Monthly Archives: August 2021

Hard at work

By Bethany Bray August 30, 2021

No employee clocks in to work each day entirely free from personal issues and struggles. However, individuals with mental illness face an extra layer of adversity in the workplace. Simply showing up and fulfilling job responsibilities can be an uphill battle for employees who are bombarded by intrusive, obsessive or critical thoughts; trauma flashbacks; depressive episodes; anxiety triggers; and other challenges.

Adding to the issue is the friction that can arise in a workplace when a mental illness — either disclosed or not — causes an employee to struggle to keep up with their workload or to take time off frequently to go to counseling appointments or tend to their mental health. Co-workers and supervisors can be unsupportive of a teammate who falls behind, sometimes regardless of whether they’re aware of the mental illness underlying their colleague’s work performance, making the situation worse.

Professional counselors can be key allies for clients whose mental health struggles are affecting — or even derailing — their work life. Being an ally includes providing support at an individual level, such as by equipping clients with coping mechanisms and talking through career-related decisions, and at a systemic level, such as by helping clients seek accommodations from an employer or otherwise advocate for themselves.

In these situations, a supportive counselor can normalize the client’s experience, help with perspective-setting and serve as a sounding board as the client talks through decisions and emotions related to work and career, says Meredith Montgomery, a supervising professional clinical counselor in Ohio and an assistant professor of counselor education at the University of Dayton. “It’s also a counselor’s role to know what different [mental health] diagnoses might bring up in a work setting. If a clinician is working with a client who meets the criteria for obsessive-compulsive disorder (OCD), you need to really do the research to know what that can potentially mean in the workplace. But at the same time, don’t buy into clichéd old ideas; look for the newest, updated information and laws that can help support them in a work environment,” says Montgomery, a member of the American Counseling Association. “Ultimately, a counselor’s job is one of support and illumination: to illuminate [a client’s] path, not to create the path, or determine the path, or push or pull them on the path, or shove them off of it, but to equip them with all the information you can to help them make their own decisions.”

A daily struggle

Behaviors that can indicate a client’s mental health is leading to problems in the workplace include frequent absences, tardiness, difficulty motivating themselves to perform their job, or job performance issues such as struggling to meet deadlines or other work expectations, says Amanda Hembree, a licensed professional counselor (LPC) and certified employee assistance professional with a private practice in New Orleans.

Perfectionism can also be a factor, she adds. For example, a client with OCD may miss deadlines or have trouble contributing to team projects because they need extra time to prepare and complete compulsive rituals or steps until an assignment is just right. This can especially be the case in job roles that involve safety, Hembree points out. Employees with OCD may feel they need to check and recheck their equipment, tools and other safety protocols repeatedly, causing them to be late or struggle to complete other tasks.

At the same time, Hembree acknowledges that many people with mental health challenges find “workarounds” to push through the workday and keep themselves from being noticed by co-workers or supervisors.

A client’s workplace challenges may also fly under the radar in counseling sessions unless the clinician fully explores how the person’s mental illness is manifesting across their life, Hembree stresses. Clients may seek counseling for a different presenting issue, such as parenting struggles or communication problems within a marriage, and fail to recognize or acknowledge that work problems can be a contributing factor to difficulties in their personal life.

“Don’t discount work,” Hembree urges her fellow counselors. “Clients are spending 40-plus hours there each week, and it will affect what they’re bringing into the counseling office. Work plays a big role in our lives, and you [the counselor] have to figure out the intersection of why they’re in your office and what is going on at work and what can be helped in both realms. None of us lives in a vacuum. Mental illness will affect every part of a whole person’s wellness — and especially work.”

Seth Hayden, an associate professor of counseling at Wake Forest University and president of the National Career Development Association, a division of ACA, also emphasizes the importance of listening for and asking clients about job-related challenges, regardless of whether their presenting concern involves work. A comprehensive client assessment should include questions about how their presenting concern manifests throughout their life, including their physical health, relationships, ability to engage in hobbies that interest them, and views on work.

If a client identifies work as a source of stress or discomfort, a counselor should explore that further in session, says Hayden, an ACA member who specializes in career transitions with military and veteran clients. This involves uncovering the thoughts and feelings the client associates with their job and how those things tie into the person’s self-concept and align with their core beliefs.

“If work continually comes up in their conversation, let’s stop there and dive deeper, talking more about the work that they do and how they feel about it,” says Hayden, a licensed clinical mental health counselor in North Carolina and an LPC in Virginia. “Have their feelings [about work] changed over time? Do an extensive examination of aspects of career and work and how [they’re] connected to other areas of life. … If you try to artificially separate them [mental health and career], it could potentially be to the detriment of the client … because they are interconnected.”

Asking the right questions

Avoidance behaviors and other signs of distress and unhappiness at work can result from any number or combination of sources, says Montgomery, who co-presented the session “Enhance Counseling Services by Integrating Clinical and Career Counseling Strategies” at ACA’s Virtual Conference Experience in April. She emphasizes the need for clinicians to fully unpack clients’ feelings and emotions about their work situation during counseling sessions.

Montgomery urges clinicians to draw on two foundational counseling skills: asking probing questions and using empathic reflection.

“We [counselors] need to make sure we are asking the right questions. We don’t necessarily want to jump on the ‘you hate your job, let’s get you out of there’ bandwagon. When you pull it apart, it could be a toxic environment, or … a bad fit, or they could make changes to make it a better fit, but often the only option clients see is to leave,” Montgomery says. “We need to explore, explore, explore, explore [the client’s situation] before we jump to any kind of solution formulation.”

When clients talk about how hard work is for them, counselors should use empathic reflection, repeating clients’ statements back to them, to allow them to think through these thoughts, Montgomery says. It may be a knee-jerk response to agree or sympathize with client statements such as “I hate my job” or “Work has been terrible since the COVID-19 pandemic,” but counselors must be careful not to inadvertently reinforce a client’s statement with their reactions, she advises.

Instead, clinicians can probe for details and ask clients to describe the feelings underneath the statements they are making. Montgomery finds that an emotion wheel can be helpful for prompting these conversations, so she suggests counselors keep copies handy in their offices or readily available for screen-sharing during telebehavioral health sessions.

Often, individuals do not fully express their experiences because they do not have the language to do so, Montgomery says. Using tools such as an emotion wheel is a way to increase a person’s ability to better understand and communicate their experience. For example, a client may initially say, “I feel angry at work.” But after looking at the emotions listed on the wheel, they may be able to better articulate their feelings by saying, “I feel underappreciated, exhausted and disrespected at work.” That deeper and clearer understanding is far more beneficial to both the client and the clinician because the solutions to feeling underappreciated are different than the solutions to feeling angry, Montgomery says.

