Monthly Archives: April 2021

From the President: Childhood development through a songwriter’s lens

Sue Pressman April 30, 2021

“Let Go and Have a Little Fun” Lele Rose

Sue Pressman, ACA’s 69th president

A year of shutdown finally brings May flowers. When I heard that every adult in the U.S. should be able to register to receive the COVID-19 vaccine by May, I realized the keys to life outside of our homes would soon unlock doors that have been closed for so long. It will mean that we can once again safely travel, go to restaurants, enjoy in-person concerts and spend time with family and friends. After all the grief and loss we have experienced as individuals and with our clients, we will soon be able to connect again in person. One thing I am most looking forward to is being able to spend more time with my daughter, who lives across the country from me.

I haven’t shared much in these columns about my home life, which is kind of ironic because, like many of you, I have been almost exclusively at home for the past year. This month, as Counseling Today’s cover story highlights child and adolescent counseling and as we celebrate Mother’s Day, I’d like to share some excerpts and interpretations of “Always Be Your Baby,” a song my daughter wrote for me as a gift several years ago. The ballad reflects some of her memories and ties in to her present-day life and projection of the future. Lianna (Lele Rose) is a full-time singer/songwriter and professional musician. Please take the opportunity to listen to her song and watch her lyrical video at https://youtu.be/dPqKmZ9upxo.

Let’s take a peek through the developmental lens of a songwriter as she reflects on her childhood and what it meant to her. Story writing is an effective way of helping us understand our clients and how they see the world.

The first verse of the song offers many developmental inferences. It immediately creates an image of the past, present and future and frames the song. Here are the first two lines:

When I was a little one, you kept
me from harm.

I watched you put your makeup on;
I wanted to be pretty just like you.

Children are observant and look at possibilities. Children grow up, but the child-parent identity remains throughout life. Abraham Maslow’s hierarchy (safety, self-esteem) can be recognized in the next two lines:

Now I’m grown, but still your little one; you still save me and teach me right from wrong.

Oh I know, you always want the best for me.

When children grow up, leave the nest and spread their wings, it’s bittersweet in many ways. This reality is affirmed through a turning point in the song in which the young adult starts to comfort the parent in a pivotal role reversal:

Don’t you know, you’re my one
and only.

Oh we know we don’t ever have
to worry, ‘cause I got you and you
got me. 

I’ll always be your baby.

The second verse identifies parents as role models. But they are not the only role models in a person’s life. Counselors, teachers, extended family members and friends also influence our development as human beings. The following lines in the song imply work and life values:

Hey, Mama, always working hard; you never give up; you get what you want.

Cook of the house, with two cats in the yard.

Near or far, I’m always thinkin’ ‘bout you, don’t you know it.

The third verse acknowledges the importance of parenting, support, influence, respect and instilling hope for the future. When children are encouraged, they are equipped to become what Maslow calls “self-actualized.”

You and Daddy raised me to be the best I could be.

Took me dancing; always asked me to play and sing.

Because of you, I listened to the Beatles too, the Stones, the Eagles, the greats, your generation tastes.

Now it’s time for me to take your song; take it with me and run like a band on the run.

Revisiting some of the themes from my daughter’s song — through the eyes of both a mother and a counselor — brings new light to its meaning and the developmental processes of young people.

CEO’s Message: The importance of professional counselors: Way more than a job

Richard Yep

Richard Yep, ACA CEO

As we enter the second month of the first-ever ACA Virtual Conference Experience, I want to thank the more than 5,000 professional counselors, counselor educators and graduate students who have come together in the digital world for this event. The fact that we have more attendees than at any other ACA Conference in the past 20 years speaks volumes. It tells me that counseling professionals remain committed to constantly improving what they do for so many people and communities. 

The amazing keynote speakers, the 300-plus content sessions and the “Breakroom” that included activities such as yoga, coloring and listening to music really showcased the profession’s ability to adapt to changing situations while still providing important (and relaxing) information to all attendees. 

We are not done just yet though! Throughout May, the ACA Virtual Conference Experience remains accessible “on demand.” All the keynotes, content sessions and other fun stuff are still available to registrants. This means that you can acquire a great number of continuing education credits — and it can be done all on your schedule. If you have not previously registered, you can do so now by visiting counseling.org/conference.

We must also remember what drove us to create the ACA Virtual Conference Experience — the COVID-19 pandemic. I realize that as vaccinations become readily available in the United States and around the world, travel and meeting restrictions will ease, schools will reopen, and the allowable size for gatherings will increase. Even as the proverbial “finish line” is in sight, however, we are not yet there. 

With all of the sacrifices so many have made to stay safe for this long, why not hang in there for just a while longer? The amount of pent-up energy and the desire to be with others, to hug loved ones and to get back to some type of pre-pandemic routine is understandable. But we are encouraged to continue to mask up, wash our hands and respect physical distancing, even when fully vaccinated. These are reasonable guidelines. 

