Monthly Archives: December 2020

Turning your emotions into positive actions: A psychological approach to COVID-19 challenges

By Esther Scott December 8, 2020

It has been almost a year since it started. These past few months have been challenging times for everyone. We are witnessing frustration on many different levels, and we have all experienced a number of emotions: anger, fear, isolation, anguish, love, anxiety, solidarity, grief — with anger and anxiety being the most powerful ones over the summer.

Now, as we begin the transition from autumn to winter, depression is positioning itself to become the frontline emotion. With dissatisfaction from a lack of activities and face-to-face encounters, negative current events and a generalized sense of loss, we may face an increased risk for situational depression. The opportunity for situational depression to creep in becomes even greater as the days get shorter and we spend more time inside and in the dark as winter approaches.

In light of our current situation and these potential threats, understanding our emotions and recognizing the symptomatic behaviors of depression will be key to avoiding the creation of habits that could have long-term negative consequences. Instead, let’s focus on turning our emotions into positive actions that can build our resiliency skills.

Understanding your emotions

Everyone reacts in their own way to the events we are experiencing, but the emotions of anger and anxiety are common to almost everyone. We may be angry because progress in the area of race relations seems painfully slow, because of the rioting and looting we have witnessed, or because the government response to all of these things was not what we wanted or expected. Many people are experiencing anxiety and emotional fatigue due to all of the restrictions that COVID-19 brought to us this past summer, which limited our ability for recreation and recharging. Many are also experiencing exhaustion from all of the cultural changes that have taken place in just a few months but that have seemed to drag on for decades. Let’s take a closer look at these emotions.


Anger is often called a secondary emotion because we tend to resort to it to protect ourselves from or to cover up other vulnerable feelings. We almost always feel something else first before we get angry. We might first feel afraid, attacked, trapped, offended or disrespected. If any of these feelings are intense enough, we think of the emotion as anger.

What to Do

First, answer the following questions: What types of situations set you off? Are there people, situations or events that you simply need to avoid?

Second, check your thoughts. Be sure to take a step back and identify how you might need to change in your prejudices and in your interactions with others. Anger is a feeling, and it tells us there has been an injustice; that we are being denied something we should have. It provides its own justification. But it is an emotion that impairs critical thinking. There may be other elements that need to be considered before we act in anger.

Finally, focus on what matters most: love. After witnessing so many recent and ongoing tragic events, it is important to identify how we can respond to what is happening in our world in a positive way. It is most effective to connect through empathy and positive actions.

Fear and anxiety

Fear has a purpose: to keep us alive. When being chased by a lion, it is a natural and healthy reaction to feel afraid. Fear triggers the release of adrenaline and gives us the push to keep running. However, when we fear irrationally, we unnecessarily trigger cortisol, and this can have a negative effect on our physical health.

Almost everything about the coronavirus pandemic is uncertain: how many more people will become infected and possibly die, how much more the economy and job market will be impacted, how soon things will return to “normal.” Uncertainty can cause feelings of extreme discomfort and activate irrational fears that hold us back from fully experiencing life. It might also interfere with our ability to solve problems or prevent us from being objective in finding solutions. Even worse, elevated levels of anxiety can actually compromise our immune system, making us even more vulnerable to the virus.

 What to do

First, replace fear with strength. The presence of the coronavirus does not have to become a traumatic and overwhelming experience that marks us for life. On the contrary, it can be an excellent opportunity to exercise our resilience. The ability to handle adversity will be a critical component to our success moving beyond COVID-19. Maintaining an optimistic attitude is essential to supporting recovery. Being optimistic helps make your thoughts and emotions much more positive, which in turn gives your immune system a boost.

Second, have an action plan. Having a plan of action allows your brain to feel in charge. The next time you experience an attack of anxiety, write down your worries and identify your options. Examine your worries, aiming to be realistic in your assessment of the actual concerns and your ability to cope. Identifying what worries you and then focusing on what you can control will calm the nervous system and provide a feeling of inner strength.

Third, focus on the future. This will move you from paralyzing anxiety to action. Remember, anxiety comes from not knowing what will happen, and depression comes from believing that there is nothing we can do to change it.

Imagine yourself coping and adapting. Studies have shown that religious individuals involved in tragic circumstances often reported finding hope, peace and even increased joy in the midst of the experience. This consequently led them to report high satisfaction in their lives. “We are hard pressed on every side, but not crushed … struck down, but not destroyed” (2 Corinthians 4:8-9). We can all benefit from this kind of optimism.


