Monthly Archives: December 2021

Our most-read articles of 2021

Compiled by Bethany Bray December 31, 2021

One silver lining of the COVID-19 pandemic is how mental health has become part of the national conversation throughout the past two years. It’s no surprise then that some of 2021’s most-read articles at the Counseling Today website dealt with trauma, grief/loss, suicide and a range of mental health issues connected to the pandemic, including the strain it has put on children and adolescents.

More than 130 articles were posted at ct.counseling.org in 2021. Other popular articles focused on professional issues such as pro bono counseling, eye movement desensitization and reprocessing (EMDR) therapy, the future of the counseling profession, eating disorders, client assessment and treatment planning, and starting a career during the pandemic.

What were counselors reading in 2021?

Here are the most-read articles posted in 2021 at ct.counseling.org:

“Untangling trauma and grief after loss” (feature article, May magazine)
“The forces that could shape counseling’s future” (cover story, January magazine)
“Taking a strengths-based approach to suicide assessment and treatment” (Member Insights, July magazine)
“Trauma stabilization through polyvagal theory and DBT” (Member Insights, September magazine)
“Tapping into the benefits of EMDR” (feature article, October magazine)
“How COVID-19 is affecting our fears, phobias and anxieties” (feature article, March magazine)
“There’s nothing small about trauma” (cover story, July magazine)
“Pro bono counseling: How to make it work” (online exclusive posted in March)
“Internet gaming disorder: A real mental health issue on the rise in adolescents and young adults” (online exclusive posted in September)
“Perspectives on grief and loss” (cover story, November magazine)
“Five regrets of the counselor” (Member Insights, March magazine)
“Working with clients who are angry at God” (Knowledge Share, May magazine)
“A firsthand experience of grieving pet loss” (Member Insights, August magazine)
“‘But my clients don’t get eating disorders’” (Member Insights, January magazine)
“Feeling the strain: The effects of COVID-19 on children and adolescents” (cover story, May magazine)
“Suicidality among children and adolescents” (cover story, September magazine)
“Four lessons in building therapeutic relationships” (Member Insights, November magazine)
“Assessment, diagnosis and treatment planning: A map for the journey ahead” (cover story, October magazine)
“The intersection of childhood trauma and addiction” (Knowledge Share, April magazine)
“Finding balance in counseling private practice” (cover story, April magazine)
“Counseling outside the box” (cover story, March magazine)
“The sensitivity of boundary setting in collectivist cultures” (Member Insights, October magazine)
“Crisis counseling: A blend of safety and compassion” (cover story, August magazine)
“Starting a counseling career in the time of COVID-19” (feature article, April magazine)
“Gone but not missed: When grief is complex” (feature article, February magazine)

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What was your favorite article of 2021? What would you like to see Counseling Today and CT Online cover in 2022?

Leave a reply in the comment section below, or email us at CT@counseling.org.

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School counseling and COVID-19: ‘We can’t go back to normal’

By Bethany Bray December 22, 2021

Meeting students’ mental health needs in the midst of the COVID-19 pandemic has been and remains a moving target for school counselors, says Dodie Limberg, an associate professor of counselor education at the University of South Carolina. However, one thing has become clear: School counseling will never be the same.

“We can’t go back to normal. We shouldn’t go back to the way things were. We need to have our hand on the pulse of what’s needed and how our role addresses that,” says Limberg, an associate editor of the Professional School Counseling journal. “We started the [2021-22] school year in hopes that it would be better or ‘normal,’ but COVID is still occurring and school counselors are trying to adjust as it’s happening. … We are not in a place where we have clear solutions, and that’s a hard thing to come to terms with because we’re helpers.”

Although most school districts have returned to in-person instruction, the environment is not the same as before the pandemic. School counselors are still navigating the unknown in many ways, Limberg notes, such as the challenge of making students feel included when they are quarantined or taken out of class because they may have been exposed to the virus through travel or contact with a family member who has it. School routines and structure have returned in fits and starts for students this year; uncertainty remains an ongoing theme.