The other major issue we have been confronting is racial injustice. It has sadly been a part of our history from the beginning, but recent events have elevated it in such a way as to make it part of our national dialogue. Much has been written and discussed regarding the many facets of oppression and discrimination, the abusive practices by some in law enforcement, and outright expressions of racism. I have said it before, and I will say it again: The need for professional counselors has never been greater. 

What does this mean for you as a professional counselor, emerging counselor, counselor-in-training or someone who is responsible for the teaching, supervising and training of graduate students in counselor education? It means taking what you know and having discussions that will lead to more knowledge about the many complexities of race, ethnicity, bias and discrimination. 

I am incredibly proud of the bold steps our ACA Governing Council has taken to discuss and address many elements of systemic and institutional racism. In addition to crafting statements of solidarity and compassion, the Governing Council has approved a multistep anti-racism plan that involves the development of resources, the creation of spaces for dialogue and the establishment of a commission that will be engaged with the actions we take as an organization. Rather than just putting words into a report, our Governing Council has designated more than $100,000 from reserves toward implementing components of the work of the commission and staff. 

As a society, we have much to learn. As a profession, counselors have much to do. The path involves the following: question, discuss, reflect, counsel, grow. If this can be done with patience, respect, grace and openness, I think the importance and influence of the counseling profession will continue to flourish. 

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 ryep@counseling.org. You can also follow me on Twitter: @Richyep.

Voice of Experience: We are all writers

By Gregory K. Moffatt April 29, 2021

I have been a writer since I was a very young child. Back then, I would write stories on my notebook paper from school — the large, three-lined paper on which children learn to produce their letters — sometimes writing with a crayon. Using cardboard from discarded cereal boxes, I would make covers for my stories, binding the pages and covers with old shoestrings. I still have those simple stories, my first “self-published” works, from a time when that language didn’t even exist. These primitive tales about the world around me are carefully stowed away somewhere in my attic.

Through the years, I’ve published more than a dozen books and well over a thousand articles. It makes me smile when I get an email or phone call from a reader who begins by telling me, “I read your article,” assuming that I’ve written only the one.

Many of my colleagues don’t understand my love of writing. Putting words on paper is tedious to them, and sometimes they find even the management of their process notes to be a chore.

But that doesn’t come close to the panic my clinical students experience when they see an assignment for a paper 10-15 pages in length. What in the world could they write about that would fill that number of pages?

But when you stop and think about it, all therapists are writers in a way. When we sit in session, we listen carefully. As all of us learned long ago in our first counseling procedures course, we need to spend much more time listening than talking. And especially early on in a clinical relationship, as our clients are spilling their stories, we process those words carefully for one single purpose — to communicate that we understand.

Then, when the time is right, we produce words — nouns, verbs and modifiers — carefully chosen to ensure that our message is 100% accurate and as precise as possible within the limits of time and space. This process is repeated over and over again throughout a session.

Writing is exactly the same. I study and listen, sometimes for days or weeks, as I try to understand the subject I want to communicate. Then, instead of speaking those carefully chosen words, I write them down. I edit multiple times to be as sure as possible that those nouns, verbs and modifiers are in just the right place to most precisely communicate what I want to say within the limits of time and space.

There are differences of course. I have the luxury of editing my thoughts for days, as well as the benefit of multiple editors reading through my work before it is published. But in a way, we do the same thing in session as counselors. We think through our responses, editing them based on the directions of our past supervisors and colleagues. They are the voices in our head that function as our editors.

My goal is not to convert our readership into becoming writers. If you don’t enjoy it, don’t do it. But this lengthy simile has as its purpose something pertinent to counseling. My supervisees play their session tapes for me, and I’ll sometimes pick a random spot and ask them why they said what they did.

In that context, I’m not really concerned about the client or whether the words were the best ones. I simply want to know if my supervisees know why they said a particular thing. My rule: We never do or say anything in therapy that doesn’t have a purpose. Just like every word, comma and phrase in this article was precisely selected.

We don’t do small talk with clients. It wastes therapy time. But if you were to observe me in session with a client, in the first minute or two you might think I was engaging in small talk. Not a chance. I’m using that conversation to go somewhere specific in my session. In much the same way, my story about making primitive books at the beginning of this article was setting you up to think about words, writing and precision in therapy.

My students could listen to my session tapes, stop at any random point and ask me, “Why did you laugh?” or “Why did you ask about the client’s job?” or “Why did you sit back against your chair?” I could tell them why. My internal editor is very polished, and I produce an exact product. Words are carefully chosen, and my movements, facial expressions and use of silence are my punctuation. If you aren’t doing something similar, you should be.

 

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

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

Pandemic telehealth: What have we learned?

By Bethany Bray April 27, 2021

Last year, safety precautions and restrictions brought on by the COVID-19 pandemic in early spring caused most counselors’ in-person interactions with clients, colleagues and students to come to an abrupt halt. To continue treating clients, many clinicians shifted to conducting counseling sessions through video or other digital media. For some practitioners (and clients too), it was a “like it or not” change with a steep learning curve, especially if they had not been offering any telebehavioral health services prior to the pandemic.

