Monthly Archives: February 2023

Mental health care stigma in Black communities

Compiled by Samantha Cooper February 28, 2023

Black community, African people gathered together, a set of male and female characters wearing casual clothes and different hairstyles

Nadia Snopek/Shutterstock.com

Recent studies by the Anxiety & Depression Association of North America have shown that Black people are 20% more likely to experience significant mental health problems than the rest of the population yet only about a quarter of them seek mental health care, compared to about 40% of white Americans.

Counseling Today asked three mental health professionals who are working to improve Black mental health about the mental health challenges and barriers many Black people face. Cheryl Maxwell is the program manager for the Black Mental Health Alliance located in Baltimore and a certified alcohol and drug counselor in Maryland. Malton Cook Jr. is a licensed professional counselor supervisor in Texas who specializes in person-centered and solution-focused approaches. And Jardin Dogan-Dixon is a licensed counseling psychologist with the federal government and owner of @blkfolxtherapy on Instagram.

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Why is there a stigma against seeking mental health care in Black communities?

Cheryl Maxwell: Suspicion continues to be an issue due to negative experiences, past and present, that have impacted these communities.

Malton Cook: A lot of times, there are myths about mental health in terms of “crazy” people, so a lot of times people steer clear of counseling because of the negative stigma that’s associated with it. … I think part of it is we’re often taught to “suck it up” and be strong and not allow other people see us break. … These things are passed down from one generation to the next.

Jardin Dogan-Dixon: Some folks will say, ‘I don’t want to see a doctor and that includes a mental health doctor.’ There’s a lot of stigma we’re fighting against and a lot of mistrust we have to work through. [Black individuals] make up only about 2% of the entire population [of psychologists]. … So a lot of [Black clients] don’t see themselves in the providers they hope to work with. And we know that’s a deterrent because a lot of research suggests individuals sometimes need that familiarity; they need someone who can kind of do a referral process. A lot of Black individuals rely on word-of-mouth for health care services in the medical system, but if you don’t have individuals to see [who look like you] in the community, … then it’s really hard to bridge the mental health treatment gap.

What are the biggest mental health challenges facing Black communities?

CM: The lack of qualified Black, African American and persons of color who are certified or licensed mental health professionals.

MC: The access to or the lack of knowledge [about mental health resources]. The negatives stigmas that are still existing. … Individuals may also think there’s a lack of representation within the mental health field.

JDD: As far as therapists and psychologists go, we don’t get necessarily trained a lot to work with Black individuals. The norms in our training programs are definitely whitewashed and that doesn’t leave a lot of room to focus on the cultural nuances that may show up in therapy. I work with Black clients and their [depression] symptoms may look different but that doesn’t mean they’re not experiencing depression. It just shows up differently based on social norms, history and language barriers.

We’ll also say therapy is somewhat of a white people thing because it’s not a norm in our culture. We’ll say, “I don’t want to tell somebody my business.” [But] if family members and other people in your extended network are struggling and you’re also struggling, how are you going to help each other? For some folks, they have learned to follow a code of silence of “what happens in our house stays in our house” because we face so many unforgiving stereotypes and misconceptions in larger society about who we are and our different cultural norms. But how unfortunate would it be for you to miss out on your healing because you don’t want others to know that you’re struggling? The “strong Black woman” and the John Henryism tropes don’t always benefit us when it comes to taking care of our mental health. We feel as though we have to do it alone because we can. But our hyper-independence can really harm us in the long term. We were meant to be interdependent.

How can people help reduce the stigma around mental health within Black communities?

MC: Educating yourself, doing your own research, doing a lot of reading and being willing to ask questions. Essentially going into [therapy] with an open mind and heart and being willing to actually listen and receive information.

JDD: When I speak with my clients, I talk about how they are the experts of themselves, and I’m here to help guide them. And sometimes this could look like them understanding their baseline, which is the day-to-day functioning or their “normal” per se, and when they deviate from that baseline. You have to hone self-awareness to recognize when you’re not able to manage your stress like you used to with old coping strategies, [when] your thoughts are more ruminative and self-defeating, and/or if you’re more sad, irritable, or lonely, and ultimately be willing to ask for help.