What’s next? Grief and situational depression

The coronavirus pandemic is causing people to struggle with multiple types of mental health issues, including grief and situational depression. It is important to recognize the signs of grief and situational depression so that you can get the help you need.


Our new reality since the onset of the global pandemic has been marked by increased grief and a sense of loss. School, vacations, weddings, concerts, meetings, travels plans, social events and many other things have been canceled this year in the wake of the virus. It has forced on us an uncertain future and a collective grief.

We are mourning the loss of thousands of lives, and we are also mourning the loss of our “normalcy.” From going to work, to participating in community and religious gatherings, to engaging in the everyday routines that we previously took for granted, such as shopping or visiting with friends — everything has been impacted.

What to do

First, remember that your feelings are valid. There is no right or wrong way to feel after a loss. The shock and disbelief that have followed after all we have lost can trigger feelings of anger, regret, sadness and depression. All are common reactions. You may even be struggling with anticipatory grief, or the feeling that greater loss is still to come, because you may fear losing another family member or loved one.

Second, reach out. Although you might be tempted to shut everyone out in the midst of your grief, it is important to reach out. Talking about your feelings with someone when you are stressed or upset may not bring back what you have lost, but it can help you to feel better and less alone. Find ways to memorialize what you have lost. If you have lost someone, write a letter about your loved one’s life and their impact on you. If you lost a job that was important to you, write about all you learned during your tenure in that position. 


For many, the rapid changes brought about by the pandemic have been as scary as the virus itself. Business closures, income reduction and the uncertainty of what might be ahead have increased symptoms of situational depression in a large number of people.

According to the World Health Organization, more than 264 million people worldwide experience different types depression: major depressive disorder, bipolar depression, perinatal and postpartum depression, and situational depression. Situational depression differs from other types of depression in that it is a short-term, stress-related type of depression. It is also known as reactive depression. It can develop after experiencing a traumatic event or series of events.

Symptoms of situational depression vary from person to person, but in most cases, they include sadness, hopelessness, constant worrying, feelings of anxiety or stress, difficulties sleeping, trouble carrying out daily activities, feelings of being overwhelmed, thoughts of or attempts at suicide, lack of enjoyment in normal activities, and regular crying.

What to do

First, accept the new reality. There is something “unreal” in the world of masks and physical distancing in which we now live. It is a world that sometimes keeps us from recognizing a friend who passes by or that makes greeting your relatives with kisses and hugs seem like an outdated custom from another era. However, it is important to remember that every storm passes. “This too shall pass.”

Looking at crises as opportunities to rethink and reorganize our priorities can prove beneficial. The analogy of a diamond may be helpful here. The beauty of the diamond comes about from the extreme experience of pressure and heat. The same can be true for you. By accepting your new reality and recognizing the opportunities it has brought you, you can emerge stronger from your situation and the complex challenges you have faced.

Second, focus on progress. In the mental health community, we have observed that when it comes to overcoming depression, even small changes in our clients’ daily lives can produce positive results. When people who were extremely depressed were asked to simply write down three good things that happened to them each day, 94% of the people in the study reported that they experienced some relief from their depression symptoms. Focusing on progress increases positive feelings. If you are suffering from depression, keep a gratitude journal with three good things that happen each day. This exercise will likely help you too.

Third, be kind to yourself; you are doing the best you can. The COVID-19 crisis has generated enormous distress for us as a society. It has served as a reminder that our emotions affect our physical and mental health — a reminder that our emotions are an expression of what happens to us and what matters to us. However, it is also important to remember that the feelings of hopelessness we may be experiencing are symptoms of depression, not the reality of our situation. You are not hopeless. There is hope.



Our current global crisis has brought an opportunity for us to influence one another for positive change. The solution for change starts with us, through our words and actions. So, as you think about the realities and uncertainties of our world during the crisis we are all facing, be mindful of the different ways that you can change your emotions into positive actions, starting with being kind to others and being kind to yourself.



Esther Scott is a licensed professional counselor in Arlington, Texas. She is a solution-focused therapist. Her specialties include grief, depression, teaching coping skills and couples counseling. Contact her through her website 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.

Case conceptualization: Key to highly effective counseling

By Jon Sperry and Len Sperry December 7, 2020

In their first session, the counseling intern learned that Jane’s son had been diagnosed with brain cancer. The therapist then elicited the client’s thoughts and feelings about her son’s diagnosis. Jane expressed feelings of guilt and the thought that if she had done more about the early symptoms, this never would have happened to her son. Hearing this guilt producing thought, the intern spent much of the remaining session disputing it. As the session ended, the client was more despondent. 