Now, some counselors are beginning a return to in-person sessions or a blend of in-office and virtual sessions. What did practitioners learn — about themselves and the process of counseling — while using and adapting to telebehavioral health over the past year-plus? Did counselors pick up anything that they might apply to in-person work with clients if and when they return to a traditional office setting? From Zoom fatigue to eye-opening lessons in resilience and humility, there are stories to tell.

Counseling Today recently collected insights from American Counseling Association members who have used telebehavioral health to counsel clients through some or all of the past year. Read their thoughts (in their own words) below.

 

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Gale Brunault is a licensed mental health counselor (LMHC) with a private practice, Honoring Endings After Loss (HEAL), in Amesbury, Massachusetts.

When the pandemic first hit and all physical contact with the outside world came to a screeching halt, I remember asking myself, “How am I going to continue serving clients in a meaningful and productive manner?” After all, I only knew one way to conduct business, and that was face to face. 

Using telehealth for the first time and/or phone calls as a vehicle for serving clients was extremely challenging in the beginning. I no longer had the physical presence of observing the individual, which meant
I couldn’t “time” my response effectively. Between that and dealing with technical strains, my focus shifted, and I found myself distracted by issues that had nothing to do with client needs. Not only did it become a challenge for me to stay on task, but I was expending more energy than I wanted to each session.

Over time, the program I chose became more efficient and user friendly, which afforded me the chance to focus more on improving my skill set. I no longer had concerns that telehealth was diminishing the client-therapist relationship. In fact, the process was proving to be encouraging. 

Using telehealth has taught me that anything is possible. Though initially I had concerns that it may not be a favorable vehicle for working with grief and loss, telehealth proved to be a solid match for those unable or unwilling to leave home, particularly following a major loss. One of the most difficult tasks for bereaved individuals is living in a world without their loved one. Being able to stay home and receive therapy can be extremely helpful, particularly when initially all you want to do is isolate and hide. 

Many of my clients have asked to continue using telehealth. Some look forward to coming back to the office. Either way, I will be available. 

Some of what I’ve learned since using telehealth is that while the body reveals a lot about a person, so too does the face. There is a certain level of intimacy involved when you are only focused on someone’s face. I have become more in tune to a client’s eye movement, the pauses they take, how they play with their hair, the thinking process and word choice, etc. Though all of these pieces were evident during face-to-face time, having less to look at can deepen one’s observation and assessment of client patterns and behaviors.

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Julie Hine is a licensed professional clinical counselor at a private practice in Albuquerque, New Mexico.

Having been in the field of counseling for almost 30 years, telebehavioral health has not only offered another opportunity for professional and personal growth, I also believe it has served as a catalyst to break down barriers for access to mental health services. While an entire world lives through a pandemic, common themes have risen among almost all persons. People are experiencing a gamut of emotions, often while they feel alone and alienated from loved ones and the world around them. People are feeling hopeless and helpless, riddled with feelings of nervousness. So, what happens when the entire world is feeling like this? Telebehavioral health (or telehealth) has provided an answer.

Telehealth has given access to mental health services to all persons … where [they] live. Especially in rural communities, such as those in New Mexico. Many people who live in smaller communities or on reservations do not always have access to mental health services, whether it’s because there are no counselors in their area, or they have no means of getting into an office on a regular basis. Telehealth has opened the doors for people to access services, no matter where they live, no matter if they have a car and no matter if they have gas for that car. If a person has access to a phone or computer, they can get in-person help, without actually being [there] in person. I can now provide counseling for someone who lives four hours away without even leaving my home.

Throughout all of this, communities of people have recognized the importance of positive mental health, and I have realized that self-care is a crucial gift to ourselves as counselors. If you’re a counselor providing telehealth, remember to stand up frequently, sit up straight, take breaks, rest your eyes, eat healthy snacks and, most of all, be kind to yourself. During sessions, encourage your clients to also be kind to themselves. Emotions are heightened, so remind them not to overanalyze everything, to ask for support when needed, learn to be proactive instead of reactive, and remember to laugh because nothing is permanent, and we will get through this. People are resilient.

As a clinician in the mental health community, I plan on continuing to provide telehealth services, even when returning to an office becomes a reality. That way, I can continue to help individuals, no matter the circumstances. However, I must admit, I look forward to leaving the chair in my home office and sitting in the same room, face to face, with the individuals I serve. Nothing beats human contact and smiles of hope.

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Justin Jordan is a licensed professional counselor (LPC) and certified substance abuse counselor who treats mental health issues and substance use at his private practice in Salem, Virginia. He recently completed his doctorate in counselor education and supervision at Virginia Tech and will join the faculty in the mental health counseling program at University of Wisconsin-Parkside this fall.

