Monthly Archives: February 2021

Working our way through a pandemic

By Laurie Meyers February 25, 2021

2 Comments

To appropriate a turn of phrase from Queen Elizabeth II, 2020 was our collective annus horribilis (horrible year). The queen was referring to 1992, a year that featured the implosion of three royal marriages, a devastatingly destructive fire at Windsor Castle, and unfortunate headlines involving Sarah Ferguson’s new beau and his, ahem, admiration of the Duchess of York’s feet.

But as the meme goes, 2020 said to 1992, “Hold my beer.”

The year that the queen “shall not look back upon with undiluted pleasure” included family losses, property destruction and embarrassing press. Stressful, to be sure, but ultimately personal and mundane (although, granted, most of us don’t have to face the paparazzi). But 2020 pelted us with events of a virtually seismic nature that have in one way or another affected billions of lives worldwide. The emergence of the novel coronavirus was not the only stressor or calamity the year visited upon us, but it remains arguably the most disruptive. And perhaps nowhere is that more apparent than in people’s work lives.

When the great shutdown began in the U.S. in March 2020, most of us thought we’d be confined to the house and working virtually for only a few months. But approximately one year later, and with more than 450,000 American deaths attributed to COVID-19 through the first week of February, many people are still hunched over their makeshift office equipment.

In the beginning, some of the work-from-home snafus were funny. Newscasters broadcasting with jackets — but no pants (which seems to be the preferred work-from-home style for a surprising number of people). The boss who accidentally turned herself into a potato on Microsoft Teams and didn’t know how to change back. Amusing, embarrassing and sometimes horrifying comments and conversations caught by accidentally unmuted microphones in video conferences. Other disruptions, such as cats on the keyboard and dogs chiming in during meetings, were a bit chaotic but too cute — at least at first — for their human companions to truly complain about. But other people struggled to carve out a workspace and found themselves joining meetings from underneath the stairs or barricaded behind the bathroom door because it was the only private space in a house full of busy (and noisy) family members. Even people who frequently telecommuted pre-pandemic often found adapting to an all-virtual workplace a challenge.

Balancing work, school and child care

One of the most significant challenges to working — whether virtually or on-site — during the COVID-19 era has been the lack of child care options and the need to assist children with their virtual schooling.

“Coaching folks on how to handle their work life without child care is a big focus of my practice these days,” says Katie Playfair, a licensed professional counselor (LPC) and management consultant located in Portland, Oregon.

“I tell clients to be as flexible and creative as they can in figuring out how to get their job done despite these obligations and to consider, when possible, cutting back hours to something more manageable,” she says. “As the mother of children who are 8, 6 and 2 years old, I home-school them during the day and then work from 5 p.m.-10 p.m. every evening after my spouse gets home. It’s a rough schedule.”

Playfair says many parents are having to take breaks to help with schoolwork during the day and then catching up on work themselves at night. Even children who are old enough not to need constant supervision often interrupt the workday to request a snack, to seek permission to take a break or to ask a quick homework question. As a result, parents are continually task-switching, unable to block out time for uninterrupted work, Playfair explains.

“Developing a system to communicate with older kids about when parents are interruptible and when they aren’t is vital,” she stresses. The use of physical or virtual calendars, door signs or predetermined “office hours” when they will be available to their children can help parents protect meeting times and allow for concentrated work during the day, she says.

“Providing kids with a way to table their questions until appropriate times is the other side of this equation,” Playfair continues. “They may need a whiteboard on parents’ doors or some other ways of tracking things so they don’t forget about them and get frustrated. Older kids can also be taught to email or text parents. Nonetheless, parents may still find themselves having to work nights or weekends to make up for the work that isn’t getting done during the school day.”

Even with families in which one spouse was already a stay-at-home parent before the pandemic, the virtual work and school mix can throw a wrench into the routine, says Keri Riggs, a Texas-based LPC whose specialties include relationship stressors, stress management and work-related issues. In one couple with whom Riggs worked, the mother was accustomed to structuring her day around the schedule of their middle school-age children. The family had managed to incorporate virtual school into their routine when, suddenly, the father began working remotely.

The only available workspace was the kitchen table, and the husband frequently needed everyone else to clear out of the room so he could participate in meetings. But he also recognized the need to give his wife a break — and the need to get away from the table himself — so they scheduled in lunches and other times when they would trade responsibility for the children. Because his meeting schedule varied, the couple sat down every night and plotted out the next day’s schedule, blocking off times when the kitchen needed to be in “do not disturb” mode and carving out time for breaks, says Riggs, a member of the American Counseling Association.

Fitting in the demands of work and school is even more difficult for single parents because, absent an available and willing relative or neighbor, there is no one to help shoulder their burden. Uninterrupted blocks of time may be available only when the children are asleep. However, some work-related tasks, such as meetings and phone calls, generally have to take place during the day. To help minimize disruptions, Jessi Eden Brown, an LPC whose specialties include trauma and workplace bullying, suggests parents buy or create “some kind of super-involved art project that they [children] only get to work on during meetings, so it’s kind of like a treat.”

“I don’t love this,” she continues, “but some clients have [also] had success with a television show or movie that can be started or stopped.” Brown, an ACA member, recognizes that isn’t an ideal solution, but it may be the only way that some clients can prevent interruptions in meetings. As she tells parents, with all the stressors they’re coping with, an extra hour or two of television here and there for their children is not the end of the world.

Of course, as Sharon Givens, an LPC who specializes in career development and mental health, points out, “Not everyone was able to just pick up a laptop and go home. If you’re a housekeeper, you can’t work from home.”

This is particularly problematic for single parents, she says. Some of her clients have family members who can assist with child care during the day, but others have had to relinquish their jobs. They are experiencing devastating financial difficulties that were exacerbated by the end of federally supplemented unemployment benefits.

“And, so, we’re working together to create some strategies to pay the rent,” says Givens, president-elect of the National Career Development Association, a division of ACA. Some clients have pulled money from their retirement accounts or tapped family members for financial assistance. Givens has also helped clients find local assistance programs and search for jobs that they can do from home.

The pandemic and resulting recession have demanded that counselors put on their “practical strategy hat” to help clients, Givens says. She has advised clients to speak with their mortgage company or landlord and their utility companies to see what type of deferment or other relief they can offer.

Setting boundaries and navigating distractions

The virtual office poses other challenges, such as the blurring of boundaries between work and home. By getting rid of the daily commute, office workers have gained extra time, but it has also deprived them of a natural boundary that signaled the beginning and end of the workday, Riggs says. The computer is always right there — a siren beckoning workers to check their email one last time or to do just a little more work. Suddenly, it’s midnight, and they’ve spent all day at the computer.

Riggs works with clients to replace the commute with other routines, asking what symbolizes starting and ending the workday for them. Is it taking a shower or changing out of their work clothes at the end of the day? She also suggests engaging in rituals such as hanging a “closed” sign on the computer or home office door or voicing a mantra such as “I did my best today.”