After processing this session in supervision, the intern was no longer surprised that Jane had not kept a follow-up appointment. The initial session had occurred near the end of the intern’s second week, and she had been eager to practice cognitive disputation, which she believed was appropriate in this case. In answer to the supervisor’s question of why she had concluded this, the intern responded that “it felt right.”

The supervisor was not surprised by this response because the intern had not developed a case conceptualization. With one, the intern could have anticipated the importance of immediately establishing an effective and collaborative therapeutic alliance and gently processing Jane’s emotional distress sufficiently before dealing with her guilt-producing thought.

This failure to develop an adequate and appropriate case conceptualization is not just a shortcoming of trainees, however. It is also common enough among experienced counselors.

What is case conceptualization?

Basically, a case conceptualization is a process and cognitive map for understanding and explaining a client’s presenting issues and for guiding the counseling process. Case conceptualizations provide counselors with a coherent plan for focusing treatment interventions, including the therapeutic alliance, to increase the likelihood of achieving treatment goals.

We will use the definition from our integrated case conceptualization model to operationalize the term for the purposes of explaining how to utilize this process. Case conceptualization is a method and clinical strategy for obtaining and organizing information about a client, understanding and explaining the client’s situation and maladaptive patterns, guiding and focusing treatment, anticipating challenges and roadblocks, and preparing for successful termination.

We believe that case conceptualization is the most important counseling competency besides developing a strong therapeutic alliance. If our belief is correct, why is this competency taught so infrequently in graduate training programs, and why do counselors-in-training struggle to develop this skill? We think that case conceptualization can be taught in graduate training programs and that counselors in the field can develop this competency through ongoing training and deliberate practice.

This article will articulate one method for practicing case conceptualization.

The eight P’s

We use and teach the eight P’s format of case conceptualization because it is brief, quick to learn and easy to use. Students and counselors in the community who have taken our workshops say that the step-by-step format helps guide them in forming a mental picture — a cognitive map — of the client. They say that it also aids them in making decisions about treatment and writing an initial evaluation report.

The format is based on eight elements for articulating and explaining the nature and origins of the client’s presentation and subsequent treatment. These elements are described in terms of eight P’s: presentation, predisposition (including culture), precipitants, protective factors and strengths, pattern, perpetuants, (treatment) plan, and prognosis.


Presentation refers to a description of the nature and severity of the client’s clinical presentation. Typically, this includes symptoms, personal concerns and interpersonal conflicts.

Four of the P’s — predisposition, precipitants, pattern and perpetuants — provide a clinically useful explanation for the client’s presenting concern.


Predisposition refers to all factors that render an individual vulnerable to a clinical condition. Predisposing factors usually involve biological, psychological, social and cultural factors.

This statement is influenced by the counselor’s theoretical orientation. The theoretical model espouses a system for understanding the cause of suffering, the development of personality traits, and a process for how change and healing can occur in counseling. We will use a biopsychosocial model in this article because it is the most common model used by mental health providers. The model incorporates a holistic understanding of the client.

Biological: Biological factors include genetic, familial, temperament and medical factors, such as family history of a mental or substance disorder, or a cardiovascular condition such as hypertension.

Psychological: Psychological factors might include dysfunctional beliefs involving inadequacy, perfectionism or overdependence, which further predispose the individual to a medical condition such as coronary artery disease. Psychological factors might also involve limited or exaggerated social skills such as a lack of friendship skills, unassertiveness or overaggressiveness.

Social: Social factors could include early childhood losses, inconsistent parenting style, an overly enmeshed or disengaged family environment, and family values such as competitiveness or criticalness. Financial stressors can further exacerbate a client’s clinical presentations. The “social” element in the biopsychosocial model includes cultural factors. We separate these factors out, however.

Cultural: Of the many cultural factors, three are particularly important in developing effective case conceptualizations: level of acculturation, acculturative stress and acculturation-specific stress. Acculturation is the process of adapting to a culture different from one’s initial culture. Adapting to another culture tends to be stressful, and this is called acculturative stress. Such adaptation is reflected in levels of acculturation that range from low to high.

Generally, clients with a lower level of acculturation experience more distress than those with a higher level of acculturation. Disparity in acculturation levels within a family is noted in conflicts over expectations for language usage, career plans, and adherence to the family’s food choices and rituals. Acculturative stress differs from acculturation-specific stresses such as discrimination, second-language competence and microaggressions.