What can individuals in Black communities find out more about counseling and how to access the care they need?

CM: Through their primary care physician, church leadership, area colleges or universities.

MC: Just know that counseling is different for everyone, … so keep trying, keep looking, keep connecting until you find one [a counselor] who best fits you. It’s like dating at times.

Also, don’t approach counseling with the mindset that “I’m going to go in and they’re going to ‘fix me.’” I think people think that oftentimes we [as counselors] just wave a magic wand and everything will kind of be OK. I definitely would encourage patients in terms of working with a therapist that … it takes time to build trust.

People need to be open-minded and be OK with asking questions. … And do your own research.

JDD: I think if we are able to acknowledge that Black people experience stress and trauma at disproportionate levels compared to other racial and ethnic groups because of racism, oppression and most recently the COVID-19 pandemic, then it would also help Black folks feel like they’re not alone or “crazy” for seeking help. You may be going through a lot and therapists can validate that and help build coping skills to manage the stress and heal the trauma.

Give [therapy] three sessions: The first one is the hook; the second one gets you into the groove; and the third session you think, “Maybe I can do this.” … I tell folks to give it a chance; if [the counselor] doesn’t mesh, find another one. Don’t give up!

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Here are some resources focused on Black mental health and bringing healing to Black communities:

Black Mental Health Alliance and its database of Black mental health care providers
Therapy for Black Girls
Therapy for Black Men
The Loveland Foundation (This foundation provides vouchers to cover the cost of counseling for Black individuals, particularly women and girls. Applicants must fill out a form and be approved to receive up to 12 vouchers for counseling sessions)
African American Mental Health Providers
Black Mental Health podcast
Therapy for Black Girls podcast
American Counseling Association’s resource page on BIPOC mental health and racial trauma and healing
National Alliance on Mental Illness’s and the Mental Health America’s articles about Black and African American communities and mental health
Follow Dogan-Dixon on Instagram @blkfolxtherapy

Related reading in Counseling Today:

Samantha Cooper is a staff writer for Counseling Today. Contact her at scooper@counseling.org.

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

The loss of our ‘humanness’

By Suzanne A. Whitehead February 24, 2023

DC Studio/Shutterstock.com

Recently, I needed to undergo some medical tests in a hospital-based clinic. I arrived a few minutes early and was eventually called inside for my tests, which required four separate parts. Immediately, as I put the swaying, open-backed gown on, I began to feel my humanity slowly slipping away. I now looked like all the other patients in similar attire, and I felt the loss of myself as a human being. I started to feel like an “it” to be worked on. I had felt this way previously for other exams and tests — this was just a “refresher.”

I was prepped, injected and told to wait again; my questions went unanswered. Inside myself, I could feel my anxiety starting to well up and get the best of me. I was finally led to another room and told to lie on a table. The table was cold and uncomfortable and hurt my back, and the feeling of somehow being an “it” to be worked on, not a human being any longer, returned. I was told to raise my arms over my head, and the technician quickly left the room.

The overhanging equipment suddenly whirred noisily and began getting closer and closer to my chest and head, increasing my uneasiness. The machine rotated a bit overhead; I couldn’t see around it at all. I suddenly felt claustrophobic and a bit panicky, and finally called out for the technician after several minutes. He answered from an adjoining room and asked what was wrong.

I said I was feeling a bit anxious, asked what this test was for and asked how long it would last. He answered bluntly, “It’s for the tests you’re having.” He then aimed a fan at my head to help “with people like me,” he stated. I immediately felt demoralized again and was told it would be another five minutes under the whirring machine.

I was finally released from the “jaws” of the overhead machine. As I started to rise, I felt dizzy at first, perhaps because I had my arms stretched over my head for several minutes. I was escorted out of the room and sent back to the waiting room, again, alone with my thoughts. (It’s been my experience that human beings do not like a void of information. We try to obtain it the best way we can, and when that fails, we begin to make assumptions, which are often inaccurate. It’s simply what people do and is part of the human condition — if only the medical profession acknowledged that.)