This exploration stage of counseling should also include a focus on identifying clients’ needs and which needs are not being met through work or are being marginalized or curtailed in the workplace, Montgomery adds. For example, a client who is social and benefits from talking through challenges with others may feel isolated and struggle to process things or complete assignments if they’re in a setting where they work alone or are physically separated from colleagues by the office layout. Identifying these needs often provides clarity and helps clients move toward either making changes in their current job situation — such as asking to be moved to a shared workspace or scheduling regular check-ins with their boss — or considering a different position or career, Montgomery explains.

Montgomery first worked in the corporate and nonprofit spheres before switching to a career in counseling. She recalls her own process of adapting to a new role as a counselor educator. After some self-reflection, she realized she craved structure to navigate the varying demands of work as a university professor, and there were some ways she could ask for help and support in this realm from her employer.

Montgomery looked for tools to create structure, such as a whiteboard to make lists and keep notes in her workspace. She also suggested her department streamline processes by creating a master calendar with due dates for evaluations and other important benchmarks. Not only did this modification keep Montgomery from feeling like she was always behind, but several colleagues mentioned that they found it helpful too, she says.

Coping mechanisms

The interconnected nature of career and mental health may cause work-related discomfort to affect clients when they are off the clock. This can manifest in many ways, including sabotaging their ability to get to work on time in the mornings or channeling feelings of frustration or unhappiness toward family members after a frustrating workday.

Amanda Barnett, an LPC who specializes in mental health and work issues with clients at her private practice in Gainesville, Georgia, helps clients who struggle to separate work stressors from their personal lives to build intentionality into their routines. She suggests clients visualize changing “hats” as they transition to and from work. For example, a client may take off their accountant hat and put on their dad hat as they leave the office. For some professions, this transition is literal because employees change into work uniforms or wear a tool belt or other work equipment, notes Barnett, an ACA member. Regardless, she urges clients to take time to center themselves, give themselves a pep talk and be mindful about setting themselves up for the workday or for their return home.

Hembree notes that offering psychoeducation regarding how anxiety manifests in the body and providing tools to lower stress and anxiety in the moment can be particularly helpful with this client population. Breathing techniques can be a useful go-to tool in the workplace, especially because some of these techniques can be used without other people noticing, she says. Hembree, who has extensive experience working with clients through employee assistance programs, often teaches clients “box breathing,” which involves inhaling for four counts, holding for four counts and exhaling for four counts. This technique can be done discretely even when an employee is sitting in a work meeting or preparing for a presentation, she points out.

Another powerful yet simple tool is helping clients realize that they can take a break — even if just for a moment — when things begin to escalate at work. Many clients get so wrapped up in the emotions they feel when they are stressed that their instinct is to dive further into the situation rather than pull back for a moment.

“Unless you’re on a heart-transplant team, you can take five minutes to have a snack, take a break, meditate or do a grounding technique,” Hembree advises. “Even if your boss is breathing down your neck and saying, ‘I need this yesterday,’ you will do a lot better if you take a couple of minutes to ground … and center yourself — and your work will be better because of it.”

Hembree also finds techniques that counter negative self-talk to be helpful with this population. Clients who struggle in the workplace can easily fall into the “comparison trap,” she says. But as is the case when people compare themselves with others based only on what they see on social media, workers see only a portion of others’ lives at work. When a client is bombarded by negative self-talk, a co-worker’s success can send them further down that spiral. It’s easy to compare themselves and catastrophize, thinking that they’ll never be as good as their co-worker, that they are a failure, or that they are about to be fired, Hembree notes.

“Perhaps a co-worker gets praise from the boss. But what [the client] didn’t see is that [the co-worker] stayed up until 2 a.m. to finish [the work assignment], missed their kid’s soccer game, got in a fight with their partner and gave themselves an ulcer to get this modicum of praise from the boss,” she says. “A counselor can offer psychoeducation that others have good and bad days, and you will have a day when you’re the superstar.”

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Disclosure

The decision to disclose one’s mental illness in a work setting can lead to the good, the bad or the ugly. In a best-case scenario, an employer will respond to disclosure in a supportive and understanding way. Employees whose mental health challenges are affecting their work life can find support in an understanding ally — whether it’s a supervisor or a trusted co-worker — who knows the reason behind their work struggles. However, disclosure in a worst-case scenario can leave an employee open to direct or indirect hostility, misunderstanding, awkwardness, retribution or discrimination from an employer.

“There should be an element of dignity in work and being able to say things without any fear. But [counselors should] recognize that there are precarious elements of work that don’t make it easy for people to do that,” says Hayden, who presented “Career Development and Mental Health in the Context of COVID” at ACA’s Virtual Conference Experience. Hayden and the other counselors interviewed agree that disclosing one’s mental illness at work is a complicated issue that must be considered carefully depending on several factors, including how supportive the overall climate is at the client’s job.

Marina Williams, an LPC in Lexington, Virginia, who specializes in helping clients with work issues, stresses that clients should think carefully about what they have to gain by disclosing a mental illness in the workplace. This issue is even more complicated for clients whose work settings can involve direct or indirect repercussions if a worker is deemed unfit. Those in law enforcement, the military or jobs with a security clearance often feel particularly vulnerable about disclosing any type of mental health issue.

“Discrimination for mental health is very common,” says Williams, who presented on workplace bullying at ACA’s 2018 conference. “I recommend that clients not tell anyone [at work], but the exception to this is if they’re having such difficulty that they need to ask for accommodation in the workplace. But even then, I would limit [disclosure] to human resources.”

Hembree has also worked with clients who were treated differently after disclosing their mental illness in the workplace. She has heard clients talk about being treated like “fragile glass,” being denied job advancement or becoming the target of bullying behaviors such as being called a “snowflake.”

“It would be amazing if we lived in a post-stigma mental health world, but we are not there yet,” Hembree says. “I generally do not suggest that people disclose unless they are in a very supportive or progressive workplace.”

When the question of disclosing comes up in counseling sessions, Barnett encourages clients to think their situation through carefully. She cautions clients about oversharing and making the assumption that co-workers are friends. And she reminds her clients that the human resources department works for their employer, not for the employees. “Everything you say to human resources could go on your permanent record,” she tells clients. “Be aware that they have a duty to the company, not to you.”

Barnett once worked with a client who had mixed results after their boss learned about their mental health struggles. The client was having frequent panic attacks at work. Because the workplace was a closed, secure environment, the client couldn’t step outside easily or bring in personal items to help them cope.