“We need to have some grace with ourselves and our students and meet them where they’re at,” says Limberg, an associate editor of Counseling and Values. “We’re still working with students — we have to be — and at the same time, figuring out ‘What does that look like now?’ I really admire how our field as a whole, all counselors, is coping with this. We’re trying what we can, doing what we can in our ability to help people. It’s a lot, and it’s not over.”

School counseling is one of Limberg’s areas of expertise. She, along with teams of researchers, recently conducted three different studies on COVID-19’s impact on school counselors and their work with students throughout the pandemic. The research — two national studies and one involving school counselors in South Carolina — also focused on school counselor burnout and the ways COVID-19 has heightened disparities among students and schools.

Limberg and her co-researchers heard many examples of how school counselors have gotten creative and proactive to support the mental health needs of students, particularly during the 2020-21 school year when many students were learning from home. In cases where families didn’t have internet access, school counselors contacted parents via text message, personally checked on students in the community or helped transform school buses into mobile Wi-Fi hotspots.

School counselors also wielded technology to support students, such as creating a “quiet room” in Google Classroom that students could visit virtually when they needed a break or a moment of calm.

Now, in year two of the pandemic, school counselors continue to meet challenge after challenge, says Limberg, a past president of the Southern Association for Counselor Education and Supervision.

“A school counselor’s role is ideally more preventative. But it’s shifted to become more reactive [during the pandemic],” Limberg says. “We’re functioning in a state of crisis and doing triage work, while still trying to do classroom guidance, running small groups and other school counseling tasks. We are helping [students’] needs on an individual level and struggling to do so [on a] comprehensive [level].”

The pandemic revealed just how much students get out of school besides academics, including social-emotional learning, regular meals and physical activity. It also highlighted the disparities among students, Limberg adds. For example, some parents found ways to augment remote learning and non-academic aspects of school, whereas others couldn’t because they were working and maxed out themselves or because they couldn’t afford it.

The pandemic also illustrated the importance of mental health. Teachers and school administration turned to school counselors to draw on their much-needed expertise in fostering wellness and mental health, and they realized the pivotal and skilled role school counselors play in a school community. The downside, however, is that many school counselors are now constantly “on demand” by both school colleagues and parents, which has led to them being overworked and, in some cases, burned out.

“We’re just beginning to understand COVID’s impact and how it changes our roles,” Limberg says. “We’re still experiencing COVID-19 and haven’t even scratched the surface of what this will all lead to. How do we prepare and adjust our services while we’re still in the process of understanding what this is? But at same time, it’s hopeful that school counselors are being recognized as an important role for mental health in schools.”

The key to maintaining student mental health and wellness in school settings in the wake of COVID-19, Limberg stresses, is for school counselors and mental health counselors in the community to work together. Viewing all mental health professionals (including school counselors, mental health therapists, rehabilitation counselors, and marriage and family therapists) as all on the same team is an important part of this collaborative approach.

“We need to collaborate, community-wide. We need to not operate in silos. There’s so much need and not enough services,” she says. “Recognizing each other’s identities while working together is the way forward. … We’re all counselors, [so] how can we work together to help?”

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Contact Dodie Limberg at DLIMBERG@sc.edu

Find resources for school counselors at the American Counseling Association’s School Counselor Connection page: counseling.org/knowledge-center/school-counselor-connection

FamVeld/Shutterstock.com

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Bethany Bray is a senior writer 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.

Voice of Experience: Betrayal

By Gregory K. Moffatt December 20, 2021

Grouping symptoms and behaviors into categories can be very helpful. It gives us a starting place for treatment planning. By doing this, instead of mistakenly treating symptoms, we can more quickly get to the treatment of causes.

For example, those of you who work with addictions are undoubtedly aware of the underlying concept of entitlement that can lead to relapse. “I haven’t had a drink in over a year, and my brother is getting married. I’ve earned a sip of wine to celebrate with him.”

This isn’t an excuse or a rationalization so much as it is entitlement. By helping our clients see that their entitlement thinking can easily lead to relapse, we can help them avoid this pitfall and make better decisions.