There sat the others, all waiting for their time under the machine. I didn’t dare tell them not to worry, our eyes never meeting. Internally, I felt scared about what the tests could reveal and what else was in store. The same concern seemed etched on the faces of those in that waiting room. I wondered, “What if someone had just taken the time to explain what was happening to us and what we were about to experience?”

Taking time to connect

As I sat there worrying, waiting for my next exam, I began to wonder, “As counselors, do we take time during the essential beginning session to discuss with our clients what counseling is really all about?” Often, clients don’t know what to expect from counseling. Ours is a relatively new profession, and many clients, for example, did not even have counselors in their schools when they were growing up. Or the counselor role was so diminished, they rarely met them in person. Moreover, many schools did not even employ counselors until recently. Are we selling our clients short by taking it for granted that they simply intuitively know what to expect?

My diagnostic testing felt demeaning. With no sense of control, I felt a bit overwhelmed. In the end, I just wanted it all to be over. So, I sullenly complied with every command, didn’t ask more questions and couldn’t wait to leave. The experience — which was more psychologically than physically painful — left me with a bitter taste in my mouth, and I never wanted to return.

The parallels with counseling jumped out at me. Do our clients feel the same sometimes? Is that why many don’t want to return? For instance, according to Joshua Swift and Roger Greenberg, in a meta-analysis published in 2012 in the Journal of Consulting and Clinical Psychology, 1 in 5 clients end psychotherapy prematurely. As counselors, do we spend the necessary time to understand the culture and concerns of our clients, as well as address their fears?

Those special medical technicians who do take the time to develop a human connection first make all the difference in one’s experience. Can we say the same for ourselves as counselors? As human beings, we all crave human connection; it is the very heart of counseling. For the sake of time, are we rushing through this vital aspect of the process?

How we treat our clients

I am reminded of the many times I got extremely busy as an agency clinician and, later, as a school counselor in my own career. I would see the long line waiting at the door of our school counseling offices or sigh a bit when one of my clients finally disclosed that huge revelation they’ve been holding back the last six sessions, with five minutes left in our meeting. My heart would sink as I realized I couldn’t go over the session time because my next client was waiting. During those times, I remembered that as counselors, we are instructed not to get “too close” to our clients for fear of losing our objectivity.

Although being objective is vital to the counseling relationship and the client’s well-being, does it also mean that we must sacrifice their humanity? Sadly, I have worked with some physicians, nurses and respiratory therapists (one of my former professions) who have become cold, distant and indifferent to their patients. They have absorbed the “lesson” about not getting too close to their patients all too well and have become detached when their patients don’t respond well to their interventions or ultimately die. It allows them to not “feel” and to go on with their “routine” activities as if they were working on “machines.” Their patients know, though, and are left feeling demoralized, defeated and not heard — just like I was during my exams.

The ability to have empathy is the cornerstone of being a counselor and a counselor educator. Without this ability, we are doing our clients and students a disservice and, possibly, irreparable harm. To a degree, the ability to have empathy for the “least deserving” of our clients (e.g., individuals who have committed murder, rape or child abuse) is what sets us apart from those who are not counselors by trade. If we reject our clients for the behaviors they have committed, then we too have lost our sense of humanity for them and will judge them, harshly, just as society has.

As counselors, we never have to condone or agree with a behavior that a client has done, but we do have to see them as a human being, deserving of our care, and believe in their willingness and abilities to want to change. If we also reject these clients for the behaviors they have committed, then we have endorsed their beliefs of self-loathing and pity. We reinforce their negative self-beliefs that they are unable to ever heal and that they are undeserving of comfort, compassion and understanding. Arguably, we doom them to repeat their behaviors by our rejection, disdain and judgment. If we don’t believe in this fundamental aspect of counseling — that all persons can change and deserve our respect — then, sadly, it may be time for us to find a new career.