Sometimes, however, it isn’t employees who have trouble setting boundaries. American work culture is often brutal and not supportive of health and well-being, Playfair asserts.

“Unless an organization has set out to really change themselves into a more compassionate and empathetic place to work, they’re going to expect lots of hours, productivity and performance from everyone nearly all the time,” she says. “But even within this culture, there are opportunities for boundaries. First, I encourage people to ask their bosses, ‘Do you want the truth or what I think you want to hear?’ when an employee feels pressured past what they can take. Most people will choose the truth, and that will give the opportunity for healthy disclosure. I also like the phrase, ‘I wish I could do that for you, but I can’t because …’ to introduce a boundary.

“Finally, I think it’s helpful for employees to empathize with their bosses while still demanding support themselves. For example: ‘I understand that you’re short-staffed for this shift and that headquarters is expecting you to figure it out. That’s unfair. If our company would budget and plan sufficiently for contingency staffing, this wouldn’t be a problem for you or me, would it? I know they expect you to be fully staffed today, but they haven’t given you the resources to be successful with that, and I can’t personally make up for their poor planning.”

Brown encourages her clients to look for fellow employees who seem to be able to set boundaries. “Like ‘Bob’ — he always seems to sign off at 5. How does he do it?” she asks.

In other cases, Brown and the client may review their job description or the company’s policies and procedures manual to see if expectations for work hours have been set out.

Home itself can often be a distraction, Riggs notes. It can be difficult for people to focus exclusively on the work they are paid to do when they are surrounded by ever-present reminders of household tasks that also need to be completed, such as doing the laundry or loading the dishwasher. Cell phone pings announcing texts and social media notifications also beckon.

Riggs and her clients try out different solutions to find what works. This might involve setting a timer to complete 30-minute blocks of focused work, giving themselves a healthy reward for completing work, or setting up accountability partners. Riggs also suggests that, if possible, clients leave their cell phones in another room. If that isn’t feasible, she encourages clients to disable their notifications. She also counsels clients to prepare for the unexpected by allowing some margin for “white space” — a block of free, unscheduled time — during the day to attend to urgent requests or time-sensitive tasks.

The mental toll

Working under less than optimal conditions — or not working at all — has created significant challenges among a population that is already struggling with grief, Givens says. “All of us, if we’re being honest, are feeling a sense of loss: loss of activities, loss of career opportunities, loss of income.”

The uncertainty ushered in by the pandemic has challenged many clients’ coping skills, Givens says. She uses a variety of methods to help, including exploring what methods have supported clients’ ability to cope in the past. For some people, that involves more physical activity, whereas for others, it’s about increased (virtual) connection.

Givens also uses cognitive behavior therapy interventions such as having clients keep a thought record. They then look at this together and evaluate what is and what isn’t under the client’s control. “Many of them see the visual: ‘I spent four hours per day worrying about something that I couldn’t control,” she says.

Many of her clients are also engaging in frequent catastrophizing, obsessing about what will happen and whether they’re going to die in the pandemic. These concerns are natural, but some clients are mentally building worst-case scenarios, Givens notes. For these clients, she uses a different kind of thought record known as an evidence record. The concept is the same — clients write down their thoughts and then go over them with Givens — but what they’re looking for is any evidence to support the likelihood of their worst-case scenarios becoming reality.

All of the practitioners Counseling Today spoke to for this article urge clients to be patient with themselves as they navigate the myriad challenges of working during the COVID-19 era. Riggs recommends Kristin Neff’s five-minute self-compassion break (a guided version is available at self-compassion.org/guided-self-compassion-meditations-mp3-2/).

The practice begins by, as Neff puts it, “calling up a little suffering,” or reflecting on something that is currently causing stress or worry. Neff then provides a series of phrases “designed to help us remember the three components of self-compassion when we need it most.”

The first phrase is “This is a moment of suffering.” Or, as Riggs tells her clients, “I’m having a hard time today. I’m struggling.”

The second phrase is “Suffering is a part of life.” Riggs describes this as recognizing one’s connection to all of humanity: Not only am I struggling, other people struggle too. I am not alone.

The third phrase is “May I be kind to myself in this moment.” To support being kind to oneself, Neff suggests that listeners place their hand over their heart or another place on their body that feels soothing, then focus on the warmth of their hand and let that sensation stream through their fingers. She then recommends that listeners direct kind and supportive language toward themselves, such as words they might use with a friend going through a similar situation — e.g., “I’m here for you. It’s going to be OK.”

At the end of the practice or “break,” Neff asks listeners to notice how their bodies feel and to allow themselves to just “be” in the moment with those sensations.      

Riggs also suggests clients ask themselves what would make them feel better at that moment. “That’s really the hardest piece if you don’t know what you need,” she says. “Do I need to move my body? Do I need to journal? Call my best friend? Put on music? Give myself a hug?”

Finally, Riggs tells clients to remind themselves that the stress or anxiety they are currently experiencing will not last forever — that they won’t feel like this forever. Eventually, it will change.

Amid the suffering caused by the pandemic, Brown sees opportunities for personal growth. “Never before have we had … [such a] profound opportunity to slow down and focus on life’s priorities with such intention,” she says. “COVID-19 has affected nearly every person on the planet. Countless people live in fear, and many have lost family, friends, livelihoods and so much more.

“The tragedy is undeniable. That said, I have always believed that low moments like these potentially set the stage for meaningful change as we reflect on what is important and how our decisions either support or impede our progress.”

 

****

The pandemic and a frayed political climate have also been at the center of various instances of workplace bullying. Read more in our online exclusive article, “No rest for the bullied.”

 

 

 

 

****

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

****

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 outside the box

By Bethany Bray

2 Comments

Clients bring an unending range of presenting issues, personalities, life histories and challenges into counseling. Fortunately, counselors also have an infinite supply of tools for forging therapeutic bonds, meeting clients’ needs and helping clients tell their stories.

Counselors need only flex their creative muscles to find approaches that can bolster trust with clients and speak to each person’s unique life experiences and worldview. Exploring a client’s interest in skydiving as a metaphor for self-awareness and trust? Discussing a favorite dish or recipe as a prompt to get a client talking about family-of-origin issues? Assigning a client to play video games online with peers as a first step toward addressing social anxiety? The sky’s the limit.

Counseling Today contacted several counselors who are using interesting, fresh or different approaches to help their clients and students. We hope that you will be inspired by their ideas and possibly use them as a jumping-off point to think outside the box in your own work.

Sparking connection with photos

As the adage goes, a picture is worth a thousand words.

American Counseling Association members Brandee Appling and Malti Tuttle believe the truth of this saying holds up even in counseling settings, especially in the age of smartphones, when photography is ubiquitous. Why not leverage that by asking clients to bring photos and images into sessions, they reasoned. Prompts such as “bring in an image that represents you feeling happy” or “bring in an image that represents your family” can be eye-opening for clients and clinicians alike, Appling and Tuttle say.

