“We are all having a normal response to an abnormal critical event,” says Mark A. Stebnicki, author of Counseling Practice During Phases of a Pandemic Virus.
The COVID-19 pandemic has been a “soul wounding” event for many people, he notes. The stressors from the past two years, including loss of social connections and career opportunities, political divisiveness, the rapid spread of the virus, and loss of many lives, he argues, have created “a unique type of historical trauma.”
Stebnicki, a licensed clinical mental health counselor, certified rehabilitation counselor and professor emeritus at East Carolina University, draws upon his vast experience in the realm of disaster mental health to explore methods that counselors can use to support clients during this unprecedented time.
Q+A: Counseling Practice During Phases of a Pandemic Virus
Responses by author Mark A. Stebnicki
In the book, you talk about how Americans are facing both a pandemic virus and a mental health crisis. In your opinion, why are professional counselors well suited to respond and make a difference during this highly stressful and unprecedented situation?
Professional counselors are a vital resource to the COVID-19 generation, which has reached a mental health “tipping point.” This virus has killed more than 900,000 in the U.S. By comparison, the Spanish flu of 1918 killed approximately 675,000 Americans.
There are clinically significant mental health symptoms related to stress, traumatic stress, grief, loss, anxiety, depression, substance use disorders and other co-occurring conditions that are chronic and persistent. We have a viral contagion that has not only killed more persons than the Spanish flu but also critically strained our health care system and medical resources. We have a scarcity of goods, services and basic materials required for daily living.
Additionally, we are confronted with an irrational political ideology spreading disinformation that the 2020 election was stolen from the former president. There is a rise in white nationalism and hate crimes, such as seen in the killings of George Floyd, Ahmaud Arbery, Breonna Taylor and many other people of color. All these are critical incidents that impact our mental health and wellness. Thus, the COVID-19 pandemic has been a soul wounding experience for many.
Professional counselors are trained to provide therapeutic interventions to a variety of individuals and specialty areas. Medical and mental health care professionals now utilize telemedicine and telemental health technology to coordinate natural resources, supports and therapeutic opportunities with other allied health professionals to address the client’s medical, physical, psychosocial, mental, behavioral and career health.
The generations that emerge from this nuclear winter are planting seeds so we can have a bountiful harvest of coping and resiliency. The harvest will be cultivated in the fields of counseling and psychology so that we may rediscover the basic human instinct: how to survive and thrive simultaneously while in the face of adversity.
What would you want counselors to know about borrowing from and adapting disaster mental health response methods to support clients during the pandemic?
It helps by first acquiring the awareness, knowledge and skills to work with the unique characteristics of a multitude of natural (e.g., floods, hurricanes, tornadoes, earthquakes, wildfires) and person-made disasters (e.g., gun violence, physical violence, social and civil unrest). We begin by recognizing the unique medical, physical and mental health differences in a pandemic disaster, which is pervasive and permeates all life areas, [including] family life, career and educational opportunities, our social-emotional health, and … our mind, body, and spiritual consciousness.
Epidemiologists, virologists and other medical health care experts understand how to identify, assess and treat a viral contagion. I believe counseling and psychology are trying to understand how to do the same but may be too concentrated on the individual’s mental health symptoms. It is my opinion that we are all having a normal reaction to an abnormal critical event — a pandemic virus with over 900,000 souls that have perished. We need to clearly understand how the virus impacts all life areas (e.g., jobs, education, family, social, emotional and recreational life) and the unique losses and grief experienced by individuals, groups and cultures. Reviewing the literature in psychosocial aspects of chronic illness, disease and disability is a good place to begin.
There are some similarities in the assessment, diagnosis and treatment of the mental health and psychosocial symptoms related to a life-threatening illness and a pandemic virus because many of these conditions are a life-long challenge to individuals. Counseling Practice During Phases of a Pandemic Virus connects theoretical models that delineate the adjustment and adaptation phases of a pandemic virus. My work will assist readers to identify untreated, undertreated and unrecognized issues that precipitate fear, anxiety, mood dysregulation and irrational behaviors that may lead to the harm of self and others. The book offers an integrated psychosocial approach to identifying, recognizing, and intervening in critical life areas that have been imprinted on our mind, body and spirit.
The pandemic risk and resiliency continuum (PRRC) theoretical model [outlined in the book] also offers support to identify, prevent and prepare clients for the medical, physical, psychological, psychosocial and behavioral resiliency required to thrive under adverse conditions. The PRRC model has been reviewed and critiqued by a panel of eight experts in disaster mental health, epidemiology, medical and psychosocial aspects of chronic illness and disability, and behavioral health. Thus, the contributions of other researchers and practitioners are a foundation for this work.
What would you want counselors to know about helping clients adjust their coping mechanisms to deal with the different phases of the pandemic?
The most common and frequently reported psychological and behavioral issues reported by epidemiologists and public health experts during a pandemic virus relate to the individual’s fear, anxiety and behavioral health concerns. There are also the clinically significant mental health symptoms related to major depressive, anxiety, posttraumatic stress and substance use disorders, as well as suicidality reported within qualitative and quantitative studies.
When I discuss “phases of a pandemic virus,” I use the traditional public health model and generalize this for professional counselors. Natural disasters are typically organized in three phases: (a) disaster preparedness, (b) disaster response, and (c) post-disaster recovery. Unfortunately, there is no beginning, middle and end to a pandemic virus because many times they morph into another mutant variant which creates an endemic disease. So, post-disaster recovery looks much different than a North Carolina hurricane, Texas tornado or a California wildfire.