The client’s boss became aware of the situation after a workplace incident triggered a panic attack and the client became visibly upset in front of him during the workday. After that, the client received what they termed “reluctant” support from their boss. The boss wasn’t cruel, but he wasn’t overly understanding either, Barnett recalls. The client’s stress also increased when the supervisor revealed that he was leaving and cautioned the employee that the next boss might not be as understanding to their situation as he had been.

What did help, however, were the coping mechanisms that the client learned and honed in counseling with Barnett, as well as a focus on quelling negative self-talk. Barnett and the client also found small ways that the client could stay mindful and calm during the workday, such as by chewing gum.

Clients who work on-site at a job may need to seek permission to leave for therapy appointments. They may also face questions or comments from co-workers about their frequent absences. If a client feels they need to explain their mental health struggles at work, a counselor can help them figure out a way to ask for leave without fully disclosing. For example, Williams says, the person could tell their boss, “I’m going through something right now, and these appointments are helping me.” It’s also OK to simply say, “I have an appointment” and leave it at that, she asserts.

Hembree agrees that disclosure can involve a range of information and doesn’t necessarily have to include details about a client’s diagnosis. She once counseled a client with attention-deficit/hyperactivity disorder who had trouble maintaining focus when he had to sit still for long periods of time such as in trainings or meetings. His solution was to stand and move periodically or ask for breaks with the simple explanation that he was feeling “fidgety.”

Counselors can ask clients how they feel about disclosing and how receptive their workplace might be to their mental health issues and to providing potential accommodations. Most of all, clients should disclose at a level that feels safe and comfortable to them, Hembree says.

“Everyone has to advocate for themselves, individually. That’s going to be different for every person,” she says. “For some, they are desperate to remove the stigma of mental health issues and wave that flag for everyone in their office and create a better environment for [all employees]. But that’s not for everyone. You don’t have to pick up that battle. You don’t have to be the spokesperson for depression [or another diagnosis]. You just have to do the best you can on any given day, and that may be disclosing and it might not be, or [it may be] disclosing in different ways.”

Accommodations

Employees may need to disclose a mental illness in the workplace if they are seeking accommodations that would help their situation. Possible work accommodations include being able to leave work regularly for therapy appointments, reducing an employee’s hours or responsibilities, or relocating from a cubicle to an enclosed office for increased privacy and decreased distraction, Williams notes.

Although the Americans with Disabilities Act (ADA) affords protections for workers, the language in the law guarantees “reasonable accommodation,” Williams points out. Counselors and clients should keep in mind that employers can make a counteroffer or refuse an employee’s request based on how reasonable they perceive it to be.

Hembree urges counselors who are unfamiliar with ADA or the protections it affords to seek continuing education on the topic, do research or consult with colleagues (including professionals in related fields such as human resources) to better support their clients. ADA also has an information hotline (ada.gov/infoline.htm) that counselors or clients can call to ask questions, she adds.

Hayden and Montgomery both suggest that counselors whose clients plan to disclose a mental illness or seek accommodations at work role-play in sessions to help clients gather their thoughts and prepare for the conversation. Hayden advises that it can be helpful for counselors and clients to explore the following questions:

What is the client hoping to gain from the conversation?

How might the conversation go? What do they anticipate happening?

What reaction might they receive? How will they respond to it?

Montgomery encourages clinicians not to make assumptions about a client’s comfort level regarding asking for things they need. Just because a client works in management or a position of authority doesn’t mean that they will easily be able to advocate for themselves, she says. Counselors should also never make assumptions based on the client’s level of education, socialization, cultural background or other factors, she adds.

“Assume everyone is terrified about asking for what they need and go from there,” Montgomery advises. “If we assume that no one is comfortable, then we don’t have to worry about offending someone or leaving someone unprepared because they’re uncomfortable asking you [their counselor] for help with learning how to ask.”

Hembree believes accommodations can be helpful for clients whose mental health struggles at work go beyond being a “nuisance” and truly interfere with their daily ability to do their job. As with disclosure, workplace accommodations — and the process to seek them — fall on a spectrum and will vary from client to client. Hembree says the documentation she has written for accommodation requests has ranged from in-depth reports for clients in government positions to a brief letter confirming that a client left work to see her for an appointment on a certain date and time. No matter the circumstance, she always has clients review the document to ensure they are comfortable with it before she submits it to their employer. She tries to focus her documentation on the client’s needs rather than the client’s problems, Hembree says.

Counselors can also work with clients to explore coping strategies that they can use on their own without having to seek an employer’s permission. In Hembree’s experience, clients have found it helpful to have fidget devices, noise-canceling headphones or calm strips (textured stickers a person can touch to soothe or ground themselves) at their desk. Customizing a workspace by adding plants or using a lamp rather than overhead florescent lighting can also be calming, she notes.

In other cases, employees can ask for measures that would help their situation without framing it as a mental health accommodation, Hembree says. For example, a client may notice that a different workspace is available in their office and ask to be moved without giving a reason.

Making work work

What is the tipping point between struggling at a job because of an underlying mental health challenge and foundering in a position that simply is not a good fit for someone with a client’s diagnosis? There’s no easy answer to that question, Williams says, but “keep soldiering through” is not a solution.

The counselors interviewed for this article agree that finding answers to this question should involve exploration of a client’s identity and how the client feels their job aligns with their identity and personal values. It can also be helpful to talk through the timeline of when a client started to struggle at work and whether that coincided with other events in their life, Williams notes.

Barnett suggests that counselors prompt clients to think about how long they’ve pictured themselves in their current role. For example, they could ask, “Have you always wanted to be in this career? Is it your life’s passion? Or is it simply a way to get dollars in your bank account?”

“You have to get to whether [the job] fits with the core of their identity,” Barnett says. Ask the client, “Is this what you really want to do? Is it your passion? Is it meeting your needs? If not, give yourself that freedom to make a choice.”

Counselors can also offer the perspective that clients don’t have to stay in a career simply because it’s what they studied in school or have been doing for years, Barnett notes. Clients can try out other careers by taking on a side job or working part time and slowly transitioning into another position if it is a good fit for them.

Above all, the client should guide the conversation, Montgomery adds. “Work, like relationships, can be a great source of purpose and meaning and can be a place where we can grow and do really exciting things and fulfill our brain’s desire for stimulation. It also can be a place where we get a paycheck, and we go home and we get all those things in other places [outside of work],” Montgomery says. “If getting purpose from work is really important to you and you want to do that, then make the decision that supports that result. But it’s also OK to just get paid and use that money to do fantastic things in other places. … We get all kinds of messaging that you should be saving the world through work. But the reality is that it’s not true for everyone. Everyone has different needs, and we just need to explore how to get those met.”