The duo, former school counselors who met while working as co-coordinators of the school counseling program at Auburn University, have found that “phototherapy” can encourage dialogue and boost empathy and connection in counseling. This can be especially true in group settings, with child and adolescent clients, and with individuals who struggle with speech or whose primary language is not the same as the counselor’s.

Photos and images introduce “another mode of communication” in counseling, says Tuttle, a licensed professional counselor (LPC) who is an assistant professor and school counseling program coordinator at Auburn.

“Photographs can bring insights into someone’s life that we might miss when talking — things that the client can’t verbally express or doesn’t think to,” adds Appling, an LPC and approved clinical supervisor who is now an assistant professor in the Department of Counseling and Human Development Services at the University of Georgia. “It helps to break down walls [in session] and makes it easier for the client to talk about something that’s concrete rather than [topics] that are in the air, so to speak.”

When Tuttle and Appling have used this approach in school settings, students have often been able to display photos on their cellphones. If students don’t have access to a cellphone, they may be able to check out digital cameras from the school, or the exercise can be widened to include printed images such as postcards or magazine clippings, the counselors say.

The counselor’s role is to prompt conversation by asking questions about the client’s image and then allowing the client to reflect and speak. The counselor should never try to interpret the image or impose their feelings about it, Appling stresses.

“This is not to be used to diagnose [clients]. This is not meant to be a stand-alone tool but part of a range of counseling tools,” Appling notes. “It’s one thing that we would use, but it’s not the only thing we would use. It should be part of the therapeutic process, one tool to use in an interrelated system.”

In group settings, an assignment to bring in an image that “represents you” can help participants get to know one another, build connection and create a sense of belonging, Tuttle says. Asking group members to explain why they chose their image can prompt meaning-making, empathy and recognition of others’ viewpoints and perspectives. It can also provide the group leader a glimpse into each group member’s personality and emotions.

The exercise “builds a sense of universality and connection with one another, [prompting] conversations that might not happen organically,” Tuttle adds.

She suggests spurring dialogue in sessions (whether individual or group) by asking open-ended questions such as:

  • Why did you choose to bring this particular photo?
  • What meaning does it hold for you?
  • What would you title this photo, and why?

Appling has used this approach with a group she ran for students who were going through family transitions (e.g., divorce, a death in the family, living in foster care). When asked to share an image that represented the changes they were going through, one student brought in a photo they had taken of a unique seashell.

The seashell “was a representation, for them, of where they had been,” Appling recalls. “It looked very different than any other seashell that I had ever seen, and I initially didn’t recognize the image as a seashell. We talked about how water had changed it and eroded it. The seashell represented [the student] but also the growth and change they were experiencing.”

This intervention can also be flipped, with the counselor bringing in a photo for clients and students to discuss. When presenting on this intervention at conferences and trainings, Appling and Tuttle use an image of an aging set of concrete steps with vegetation growing through the cracks. They ask participants:

  • What do you think this image means?
  • What emotions does it elicit?
  • What does this photo remind you of in your own life?

Despite being shown the same image, participants typically share a wide range of thoughts, reactions and associations regarding the picture, Tuttle and Appling say. Some people see resiliency and growth in the vegetation, whereas others see decay and despair in the cracked steps.

“It’s really interesting to be able to see the perspective of each participant,” Appling says. “It’s a lesson that we all see things very, very differently and that it depends on the things we have been through, our different lenses. It’s a lesson that we all bring different experiences and viewpoints.”

 

Walking (and running) the walk

Counselors can use a seemingly unlimited number of running-related metaphors to encourage clients: It’s a marathon, not a sprint. Keep putting one foot in front of the other. Focus on the mile, not the marathon. You have to learn to walk before you can run.

But for Natae Feenstra, an LPC with a private practice in Smyrna, Tennessee, this approach goes beyond the metaphorical. An experienced runner who has completed multiple marathons, she sometimes conducts outdoor counseling sessions with clients as they run and talk, side by side. As a counselor who specializes in “running therapy,” Feenstra offers running sessions for clients who are comfortable with and interested in donning their sneakers and hitting the trail with her.

“For the client, it’s first and foremost a counseling session,” says Feenstra, who is working on a dissertation on running as a therapeutic treatment for trauma as part of a doctorate in counselor education and supervision through the University of the Cumberlands in Kentucky. “A goal to get to a certain number of miles is never part of a client’s treatment plan. The goal is improvement of mental health, and running is a tool for that.”

Counselors have long known the benefits that movement and exercise can have on mental health, including stimulating the release of endorphins, dopamine and other brain chemicals. Engaging in movement and exercise also offers opportunities for processing thoughts and mindfully focusing on one’s breath and stride.

“Natural bilateral stimulation — that’s all that running is. Rhythmic movement of large muscle groups, and we know that can bring amazing benefits to our brain,” explains Feenstra, a former school counselor who recently transitioned into private practice. Running therapy also offers the built-in ecotherapy component of enjoying sunlight, fresh air and views of nature as she and the client run and talk, she adds.

Feenstra’s approach is individualized. If a prospective client requests running sessions, Feenstra agrees only after having at least one consultation to get to know the client and their presenting concerns and determining whether the approach would be a good fit. She also offers walking and walk/run sessions, as well as traditional, stationary counseling sessions.

During the COVID-19 pandemic, Feenstra is conducting all of her traditional counseling sessions via telebehavioral health. She continues to offer in-person running therapy for clients who are comfortable doing that, while following health guidelines concerning physical distancing as much as possible.

Above all, she suggests running only if the client is comfortable with it. She points out that clients don’t need to be experienced runners to engage in this approach. She modifies each session to the client’s ability and comfort level. “It’s never about the pace or distance of the run. It’s about the movement, going alongside the therapeutic conversation,” says Feenstra, a member of ACA.

Feenstra has seen significant improvement in clients presenting with anxiety and depression who engage in running. Her clients have also self-reported boosts to their self-esteem, self-efficacy and overall wellness.

In addition to the mental health benefits that running provides on it own, these mobile sessions can help strengthen the counselor-client bond and support clients who might otherwise struggle to open up in a more traditional therapy setting, says Feenstra, who is also a certified running coach with the Road Runners Club of America. “Some people are intimidated by eye contact or other aspects of face-to-face sessions, or being in an office with a power differential. For some people, [running during counseling] can help them speak more freely,” Feenstra says.

This was recently the case for an adult male client on Feenstra’s caseload who presented with severe depression and anxiety. During the COVID-19 pandemic, his condition had worsened to the point that he was no longer leaving home.

When Feenstra and the client began meeting, counseling sessions were the only time the man ventured out. They eventually transitioned to mobile sessions, beginning with a walk/run mix to fit the man’s comfort level. Within a few sessions, his anxiety and depression had lessened so that he was leaving his house more frequently and beginning to reengage in hobbies and activities that he had enjoyed previously.