It is my opinion that we are challenged with a unique type of historical trauma because of the relentless spread of infection; mortality; loss of educational, career, and job opportunities; loss of financial resources; decreased interpersonal and intimate connections with friends and family members; political and social divisiveness; and many other life areas. These are soul wounding experiences for many, and therapeutic post-disaster recovery requires transcending the mind, body and spirit for optimal health in the “new normal.”
[In the book,] a conceptual model – the pandemic phase rehabilitation (PPR) – is offered to readers. This comprehensive model is applicable for practitioners and researchers providing guidelines in four phases (a) preintervention, (b) acute intervention, (c) post-acute intervention and (d) adjustment and adaptation. Consequently, the “new normal” requires some level of personal existential and spiritual growth as we adjust and adapt to an endemic virus.
In the book introduction, you argue that mental health professionals “should never again delay a disaster mental health response as we did during the summer and late fall of 2020.” How can counselors make a difference in this realm?
We cannot delay the mental health disaster response of a virus that has killed over 900,000 and infected over 63 million Americans. The human spirit and soul are at stake for professionals at the therapeutic epicenter of disaster relief.
The stench of death in hospitals, [in] tent cities and on the battlefield of a coronavirus pandemic reminds us of how fragile human life can be. Scientists have identified over 12,000 coronaviruses. Fortunately, most do not have the same transmissibility, infectious spread and mortality rates as COVID-19. Pandemic viruses have been with us since the beginning of time. They are naturally occurring events that have potential to be a public health crisis and morph into a natural disaster. In fact, diseases like rabies still exist today despite Louis Pasteur’s development of a successful vaccine in 1885. The tetanus vaccine was developed in 1927, yet we still have this shot available today to reduce infection. Measles, mumps and rubella are diseases with no treatment or cure, yet in 1971 shots were widely distributed for children. Hepatitis A and B all have potential to be a public health crisis in certain occupational settings.
Using the epidemiological example of the H1N1 flu virus, which has no cure, the best-case scenario is that COVID-19 and its mutant variants will someday be classified as an “endemic disease.” Counseling Practice During Phases of a Pandemic Virus addresses multiple areas of concern for the early identification, prevention and preparation for the next disaster.
What prompted you to write this book?
Jerry Corey [professor emeritus of human services and counseling at California State University at Fullerton and ACA fellow] states that most individuals “have a book within them” to write. The book within me, Counseling Practice During Phases of a Pandemic Virus, my 10th professional work, was influenced by my personal and professional experiences. I have been a mental health and rehabilitation counselor, counselor educator and researcher for more than 30 years. My research and clinical practice have focused on working with persons with chronic illnesses and disabilities, stress, traumatic stress and disaster mental health response in a variety of settings. My work has guided me to work with active-duty service members, veterans, veterans with disabilities and military families.
So, these are the things I have written about, professionally, since around 1993 and have not stopped. My interest in writing has most often been motivated by communities where I lived and worked and [that] have been at the epicenter of natural and person-made disasters: school shootings, workplace violence, hurricanes, floods, tornadoes and earthquakes. So, I placed the old disaster mental health hymnal on my bookshelf and decided to write a new anthem describing the medical, physical, behavioral and mental health characteristics of this new disaster, a pandemic virus that is relentless [and] never sleeps or takes a day off.
Epidemiologists and public health experts have been researching pandemic viruses for decades. However, there has been very little written in counseling and psychology to guide our profession in addressing the unique medical, physical, behavioral and mental health opportunities to thrive, not just survive, during a pandemic virus.
Thus, as a writer, I reviewed the current literature in mental health disaster response, applied my experiences in the field and then offered guidelines and models to provide a unique perspective concerning mental health characteristics of this new natural disaster. My primary intent is to offer recommendations for the preparation, prevention, [and] psychosocial and mental health treatment of individuals living through phases of a pandemic virus.
It’s been roughly six months since the book was published and conditions regarding the coronavirus continue to evolve and change. Is there anything you’d like to add or emphasize for readers since publication?
Since the beginning of the pandemic, there was a familiar phrase echoed by politicians and other public figures that “we are all in this together.” To the contrary, we are not “all in this together.” This statement implies that we all enjoy the same benefits and privileges in terms of socioeconomic status, access to quality health care, jobs [and] civil rights as well as adequate support systems and basic resources.
Many Americans still do not recognize and acknowledge the seriousness and lethality of the COVID-19 pandemic based on their questioning [of] the use of vaccines, mask-wearing, social/physical distancing and other virus hygiene protocols. I would like to offer a reframe [of that phrase]: “We are all our own best support system.” It is only when we can come together in the present moment that good things will unite our communities and regions.
The adaptation and adjustment (AA) theoretical model I propose [in the book] may assist practitioners in the identification, early intervention and triage, prevention, and preparation for therapeutic interventions during a pandemic virus. The stages of the AA model include [the] first wave of [the] pandemic virus, initial impact, fear and anxiety, denial, depression, anger and hostility, acknowledgment of the pandemic, [and] adjustment and integration.
Pandemic viruses are multidimensional in nature. They are not only biological entities; rather, the side effects of a viral contagion carry multiple medical, physical, psychological, social, emotional and occupational consequences. So, it is essential that we take a multidisciplinary approach in applied research to predict, anticipate and prepare for the next wave of a viral contagion.
Counseling Practice During Phases of a Pandemic Virus was published by the American Counseling Association in 2021. It is available both in print and as an e-book at counseling.org/store or by calling 800-298-2276.
Watch ACA President S. Kent Butler’s conversation with Mark A. Stebnicki in a recent episode of the “Voice of Counseling” video podcast: youtu.be/eyrgUj_R0bc
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.