Transitioning to telecounseling in the spring of 2020 was an easy decision based on my family’s situation. I learned very quickly that my biases had limited my ability to see the potential of telehealth software in connecting with my clients and reducing barriers to attending sessions [prior to the pandemic]. I never intended to use telehealth software for counseling and strongly believed that direct presence with clients was essential for the relationship and perceiving my clients’ needs. While I would still prefer to safely be in their presence, I now see that with the loss of presence, what is gained is a flexibility for both the client’s and counselor’s home/work lives and a chance to see clients where they are most comfortable.

In the context of COVID-19, clients felt safer meeting online, and so did I. Beyond the context of the pandemic, clients with children had [fewer] barriers [for] adapting their child care for sessions. Clients were able to meet more easily during their lunch breaks at work without commuting. And some clients who were very anxious about going into public were able to be seen in the comfort of their home. Many of these benefits will hold true once physical distancing is less of a concern, which is why I would continue telecounseling if I were not closing my practice to start a faculty position this fall.

Additionally, as a humanistic counselor, I have always tried to diminish power dynamics and have relationships based in mutuality with my clients. Telecounseling taught me that asking clients to enter my office [in person] always comes with some authority, as having to log in to sessions from my office/bedroom, often with the sounds of young children in other parts of the house, erased that [imbalance]. I had to relinquish some of the boundaries I have worked hard to create with my physical counseling space, which came with discomfort but also a beneficial humility on my part that I was in less control — of technology glitches, distractions in my home and the state of the world. I also see that my clients often feel freer expressing themselves when meeting with me from the comfort of their own couches or other parts of their home. I have consistently received feedback from my clients that there are aspects of telecounseling that have improved the process.

One of my main suggestions to counselors and students who must choose to integrate telecounseling into their practice is to have a solid plan for backup communication when technology issues occur. Realize that host platforms have issues sometimes, clients’ hardware can have problems, your hardware can have problems, and software or internet connections can crash. Also, many clients need to be coached on how to use the technology properly, and they need to have access to a usable digital device (which most clients in my private practice do).

I also think that humility, honesty and authenticity remain key counselor traits with telecounseling, which means acknowledging when the technology is creating a barrier or problem in communication.

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Stephanie Brookins is an LPC in private practice in Columbus, Georgia, who specializes in the treatment of posttraumatic stress disorder (PTSD).

I was initially resistant to the idea of telehealth and would not have imagined that it might become a permanent part of my practice. I realize now that much of my negative view was shaped by the discomfort of the unknown and not having considered how the initial stress might resolve. My first experience with telehealth was several years ago with a client who had temporarily moved to another part of the state and wished to continue individual therapy with me. Issues regarding privacy and internet connection and overall discomfort with the technology led to a negative experience for [me] and the client, and I referred her to another provider. 

What I’ve found in the past year is that after the initial adjustment to technology and change, it’s relatively easy to forget that we are connecting via technology. However, that’s not always the case. Due to schools being closed, some clients have issues with child care and will have to interrupt their session to help their child with school or manage some parenting crisis. Other clients have plumbers dropping by or pets that want attention. Initially, some clients would attend telehealth sessions in bed, half awake and dressed in pajamas. This necessitated discussions about boundaries and structure that could be uncomfortable. 

There have been some unexpected benefits of telehealth. Clients with chronic health issues and periodic flare-ups would have to miss appointments in the past [because] they were unable to drive and physically get to appointments. Now we’re able to meet online and just limit the amount of time if needed. This has led to a decrease in last-minute cancellations. Some clients are able to access care now when transportation or time have presented limitations for them in the past. 

As an eye-movement desensitization and reprocessing certified therapist, I’ve had to adapt the mode of bilateral stimulation used in processing. I’ve been surprised at the work clients have still been able to do, even [with us] being physically apart and using self-tapping in place of eye movements or theratappers. 

With environmental safety precautions, I’ve been able to maintain in-person counseling as an option for clients during the past year. Some people are not comfortable with using technology, need the human connection of seeing a therapist face to face, or do not have reliable internet connection, so it’s been important to me to continue to offer that option. I imagine I’ll continue to adapt to my clients’ needs and will continue to provide both telehealth and in-person therapy.

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Nicole Sublette is a licensed clinical mental health counselor and certified hypnotherapist who also serves as a social justice advocate, as a public speaker, and as an anti-racist educator for the state of New Hampshire.

I have learned that telehealth makes treatment more accessible to people who might not otherwise be able to engage in treatment due to scheduling or distance. I have not found too many differences between telehealth and in-person [counseling] in my practice. However, I will have increased gratitude for in-person sessions in the future. There will not be trouble with sound or video. There will not be the interruption of therapeutic flow due to technical difficulties.

Through the past year, I have learned about my own resilience and adaptability. This was momentous for me, specifically in these uncertain times. Previously, I would not qualify myself as tech savvy. Using telehealth and adapting to an online format for treatment has expanded my growing edges and helped me to also lean into my own capacities. In uncertain times, it helped me to also learn my strengths and ability to adapt. Also, techniques that I previously thought could only be done in person, such as cognitive processing therapy for PTSD, can also be done via telehealth.