“The platform of running therapy was what prompted him to leave the comfort zone of his house. A telehealth platform would not have made him leave his house, and he was not interested in pursuing [therapy in] an office environment,” Feenstra says. “In this case, the running therapy was what helped him pursue counseling services. I think it was the running piece that was intriguing [to him], and it was so helpful to get him outside to conquer his anxiety.”

Running therapy “is not a miracle treatment, of course, but there are cases where it can make a difference, just like any therapy,” she adds. Running therapy, pioneered by American psychiatrist Thaddeus Kostrubala, has been around since the 1970s, she notes.

For running sessions, Feenstra meets the client in a park, on a trail or in another public place that she is familiar with or has checked out ahead of time. She begins by warming up with the client and chatting as they stretch. After completing a run or walk, they finish by cooling down and reflecting on the session together.

Feenstra acknowledges the potential lack of confidentiality when holding counseling sessions in a public place. She addresses this with her clients ahead of time, both with detailed language in her informed consent forms and verbally, explaining that they can pause their conversation whenever another person is within earshot.

“I let the client dictate,” she says. “I let them know that [they] can choose to lower their voice, stop talking or continue talking if they are comfortable.”

While many counselors may not be runners themselves, they could have clients who enjoy running. Practitioners don’t have to offer running therapy to leverage running’s benefits for their clients, Feenstra points out. She sometimes incorporates running by assigning clients to run outside of session (again, only if they are interested and able) and then uses that to prompt counseling work in their next session together. Running provides an opportunity to relieve stress, tap into the subconscious and process thoughts away from the distractions of life, Feenstra explains.

Clients may find it helpful to keep a journal to record their thoughts, questions and discoveries made while running. This can be used as a self-development tool or as something the client brings into sessions, Feenstra notes.

“Since the run time is often prime time for thinking, clients and counselors can discuss [in sessions afterward] how the run went and what their thought process was like on the run,” Feenstra says. “Also, since running has an innate mindfulness component, this [aspect] can be used as a counseling tool. The counselor might give the client a thought to ponder or a mindfulness activity to meditate on during their run time.”

 

Movies and moral development

One of Justina Wong’s clients had served a long military career as a sniper with a special forces unit. His experiences in service, including multiple deployments overseas, had left him with posttraumatic stress disorder and a relative inability to show or express his emotions. When he did, it often manifested as anger. His relationship with his wife and family was becoming increasingly strained, and one of his children was beginning to fear him.

In counseling, what clicked for this client was Wong’s suggestion that he watch two movies that, on the surface, were geared toward children: Charlotte’s Web and Inside Out. Wong’s client was able to see himself — and many of the emotions he was having trouble identifying and expressing — in the moral arc these movie characters experienced.

“The response that he had was very powerful,” says Wong, who completed an internship at a nonprofit that serves military veterans and their families as part of her master’s in counseling program at the Chicago School of Professional Psychology. As they processed the movies together in session, “We talked about healthy coping skills and unhealthy coping skills. He began to open up more about what he saw and experienced in the military. He had a very hard time differentiating [between] feeling angry and feeling sad, which is common among this population. Feeling angry is accepted, but feeling sad is seen as [a] weakness or being undependable.”

Cinematherapy, or using movie storylines, characters and themes as a therapeutic tool, can be particularly helpful with child or adolescent clients and those who struggle with depression, trauma, loss or social anxiety, Wong says. It’s also useful for individuals who might not respond well to more traditional counseling interventions and those who have trouble opening up to a counselor, she adds.

Clients can observe and learn from movie characters’ struggles, growth and perseverance in the face of challenges throughout their story arcs, explains Wong, a member of ACA. Clients “can feel like they’re not alone because someone else [a movie character] is going through a similar thing. They can see a character’s unhealthy behavior, coping skills and what they did or didn’t do to manage. It can help clients communicate and voice their emotions and understand what their values are.”

A counselor can either assign a client to watch a particular movie (that the practitioner has vetted) outside of session, or the counselor and client can watch film clips together in session. Either way, the important part of the intervention involves the therapeutic discussion afterward, Wong says.

Wong, a recent graduate of the Chicago School, prompts dialogue with open-ended questions. For Inside Out, these include:

  • Which emotions do you consider to be positive, and which do you consider to be negative?
  • Tell me about a time when you suppressed a particular emotion and, as in the movie, your “island” started falling apart.
  • What islands do you have in your life?
  • What role do joy, sadness, anger, fear and disgust have in your life?
  • Describe a time you felt embarrassment, shame or guilt regarding something from your childhood.

Wong stresses that cinematherapy must be individualized when used in counseling. Practitioners should carefully consider whether the approach is a good fit for each specific client and appropriate for their presenting concerns and therapeutic goals. She uses only movies that she is very familiar with and has prescreened. Her list includes About Time (2013), Mulan (1998 animated version), Yes Man (2008), The Lion King (1994 animated version), Eternal Sunshine of the Spotless Mind (2004), Toy Story 3 (2010) and others.

“You really want to do your due diligence and make sure you’re using this intervention to the benefit of the client,” says Wong, a certified trauma professional. “If you don’t, it [watching movies] just becomes a recreational activity.”

The therapy goals of Wong’s veteran client included mending his relationship with his family and being able to have conversations without becoming triggered and angry. As a grown man and hardened military veteran, he initially bristled at the idea of watching children’s movies. But when he began to understand how they could help him strengthen his family relationships, he agreed. He watched Inside Out with his entire family and discussed Wong’s therapeutic questions afterward with his wife.

When Wong suggested he watch Charlotte’s Web, she warned him about the movie’s sad ending because he had never seen it before. Even so, Wong recalls, he was very upset in the following counseling session. As they began discussing the movie, the client realized that he identified with Wilbur’s feelings of isolation and loneliness. The pig’s friendship with the spider, Charlotte, reflected the camaraderie he felt and the bonds he had formed with the soldiers in his unit, some of whom had not made it home alive.

“He put two and two together and understood that when Charlotte dies, she couldn’t return home with Wilbur, and he [the pig] was angry, sad and in despair. [The client] had served in special forces and had lost many friends and was trying to bury and push away his troubles. … After processing it [in therapy], he understood why I chose that movie for him to watch,” Wong says. “The lightbulb turned on for him when Charlotte and Wilbur have a conversation in the movie and she tells the pig that she can’t return home with him.”

Wong talked these issues through with the client, supporting him as he processed, during which he began to show emotion and cry — a major breakthrough for someone who had appeared emotionless and “very by the book” at intake, according to Wong.

The movie discussion spurred the client to open up to Wong. He disclosed that during one of his deployments, several soldiers he was in charge of had died as they worked to secure and occupy an area. The area was eventually retaken by insurgents, and the client wrestled with feeling that his comrades had “died for no reason,” Wong says. He struggled with moral conflict and felt frustrated and betrayed by his commanding officers and the government. “It was powerful progress. He was able to talk about that, which he had never [done] before,” she says.