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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.

Suicidality among children and adolescents

By Laurie Meyers August 25, 2021

This past spring, Children’s Hospital Colorado declared a “state of emergency” in youth mental health. Over the course of the COVID-19 pandemic, the hospital system’s pediatric emergency rooms and inpatient units had become increasingly overrun with children and adolescents with serious mental illness, many of whom were actively suicidal.

“It has been devastating to see suicide become the leading cause of death for Colorado’s children,” the hospital’s CEO, Jena Hausmann, told journalists and reporters at a pediatric mental health media roundtable on May 25.

This mental health crisis is not confined to Colorado, however. Pediatric medical systems across the nation have reported a significant and sustained rise in mental health-related visits for children and adolescents that began in spring 2020. According to the June 18, 2021, issue of the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, mental health-related emergency room visits among adolescents ages 12-17 increased 31% compared with the rate in 2019. In addition, the report found that in this age group, the mean weekly number of emergency room visits for suspected suicide attempts was 22.3% higher during summer 2020 and 39.1% higher during winter 2021 than during the corresponding periods in 2019. This increase was more pronounced in girls; during winter 2021, suspected suicide attempt visits to the emergency room were 50.6% higher among girls ages 12-17 than during the same period in 2019.

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A confluence of factors

Research indicates that mental health concerns and suicidality have been increasing in children and adolescents for years. The current crisis cannot be linked to any singular cause, but it is evident that the isolation and anxiety of the pandemic added an accelerant to an already burning flame.

Renee Turner, a licensed professional counselor (LPC) in San Antonio, points to several factors she believes have been detrimental to child and adolescent mental health. Although she declares she is not by any means anti-technology, Turner admits she is concerned about the influence of social media, which not only continues to feed cyberbullying — which, unlike “old-school” offline bullying, is inescapable and omnipresent — but also encourages children and adolescents to view the world through an artificial lens, she says. “Children don’t have the ability to sort out what is real, what’s true,” and many parents are not teaching them how to consume online content in context, explains Turner, a registered play therapist supervisor. Technology is all-consuming, and many parents do not monitor or restrict their children’s screen time.

For that matter, Turner notes, many adults struggle with their own screen addictions. She believes this contributes to another modern problem: attachment issues. The rise of dual-income families, in which parents work demanding hours or multiple jobs for financial reasons or because of career demands, makes it more difficult to find time for bonding, she asserts.

Turner also considers the pressure of living in such an achievement-oriented society another potential factor in the increase of suicidality among this population. “I see kids who are chronically overscheduled,” she notes. These young people are involved in myriad activities in consistently competitive environments in which achievement is conflated with self-worth, Turner points out. “It’s all [based on] their output, instead of them being valuable for just being them,” she says.

Turner, the director of Expressive Therapies Institute PLLC, has counseled middle school-age children who are already anxious about how they’re going to get into college. The demands on their time are such that they are staying up late into the night to get everything done, she says. What really stands out for Turner is that some of her clients who are in middle school and younger are self-harming and suicidal because they see no end to the treadmill they find themselves on. The COVID-19 pandemic further complicated the situation, she says, because children and adolescents struggled with online schooling even as parents tried to juggle working from home, taking care of the kids and helping with schoolwork.

Turner stresses that children and adolescents need to have areas of their lives that exist simply for enjoyment — not performance. “If everything is evaluated, everything becomes work,” she observes.

Sarah Zalewski, an LPC who specializes in child and adolescent counseling, was working as a school counselor in a Connecticut middle school at the beginning of the pandemic. She noticed that the coronavirus restrictions had a profound effect on her clients and on students. “The kids who were in virtual schooling and separated from their peers struggled way more than those in school,” she says. “That routine and the connection with their peers is almost like a distraction from the stuff that is going on in their heads.” Things that had been on a “low boil” suddenly flared up, she says.

Children and adolescents also seemed to struggle with the loss of familiar routines, Zalewski adds. Interestingly, she noticed that students who had been perennially overscheduled before the pandemic had a particularly hard time coping.

Catherine Tucker, a licensed mental health counselor in North Carolina and Indiana who specializes in trauma therapy for children, adolescents and adults, notes that early adolescence (approximately 11 to 14 years) is a particularly vulnerable time. “One of the normal developmental pieces [during early adolescence] is that every generation thinks they’ve invented all the normal problems, such as peer pressure, sex, bullying, dating. They feel like nobody older than them can possibly understand what is happening to them,” she says. As a result, adolescents often feel seen and understood by their peers but not by adults, especially their parents, notes Tucker, an American Counseling Association member and a licensed school counselor at the middle school level. This is a vital source of emotional validation that adolescents have been missing while separated from their peers, she points out.

Tucker also thinks that we’re underestimating the value of physical contact. “Just basic touch; it doesn’t have to be intimate. Just being near other people. The more we find out about neurobiology, the more we learn that things like eye contact, physical gestures and cues can help regulate the nervous system,” she says.

Marginalized populations are at an even greater risk for mental health issues and suicide, and the disproportionate toll of COVID-19 on Black, Indigenous and people of color communities has been an exacerbating factor. Brenda Cato, a professional school counselor who has experience with elementary, middle and high school students, says many of the students at her predominantly Black high school in Augusta, Georgia, saw school not as a social event but as an escape. Most of her clients come from impoverished homes where parents are working multiple jobs and utilities are skyrocketing. At school, these students get two meals a day. Cato believes not being able to get these meals during the pandemic played a significant role in students’ general inability to cope.

Working with parents

The counselors interviewed for this article contend that educating parents is a vital part of addressing the suicide crisis among children and adolescents. Learning the warning signs of suicide and knowing what to do if a child becomes suicidal is crucial for parents, but it all begins with establishing communication and a sense of trust and safety. “The most important thing is to be able to establish a safe … [environment] where your kid can come and talk to you,” Zalewski says.

She advises parents to schedule regular one-on-one time with their children. That might involve going out to eat ice cream together or playing games and talking, for example, but she emphasizes that the time should be spent without the parent being on their phone. It is important for children and adolescents to know that they have their parent’s full attention, she says. Zalewski also recommends having regular conversations in which the parent communicates that anything their child tells them in that time or space has no consequences.

Turner’s clients include overscheduled and single parents who often struggle with the idea that to truly be there for their children, they need more time — time that they don’t have. So, Turner emphasizes quality time to these parents. “It’s essentially meeting the child where they are,” she says. “Taking an interest in what the child is interested in and asking them about that, engaging in their world.” Turner suggests parents have “date nights” with their kids and schedule times when everyone shuts off their phones and puts them in a basket to create a distraction-free zone.