I have adapted [to telebehavioral health] by asking more somatic questions of clients and discussing how the body is handling symptoms. Asking questions about what I was previously able to observe with my eyes has opened up dialogue in ways I would not have imagined. Asking increased questions can decrease the potential for avoidance for both the therapist and the client.

To my counseling colleagues, I would say conducting sessions via telehealth gets easier with time. Utilizing the same rapport techniques that one uses in person can be very helpful with telehealth, such as asking open questions and conveying authentic curiosity. Also, address the elephant in the room about any discomfort for both the therapist and the client. Share about how you can learn together. Process together any discomforts one might have with using telehealth, then work together to create a plan to ease discomfort. Humor is also a great way to ease tension.

I absolutely plan to use telehealth in the future. It is my hope to do a mix [of telehealth and in-person counseling]. Currently, I am one of the very few BIPOC (Black, Indigenous and people of color) therapists in my state. Nationally, BIPOC [constitute] about 4% of practitioners in the mental health field. Telehealth has made therapy accessible to BIPOC folx around the state. I am able to provide treatment to clients who would otherwise not be able to travel to my office due to the distance. With continued escalating events of police brutality, therapy for BIPOC has been very critical.

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Laura Sladky is an LPC and licensed chemical dependency counselor who works as a school counselor in Dallas.

Through video/telehealth as a school counselor, I have learned that being able to quite literally see into someone’s world offers such insight into the way they organize and carry out their daily lives (pets, plants, family relations) as well as their sense of self. In short, telehealth offers the opportunity to know clients differently and inadvertently know their world beyond my office.

Throughout the past year, I have been acutely aware of my sense of justice and desire for equality. Of course, these traits are essential when developing a therapeutic alliance and conveying unconditional positive regard to a client, but on a systems and global scale, I have become painfully aware that individual problems do not exist in a vacuum, and change requires advocacy. In sum, this year was the “real life” representation of many theoretical concepts like Maslow’s hierarchy of human needs. Humans cannot be thoughtful, insightful and self-reflective if their basic needs (food, shelter, safety) are not met. Individuals’ autonomic nervous system becomes activated under threat and chronic stress (winter storms, unemployment, death of a loved one, fear of contracting a disease) and, consequently, higher-level thinking at the prefrontal cortex level is inaccessible. Moreover, I have learned about the inextricable link between humanity, trauma and the imperative nature of sensory integration. While the past year has been exceptionally disruptive and devastating in a variety of ways, our ability to make sense of our experiences and enact pro-social connection predicts our ability to recover — and not become further traumatized — by our experiences.

This year, with the social/political climate, I have asked more intentional questions to check in regarding media coverage/social media and how that has impacted the individuals I work with. Whether we are consciously aware of it or not, our brains become easily biased. Hearing a negative headline can begin a downward spiral and, before you know it, everything can seem awful. It helps me understand the level of distress knowing how much screen time people are exposed to.

In addition, helping individuals sift through what is in and out of their control (acceptance vs. change skills) and actionable steps to take to alleviate distress has been paramount. Asking questions is so important because you don’t know what you don’t know. In equal measure, not having the client in full view can impact nonverbal cues (bouncing leg, posture, etc.) but further reiterates the importance of tracking, asking questions and helping clients be aware of their bodies/ feel safe in their bodies.

It is so refreshing for those we work with to understand that we also experience undesirable situations (Zoom glitching, our pets interrupting calls, when we miss the client’s meaning) and witness how we cope in the moment. Radically open dialectical behavior therapy tells us that making mistakes is pro-social, helps us feel connected to others and eases our nervous system. For counselors who are working to connect or finding this challenging, I think briefly self-disclosing your own minor inconveniences helps build rapport with clients.

Our lives were unceremoniously upended, leaving us to confront grief and ambiguous loss daily and, in fact, it is weird even after a year. However, weird does not inherently mean bad. One of the best ways to work through the weirdness of Zoom life is to acknowledge it. In doing so, counselors can validate this experience, give it a name (awkward, different, etc.) and help facilitate the client management of these feelings.

I think offering a variety of mediums for therapy is the future of our profession, and I plan to make myself accessible through a variety of settings.

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Michael T. Greelis* is an LPC, licensed marriage and family therapist and approved clinical supervisor in private practice in Herndon, Virginia, who has seen adolescents and adults with mood and anxiety disorders and other life challenges for 25 years.

On March 17, 2020, I made a complete transition from in-person, face-to-face [counseling] to videoconferencing for my practice — about 30 sessions per week. The change was immediate for all clients from March 18 on. Based on the Centers for Medicare & Medicaid Services and [National Institute of Allergy and Infectious Diseases Director] Dr. Anthony Fauci’s statements, we either converted to virtual visits or risked our health and that of our clients if we continued in-person meetings. I saw that my clients and my colleagues reflected a high value on treatment by making this complete transition on very short notice. I learned that therapists and clients can make a major transition work with commitment and flexibility and that the work itself — face to face in person or on video — is what matters.