When used intentionally, cinematherapy can be a powerful tool, Wong notes. She was inspired to explore the approach after hearing Samuel T. Gladding, a past president of ACA and a professor of counseling at Wake Forest University, present on a range of creative interventions, including cinematherapy, at the International Association of Marriage and Family Counselors conference in January 2020. “It’s up to the counselor to be as creative — or not — as they want to be,” Wong says. “I never thought of myself as a creative counselor, but when I heard Dr. Gladding’s presentation … I guess I’m more creative than I thought I was.”

 

Once upon a time

As a doctoral candidate at North Dakota State University, Robert O. Lester recently taught a class on group counseling to first-year, master’s-level counseling students. Most students, Lester notes, came into the class with an innate understanding of empathy, but as the class neared its end, he looked to delve deeper, teaching empathy in an applied manner.

He turned to fairy tales. Lester asked students to write a tale that illustrated some of the challenges they had encountered and the personal growth they had experienced over the span of the class. The assignment had just two requirements: Begin the story with “Once upon a time …” and don’t make fun of any tale shared in class.

The exercise succeeded in opening students’ eyes to a greater understanding of empathy while spurring the growth of their professional identities. It also equipped them with a creative intervention that can be used with clients in counseling sessions. Going through the “imaginative labor” of observing one’s self in unfamiliar places or scenes expands our concept of what is possible, Lester explains.

“Many students began with ‘I don’t have a story to tell,’” says Lester, a school-based counselor and ACA member. “You don’t need to have gone through some great suffering; you just need to be up close to your own desire and belief. It’s the distance of suffering that empathy can’t cross. It was an assignment to bridge the distance between ourselves and others by keeping the desire and suspending the disbelief. It’s about a willingness to let other worlds be possible. This is the initial move of empathy.”

Weaving one’s experiences into a fairy tale can be a helpful exercise for counseling students and clients alike because the stories are compact and give the writer the satisfaction of identifying a coherent story arc and conclusion, even if it’s not a happy one, Lester says.

Writing fairy tales “is expressive, playful and may surprise you. It can loosen the tongue for serious talk. Letting people become a little more enchanted and surprised with themselves would have a lot of possibilities [in counseling]. Then, it would be on the counselor to facilitate a good discussion afterward,” says Lester, who is now living in California and working as a counselor at an alternative-education high school while he completes his doctoral dissertation. “One of my favorite things about this [intervention] is when we surprise ourselves. … It can certainly break some of the narrative ruts we can get into.”

In counseling sessions, prompting clients to express themselves through fairy tales could be a good fit for “any situation where you want someone to begin trying on differences,” Lester says. “Organizing our experiences into an imaginative story — a story where there’s room for enchantment, and the marriage of emotion and imagination — [can be beneficial] for clients who operate with a lot of constraint in their life, either self-imposed or imposed by culture or external forces, especially if they’re having trouble imagining themselves otherwise.”

Fairy tales offer students and clients a chance to cast themselves in new roles, organize their experiences into a sequence, and reflect on the challenges they’ve overcome and how they’ve grown from start to finish, Lester explains. In turn, they gain an appreciation for their belief of what they’re up against and their desire for how they go on.

This benefit was magnified when Lester invited his counseling students to share and discuss their fairy tales in class. This enabled them to see how different each of their journeys were.

“At the deepest level, I was hoping the fairy tale project would be a hermeneutical project [and] part of their professional identity development — marrying your own worldview into the profession [and] taking the feelings of others seriously and compassionately, especially those who don’t experience the world as we do,” Lester says. “They are just beginning in counseling and have to learn to honor others’ worldviews. This fairy tale [assignment] was a compact way to help them begin by rendering their own experiences as unusual and in need of close reading.”

One of Lester’s students wrote an impactful fairytale about a protagonist named Mia. She lived in an idyllic village where everyone knew one another and worked according to their talents — except for Mia, who spent much of her time alone, reading. Although she liked her fellow townspeople, Mia felt something was missing in her own life, Lester says. She harbored an intense curiosity and sense of imagination that many of her neighbors did not share.

Her story took a turn when some creatures from the outlying forest visited her and asked for her help. An ancient well where they lived, deep in the forest, had dried up. The well was the source of the creatures’ magical powers.

Kindhearted Mia knew she had to help and journeyed into the forest, where she found the well in shambles. Her heart broke for the forest creatures, and at a loss for what to do, Mia began to cry. As her tears flowed, they filled and restored the well. Mia’s compassion had saved the day. Not only had she revived the creatures’ source of magic on her quest, she had also discovered her own sense of purpose.

In class discussions afterward, the student who wrote Mia’s tale talked about feeling alienated in the small town where she grew up. Everyone in town seemed to know how they fit into the fabric of the community, but this student was never able to find her niche, Lester says.

Her fairy tale was a beautiful description of this concept. “She [Mia] is looking for a world where her tears have a place and can do something on behalf of others,” Lester explains. This paralleled the student’s own struggle to find her way and cultivate her professional identity.

“We all go through growing up and forming identity, but her fairy tale elevated the experience,” Lester says. “Suddenly, Mia’s tears could do work and were life sustaining. I find that incredibly moving — that language of having permission to cry, because you don’t know what wells your tears might replenish. To me, that’s a whole other order of coming to apply empathy. [Learning empathy] begins with ourselves and becoming empathic with some of the pain and beauty of growing up. … There’s something poetic in that everydayness.”

 

Culinary therapy

Each of the elements in chef Samin Nosrat’s 2017 cookbook, Salt, Fat, Acid, Heat, can be used as therapeutic metaphors in counseling work with clients, suggests Michael Kocet, a professor and chair of the Counselor Education Department at the Chicago School of Professional Psychology.

If a dish doesn’t have enough salt, it can be bland, but if the cook oversalts the dish, it becomes inedible. “One little [extra] pinch of salt can ruin a dish,” Kocet says. “Talk that through with the client: In life, what do you have that’s not enough or too much? What in your life is that extra pinch of salt? Is it unleashing an opinion on a family member? How can we control that?”

Similarly, acid is very powerful and must be wielded correctly, as in ceviche, in which citrus juice is used to cook the dish without heat. Continuing the metaphor, a counselor can ask a client about the “acid” they have in their life. “Maybe their sarcastic humor is biting. Talk about when that can be useful and when it can be hurtful,” advises Kocet, a licensed mental health counselor and approved clinical supervisor who provides pro bono counseling at the Center on Halsted, an LGBTQ community center in Chicago.

Food, eating and cooking are so intertwined in most people’s life histories, perspectives and preferences that they can become beneficial tools when leveraged in counseling, says Kocet, who taught a course on “culinary therapy” when he was a professor at Bridgewater State University in Massachusetts. Although he no longer teaches that class, he continues to weave culinary elements into his work with clients and students in Chicago and has provided workshops and trainings on the topic.