It can also be helpful to teach parents to establish “bursts” of listening time, Turner says. For example, when a parent is in the middle of something and a child is saying, “Mom, Mom, Mom,” the parent can reply, “OK, I have five minutes right now, so tell me what you need to tell me.”

Of course, parents may struggle with how to respond appropriately when they find out that their child is experiencing a mental health crisis, especially if the child says, “I don’t want to live anymore.” Zalewski reminds parents that it is important to first take a moment to listen to their child. She then advises parents to say something that lets their child know they are there for them. For example, “Thank you for telling me. That was a brave thing to tell me. Do you want to tell me more about that?”

Zalewski then helps her clients plan for the next steps. “It doesn’t need to be a heavy-handed thing,” she says. Parents can use language such as “We are going to collaboratively figure out what our next steps are. I don’t want you to feel that way, and I want to keep you safe.” The child and parents can then discuss options.

She adds that parents should ask one crucial question: “Are you able to keep yourself safe?” If the child isn’t sure, she advises parents to say, “I think maybe we need to go to the hospital and see if the counselor there can give us some ideas.” In many states, clients can call 211 to reach appropriate health agencies and even request that a mobile crisis unit come to the home to help establish a crisis plan, she adds.

But even children and adolescents who have trusting and open relationships with their parents don’t always speak up when they’re experiencing suicidal thoughts. So, counselors need to ensure that parents recognize the warning signs, which are similar to those in adults. “What’s scary is that adolescents can be so much more impulsive than adults, especially … kids who have poor impulse control generally,” Tucker acknowledges. “There are fewer warning signs and fewer opportunities for intervention.”

Tucker emphasizes the importance of educating parents about reducing children’s access to means of suicide, such as having unlocked firearms and medications in the home.

“The warning signs that I look for are not necessarily different than [those for] adults but are often written off as ‘teenage behavior,’” Zalewski says. For example, withdrawing may be either a warning sign or simply a wish to be alone. Parents should look for major changes in their child’s behavior in areas such as eating, sleeping and socializing, she says. Giving away prized possession is also a major red flag, she adds.

Zalewski stresses that parents should not dismiss a child’s statement of wanting to hurt or kill themselves. “So many parents have said, ‘I thought this was just them expressing themselves for attention.’ If this is your kid’s way of getting attention, you need to pay attention and find out why they are using those words,” she says.

Zalewski also urges parents to honor their intuition: “If you think there is a problem,” she says, “there probably is.”

Teachable moments

Cato faced a different kind of challenge when educating parents of students who had been identified as suicidal. “I was working in a predominantly Black elementary school, and a teacher sent a child to me who had been making suicidal comments,” she recalls. After assessing the student, Cato called the grandmother, who was the child’s guardian. The woman was irate and asked how many students in the school had been tested for suicide. Cato reassured the grandmother that the school didn’t test — it assessed. This taught Cato the importance of educating parents on suicide rates and the percentage of children who attempt or die by suicide.

Cato didn’t approach the situation with the student’s grandmother from the attitude of “your kid is suicidal, and you will get help.” As a parent herself, she knew that if she didn’t understand what was happening with her own child, she would want someone to walk her through it. So, Cato sat down with the grandmother and explained that her granddaughter wouldn’t necessarily be put on medication or need ongoing therapy. However, Cato recommended that the child be seen by an expert. She told the grandmother that the school just wanted to make sure the child was OK and that she wouldn’t harm herself. Cato also reassured her that her granddaughter would not be stigmatized or labeled as a “problem” student, nor would a note be put in her permanent record. “I think everything is about how you communicate with people,” Cato says. Besides, the grandmother’s concerns were understandable, she adds. Black students are commonly — and disproportionately — diagnosed with serious mental health issues, Cato says, adding that she has seen students of color sent to special education classes based solely on disciplinary issues.

After the student was medically cleared, Cato worked with the student to create a reentry plan that included regular check-ins. These were sometimes as simple as walking casually with the child and asking her to rate her day on a scale from 1 to 10.

Cato tries to turn all her interactions with students and parents into teachable moments. She provides them with pamphlets, resources and crisis hotline numbers, and every time she visits a classroom, she reminds students that the counselors and teachers are there for them. She says she tries to “help them to understand it is not abnormal to feel this way.” She purposely uses “we” when she speaks to students: “We’ve all gone through rough times; we all need help sometimes.”

Zalewski believes it is essential to also point out and honor the resilience strategies that children are already using. If listening to music helps a child or makes them feel better, then it is a good coping skill, she says. Discovering coping strategies helps build children’s confidence, she notes, and she informs parents of their children’s coping strategies too.

For that matter, Zalewski has found that her young clients often love to teach the strategies they have learned in session to their parents. In fact, to encourage clients to practice a skill outside of session, she recommends that they teach their parents how to correctly take a deep breath and explain what deep breathing does to the brain to calm the body. “Because then we’re helping parents regulate, [and] then we are co-regulating,” Zalewski says. “It can also really give a child a sense of self-efficacy that a lot of kids are lacking because kids are inherently powerless.”

She also works with clients on mindfulness, guided imagery, progressive relaxation, and identifying what physical activities they enjoy and why. For example, a child might like to play basketball in the driveway, but in Connecticut, snow often gets in the way. So, Zalewski helps them figure out the source of their enjoyment: Is it the physical energy they’re expending? Is it the repetition? They then come up with alternatives such as using weights in the basement. Zalewski is a firm proponent of anything that can get clients moving and (when possible) outside. “Nature is reparative for most humans,” she notes.

Tucker says that before the pandemic, children and adolescents were already experiencing stress related to a lack of connection, which she thinks could be associated with too much screen time. As children and adolescents begin to return to in-person activities, it is crucial to make sure they strike a healthy balance between screen time and social activities such as playing sports, working on art projects or simply hanging out together, she stresses. She also believes that the currently common practice of banishing recess in favor of test preparation or other extra classroom work has contributed to children’s anxiety levels. She argues that kids need a lot more time dedicated to free play and imagination.

Helping the helpers

Julia Whisenhunt, an LPC and certified professional counseling supervisor, specializes in studying and training others in suicide prevention. She always frames her workshops around suicide data to “help people understand that [suicide] isn’t uncommon.” Her goal isn’t to normalize the idea of suicide but rather to let people know that it happens and there is help.

“I know there’s an assumption that talking about suicide makes people suicidal, but the research doesn’t bear that out,” notes Whisenhunt, an ACA member who is an associate professor in the counseling department at the University of West Georgia (UWG). “I think it’s the opposite. I’m confident that trainings have saved lives and helped individuals. I know that. I’ve lived it. The suicidality is there — people are just struggling in silence.”

