrated into daily practices. This can lead to a ripple effect, with the counseling profession serving as a model for wellness integration throughout other organizations.



Rebekah Lemmons strives to improve outcomes for children, emerging adults and families. For the past decade, her practice and research have primarily been based in the nonprofit sector, with an emphasis on conducting program evaluation, teaching, engaging in service leadership, consulting and providing supervision to clinicians. Contact her at


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