In addition to tapping into a bountiful supply of culinary-related therapeutic metaphors and conversation starters, counselors can consider giving clients the assignment (when appropriate) of cooking a dish at home and debriefing in session afterward. The dish doesn’t need to be anything complicated, Kocet emphasizes. It could be a peanut butter and jelly sandwich or a simple salad, he adds. Cooking or preparing food mindfully, no matter the recipe, can prompt reflection. Tracking experiences in a cooking journal may also benefit clients who respond well to this approach.

“Food is often a binding element,” Kocet explains. “If I have a client who is struggling in a relationship, I might have them cook a recipe that represents their relationship and talk about that [in session afterward]. Or if a client and their partner are from two different cultures, I might have them cook a meal that incorporates elements from their two cultures. … One aspect to [help] forge cultural connection with clients is to discuss food: what they grew up eating and what was ‘celebration’ food. That’s one way to get to know the client a little more. Clients are often really proud of food and cultural traditions, and it’s one way to connect and break down barriers in a counseling setting.”

Assignments for a client to cook with a partner or family member can prompt bonding and offer a fun and creative way to work on healthy behaviors introduced in counseling, Kocet adds. Also, cooking “failures” don’t have to be failures when talked about and learned from in counseling. Perhaps a client forgot an ingredient or strayed from the recipe. How does that parallel the choices made and lessons learned in their life outside of the kitchen?

Even time spent cleaning up and washing dishes after cooking can serve as a mindfulness exercise, Kocet points out. Practitioners could suggest that clients take time to reflect on how they felt stepping outside of their comfort zone to try a new recipe as they clean up the kitchen and feel the dishwater on their hands.

Kocet has developed a culinary version of the genogram mapping tool that he uses with clients to delve into family issues. He keeps a small collection of cooking spices and a sleeve of mini paper cups in his counseling bag. As he begins the exercise, he lines all of the spice containers up on the table and asks the client to select a spice that represents them and other members of their family circle. The client pours a little bit of each person’s spice into a separate cup. Eventually, a constellation of spice-filled cups is displayed in front of them.

Kocet prompts the client to talk through why they chose that particular spice for each person. Cinnamon or red pepper flakes might signify either a warm personality or a hot temper, Kocet points out. The exercise encourages clients to talk through issues related to their own identity and helps the counselor better understand how the person views their family network, Kocet explains. Similarly, questions that invite discussion of traditions and memories surrounding food can encourage clients to reflect and open up, while giving practitioners additional context on clients’ families of origin and related emotions.

Kocet, an ACA member and a past president of the Society for Sexual, Affectional, Intersex and Gender Expansive Identities (SAIGE), a division of ACA, specializes in grief counseling. “If a client is missing someone they lost, such as a grandmother, it can bring comfort to cook a dish that she used to make,” he says. “Cooking uses all the senses — we can connect with loved ones through the tastes and smells [involved] in the act of cooking.”

As with any counseling intervention, practitioners must be mindful of the ethical ramifications of incorporating cooking and culinary elements into therapy and consider whether it is appropriate for each individual client, Kocet stresses. Clinicians should practice caution in using the approach with clients who struggle with disordered eating, and cooking assignments should not be given to clients who have a history of suicidal ideation or self-harm because knives and other equipment could be involved, he says.

Kocet plans to continue exploring the use of culinary elements in counseling and is in the early stages of a research study on therapeutic cooking as a coping tool for the isolation, anxiety and depression people have experienced during the COVID-19 pandemic.

 

*****

Staying within scope of practice

Practitioners considering the use of nontraditional approaches in client sessions must always keep the profession’s ethical guidelines in mind. Professional counselors’ licensure guidelines and scope of practice vary from state to state. Practitioners must ensure that any approach, whether a widely used talk intervention or one of many complementary methods such as aromatherapy, reiki, yoga, acupuncture and others, fall within their state’s scope of practice regulations before using them with clients or students.

In addition, counselors must consider the potential risks to client welfare, whether the approach is evidence-based (which is called for by the 2014 ACA Code of Ethics), and their own level of competency in using the method.

 

*****

Contact the counselors interviewed for this article:

*****

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

****

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: Managing requests for client information

By Gregory K. Moffatt February 23, 2021

1 Comment

In nearly four decades of practice, I’ve experienced a number of attempts by various individuals to gain access to my client records. Here are a few of them.

  • Two police officers showed up in my office asking for records regarding a former client. They told me that the person was of interest in a very serious crime and they were trying to close that case. Would I please give them my records for that client? When I told the officers that I would be happy to comply with any order from the court, they pressured me. “Really! You are going to make us get a subpoena?” Yep.
  • An attorney sent me a very official looking letter that I believe was deliberately drafted to look like a court order. It was full of legal jargon and demands for information regarding a former client. I could have simply thrown it in the trash, but instead I called the attorney’s office. I knew the attorney would be waiting on my call. Sure enough, when I told the receptionist who I was, she immediately patched me through to his office. He answered on the first ring.

“I’m calling regarding your ‘request’ for information from me,” I said. Not waiting for him to make a comment, I continued, “I’m sure you know I cannot even acknowledge who my clients are without a court order or the client’s permission. Do you have either of those?” Of course, he did not. The call was polite and short. I never heard from him again.

  • A parent called my office seeking “any records whatsoever” I had pertaining to my therapeutic relationship with his son, who was a minor at the time. Ordinarily, I would have been happy to chat with a parent. However, I knew that this father’s custodial rights had been terminated by the court (my client’s mother had provided those documents to me), so the man calling me had no legal right to his son’s records. I declined his request.

Without experience, it might be easy to be intimidated by police, angry parents or clever attorneys. But you cannot be arrested (as I was threatened on one occasion) for following counseling ethics and HIPAA requirements regarding client information. In fact, you will likely be in greater trouble if you concede to these “requests” and thus violate our code of ethics.

To make your life a little less stressful, let me suggest three simple statements/rules that will help you know when to divulge information and when to stay silent.

First, never forget this line: “Who my clients are or are not is confidential information.” The two officers I mentioned above began by saying, “We are here to talk about M— S—, one of your former clients. Do you remember her?”

They were playing me. If I had acknowledged that I remembered her (as, in fact, I did), they would already have been on their way to pressuring me for more information. I simply delivered the line above and then shut my mouth.

Second, remember to ask, “Do you have a court order?” No court order is verbal. Police officers, lawyers and others have tried to tell me they had a court order and wanted me to provide information. I always state that I’m happy to comply with any court order that I receive. Unless a court order is provided to me, that is nearly always the last I will hear about a request for information.

Even if a printed order is provided, it must be signed by a judge. The lawyer who tried to scam me knew he couldn’t forge or fake a judge’s signature without risking losing his license and perhaps going to jail. I always first flip to the last page of the order to see what judge signed it. No judge’s signature, no information.

Finally, ask, “Who has legal right to this information?” Without a court order, that legal right generally lies exclusively with the client, but in the case of minors, those who have legal guardianship can request records as well. That can get complicated, as I indicated in the scenario above. If I hadn’t anticipated the question of legal guardianship, I might have provided client records to a person who had no right to see them.