Precipitants refer to physical, psychological and social stressors that may be causative or coincide with the onset of symptoms or relational conflict. These may include physical stressors such as trauma, pain, medication side effects or withdrawal from an addictive substance. Common psychological stressors involve losses, rejections or disappointments that undermine a sense of personal competence. Social stressors may involve losses or rejections that undermine an individual’s social support and status. Included are the illness, death or hospitalization of a significant other, job demotion, the loss of Social Security disability payments and so on.

Protective factors and strengths

Protective factors are factors that decrease the likelihood of developing a clinical condition. Examples include coping skills, a positive support system, a secure attachment style and the experience of leaving an abusive relationship. It is useful to think of protective factors as being the mirror opposite of risk factors (i.e., factors that increase the likelihood of developing a clinical condition). Some examples of risk factors are early trauma, self-defeating beliefs, abusive relationships, self-harm and suicidal ideation.

Related to protective factors are strengths. These are psychological processes that consistently enable individuals to think and act in ways that benefit themselves and others. Examples of strengths include mindfulness, self-control, resilience and self-confidence. Because professional counseling emphasizes strengths and protective factors, counselors should feel supported in identifying and incorporating these elements in their case conceptualizations.

Pattern (maladaptive)

Pattern refers to the predictable and consistent style or manner in which an individual thinks, feels, acts, copes, and defends the self both in stressful and nonstressful circumstances. It reflects the individual’s baseline functioning. Pattern has physical (e.g., a sedentary and coronary-prone lifestyle), psychological (e.g., dependent personality style or disorder) and social features (e.g., collusion in a relative’s marital problems). Pattern also includes the individual’s functional strengths, which counterbalance dysfunction.


Perpetuants refer to processes through which an individual’s pattern is reinforced and confirmed by both the individual and the individual’s environment. These processes may be physical, such as impaired immunity or habituation to an addictive substance; psychological, such as losing hope or fearing the consequences of getting well; or social, such as colluding family members or agencies that foster constrained dysfunctional behavior rather than recovery and growth. Sometimes precipitating factors continue and become perpetuants.

Plan (treatment)

Plan refers to a planned treatment intervention, including treatment goals, strategy and methods. It includes clinical decision-making considerations and ethical considerations.


Prognosis refers to the individual’s expected response to treatment. This forecast is based on the mix of risk factors and protective factors, client strengths and readiness for change, and the counselor’s experience and expertise in effecting therapeutic change. 

Case example

To illustrate this process, we will provide a case vignette to help you practice and then apply the case to our eight P’s format. Ready? Let’s give it a shot.

Joyce is a 35-year-old Ph.D. student at an online university. She is white, identifies as heterosexual and reports that she has never been in a love relationship. She is self-referred and is seeking counseling to reduce her chronic anxiety and social anxiety. She recently started a new job at a bookstore — a stressor that brought her to counseling. She reports feeling very anxious when speaking in her online classes and in social settings. She is worried that she will not be able to manage her anxiety at her new job because she will be in a managerial role.

Joyce reports that she has been highly anxious since childhood. She denies past psychological or psychiatric treatment of any kind but reports that she has recently read several self-help books on anxiety. She also manages her stress by spending time with her close friend from class, spending time with her two dogs, drawing and painting. She appears to be highly motivated for counseling and states that her goals for therapy are “to manage and reduce my anxiety, increase my confidence and eventually get in a romantic relationship.”

Joyce describes her childhood as lonely and herself as “an introvert seeking to be an extrovert.” She states that her parents were successful lawyers who valued success, achievement and public recognition. They were highly critical of Joyce when she would struggle with academics or act shy in social situations. As an only child, she often played alone and would spend her free time reading or drawing by herself.

When asked how she views herself and others, Joyce says, “I often don’t feel like I’m good enough and don’t belong. I usually expect people to be self-centered, critical and judgmental.”

Case conceptualization outline

We suggest developing a case conceptualization with an outline of key phrases for each of the eight P’s. Here is what these phrases might look like for Joyce’s case. These phrases are then woven together into sentences that make up a case conceptualization statement that can be imported into your initial evaluation report.