I immediately adapted my approach so that I focused on content rather than the medium and avoided incorrect assumptions (some cognitive behavior therapy on my part). I assumed that my clients and I would make teletherapy work and that we’d pick up on the requirements for that. What works is a focus on substance over style and letting [your counseling] style evolve as necessary.

My overall impression of videoconferencing for therapy (we call it teletherapy in Northern Virginia) is very positive. Prior to the COVID-19 crisis and emergency measures, I was a skeptic. On March 17, 2020, it was clear that I had to either migrate to teletherapy entirely or stop practicing. My ability to adapt to that change and the receptivity of my clients to make the change had a reciprocal positive effect. Every client in the transition remained in treatment, and clients who started during the virtual-only period followed a course of treatment similar to that expected during in-person times.

Post-COVID-19, I plan on a hybrid approach combining in-person with teletherapy based on client conditions and needs. This is both my preference and that expressed in very clear terms by my clients.

My advice to counseling colleagues is to focus on the work and client needs, pay extra attention to your experience of videoconferencing at the outset with each client, and ask clients how they think treatment is progressing. Also, use the special features of the medium. I’m always surprised to see that none of my colleagues use a green screen to project backgrounds more appealing than the same wall, office, etc., for every meeting. I am pushing myself to have a set of images, videos and text passages on hand [to use in sessions], if they’re beneficial. And I’m learning how to insert materials from the internet or from my files in real time during sessions.

*Greelis is advocacy chair for the Northern Virginia Licensed Professional Counselors and was involved in NVLPC’s recent survey on the use of telehealth by LPCs during the COVID-19 pandemic. See the survey results here.

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Rob Freund is an LMHC and an assistant professor at Nova Southeastern University in Davie, Florida, who also works in private practice with couples and individuals.

Prior to the pandemic, I had received training in telehealth counseling and conducted it across state lines in Florida and New York, where I was dually licensed. The format therefore wasn’t too strange for me, but the frequency of my utilizing it was more challenging. I, like many, experienced “Zoom fatigue” from using telehealth communication platforms exclusively. I learned that more so than usual, pandemic notwithstanding, I needed to separate myself from my workspace and engage in deep, deliberate self-care in order to bring my best self to the therapy space. Spending time in meditation and communication with nature became essential for me. I also realized just how much value there is in shutting off the computer and disconnecting so that I can better reconnect with my clients.

One aspect of this work that I do plan to bring to my in-person therapy is the utilization of technology in the therapy space itself — using my tablet to bring up materials for discussion, real-time sharing of resources, using digital drawing tools to portray and invite collaboration with the client. It has provided an opportunity to evolve the tools I bring into the space.

We rely so much on being in the room with clients that the absence of many shared experiences of the space — behavioral cues of seeing the full body, the opportunity to have natural eye contact patterns, smell and other sensory cues — is at times disorienting. What’s fascinating is to experience the human capacity for adaptation. I noticed myself beginning to have heightened attention to the sensory information that I did have access to — facial cues, speech patterns and nonverbal speech cues — and adjusting my work accordingly. We can be remarkably resilient, and I found clients to be the same.

I do think there are concrete things that counselors can do to facilitate adaptation to this new model of conducting therapy. Firstly, developing grounding strategies and preparatory work for before and after the session is personally important to the clinician, particularly if you are working/living in a smaller space. Secondly, I would encourage counselors to pursue training in emotional communication and recognition of nonverbal behavior. The Paul Ekman Group has excellent training resources for recognizing micro- and subtle expression displays, and books like Unmasking the Face: A Guide to Recognizing Emotions From Facial Expressions (by Paul Ekman and Wallace V. Friesen), Emotions Revealed: Recognizing Faces and Feelings to Improve Communication and Emotional Life (by Paul Ekman) and What Every Body Is Saying: An Ex-FBI Agent’s Guide to Speed-Reading People (by Joe Navarro and Marvin Karlins) are excellent for expanding one’s nonverbal/emotional acumen.

Like any tool, telehealth has its pros and cons. The portability and absence of commute often benefited [me] and my clients. However, I noticed that for some, there is increased value in experiencing therapy outside of the home environment.

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Grace Hipona is an LPC at NeuroPsych Wellness Center P.C. in Fairfax, Virginia, who holds a doctorate in counselor education and supervision.

The pandemic has challenged me to view the counseling process from a different perspective. It has challenged me to be more flexible and to reassess my own coping strategies. It has tested my resiliency and ability to continue helping others while I navigate my own circumstances. The process has given me the opportunity to truly connect with clients, since we are all experiencing the pandemic at the same time. Even though we may not discuss the pandemic directly, I am aware of how we may be impacted. I also continue to evaluate and monitor my own thoughts and emotions so the client’s perspective is primarily front and center, and I help support them based on their lived experiences.