If you have no experience with court orders, always consult with your professional organization or a trusted and experienced colleague. If you have questions about a court order, you can call the court to confirm or clarify.

One final caveat: I am not an attorney. I know some jurisdictions may have systems in place that differ from what I’ve described, so check with legal counsel in your area before you need it. You will then be prepared.

 

****

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

****

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.

Online role-playing games as group therapy during the COVID-19 pandemic

By Per Eisenman and Ally Bernstein February 18, 2021

Leave a comment

During the challenging era of COVID-19, many young people are experiencing the sort of isolation that can interfere with healthy social development. This may be particularly true for young people who were already wrestling with significant mental health challenges before the pandemic. Telehealth group therapy that utilizes role-playing games offers a hopeful modality for facilitating individual growth in a group context.

Setting the stage

When one of us logs in to the Zoom session 10 minutes early, a picture of a cat immediately pops up. Martin has been waiting all morning for the group to start. He appears briefly and shows us his cat, Betty, sitting on his lap, before turning the video off so that only the photo of Betty is visible.

Gradually, everyone else joins and our game begins. Martin is committed to the group; he has never missed a session and is always early. In Dungeons and Dragons and other role-playing games, group members play fantastic adventurers, working together to overcome obstacles and gain rewards. The facilitator narrates a story, and the group members describe how their characters respond.

Martin plays an elf wizard named Sylvan who has a cat (also named Betty) as his magical animal companion. Martin was initially a bit shy but has integrated into the group and participates in collaborative decisions; he also loves to talk about Sylvan’s cat and backstory. Martin joined the group after the COVID-19 stay-at-home order in the spring of 2020, once we moved to a virtual environment. As is the case with some others in the group, this is Martin’s only social contact outside his family.

The therapeutic group allows for a structured social interaction — a place where people can connect, practice social skills, and modulate their inner and outer worlds. Many of the young people we work with experience social anxiety, depression or social skill deficits. The experience of a safe social setting where they can experiment with becoming someone else allows them to develop connections that can be both an antidote to loneliness and an opportunity for growth.

The COVID-19 pandemic has been a time of isolation. Young people especially are having fewer opportunities to develop socially, and schools are not able to provide as many opportunities for social contact. Telehealth group therapy using role-playing games creates opportunities for social connection and resiliency-building that may not be possible in person during the pandemic.

Collaborative creativity

Role-playing games hold a place in the pop-culture imagination as a niche interest, but their popularity has increased in recent years, and therapists have started implementing the games more widely as a group therapy modality for older children and adolescents. In role-playing games, one facilitator describes an imaginary world, and the participants (playing characters) describe their actions in that world. Sometimes success and failure are based on dice rolls, but players’ creativity and collaboration are also key in helping a group achieve its goals within the world. The game has many decision points, and each player can change the course of the story.

Martin’s character, Sylvan, has blasted open treasure chests with fireballs, duped goblins by pretending to be their grandmother, and hatched a dragon egg. Martin’s creativity influenced the world for himself and the other players, creating a new set of circumstances and changing the direction of the story.

During the game, the facilitator sets the stage: “You enter the pirate’s cavern. As you go in, you see a couple of pirates standing guard.”

The group members discuss how they would like to respond. Should they fight the pirates or try to sneak past them?

“Let’s trick them,” Maya suggests enthusiastically. Maya is shy in real life, but in the game, she plays a tough brute who likes smashing down doors. Martin’s character is cunning and enjoys deception. He likes the idea, and they work together to come up with a ruse.

Martin’s character says, “We are poor pirates who have lost our way in the tunnels. Could you tell us the way to the ship?” He rolls the dice to see whether he can convince the pirate guards to let them pass.

Traditionally, role-playing games are played in person, sitting around a table with maps of the adventure setting, rolling dice, and telling the story together. However, it is possible to play the games remotely through videoconferencing and the use of online platforms. In recent years, remote role-playing game use has increased dramatically. The virtual medium confers new benefits during the COVID-19 pandemic and in an era of physical distancing. It translates surprisingly well to a telehealth group therapy experience. Martin, who struggles with social anxiety, told facilitators, “I like playing online better. I can turn off my video.”

Emergence of change

In the many groups we have run with colleagues, we have observed the emergence of group dynamics and group member interactions that have influenced the choices members make and their participation in the group. Some group dynamics become apparent through the group members’ interactions with one another or from the progress of the group over the course of many sessions. Other patterns emerge in the development of individual group members and the impact they have on the group.

We were particularly struck by the memory of Kendra, who had a very clear vision of how she wanted the game to proceed. She wanted to control the narrative so badly that she soon began frustrating the other players.

“Can I roll the dice to persuade Maya that she should give me her gold?” Kendra asked. She prioritized stealing gold or impressing pirates controlled by the game master over helping the other characters.

This led to frustration among the other group members. Some members began to go silent. One spoke out angrily against Kendra, suggesting the group members’ characters fight Kendra’s character. The frustration of the group turned into a discussion, and Kendra ended up changing her character’s behavior entirely, deciding that her character needed to work with the group and eventually save them, sacrificing herself for the greater good.

She said, “I want my character to help the group, but the shift has to make sense for her character arc. She can’t just change overnight.” We had numerous discussions about what it might mean for her character to develop.

We asked the other group members what they valued about the game, and another member said, “Working together as a team.” The emotional message felt palpable. We were thrilled that the adolescent participants were able to lead this discussion themselves and process as a group with only minimal prompting from the adult facilitators.

Role-playing games involve the players describing the actions of their characters, while the game master describes the rest of the world and the people who inhabit it. The world is imaginary, and visual aids are optional. In a therapeutic group, this system allows for group members to explore identity construction and navigate group dynamics. Therapy groups for teens support the essential task of identity development in the context of relationships with peers and adults.

Much like with any good therapeutic group, what happens within the context of the game often reflects the members’ lives out-of-game. When the game master is also a therapist, questions such as “How are you similar or different from your character?” and “Why did your character make that decision?” make the game a clinical experience. The avatar of the character allows each group member a safe distance through which to explore, process, experiment, fail and succeed.

Group process as an adventure

Role-playing games have long been an effective group therapeutic modality, but creating a shared imaginary world presents unique opportunities during the COVID-19 pandemic, when we are unable to safely convene in person.

Every age has different developmental tasks to achieve, and during the pandemic, these tasks have either been interrupted or have required us to make notable changes in how we carry them out. With schools shifting the way education is delivered because of the pandemic, the amount of social interaction has been significantly reduced. On the whole, we are spending more time isolated from others, and young people are having fewer opportunities to develop socially. Role-playing games, a high-interest activity, allow for social experiences to happen through telehealth in a way that might currently be impossible in person.

Role-playing games feature goals, conflict, choices and relationships. Young people can do something together by completing tasks that require creativity and teamwork. Playing every week creates routine and ritual. Having a group means that young people have regular contact with adults and peers outside their immediate family.