Presentation: Generalized anxiety symptoms and social anxiety

Precipitant: New job and concerns about managing her anxiety

Pattern (maladaptive): Avoids closeness to avoid perceived harm


  • Biological: Paternal history of anxiety
  • Psychological: Views herself as inadequate and others as critical; deficits in assertiveness skills, self-soothing skills and relational skills
  • Social: Few friends, a history of social anxiety, and parents who were highly successful and critical
  • Cultural: No acculturative stress or cultural stressors but from upper-middle-class socioeconomic status, so from privileged background — access to services and resources

Perpetuants: Small support system; believes that she is not competent at work

Protective factors/strengths: Compassionate, creative coping, determined, hardworking, has
access to various resources, motivated for counseling

Plan (treatment): Supportive and strengths-based counseling, thought testing, self-monitoring, mindfulness practice, downward arrow technique, coping and relationship skills training, referral for group counseling

Prognosis: Good, given her motivation for treatment and the extent to which her strengths and protective factors are integrated into treatment

Case conceptualization statement

Joyce presents with generalized anxiety symptoms and social anxiety (presentation). A recent triggering event includes her new job at a local bookstore — she is concerned that she will make errors and will have high levels of anxiety (precipitant). She presents with an avoidant personality — or attachment — style and typically avoids close relationships. She has one close friend and has never been in a love relationship. She typically moves away from others to avoid being criticized, judged or rejected (pattern). Some perpetuating factors include her small support system and her belief that she is not competent at work (perpetuants).

Some of her protective factors and strengths include that she is compassionate, uses art and music to cope with stress, is determined and hardworking, and is collaborative in the therapeutic relationship. Protective factors include that she has a close friend from school, has access to university services such as counseling services and student clubs and organizations, is motivated to engage in counseling, and has health insurance (strengths & protective factors).

The following biopsychosocial factors attempt to explain Joyce’s anxiety symptoms and avoidant personality style: a paternal history of anxiety (biological); she views herself as inadequate and others as critical and judgmental, and she struggles with deficits in assertiveness skills, self-soothing skills and relational skills (psychological); she has few friends, a history of social anxiety and parents who were highly successful and critical toward her (social). Given Joyce’s upper-middle-class upbringing, she was born into a life of opportunity and privilege, so her entitlement of life going in a preferred and comfortable path may also explain her challenges with managing life stress (cultural).

Besides facilitating a highly supportive, empathic and encouraging counseling relationship, treatment will include psychoeducation skills training to develop assertiveness skills, self-soothing skills and relational skills. These skills will be implemented through modeling, in-session rehearsal and role-play. Her challenges with relationship skills and interpersonal patterns will also be addressed with a referral to a therapy group at the university counseling center. Joyce’s negative self-talk, interpersonal avoidance and anxiety symptoms will be addressed with Socratic questioning, thought testing, self-monitoring, mindfulness practice and the downward arrow technique (plan-treatment).

The outcome of therapy with Joyce is judged to be good, given her motivation for treatment, if her strengths and protective factors are integrated into the treatment process (prognosis).


Notice how the treatment plan is targeted at the presenting symptoms and pattern dynamics of Joyce’s case. Each of the eight P’s was identified in the case conceptualization, and you can see the flow of each element and its interconnections to the other elements.

Tips for writing effective case conceptualizations

1) Seek consultation or supervision with a peer or supervisor for feedback on your case conceptualizations. Often, another perspective will help you understand the various elements (eight P’s) that you are trying to conceptualize.

2) Be flexible with your hypotheses and therapeutic guesses when piecing together case conceptualizations. Sometimes your hunches will be accurate, and sometimes you will be way off the mark.

3) Consider asking the client how they would explain their presenting problem. We begin with a question such as, “How might you explain the (symptoms, conflict, etc.) you are experiencing?” The client’s perspective may reveal important predisposing factors and cultural influences as well as their expectations for treatment.

4) Be OK with being imperfect or being completely wrong. This process takes practice, feedback and supervision.

5) After each initial intake or assessment, jot down the presenting dynamics and make some guesses of the cause or etiology of them.

6) Have a solid understanding of at least one theoretical model. Read some of the seminal textbooks or watch counseling theory videos to help you gain a comprehensive assessment of a specific theory. Knowing the foundational ideas of at least one theory will help with your conceptual map of piecing together the information that you’ve gathered about a client.

We realize that putting together case conceptualizations can be a challenge, particularly in the beginning. We hope you will find that this approach works for you. Best wishes!



For more information and ways of learning and using this approach to case conceptualization, check out the recently published second edition of our book, Case Conceptualization: Mastering This Competency With Ease and Confidence.