In April 2020, I wrote a column for CT Online about grief. I argued that grief underlies many of our clients’ issues. They may be grieving the loss of childhood, the loss of dreams, the loss of a marriage, or strained relationships with their children, parents or other loved ones.

Again, if our clients can recognize that grief underlies some of what they are experiencing, we can help them work through it like we would any other client who is dealing with a more obvious loss.

It is this kind of thinking that leads me to consider another category — betrayal.

Just as we may tend to think of grief too narrowly — as if it applies only to those clients who have experienced the death of a loved one — we can do the same thing with betrayal. This word is most often applied in the case of infidelity in a relationship, but I’ve learned there are many other ways in which we feel betrayed.

Certainly anyone engaging in an emotional relationship outside of a committed relationship will create a sense of betrayal in their partner. But let’s broaden our thinking to all social relationships.

Any engagement with another person — a co-worker, a weekly tennis date, a parent, child or even neighbors — involves social contracts. These contracts sometimes involve written agreements. Job contracts, marriage contracts, and informed consent for counseling are all explicit social contracts with clear expectations for behavior.

But much of our existence in our social worlds is made up of unwritten social contracts. These are implicit promises to behave in a certain way. “We always meet for coffee on Friday mornings at 8 before work.” Nobody would write that down, have it notarized and have all parties sign it. But the unwritten contract can be just as powerful as a written one. When the agreement is broken, we feel betrayed.

I’ve spent many years consulting with businesses and evaluating employees who are presenting disruptive, concerning or dysfunctional behaviors in the workplace. Many of them have been able to function fairly well in other environments, but in the workplace, they have felt betrayed. Therefore, their dysfunctional behaviors seem rational to them.

Valentina Shilkina/Shutterstock.com

For example, we would have no trouble understanding a husband who loses his cool after finding out that his partner has had an affair. After all, he was betrayed. The same emotional response happens in the workplace when an employee believes they have worked hard and earned a raise or promotion yet have been passed over. The employee with weak coping skills or other compromising mental health issues might behave in seemingly inexplicable ways. But I can see what’s happening. Metaphorically, they’ve found their partner in bed with someone else.

In couples counseling, I see this happening over time. Even if there are no outside relationships compromising the marriage, a sense of betrayal can still exist. “I’ve stayed home, cleaned house, given up my career and done laundry for 15 years. All I ask is a little appreciation.”

“Ah … so what you’re telling me (in counselor terms) is that you had an unwritten social contract with your partner — an expectation that you would do X, Y and Z and, in return, you would receive A, B and C. The contract has been violated and you feel betrayed?”

Resolving that betrayal, along with whatever other systemic dynamics may be at play, is a critical step in healing resentments. The partner may be totally unaware of the unwritten expectations — the fine print in the social contract. Sometimes healing can begin by simply articulating those expectations, negotiating them and putting them into practice.

Just like the large categories of entitlement and grief, betrayal is not a universal emotion in all dysfunction, but it is so big that I always consider this in evaluation and treatment planning. This helps me be more efficient and can begin the healing process sooner.

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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.

Returning to campus with a wellness focus

By Bethany Bray December 16, 2021

Youngstown State University (YSU) held most of its classes virtually throughout the 2020-2021 school year to ensure the safety of students and staff during the COVID-19 pandemic.

In some ways, this has led to two classes of freshman on the campus this year, says Kristin Bruns, an associate professor and coordinator of the College Counseling and Student Affairs program at YSU: True freshman who are beginning their college careers and sophomores who are interacting with peers on campus potentially for the first time.

Last year, YSU students did not have regular access to the locations and activities that often foster friendships and connection organically, such as eating in dining halls and in-person events organized by student affairs offices. That shift, along with the overall stress of the pandemic, has affected student wellness across the board, most notably in the realms of mental health and social wellness, notes Bruns, a licensed professional clinical counselor (LPCC).

YSU’s student counseling center saw such an increase in demand for services last year that they contracted Bruns and Amy Williams, a colleague who is an LPCC and assistant professor in YSU’s Department of Psychological Sciences and Counseling, to counsel students in addition to their teaching duties.