Finding our own balance

Not getting “too close” to our patients or clients is a self-protection mechanism. It is fundamentally a correct premise, but humanely flawed. Finding a balance between objectivity and empathy is the key. Whether we are treating patients or clients, the same premise applies. It is essential to their well-being and, I posit, to yours as well that you find your balance and always reevaluate and assess it. If you feel yourself becoming resentful toward some of your clients, or feel too rushed with them, or feel that you are becoming too preoccupied with the time spent on them, challenge yourself to be proactive to take the internal steps to work on this.

If the system needs changing, find the courage to be the voice for your clients. If working with clients in a group setting makes more sense, initiate that adjustment. If challenging the status quo requires speaking up, do so for the sake of your clients. Remember the basic tenets of your code of ethics — to always advocate for social justice, equity and cultural competence. If you need more training, obtain it. If you need more supervision, don’t be afraid to ask for it. Not only will you be following the ethical principles of self-care and wellness, but your clients will benefit from your self-investment tenfold.

If any of this resonates with you as a clinician, that is a healthy response. Human beings were not designed to be “garbage bags,” to continually just stuff our feelings until we are about to explode. If we do so outwardly, we are accused of just being too angry and emotional; when the implosion is internal, it can lead to deep and unresolved depression. No one wants to feel like they are not being listened to, are not being heard and are simply “taking up another’s time.”

If you can relate to having felt this way during a medical exam or trip to your doctor, then you can relate to what it may feel like being a client and being afraid no one will understand you. Some clients can get past some rudeness or hurriedness of staff, but they won’t do so with you as their counselor. The adage that a person may not remember everything that you say but will definitely remember how you made them feel is so true.

When we are treated as less than human, we lose our humanity. For those who do it to us, unconsciously or not, they do too. Our treatment of each other becomes rote, mechanical and unattached. The preambles to the ethics codes for both the American Counseling Association and the American School Counseling Association share the principles of autonomy, beneficence and nonmaleficence; these are essential tenets to practice our counseling craft and to live by. A basic premise of counseling is to form a therapeutic relationship of trust. It is incumbent upon all of us as counselors and human beings to always remember to do just that.

Best wishes to each of you.

Suzanne A. Whitehead is an associate professor and the program coordinator of the counselor education program at California State University, Stanislaus. She is a licensed mental health counselor, a retired school counselor and a licensed addiction counselor. Contact her at swhitehead1@csustan.edu.

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

Helping youth in foster care cope with grief and abandonment

By Lisa R. Rhodes February 23, 2023

A teenager with a sad face sits on the grass and dreams of a better life in the sunset

Marian Fil/Shutterstock.com

Youth who are aging out of the foster care system frequently wrestle with feelings of grief and abandonment. Counselors who have studied the research literature or have treated this population for many years say the losses experienced by youths during the aging-out process can have a lasting impact on these clients.

“There are relationships that foster youth have with individuals in the system that are discontinued upon aging out. This can be a significant loss that needs to be grieved,” says Brian Russ, a licensed mental health counselor and an assistant professor in the Department of Counseling at Xavier University in Cincinnati. “Along with the loss of their childhood, these older adolescents and young adults can also feel a loss of hope for ever being adopted,” he explains.

Amy Watson, a licensed professional counselor supervisor in Dallas who has more than 20 years’ experience counseling children and youths in foster care, says these clients grieve what their lives might have been like if they never entered the system. However, these youths seldom reveal anything about what they have lost or experienced during their time in foster homes, she adds.

“These clients are definitely traumatized and go into fight, flight, freeze and fawn mode when triggered, which helps [to] temporarily protect them from further losses,” Watson says. “In counseling, we work on ways to manage triggers, process negative feelings and increase coping skills so they can get better at opening themselves up in future relationships.”

Providing unconditional positive regard

Russ, who has worked as a home-based clinician, outpatient coordinator and clinical director at Newaygo County Mental Health in White Cloud, Michigan, suggests that clinicians approach grief with this population by using person-centered therapy techniques.

“There are a lot of complex emotions that need to be processed, and a person-centered counselor can help by offering a safe, therapeutic environment that facilitates the core conditions of unconditional positive regard, empathy and genuineness,” he says. “In this environment, the client can process their emotions without feeling judged, which is necessary for the grieving process.”