Also, Len and Jon Sperry published a new book in November 2021, titled The 15 Minute Case Conceptualization: Mastering the Pattern-Focused Approach.



Jon Sperry is an associate professor of clinical mental health counseling at Lynn University in Florida. He teaches, writes about and researches case conceptualization and conducts workshops on it worldwide. Contact him at or visit his website at

Len Sperry is a professor of counselor education at Florida Atlantic University and a fellow of the American Counseling Association. He has long advocated for counselors learning and using case conceptualization, and his research team has completed eight studies on it. Contact him at

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


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.

Perinatal health: Education and screening in counseling

By Rebekah Lemmons December 2, 2020

Perinatal health encompasses multiple women’s mental health issues related to pregnancy and the postnatal period. During these times, clients may be at increased risks for depression, anxiety and related mental health needs. Perinatal care providers often see clients for other needs such as infertility, miscarriage and infant/child loss and grief. 

Why is this important for clinicians to know?

Clinicians can provide preventative care and screenings to access for specialized service needs. Early intervention can help minimize the impacts of these issues on the mother and child. Maternal health services can also provide support for life changes as a part of routine perinatal progression.

Many women receive benefits such as education and planning related to finding a trauma-informed provider, developing a birth plan that is empowering and fits their lifestyle, and planning for support needs during and after pregnancy. Providers can also aid in finding and advocating for appropriate support services (e.g., physical therapy for pelvic floor wellness) during and after pregnancy.

Similarly, early intervention and preventative care impacts the development of the child and can serve as a protective factor. The Adverse Childhood Experiences studies and related studies provide the rationale for providing a healthy, safe and nurturing environment for children. This includes the period of being in the womb because epigenetics and maternal health impact a developing child in many ways. In this aspect, preventative care for mothers acts as a protective factor for children. 

How can I tell if my client needs specialized services?

Proactive and ongoing mental health services have an array of benefits for clients. As part of your services, providers can monitor and assess the need for specialized perinatal care.

The first step is to receive education on the risk factors and what to look for when working with this population. Risk factors for perinatal issues include a history of mood disorders or related mental health conditions such as depression, anxiety, posttraumatic stress disorder or obsessive-compulsive disorder. Physical symptoms such as hormonal imbalances or prior complications from a past pregnancy, labor, delivery or loss of a pregnancy can also increase these risks. Social factors, such as a lack of support from family or friends, or stressors such as poverty can also heighten the risks for perinatal support needs.

Warning signs may include mothers who are experiencing feelings of guilt, hopelessness or anger, sleep disturbances and related physical symptoms. This can also manifest as mothers having thoughts of hurting themselves or the baby and experiencing a loss of interest in activities that used to bring them joy.

See the screener at the end of this article for added specifics on what to look for with perinatal clients. This screener can be used to assess the need for specialized referral services and can also help you, as a provider, to gather information and monitor ongoing changes during the client’s perinatal period. This helps you to effectively plan for treatment and any related support services, as appropriate.

How do I know if a counselor is trained to provide perinatal services?

PMHC is the official credential for perinatal mental health counseling. If you have access to a certified professional in your area, you can recommend them for perinatal services as part of stand-alone or support services to use in conjunction with the current therapy the client is receiving.

Some locations have limited certified professionals in their area. Other geographic areas have no certified professionals for this population. Clinicians can recommend competent service providers after asking the providers about their training, experience and credentials related to providing these services. Some providers are not certified but still have training in this area or are receiving supervision/consultation to become certified in this specialty.

How can clinicians receive further education and support to provide perinatal services?

Clinicians can attend specialized trainings and also engage in consultation and supervision to build competency in this area. Many continuing education providers now offer trainings related to women’s issues and provide sessions on postpartum depression or anxiety. These can help to increase your awareness of women’s issues.

For clinicians wishing to provide services exclusively to this population, certification is another great way to build your skills for this focused area of counseling. Perinatal mental health certification is available at

Integrative screener for perinatal health and well-being

The purpose of this screener is to provide a brief reference guide for the identification of specialized service needs. Adjustments and changes to typical routines and day-to-day life are part of pregnancy and postnatal times. To help best meet your needs during this time, a certified perinatal mental health provider can evaluate and assess your specific mental health needs and goals.