Games can be adapted for different age groups and needs. Children and adolescents can develop executive function and practice resiliency. The technology necessary to play the game online can malfunction and lead to frustration, allowing participants to practice patience and engage in troubleshooting. Also, because the games are fun and silly and joyful, the fantasy setting can provide everyone with a much-needed break from the stress and grief of the current world (or a way to process grief and loss, because characters can die too).

This innovative form of group telecounseling provides an opportunity to engage young people who might not otherwise actively participate in a group process. It also provides an opportunity to support the cultivation of interpersonal relationships with group members in serious need of social skill development. Right now, during the pandemic, if we want to offer something that simulates living and striving in close proximity to others, we can. These challenging times call for innovation. Therapy can become exactly what kids need: a safe but exciting place to be challenged to grow. In other words, an adventure.

 

*****

Related reading, from the CT archives: “The power of virtual group therapy during a time of quarantine”

*****

 

Per Eisenman (peisenman@csac-vt.org) and Ally Bernstein (abernstein@csac-vt.org) are community mental health counselors in the Youth and Family Services Program at the Counseling Services of Addison County in Middlebury, Vermont. They have been leading therapeutic groups for teenagers using role-playing games since 2015 and 2018, respectively. At the beginning of the COVID-19 pandemic, they transitioned these groups to telehealth.

****

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: Hope in action and mental health

By Cheryl Fisher February 16, 2021

1 Comment

Hope is being able to see that there is light despite all of the darkness. – Desmond Tutu

 

[NOTE: This is this first piece in a COVID-19 recovery series]

Without a doubt, 2020 was a challenging year. Many of us greeted the New Year with arms wide open in anticipation of better days ahead. Out with the old and in with the new. The months of isolation, social and physical distancing, masking up and suffering so many losses has taken their toll on our mental health. Public surveys and reports from mental health authorities show that rates of depression and anxiety have increased exponentially as people attempt to navigate remote work, virtual classrooms or even worse — unemployment. Election fatigue, inaugural distress and racial injustice continue to plague society. Coping strategies are restricted with the closing of gyms, places of worship and many other gathering spaces due to COVID-19. Reports of Zoom fatigue have blanketed media. People who have access to resources are reaching out to mental health providers who are also feeling the exhaustion from a year of unprecedented circumstances. My own practice has been booked months in advance, and I am turning away new client inquiries and referring to colleagues whose schedules are also full.

Yes, 2020 was a year like no other for many of us. Only time will tell if 2021 will be as chaotic, but we already face challenges such as continuing political unrest, the attack on the U.S. Capitol, the presence of new, more transmissible COVID-19 variants and the snail-paced vaccine distribution process. As we forge ahead, recovery from the trauma will take time, patience and work. Yet, there are signs of change. Glimmers of hope. Flickers of light from the shards of a very broken year.

The New Year promised a fresh start, and the appearance of the “Christmas Star” on the Winter Solstice was a beautiful way to usher in 2021. The “star” is actually an astronomical event during which Jupiter and Saturn align so closely that they look like one radiant light.

Although Saturn and Jupiter align with each other every 20 years, it has been 400 years since they were this close to each other and nearly 800 years since the “Great Conjunction” occurred at night. Some have speculated that the star described in the Bible as leading the three Wise Men to the site of Christ’s birth in Bethlehem was, in truth, a Great Conjunction. Whatever the explanation, it was a sign of hope and peace to those who followed — and the key element is they followed.

Saturn, top, and Jupiter, below, are seen after sunset from Shenandoah National Park, Sunday, Dec. 13, 2020, in Luray, Virginia. Photo credit: NASA/Bill Ingalls

Hope and mental health

As mental health clinicians, we know the importance of hope in wellness. Yet, we often forget that hope is also a verb. We create a space for hope in our sessions with our clients. We hold hope when our clients are unable.

There are three elements that accompany the experience of hope.

Having goals

Having something to work toward can provide us with structure and predictability. However, we want to craft goals that are specific, measurable, attainable, relevant, and timely (SMART). That should sound familiar to counselors. Often goals are too broad. For example, in my other life I owned an aerobic company and often provided personal training to people who attended the aerobic classes. Goal setting was an integral part of the training. At times, my clients would give me goals such as, “I want to be healthy.” “I want to be skinny.” “I want to be happy.” or “ I want to be active.” I would follow up each request with “What exactly does that mean? Paint a picture for me of what being “healthy, skinny, happy, or active” means to you? Then we would break it down into specific, manageable goals in which “being healthy” may mean running a first 5K race or being skinny may mean losing 10 pounds.

This year, one of my big goals is to celebrate my parents’ 60th wedding anniversary this summer with family face to face, even if we need to meet outdoors. I have missed my family desperately this year. However, we have family members who are vulnerable, and we have resisted gathering this year because of the risks of COVID-19. What more joyous way is there to come out of the darkness of the pandemic than by celebrating the commitment and legacy of my parents’ union together.

Feeling empowered to shape your daily life.

Envisioning the outcome of your goal is so much a part of the process. Performance psychologists have utilized imagery for decades with athletes. Imagine yourself as already attaining the goal. Feel it already accomplished.

It is also important to recognize our agency and there are times when we really do not have control over things. I like to ask myself, “What do I have control over? What don’t I have control over?” I then focus on areas under my control.

For example, I worked toward a family gathering goal with something I could control by scheduling renovations to my home during the pandemic lockdown. I now have the space to celebrate when I am able to gather with my family again.

Additionally, I have been fortunate to be included in the first rounds of the COVID-19 vaccine rollout. So, I will be fully immunized, as will be most (if not all) of my family members by summer. While I still anticipate taking precautions, there will be greater confidence in gathering.

Identifying ways to make goals happen.

Really lean into the role you play in accomplishing your goals. What steps do you need to take to achieve them? If you want an advanced degree, what is the next step? Information gathering? Taking the GRE? Applying for funding? Create a chart of the actual actions needed to be taken to achieve your goal.

As I make ready my home for celebrations and follow the CDC guidelines around my vaccine schedule and follow up protocol, I am furthering the vaccination efforts by volunteering with my local medical response corps. I am assisting in providing human resources to advance the distribution of the vaccines so that my family and community will have a better chance of achieving full immunization sooner. Check with your local agencies to see how you can promote the change you want to see. For example, senior and community centers need assistance with helplines that reach out to vulnerable populations to help them navigate the online vaccine registration process.

Hope in action requires motion. It requires feeding the flame with movement toward goals, desires, dreams. Hope is choosing to look beyond the darkness to recognize even the smallest glimmers of light and then magnifying them with our words, actions and deeds. The Wise Men saw the brightness of the star, and rather than stay in the darkness, they chose to follow the light. That is hope. Hope in action.

Let your COVID-19 recovery begin with hope in action.

 

****

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 cyfisherphd@gmail.com.

 

****

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.