Russ offers the following guiding thoughts that can help counselors when working with grief from a person-centered approach:

Detect and reflect. Grief often manifests outside of our awareness; therefore, it is important for counselors to detect the grieving process when it is less explicit. After identifying grief, counselors using the person-centered approach should reflect this to the client to help build awareness and establish an empathic understanding. For example, a counselor could say, “I sense a deep feeling of sadness inside of you. Could this be grief from your loss?”
Offer a safe space and go at the client’s pace. The counseling environment should be rooted in unconditional positive regard. The client should feel safe to express what they are feeling, and because the grieving process can be unique to each individual, the client should move at their own pace. In session, a counselor could tell the client, “I want you to feel like you can work through this grief in whatever manner you feel would be helpful and at whatever pace you feel comfortable. I want this to be a safe space to do this work.”
Help clients make meaning and express their feelings. The counselor’s role is to help clients discover their own meaning about what they are grieving. Clients should have the opportunity to express their feelings in their own way. Clients can have a cathartic experience by expressing their feelings in the therapeutic environment. To facilitate this, counselors could say, “I am curious about what this grief means to you. Do you have any thoughts?” or “Have you found ways of expressing your emotions in the past that have been helpful to you? I am wondering if that would be helpful to you in our session.”
Provide support until the end and don’t be afraid to start the process again. Allowing clients to work toward their own understanding and conclusion regarding their grief is at the heart of the person-centered approach. Clients may want to work toward accepting the loss or saying goodbye. Conversely, they may want to find a way for whatever they have lost to stay with them forever in some form. To help clients work toward their own conclusions, counselors could ask, “How do you feel about where you are at in regard to processing your grief?” or “Is there more work to be done?”

“Our job as counselors is to help the client find this conclusion, and I say ‘conclusion’ with the idea that grief may or may not have an end,” Russ observes. “Some grief lasts forever, and some grief may be cyclical. Either way, we support the client throughout the process.”

Russ says feelings of abandonment often go hand in hand with grief. “There is a loss with both phenomena, but abandonment may connect stronger to feelings of worthlessness,” he says. Allowing clients to “experience unconditional positive regard can help with worthlessness.”

Processing past emotions

Clinicians who work with youth who are aging out of the foster care system can help them to peel away the emotional defenses they have developed to protect themselves from hurtful people and situations. Watson says clinicians can use a cognitive behavioral approach to reframe clients’ thoughts by asking open-ended, empathic questions to start the process. For example, counselors might say:

Tell me about your losses and how you have coped with them.
What would you tell a young person entering foster care about losing siblings and family?
How has loss helped you to develop as a person?

“My clients have a hard time sharing about grief and sadness because they don’t feel safe and have a hard time being vulnerable,” Watson notes. “Once they build trust, they open up more and know I am safe for them. When youth[s] move around a lot, they lack consistency in relationships. Relationships are where youth[s] heal.”

Helping clients work through feelings of abandonment also better prepares them to form positive relationships in their present and future.

“Every person has a right to happy and healthy relationships with boundaries,” says Watson, a board member at WAY Alliance, a North Texas nonprofit dedicated to helping foster care youth transition to independence by providing mentors. “We live in a social world. … If youth do not work through abandonment, they will not have the skills or confidence to be open to relationships and roles throughout life.”

Watson used a trauma-focused cognitive behavioral approach when working with a 17-year-old young woman in foster care whose breakup with a boyfriend triggered feelings of abandonment from her past. The client had been in foster care for about three years, but child protective services had been involved in her life since early childhood when she was removed from her home of origin. She was then placed with an aunt until she was sexually abused by a relative while she was in her aunt’s care.

When Watson began working with the client, she was living in a group home that provided transitional living services. The client, who had also been sex trafficked, had feelings of low self-esteem and was desperate for the approval of men, which Watson describes as a consequence of her trauma.

“The past relationship with her boyfriend was age appropriate (unlike her past encounters with men) and had the boundaries of a normal consensual relationship. The client was especially disappointed because she finally had the experience of dating like the average teenager and felt it was safe,” Watson recalls.