When Bruns and Williams applied for and were awarded a federally funded COVID-19 relief grant this past summer to support students’ mental health as the YSU campus reopened in the fall of 2021, they knew the project should have a wellness focus. The result is a campus-wide program with dozens of initiatives focused on student wellness, including a depression screening event; sessions on conflict resolution, stress management and many other topics; and incentives for students to engage in wellness-focused activities.

The YSU Department of Campus Recreation was already using a wellness model with nine pillars (emotional, career, spiritual, physical, financial, aesthetic, environmental, social and intellectual) prior to the COVID-19 pandemic, so it was a natural fit to use that same model for the grant program, Bruns says. Each month has roughly 10 activities or initiatives focused on one of the wellness model’s pillars.

“From a college student development lens, we know that learning is not just academic learning,” Bruns says. “Students learn through being engaged on campus. The [grant program’s] focus is to get them engaged not just with wellness topics but [also] with peers.”

“Given that many things happened virtually for over a year and many are still happening in a virtual format, there have been challenges to get students reengaged on campus,” she continues. “Students talk about how difficult it is. They’re learning or relearning what opportunities exist for being engaged on campus. For those who have been online primarily at the end of the high school experience and then entrance to college, they may be learning how to make friends in this atmosphere. We have needed to equip them with skills on how to ask questions [and] how to approach a professor or a peer.”

Adding to this learning curve is the fact that some students are still struggling with the impacts of the COVID-19 pandemic, including increased anxiety, loss over last year’s missed experiences and financial worries, Bruns adds.

When planning the grant program, aptly named “Bouncing back from COVID-19,” Bruns and her cohort partnered with more than 20 different offices on the YSU campus to create and help promote wellness-focused activities. They are also making the program’s resources and materials available to YSU staff, and some professors have been incorporating lessons on topics such as resilience and stress management into classes.

Ten YSU counseling graduate students are involved and help run activities and information booths, such as a monthly table events with resources and giveaways.

Program organizers are intentional about distributing resources and information about how to find support, both on the YSU campus and in the local community, at each wellness activity, Bruns says. They also hosted a workshop for faculty at the start of the year on students’ needs in the midst of the pandemic, including a recommendation to check in with students regularly and information on how best respond to student concerns.

Campus-wide workshops for students have included sessions on making smart choices with substance use, organization and time management, mental health and mindfulness, and physical health, including the importance of hydration, sleep, healthy eating and physical activity.

Bruns, Williams and their cohort will report the full results of the grant program later in 2022, but so far, they’ve seen it boost student engagement and make campus reentry a little easier for all involved.

“Our wellness focus is trying to take away the stigma of [help seeking] and understand that an approach through a self-care and wellness lens can help better manage symptoms and mental health,” Bruns says. “We are engaging students by bringing the opportunities to them in a variety of ways (e.g., to the classroom, tabling in the student union, hosting small groups and campus-wide workshops). We wanted to make the materials and information accessible to the students and for them to have these types of conversations to see they aren’t alone in their wellness journey. We knew that it was a need.”

Find out more about the grant program at ysu.edu/bouncing-back.

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Look for an in-depth cover story on addressing client wellness in the January 2022 issue of Counseling Today.

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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.

Real talk

By Peter Allen December 13, 2021

I love doing couples work. It is endlessly fascinating, usually challenging and often rewarding. It is a privilege and a sacred responsibility to sit in a room with two people who are both bearing their souls to each other with the shared goal of improving their relationship. When I ask couples what their goals are early on in therapy, more often than not, they tell me they wish to communicate better.

At first glance, this seems like an easy task. Many couples who come to counseling have been experiencing a lot of conflict in the relationship, and their communication might typically include yelling, insults or perhaps passive-aggressive statements and various forms of manipulation. It is very tempting to think that if we can teach them to use “I” statements and a calmer tone of voice and to verbalize feelings and perceptions rather than insults, then loving harmony will follow. It is in fact so tempting to believe this that we may ignore much of what we know about human behavior and biology in the pursuit of facilitating these relational improvements.