It is important when training people who are not mental health professionals to emphasize that their role is not to “save” an individual who is suicidal but rather to get them help, Whisenhunt adds.

Although Whisenhunt’s workshops are geared toward college staff (and students in positions of authority, such as resident associates), she is trained in Applied Suicide Intervention Skills Training (ASIST), which can be used to train staff in public school districts. ASIST is a 14-hour training created by the company LivingWorks that is grounded in research, Whisenhunt says. UWG’s counseling department does ASIST training with practicum students, and Whisenhunt says they report feeling much more confident once they have taken the course, even though they have already learned a good deal about suicide in their program.

One of the main components of ASIST is the “pathway for assisting life,” Whisenhunt explains. “They have a model for how to have a conversation about suicide with someone.” She tells practicum students that this is a model that summarizes everything they already know, but it presents the information in a format that is easy to keep at hand in a crisis.

The first part of the model is about connecting with suicide, she says. It has two main tasks: exploring indications of suicide risk and then spotting warning signs and naming them. Once warning signs are identified, trainees learn to act directly without beating around the bush, Whisenhunt says.

Whisenhunt and her follow trainers also instruct workshop participants on how to talk about suicide and what to do if someone is expressing suicidal thoughts. She warns participants not to ask, “Are you thinking of hurting yourself?” because that could mean many different things to the person. Instead, she encourages training participants to be direct and not be afraid to use the word “suicide.” For example, they could ask, “Are you thinking of killing yourself? Are you thinking of suicide?”

She also advises them not to ask leading questions. “If you ask, ‘You’re not thinking about suicide, are you?’ the person knows the answer you want them to give,” Whisenhunt explains. “If the person seems hesitant, trust your gut, talk a bit more, make them feel more comfortable, and circle back around.”

She also tells people to keep asking about suicide. Don’t just ask once and feel “relieved that you got that out of the way,” she insists. “If you felt like you needed to ask and the answer doesn’t feel right, ask again,” she says. “A lot of people don’t want to die — they just want the pain to end. Help them know there’s another way out.”

Counselors also need to be prepared to provide resources, Whisenhunt adds. She advises her trainees to keep hotline numbers in their phones and to carry suicide prevention cards in their wallets.

“When talking with an individual and hearing about their despair, chances are you are going to hear something that means that they don’t want to die. It’s often something like, ‘I don’t want to leave my dog,’” Whisenhunt says. “If you hear that little thing that says they don’t want to die, you don’t [want to] be manipulative, [but] you say, ‘I know that you’re in a lot of a pain, but it seems to me like you’re still thinking about living because you want to be there to take care of your dog.’ That’s the turning point — where they start to turn away from suicide and toward life.”

Counselors can then ask clients if they want to develop a plan to keep them safe for now, Whisenhunt continues. The use of the phrase “for now” is important, she stresses, because when people are in a suicidal crisis, talking about living for years and years is overwhelming to them. The safety plan should be for a matter of hours or days — just until the person can be connected with help, she explains.

The ASIST safety plan includes “safety guards” and “safety aids.” Whisenhunt says safety guards include protecting clients from risk factors such as a plan to die by suicide, problematic alcohol or drug use, prior suicidal behavior, or mental health concerns that might exacerbate risk. Counselors can help clients consider ways to mitigate these risks such as by reducing or eliminating drug use.

Guarding also involves being mindful and looking at previous suicide attempts for clues to keep the client safe, Whisenhunt adds. For example, the client might be impulsive, so part of keeping them safe involves having someone stay with them for a few days.

Safety aids are elements that help improve a person’s chances of staying safe, Whisenhunt explains. Counselors can help clients consider the strengths they already possess and the supports they need to build. “It’s strengths-based,” she says. “We try to help individuals see their strengths and resilience and see options to help them feel better.”

Being prepared

Counselors may be trained in suicide assessment and prevention, but putting that knowledge to use can still be a scary prospect, Zalewski acknowledges. For that reason, she stresses the importance of specialized training. If possible, she recommends that counselors find a local training opportunity with someone who can continue to serve as a resource for them afterward. She chose to work with a mobile crisis unit to learn more about helping those in suicidal crisis.

“There are a lot of modalities out there for suicide assessment,” Zalewski notes. “I would recommend not just picking one modality to learn. To be competent, you have to have a good understanding of what’s out there. Whatever you choose to work with has to mesh with you as a human. Explore what’s out there [and] learn several. … It’s well worth it, so when you are faced with some child who has decided they don’t really feel like living anymore, you’re not looking in your file cabinet or texting saying, ‘OMG.’”

Supervision is also essential, Zalewski stresses. “As counselors,” she says, “it’s easy to get to the point where you think, ‘I’ve been doing this for years, and I don’t need supervision.’” But that’s not the case. Sometimes, Zalewski says, she’s certain that she knows something, but supervision helps her realize that somewhere along the way, what she thought she knew got twisted.

Counselors also need to have their own sources of support when doing this difficult work. “If you’re working with children and adolescents who are suicidal, it is a heavy weight,” Zalewski acknowledges. “It is so easy to question yourself.” And if the all too imaginable happens and a client completes suicide, the counselor is going to need backup, she adds.

“Everyone in the end makes their own decisions,” she says. All that counselors can ultimately control is the level to which they provide clients with the best preventive tools, and “a good supervisor will help you assimilate that.”

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Laurie Meyers is senior writer at Counseling Today. Contact her at LMeyers@counseling.org

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

Voice of Experience: The ughly child

By Gregory K. Moffatt August 23, 2021

I was an ughly child, but I doubt that you would think that by looking at my grade school pictures. For the most part, I suppose I looked like any other kid. Nothing about me was exceptional in either direction. I wasn’t exceedingly attractive nor was I noticeably unfortunate looking.

But ughly children know who they are. They are the children teachers prefer not to see on their class rosters at the beginning of the fall semester and the ones who cause parents to grimace when they realize “that child” will be attending a birthday party. Even most therapists don’t like seeing these children’s names on their agenda for the day.

Ughly children demand others’ energy. They break things. They often rub people — including their peers — the wrong way. That is what makes them “ughly” — they cause us to go “ugh.”

Consequently, they are never the first ones chosen for games, and often their comments and thoughts go unnoticed, as if they weren’t there at all. Over time, they learn that they are irrelevant, sometimes even at home.

I run a camp for grieving children every summer. We always have a few children who demand far more of our time than do others. Some require a dedicated staff person 24/7. They force us to use all of our skills and, often, all of our energy.