This screener can be utilized along with the PHQ-9 and Edinburgh Postnatal Depression Scale. This questionnaire more broadly encompasses base-level indicators for postnatal depression, postnatal anxiety and traumatic birth syndrome symptoms. This screener can be self-administered or administered by a provider, spouse or friend. Please remember that regardless of your screener results, proactive and maintenance counseling can be part of an integrative health plan to help your reach your wellness goals.

Please rate the below statements based on a scale of 1-4: 1 being strongly disagree, 2 being somewhat disagree, 3 being somewhat agree and 4 being strongly agree.


  1. A) Postnatal depression symptoms

__ I regularly engage in activities that I enjoy.

__ My relationships are as strong as they were before pregnancy/childbirth.

__ I feel as happy as I did before pregnancy/childbirth.

__ I can acknowledge my strengths and appreciate myself as much as I did before pregnancy/childbirth.

__ Total score


  1. B) Postnatal anxiety symptoms

__ I am able to accept my mistakes and do not dwell on them.

__ I let things go and do not spend time worrying about things I cannot control.

__ I feel as calm and centered as I did before pregnancy/childbirth.

__ I have the skills needed to manage concerns as they come up.

__ Total score


  1. C) Traumatic birth symptoms

__ I had a positive birth experience.

__ I felt listened to and heard during my birth experience.

__ My wishes were respected during labor and delivery.

__ My providers and supports met my needs during labor and delivery.

__ Total score


  1. D) Recovery complication symptoms

__ I have recovered physically from labor and delivery.

__ I have recovered mentally and emotionally from labor and delivery.

__ I have the support needed to fully recover.

__ I have the resources needed to fully recover.

__ Total score


  1. E) For pregnant women only

__ I appreciate my body as much as I did before I was pregnant.

__ I have a healthy perspective.

__ I have the emotional support I need to be well while pregnant.

__ I have the resources I need to be well while pregnant.

__ Total score


Scoring criteria for all indicated areas:

Scores of 3 and 4: Continue your current wellness plan. Continue to monitor symptoms using the screener as needed. Remember to seek a specialist if you feel it is needed, regardless of your scores.

Any scores of 1 or 2: Seek a perinatal specialist.



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


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.

CEO’s Message: So long and good riddance, 2020

Richard Yep December 1, 2020

Richard Yep, ACA CEO

When those in the optometry profession refer to 20/20, they’re referring to good visual acuity — from 20 feet away, you can clearly read the eye chart. So, when we think about the year 2020, it is ironic that so much of what we have “seen” are things that were anything but clear when we started out 12 months ago. Professionally and personally, the impact of COVID-19, racial tension, police brutality against people of color, and a very tumultuous national election here in the U.S. has resulted in disruption, divisiveness and societal fractures in the very fabric of what makes us members of the global community.

In addition, rising levels of food insecurity, the loss of jobs and an economy in peril contribute to increasing concerns about the mental health of adults, teens, couples, families and children. From anxiety to much more serious issues, we have a global community in crisis.

As we close out the year and reflect on what we have experienced in 2020, I wonder if people will react by choosing to be vicious or virtuous. Professional counselors have an incredibly important role to play in cultivating what I hope will be a path toward a community that embraces virtue. Our local communities, our nation and, in fact, our global peers can emerge from all that we have experienced with a renewed strength to address the ills of our society. Not to place too much pressure on the counseling profession, but I think that your efforts, whether you impact one person or one thousand people, can make an incredible contribution to the healing that is necessary.

The past year exposed many areas of darkness that exist in society. My hope for 2021 is that we will all come together to discuss, discern and find solutions to the insidious destruction of civility and common concern for one another that we have witnessed. I want to note that these comments are not about any political party, ideology or movement. I am referring to finding a way forward that can address the problems that were discovered and presented in 2020. We need to have respectful conversations that include agreeing to disagree on certain things, as long as we figure out a way to create an environment that fosters solutions. Our collective goal is to lift up and improve the lives of all.

Professional counselors have a key role in working with clients, groups, families, communities and public policy officials. In addition, there is a whole cadre of graduate students currently enrolled in counselor education programs who need the advice, consultation and support of those who have been practicing and those who teach.

I guess I am an optimist at heart. I believe there is a bright future ahead for professional counseling. The American Counseling Association continues in its desire to be your professional partner. We need to know what we can provide to help you meet the challenges, and exceed the expectations, of those you serve. I’m serious when I say, let me know what you want from ACA!

Last month in this column, I encouraged you to practice self-care. This month, I’ve shared why such energy and renewal will be necessary in the year ahead. Each of you can contribute to making this world better. As we begin to put 2020 in the rearview mirror, take a moment to reflect on how you overcame challenges this year, and then know that the resilience you possess truly makes you an even better professional counselor.