It is also alluring to believe that helping people improve their communication is largely a data-driven endeavor. In other words, I have information (data) as a counselor that they don’t have, and if I simply impart this information to them, they will “learn” it, and then their relationships will improve. In reality, improving communication is much more process-oriented, which means that being effective involves observing conditions in real time and constantly responding to those dynamics.

I spent far too much time as a professional counselor simply trying to give people the right words to say, and I suspect that many of my colleagues have had a similar experience. But what I have found time and time again is that many of our clients show up to a session perfectly capable of communicating well (and here’s the catch) when they are calm. In my own practice, I have discovered that emotional regulation skills are absolutely integral to good communication. I can have the prettiest, most assertive words in the world for my partner, but if my lid is flipped and I am dysregulated, it will not matter at all.

It merits mentioning that certain qualities and attributes we may wish to develop as human beings really count only when something important is at stake. For example, let’s consider the quality of patience. It is very easy to be patient when we don’t have to wait or when we feel no stress or pressure to get something done. But patience means having the ability to wait with equanimity regardless of what other factors are present. Patience is the quality of not getting upset when you have to wait for something.

Another example is the quality of loyalty. It is the easiest thing in the world to be loyal when you don’t have to sacrifice anything. True loyalty can be known only when something of value is sacrificed to maintain that loyalty. If you want to know who your loyal friends are, become a social pariah and see who still comes to your birthday party. Spoiler alert: That number will be less than 100% of your total friend group.

Techniques must work in real conditions

We understand patience as waiting calmly, regardless of the other factors. We know loyalty to mean that one stands by their friends or co-workers, even when that standing comes at a personal cost, such as missed opportunities or alienation from others. And so shall we know and recognize good communication skills when they are used in moments of difficulty.

This is important to restate and remember: Anyone can communicate well when they are calm, stable, well-fed, comfortable, etc. However, when those conditions are present, we rarely need to practice good communication skills.

When I work with couples, it is not usually the case that both parties in the room feel completely calm or at ease during the session, because difficult and very personal subjects are routinely discussed. My clients live in the real world, and their relationships are with real, complicated, conflicted human beings. They have children, they have blended families, they have traumatic experiences and upsetting memories, and all of those elements can be front and center in a session. The most important time we need to communicate well is when we are unhappy or insecure or angry or tired because this is exactly when poor communication can create additional problems.

At first, couples will not remember to use “I” statements when they get triggered because using “I” statements requires the prefrontal cortex to be online and operational. If we teach people the right words but not the methods to access those words, then we are in effect placing positive communication habits in a museum, making them something to be observed and admired but not held and utilized. Weaving together the right words and the emotional regulation techniques that allow those words to be accessed is critical to helping couples actually implement positive communication tools in their daily lives — when it counts.

Practice, practice, practice

We also need to help our clients develop a consistent communication skills practice, regardless of variations in their moods and responsibilities. Think of it this way: If you want to get good at shooting free throws, you practice when you’re happy and when you’re sad and when you’re bored. You practice in the sunshine and in the rain. You shoot so many free throws that muscle memory develops and outside conditions no longer play much of a factor in how you set up and take the shot. You control what you can control, and you let go of what you cannot control. That is what makes a great free throw shooter. Becoming a skilled communicator is no different.

When we help our clients develop a practice of positive communication skills in any situation, they become good at positive communication in any situation. Weird, right? When couples are experiencing wonderful times together, we encourage them to share feelings and impressions. We prompt them to recognize and praise their partner’s efforts and to ask for what they need. Just as with any training, the best practice early on is done in low-pressure situations to build confidence.

Over time, people develop greater skills and habits, and the increased communication provides ongoing context for each partner to observe and consider. And, often, context is the great equalizer in couples therapy. When we know what our partner is experiencing, we are much more likely to consider it and respond compassionately than when we have no idea.