Zdan Ivan/Shutterstock.com

It would be far easier if all of my campers were cute, cooperative and fun to work with. But ughly children are my favorites. I would be lying if I said that I looked forward to the hard work these children require of me. Camp is exhausting enough given the outdoor conditions, poor sleep and, of course, the energy required to help children through their grief. I would also be lying if I said that I haven’t sometimes thought “ugh” upon seeing certain names on my own therapy agenda.

I realized long ago, however, that these children are accustomed to the exasperated inflection in the voices of those who speak to them. The world these children live in is full of adults and kids alike who give clear indication that life would be much easier if ughly children weren’t in it. Mostly, that message is unintended, but it is the message these children receive nonetheless.

I work hard to communicate a very different message. I make sure to pick them first, to listen carefully to their stories, and to show patience that they sometimes don’t know what to do with. It is amazing how quickly I build rapport with these children and, consequently, how hard they will work to please me. That makes behavior modification much easier.

So, whether it is for a few days at camp or throughout months of therapy, I commit to acting like I might be the only person that day (or maybe ever) who makes these children feel that I am glad to see them rather than perturbed that they need something from me.

It would be a mistake to think that ughliness is limited to children. It isn’t. Adults can be ughly too and, like the children I’ve described, they know who they are. Their lives have been replete with rejection, and that is often at the core of some of their troubles.

Many years ago, a client of mine was an ughly child. I know because he told me so. “My teachers don’t like me,” he said on the first day we met. He wasn’t complaining. Just stating the facts. This young boy had endured several major life events that would have challenged any adult.

He was rambunctious and broke something nearly every time he came into my office. Upon his departure each day, the sand from my sand tray was always all over the floor and most of the toys were off the shelves. He was hard work, but I loved that child. I was his lifeline to a more peaceful future. We worked together for several years as he weathered many storms.

Today he is approaching 30, and I occasionally see him in the community. He is 6-and-a-half-feet tall and outweighs me by at least 50 pounds. Yet each time I see this very successful young man, he hugs me with the deepest affection. I’ll always be his “Dr. Gregory.”

Anybody can work with easy children. Professionals take on the challenge of the hard ones, and that is why ughly children are my favorites. Maybe they can become your favorites too.

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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.

Counseling Today recognized with five awards

August 18, 2021

The Counseling Today staff won a total of five awards in APEX 2021, the 33rd annual awards program recognizing excellence in publishing.

Senior editor Lindsey Phillips received a Grand Award in the writing category for her July 2020 feature “Putting first responders’ mental health on the front line s.” Of nearly 1,200 entries, only 100 Grand Awards total were presented across 13 major categories.

Senior writer Laurie Meyers earned Awards of Excellence in two separate writing categories: one in COVID-19 media newspaper/magazine articles for her December 2020 feature “Facing a winter of discontent” and another in health and medical writing for her May 2020 feature “Life after cancer.”

Senior writer Bethany Bray won an Award of Excellence in the feature writing category for her October 2020 cover story, “Helping clients develop a healthy relationship with social media.”

The August 2020 issue of Counseling Today was recognized with an Award of Excellence in the category of best magazine, journal and tabloid issue over 32 pages. Among the articles featured in that issue was a cover story on racial trauma and Black mental health.

The Counseling Today staff have received a total of 58 awards for writing, design and website excellence over the past 16 years.

Learning about the experiences of canine-assisted therapy handlers

By Kelly Carapezza August 17, 2021

Interacting with animals, especially dogs, regularly elicits an immediate rush of the warm fuzzies for me. I also witness this among fellow shoppers when I walk through the pet store with my long-haired German shepherd. “Oh, how beautiful!” they will exclaim as they give themselves permission to pet my dog rather than greeting me.

It makes me chuckle at how quickly some people will jump at the opportunity to engage with animals, and then humans become an afterthought. If I don’t have my buddy with me, my visit to the pet store is much different — less greeting and more shopping.

Throughout history, animals have provided loyalty and companionship to humans. Sigmund Freud noticed that using his dog in counseling sessions helped clients feel more comfortable expressing emotions and sharing personal information about themselves. Several decades later, psychologist Boris Levinson momentarily left a child who was mentally ill with his dog. Upon returning, Levinson found the child interacting with the canine. This incident sparked further research into the use of animal-assisted therapy (AAT) with children.

During the 1980s, the Delta Society started defining formal and informal definitions and interventions incorporating animals into human treatment. Today, AAT is implemented among military veterans diagnosed with posttraumatic stress disorder. AAT has also been used as an adjunct therapy among families referred by child protective services and has facilitated growth in family functioning. Nonprofit organizations have registered various animals to provide mental and emotional support to humans. Approved animals include horses, canines, cats, llamas, alpacas, rats, rabbits and birds.

Dogs and CAT

As a dog lover and dog owner, I am drawn to the use of therapy dogs in various settings. Specifically, canine-assisted therapy (CAT) is a burgeoning treatment modality underneath the umbrella of AAT with a particular focus on canines. Over the past decade, dogs have been used in various settings, including nursing homes, schools, hospitals, libraries and more. Most of the research literature focuses on the impact these animals have on different populations. However, research is lacking on how canine handlers themselves are affected as treatment vessels.

Canine handlers come from a variety of backgrounds ranging from volunteers to trained clinicians. With proper certification, canines can facilitate a variety of therapeutic encounters. However, handlers who are certified or licensed professional counselors may offer even more empathic interactions than do volunteers from career backgrounds outside of counseling.

In the context of a therapy animal team, handlers maintain various characteristics to be successful. AAT is not practiced by everyone, so handlers need to consider personal motives. One characteristic that Michael Firman and colleagues found indicated in a 2016 study was intrinsic motivation. This includes AAT handlers who practice not for monetary benefit but because they are passionate about AAT.

Pet Partners is one of several national nonprofit organizations that registers a variety of handlers and animal teams. Handlers must complete and pass the online or in-person handler course, pass the required in-person team evaluation, and submit required applications and a background check to officially register as a team.

Handler experiences needed

I often wonder what it’s like to provide CAT therapy to people. As a counselor, I’ve experienced rapport building with a variety of people, from young children to older adults. Through my observation of several colleagues, it seems that having a dog present with clients certainly influences human interactions.

According to a qualitative study published by Anna Swall and colleagues in 2016, more studies are needed to explore the experiences of canine handlers involved in providing CAT. Swall’s study further indicated that CAT handlers were able to use canines to build therapeutic rapport between the participant and the handler. Therapy animals are trained to demonstrate Rogerian concepts such as unconditional positive regard. For example, if a child in a reading program makes a mistake while reading aloud, the canine does not laugh at the child or make judgments. It is quite the opposite. Therapy canines are used to decrease discomfort in humans and provide a supportive and loving environment.