Prior to the pandemic, my overall impressions of telebehavioral health were neutral to negative. However, since March 2020, I have only used telebehavioral health to provide counseling services. Through this time, I have shifted my thoughts and feelings, and I now have a more positive outlook on telebehavioral health. I appreciate the convenience and flexibility it provides. My clients appear to have similar feelings and thoughts about telebehavioral health. I have had several mention that they likely wouldn’t have participated in counseling if this opportunity was not available.

Our practice continues to assess and reassess the role that telebehavioral health plays in counseling. We have a provider meeting at least once a month, and since the beginning of the COVID-19 pandemic, we consider all the benefits and challenges. However, we have not made any long-term decisions about the role of telebehavioral health. Being able to partner with health insurances will be a guiding factor. If health insurances continue to cover telebehavioral health, it will provide flexibility. Moving forward, I believe in our field, and across other fields, providing opportunities for either or both [in-person and telehealth] will be one of the lasting impacts of the pandemic.

To better connect with clients, my counseling approach has shifted over the past year to being more directive or straightforward. In other words, if I am at all uncertain about how I am interpreting a client’s thoughts or feelings, I directly ask. For example, I say, “I am not sure how you are feeling or what you are thinking right now. Do you mind explaining it to me further?” Generally, clients have been appreciative of the opportunity to clarify their perspective.

To emit levels of sympathy, empathy and understanding, I find myself amplifying my facial expressions, nonverbal cues and verbal statements in general. For this reason, I believe remote counseling can be more exhausting. Reflexively, I place more effort in self-care so I can recover and refuel for future sessions.

The use of formal assessments or evaluations has also become more integral in my counseling process. Aside from the initial intake, I found using formal brief assessments intermittently beneficial to help support my clients. I also verbally make a concerted effort to ask evaluation-related questions such as “How are you feeling today — better, worse or about the same?”

 

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The future of telehealth

Insurance coverage has expanded and regulations regarding telebehavioral health have been relaxed in many states out of necessity during the COVID-19 pandemic. Will these changes remain as pandemic restrictions are loosened and many helping professionals return to in-person office settings? Find out more in our online article “The future of telehealth: Looking ahead.”

Also be sure to read this month’s “Risk Management for Counselors” column on page 8 of the print version of Counseling Today‘s May magazine, available for ACA members to download here.

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Action steps to learn more

  • Read Section H, “Distance Counseling, Technology, and Social Media,” of the 2014 ACA Code of Ethics at counseling.org/ethics.
  • Search for articles with the tag “coronavirus” at ct.counseling.org.
  • Browse ACA’s continuing education offerings by topic, including telebehavioral health, at aca.digitellinc.com/aca/.

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

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

‘Color of Money’ columnist offers counselors tips for financial health

By Lindsey Phillips April 26, 2021

Michelle Singletary, a nationally syndicated personal finance columnist for The Washington Post, knows firsthand the importance of money management. It was a lesson she learned at a young age from her grandmother, who raised Singletary and her four siblings on a limited income in Baltimore.

“She was a nursing assistant, and she never made more than about $13,000 a year,” Singletary told the audience to open up the fourth week of the ACA Virtual Conference Experience. Singletary noted that her grandfather struggled with alcoholism, so his paychecks rarely made it home.

“The thing that makes me want to help people is how I grew up and how my grandmother managed with so little. … She was a wonderful money manager,” said Singletary, who writes the syndicated newspaper column “The Color of Money.” She acknowledged that she acquired most of the wisdom she would be sharing with the audience through observing how her grandmother cared for her and her siblings without having much money.

Singletary’s keynote stressed the importance of professional counselors taking care of not only their mental health but also their financial health. She then provided five steps for focusing on financial health.

Step 1: Triage your budget

Singletary, author of four personal finance books, including the upcoming What to Do With Your Money When Crisis Hits: A Survival Guide, compared handling a budget during an economic crisis with the way that medical professionals prioritize patients based on medical need when arriving in the emergency room. When facing a job loss or economic uncertainty, people should also triage their bills, focusing first on necessities such as mortgage/rent, auto loans, utilities and child support, she explained.

Step 2: Be careful with credit

The last thing counselors need is to be overwhelmed by debt, Singletary said. The overall household debt in the United States was $14.27 trillion by the end of August 2020, with most of the debt going to credit card payments, student loans and car loans, she noted.

Singletary told the audience that the best way to reduce debt is “the debt dash approach”: Pay off the smallest debts first (regardless of the interest rate). “Psychologically, people get defeated by the slow process of paying off debt. So, the debt dash gives them something to look forward to in [the] short term, and it encourages them going forward,” she explained.