The more couples practice this in various mood states and settings, the more likely they will be to access these skills when they really need to, during times of great difficulty. We should also encourage them to share feelings, impressions and needs when they are bored, mildly annoyed or at their wits’ end because, well, that’s life sometimes too.

I share this at some point with almost every couple I work with: If you make your partner guess what you need, they will get it wrong. If you tell them what you need, they have the best chance of giving what you need to you. Help your clients develop the practice and habit of asking for what they need, when they need it. This aspect alone will reduce conflict noticeably because so much conflict is centered on partners attempting to ascertain the needs of the other and getting it wrong.

Conversely, in the absence of any specific dialogue about the needs of the other, it is easy to forget for short or long periods of time that our partner would need anything at all from us. But when our partner shares and we hear what they need, we can respond to that.

Building positive communication habits

There are many ways we can help people integrate these concepts and habits into their lives. Emotional regulation can be as simple as prompting someone to take a few deep breaths while they contemplate what they want to say or asking them to let the weight of their body acquiesce to gravity and simply relax down toward the earth.

I usually ask people to identify the emotion they are experiencing and see if they can rate its strength on a scale of 1 to 10. We can ask them if they feel any sensations in their body and any associated emotions or thoughts, bringing about mindfulness of their own state prior to communicating.

I am inviting them to tune in to their own experience and tell me what they are noticing in terms of any conditions that are present. Because if they are noticing things about how they are thinking and feeling, then we know that the prefrontal cortex is working. And all of this is about slowing down and creating some opportunity for self-reflection prior to dialogue. It’s not something we need to overthink; most people will have a sense of when they are functioning well and can communicate well and when they might not be, if we direct their attention toward these factors.

I love using normal cues in the day to prompt practice. Many people eat three meals a day, so they consistently have three natural stopping points in the day to practice some of the skills discussed above. I will say to a client, “How about during lunch today, you praise your spouse for supporting you?” or “Try asking for what you need at dinner tonight, even if it is something small.”

We could prompt the use of a specific skill at any natural point in a client’s day. And we can encourage clients to be transparent, even telling their partner that they are deliberately practicing skills and would appreciate their support with those efforts (very cleverly practicing two skills at once). Their partner sees them practicing and investing in better communication, and that can be contagious.

I encourage clients to communicate well when they can or to take some time apart and buy themselves some time when they can’t. I have never heard an emotionally regulated person call their partner a harsh name or deliberately insult them in session. I have heard plenty of dysregulated people do that.

At the macro level, we know American culture places a high value on fixing problems, but at the micro level, many of us are less adept at assessing when we lack the proper tools to fix any given problem. At the risk of using too many metaphors in one article, one should not attempt to climb a mountain on an empty stomach or without water. And couples should not attempt to problem-solve serious relationship issues when they are hungry, hurt, exhausted or otherwise low on personal resources.

When it comes to having conflict with a partner, a persistent myth exists that it is wise and desirable to “hang in there.” Let me state this unequivocally — it isn’t. It is far wiser to disengage, before additional damage is done, than it is to stay in the conversation when it is clear that neither person is giving any ground or understanding the other.

If my anger is an 8 on a scale of 1 to 10, that is not the best time for me to speak with you. If I want to perform reasonably well, I should probably get my anger down at least to a 4 or a 5 before I re-engage in a discussion. My task is to recognize that in myself ahead of time. Because I cannot wait until I have no feelings whatsoever to communicate, I am always trying to find that sweet spot when I am regulated enough to communicate well.

This is more important than any particular arrangement of words that we can teach our clients. Part of helping couples improve their communication skills is helping them pick their moments. Just as climbing a mountain should be attempted from a position of confidence and strength, so should problem-solving and conflict resolution flow from this position in couples work.

The important thing for us to keep in mind is that without emotional regulation and consistent practice, attempting to improve communication will be very difficult. Pretty words will not be enough.

Prostock-studio/Shutterstock.com

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Peter Allen is a licensed professional counselor and writer based in Redmond, Oregon. Contact him at peterallenlpc@gmail.com.

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, visit ct.counseling.org/feedback.

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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.