In a study conducted by Nancy Eisenberg in 2015, researchers found that an individual’s ability to cultivate an emotional relationship with animals is congruent with their emotional connections toward people. Therapy animals also can serve as mediators when clinicians are attempting to build rapport with particular clients. And with animals included in therapeutic interactions, counselors have an additional model of empathy-like responses to present to clients.

Research has shown that dogs can also display sensitivity to human emotional states, as evidenced by their responding to negative emotions such as crying. Specifically, canines have responded to distress in humans by producing expressions and postures such as a relaxed open mouth and facial mimicry. In AAT settings, animals can supplement traditional therapeutic interactions by demonstrating positive behaviors with humans who are experiencing negative emotions.

MicroOne/Shutterstock.com

My firstborn

I tend to treat my dog as if he is human. I talk to him regularly about what to put on the calendar and ask for his opinion about handling specific client scenarios at work. Sometimes the bonds we share with our pets may seem silly, especially to those who do not have pets, but there is no denying how special and important these bonds are to us.

Handlers also develop a unique bond with their animal. This bond influences the animal and its response to the environment. In a 2019 study, Stephanie Kuzara and researchers identified various handler interaction styles, including authoritative and permissive. For example, CAT handlers working with students displayed increasing warmth behaviors, known as permissive styles, toward their canines when students approached the therapy animal team. In contrast, handlers showed authoritative styles by increasing control over the canine alongside demonstrating warmth behaviors depending upon student personalities.

Such observations led to further questioning about how the handler-canine relationship influences therapeutic outcomes. Researchers recommend studying handler interaction styles and how they affect the therapy animal and therapeutic atmosphere. Few studies currently exist regarding handler-canine dynamics; these studies are needed to better understand handler and canine team suitability and standards.

Ethical considerations

Animal welfare is crucial to AAT interventions. Counselors are trained to manage compassion fatigue and burnout, and therapy animals also have limits. Handlers are trained to be aware of an animal’s stress triggers. For example, a therapy animal engaged in visiting hospitals may experience too much stimulation due to the bright lights, fast-paced environment and medical equipment. In such a case, the handler may instead provide AAT in nonmedical settings such as schools or outpatient settings. Knowing the animal’s window of tolerance will prevent the animal from harming others and allow it to continue performing at full physical and mental capacity.

Furthermore, if the animal is sick or injured, it will not be used in therapy until receiving veterinary approval to resume AAT. Animals that become fatigued, irritable, stressed or frightened are removed from sessions by handlers so that they can rest and take breaks. AAT clinicians also provide antibacterial wipes and soap to use before and after AAT interactions. Providing clients with this information can help establish expectations for AAT and acknowledgment of both animal and human welfare.

The American Counseling Association’s ethics code indicates that counselors are to do no harm. AAT therapists must take the added dynamic of a therapy animal into account so that the animal does not damage the therapeutic relationship. Specifically, AAT clinicians must be sensitive toward individuals who do not like dogs or who have pet allergies. In these cases, most AAT clinicians will leave the therapy animal at home or in another room to avoid causing the client added stress in sessions.

AAT clinicians are also required to include AAT specialization and risk management information when clients complete their informed consent. This information serves as a waiver of safety, meaning that clients agree to the risks outlined in the consent form. Furthermore, animals used in therapy must undergo extensive training to ensure others’ safety and decrease the risk of physical harm from jumping, scratching or biting. AAT training and evaluations are meant to reduce client safety risks and ensure that proper precautions have been taken.

In 2016, ACA released the Animal-Assisted Therapy in Counseling Competencies, which indicate the practice of basic counseling skills in addition to using an animal to enhance therapy. These competencies are the latest breakthrough to provide clinicians with a direction to practice AAT in counseling, but more research studies are needed for practice standardization.

Counselor education and supervision

I am a counselor educator-in-training, and I think it would be exciting to incorporate AAT into accredited course curriculums. For example, counselor education and supervision programs could offer an elective course for students who are interested in this type of adjunct therapy. Furthermore, students who become certified in AAT can conduct research and focus on advancing the knowledge of CAT within the counseling field, just as many other professions have included AAT in their research.

In addition, studies focused on AAT handlers could inform other AAT practices, including CAT. Analyzing handler empathy could also provide new information regarding empathizing with challenging populations. In 2019, Lyndsey Uglow conducted a study to explore the effectiveness of AAT in a hospital setting and concluded that uniformity and treatment standardization were needed to ensure reliability and consistency when practicing AAT among various populations. Therefore, collecting qualitative research data may supplement AAT handler protocols on a broader scale.

Developing settings

Exam time was always exciting for me as a college student because of the therapy dogs that would visit the library at the end of the semester. It was a great way to take a break from the stress and strain of studying, and it also boosted my mood.

Therapy animals have become increasingly popular in other settings, including the workplace. It is not uncommon to hear about designated pet-friendly areas that allow well-behaved animals to interact with employees. Furthermore, Pet Partners has provided therapy animal teams for workplace well-being visits. Animal-assisted workplace well-being (AAWW) is implemented to increase employee satisfaction and productivity. AAWW has proved to decrease stress levels and often leads to effective collaboration between employees.

Therapy animals have also been used recently for animal-assisted crisis response (AACR) to assist in the aftermath of mass shootings, natural disasters and other community crises. AACR is not a mental health intervention per se, but handlers are trained to provide psychological first aid concepts to facilitate recipient stabilization.

Finally, AAT has been offered to patients in minimally conscious states. In a 2019 study by Karin Hediger and colleagues, researchers found that AAT increased patient arousal, indicating possible increased levels of consciousness. Therefore, the AAT application could serve as a breakthrough in neurorehabilitation for patients with disorders of consciousness.

Further research

As a doctoral student, I am currently in the process of conducting a qualitative study that will analyze a variety of handler experiences, from school counselors to licensed professional counselors to marriage and family counselors. Overall, AAT continues to grow as researchers explore various aspects of this adjunct treatment. CAT requires further exploration in the context of a handler’s perspective working with their four-legged co-therapist to promote a positive environment across a wide array of populations and backgrounds. I look forward to contributing to the literature in this area post-dissertation.

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Kelly Carapezza is a licensed professional counselor who works in the private practice setting, specializing in trauma therapy and eye movement desensitization and reprocessing. She has experience training her German shepherd in basic obedience and therapy dog classes and anticipates obtaining AAT certification through Pet Partners. Contact her at kelly@hillcitycounseling.com or through LinkedIn.

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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.