As always, I look forward to your comments, questions and thoughts. Feel free to call me at 800-347-6647 ext. 231 or to email me at You can also follow me on Twitter: @Richyep.

Be well.


From the President: Renewing focus on self-care and wellness

Sue Pressman

“As you grow older, you will discover that you have two hands, one for helping yourself, the other for helping others.” — Maya Angelou


Sue Pressman, ACA’s 69th president

Happy holidays! It is hard to believe we are coming to the end of the year 2020. It has been quite a roller coaster ride this year, with emotions and events that have taken us up summits and on dives, complete with loops and curves, hand-gripping moments and also some relief.

As counselors, we often ride the roller coaster with those we serve. Because we understand the importance of work-life balance, many of us have conversations with our clients about the importance of personal values, lifestyle management and self-care. Given the distress surrounding the coronavirus pandemic and resulting life changes, self-care can seem an impossible task to many, further taking a toll on their emotional and physical well-being.

As counselors, it is sometimes hard to remember to be good to ourselves. That is why I want to focus this column on the importance of taking care of yourself, especially during the holidays, through both happy and difficult times.

The Global Wellness Institute defines wellness as “the active pursuit of activities, choices and lifestyles that lead to a state of holistic health.” Each of us is unique in how we take care of ourselves in different ways. The need for self-care is documented in books, research and even an ACA task force that focused on the importance of wellness and counselor self-care. Emotional, social, spiritual, intellectual and physical wellness are essential, and as counselors, it is our ethical responsibility to practice self-care and wellness for ourselves to best support those we serve.

As we coast into 2021, it has never been more imperative that we practice what we teach and advocate as counselors. To be our “healthiest self” by participating in daily exercise and incorporating wellness strategies into our lifestyle is of paramount importance. My adult daughter who is a certified yoga instructor often reminds me of the importance of conscience lifestyle living. Sometimes, just doing something as simple as getting outside for a walk, getting in touch with an old friend or listening to your favorite music can be healing and nurturing.

The National Institutes of Health (NIH) provides five wellness toolkits that offer ways to practice a healthy lifestyle. These toolkits (see cover how to make our environment safer, how to handle life’s stresses, how to increase our physical well-being, how to create positive social habits, and how to protect our health.

From NIH, here are six strategies for improving your emotional health.

1) Brighten your outlook: Manage negative emotions and hold on to positive emotions.

  • Remember good deeds.
  • Forgive yourself.
  • Spend more time with friends.
  • Explore your beliefs about the meaning of life.
  • Develop healthy physical habits.

2) Reduce stress: Learning healthy ways to cope with chronic stress can boost resilience.

  • Get enough sleep.
  • Exercise regularly: Thirty minutes a day can make a world of difference.
  • Build a support network.
  • Set priorities.
  • Think positive.
  • Try relaxation methods.
  • Seek help.

3) Get quality sleep: Sleep affects both our mental and physical well-being. It is essential to allow your body to get the rest it needs to be the best version of yourself.

  • Go to bed the same time each night and get up at the same time.
  • Limit the use of electronic devices before bed.
  • Relax before bed by meditating, reading or listening to calming music.

4) Cope with loss: Learn healthy ways to help yourself through difficult times.

  • Talk with caring friends.
  • Find a grief group.
  • Talk with your doctor.
  • Consider additional support.
  • Be patient. Mourning takes time. Grief can be a roller coaster of emotions.

5) Strengthen social connections: Our relationships can have positive effects on our health.

  • Join a group that engages in your favorite hobbies, such as hiking, painting or quilting.
  • Volunteer for things that you care about.

6) Be mindful.

  • Take some deep breaths. Breathe through your nose to a count of four, hold for one second, and then exhale through your mouth to a count of five. Repeat often.
  • Enjoy a stroll.
  • Practice mindful eating.
  • Find mindfulness activities or resources such as yoga and apps.

Finally, if you are looking for a good book as we approach the holiday season, pick up a copy of Counselor Self-Care (2018) by Gerald Corey, Michelle Muratori, Jude T. Austin II and Julius A. Austin (published by ACA). I especially loved Chapter 2, which discusses seasons of a career and includes some wonderful relatable stories. It was featured as part of ACA’s package of 15 free continuing education products this year.

Looking forward to ringing in 2021 with hope for wellness, peace and a year of new beginnings!