She also provided the following tips to avoid going into debt:

  • Only charge what you can pay off the next credit card billing cycle.
  • Use cash, not plastic, when possible because it helps you spend less overall.
  • Don’t buy a car that requires more than a four-year loan.
  • Don’t take advantage of the current pause on student loan payments if you still have a stable income; continue to make those payments.
  • Consider moving home for a few years after college to save money. That way, paychecks can be applied to paying off loan debt rather than on rent or mortgage.

Saving money and paying off debt shouldn’t be an either-or decision, she asserted. “If you’ve only been paying off debt, you don’t have a savings cushion. … You don’t want to have all this money in the bank earning nothing and you’ve got high-interest credit card debt,” Singletary said. “You want to do a combination of both, so that you’re paying off debt and you’re saving.”

Step 3: Stick to a budget

Drawing on her grandmother’s sage advice that “every penny ought to have a purpose,” Singletary told the audience that every dollar they earn has a job — retirement savings or household expenses, for example.

She recommended budgeting for an emergency fund and a “life happens” fund. The emergency fund should have three to six months’ worth of living expenses because it operates as a backup in case of an economic emergency such as losing a job or having to take time off work to help a sick family member. Put money in that fund and don’t touch it unless there is a true emergency, she stressed.

The life happens fund is for more common incidents and inconveniences such as the car breaking down. It’s OK for money to flow in and out of this fund, she said, but she advised keeping approximately $1,000-$2,500 in such an account.

Counselors should also budget for continuing education opportunities and insurance, she added. Every month, counselors can set aside funds for these two items so that when the time comes, the money “is right there for you to invest in yourself,” she told the audience.

Singletary also offered five tips to practitioners on managing self-employment income:

  • Set a baseline for expenses.
  • Establish one account from which to pay all monthly expenses.
  • Create a “sweep account” to deposit any earnings from a side job. (This account can help offset fluctuating self-employment income.)
  • Avoid splurging when you make more than anticipated one month.
  • Set up a separate account to pay estimated taxes.

Step 4: Become an informed investor

Singletary discussed three main threats with investing: 1) inflation, 2) inaction and 3) panic over fluctuating markets. “If you don’t invest and keep pace with inflation … you’re going to lose earning power,” she said.

She advised counselors not to wait to invest. “The biggest advantage you have as an investor is time,” she emphasized. By investing your money and letting it compound over time, “you’ll do just as well as trying to find the next great stock.”

She also told the audience that they could become “a 401(k) millionaire” by investing early, contributing a minimum of 10-15% of their paycheck toward retirement, meeting the requirements to get the full employer match (if offered), considering mutual funds that invest in stocks and not cashing out when changing jobs. Counselors can also use retirement calculators (such as AARP’s) to help them determine if they are saving enough for retirement, she added.

Step 5: Be content

Singletary finds that an entitlement mentality often prevents people from being content with what they have. People fixate on the notion that they deserve more, owe it to their children to give them more, or must do whatever they need to do to get what they want. “But the truth is you deserve what you can afford,” Singletary said. “You owe it to yourself and/or your child to live within your means. And that means saying no to yourself and no to your kids.”

“We have blurred the distinction [between needs and wants],” she told the audience. “Need means it’s something that is essential, and [a want] is … [a] desire.” She shared one simple question that can save people a lot of money when answered honestly: “Is it a need or a want?”

Singletary also advised the audience to focus on being grateful. One Sunday at church, her pastor asked the congregation how many people were rich. Only a few people raised their hands. Then the pastor asked a series of questions: How many of you got up this morning and drank a clean glass of water? How many of you can get into your car and drive to your job? How many of you have a job? How many of you have somebody who loves you?

Singletary admitted that she felt ashamed for not having raised her hand after the initial question. She had focused on the monetary value of “rich” rather than seeing and acknowledging all she had in her life. “We’re never content enough to know that we’re rich enough,” she observed.

It’s not just about the money

Singletary expressed her appreciation for the therapists she has had in her own life. Her desire, she said, is for more people to be able to follow their purpose and enter the mental health fields rather than avoiding them out of fear that they won’t make enough. “If you don’t budget well, you might end up doing something or taking a job that really isn’t right for you because you’re trying to make more money,” she cautioned.

Her daughter, who is a social worker, didn’t have to make that choice because Singletary taught her how to take care of her financial health and “to live in the salary for the profession [she had] chosen.”

“Don’t do things just for the money,” she advised. “Figure out what’s … really, truly important and put your money in that. … Know enough [about money] so that you can make better financial decisions, and that will make you a happier person and a better counselor.”

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Read more about the connection between personal finance and mental health in Counseling Today‘s recent feature article, “Money on the Mind.”

 

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This keynote address is part of a month of virtual events, including hundreds of educational sessions and three additional keynotes, that lasts through April 30.

Find out more about the American Counseling Association’s 2021 Virtual Conference Experience at counseling.org/conference/conference-2021

Registration is open until April 30; participants will have access to all conference content until May 31.

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Lindsey Phillips is the senior editor for Counseling Today. Contact her at lphillips@counseling.org.

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