In session, the client expressed negative statements such as “I’ll never have another boyfriend”; “I trusted him. I loved him. I thought he was different”; and “People don’t want me.” To help the client process her feelings of abandonment, Watson asked the young woman several self-reflective questions:

“How does the end of this relationship impact your self-image?”
“Can you see this breakup as part of normal dating rather than the belief that everyone is compatible?”
“How do you feel about the breakup now that some time has passed?”
“What would you tell someone going through a similar dating experience?”
“How does it feel to realize that your family was not there for you and did not protect you?”
“What has helped you cope with being on your own?”

With Watson’s help, the client began to view the breakup as an experience for personal growth rather than one of ruin and rejection.

“We discussed how she could take this time to focus on herself” and move forward, Watson says. The client noted in session that she wanted to grieve only for a week and then “be over it.”

Watson helped the client focus on her schoolwork, which she had been neglecting, and look for a job. They also discussed how she could put her energy into building other relationships — by talking to a staff person she was close to at the group home, for example.

Eventually, the client’s statements began to reflect a new sense of personal power, Watson says. She was now saying, “I know I need to be strong,” “I realize I need to get over this,” “I can’t let it stop me” and “I can’t let it keep me down.”

In a later session, the client “was also able to connect how abusive her trafficker was when she once thought he loved her and protected her and could now see she was a victim,” Watson says.

“This is a big step in healing,” she notes. “That’s all trauma processing. … The goal was for [the client] to find a way to build herself back up.”

Working on self-worth is vital for these youths whether they are recovering from grief, abandonment, or both. “Counselors can help youth with this by assisting them to discover their strengths and giving them opportunities to build self-esteem and self-worth by doing new things, taking risks and gaining confidence,” Watson says.

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Learn more on this topic in the feature article “Counseling youth aging out of foster care” in the February issue of Counseling Today and in the online exclusive “Is Medicaid properly serving youth in foster care?”

Lisa R. Rhodes is a senior writer for Counseling Today. Contact her at lrhodes@counseling.org.

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

Voice of Experience: Social media and mental health

By Gregory K. Moffatt February 21, 2023

person sitting in front of a laptop with negative social media icons coming out of the screen indicating cyberbullying

Image by Htc Erl from Pixabay

Earlier this month, viewers across the country were stunned by a video showing the assault of 14-year-old Adriana Kuch in the hallway of her New Jersey high school and to learn that she took her own life the next evening. The cruel attack on the young woman by her high school peers was broadly shared on social media. Adriana’s father said the pain his daughter felt in being attacked paled in comparison to the humiliation she experienced online.

Bullying has always been a problem. I was bullied off and on through many of my years as a student. It was frightening and temporarily humiliating. But bullying has evolved with the advent of social media. Three major changes have escalated the impact of bullying.

The first major change involves increased exposure to embarrassment and humiliation. In 1968, the first year a bully picked on me at school, most of what he did to me was either just between us or witnessed only by a handful of people. Once it was over, it was over. I don’t remember ever carrying my humiliation into the next day, and each incident was known only by those who had witnessed it or those who heard about it during its short-lived “news” cycle.

Today, seemingly everyone has a device to document events, to share events and to view/experience these events as often as desired. That allows not only the “news” cycle to remain alive but for the entire world to witness one’s abasement. I can’t imagine the weight of that kind of ongoing embarrassment.

Recently, an Arizona man ran naked across the green at a Phoenix golf tournament. In one video, I saw hundreds of golf fans in the stands on their feet, nearly all of them with their phones in the air, capturing the event. This is our world.

Second, cyberbullying can take place no matter where the child is. When I was bullied, it was almost exclusively at school. Otherwise, bullies had no access to me or I had options for avoiding them. Today, a child can effectively be bullied while alone in the middle of a desert.

Finally, online bullying doesn’t require the bully to face the consequence of the mean thing said. I wrote a newspaper column for 30 years. Comments about my column were often kind and thoughtful, but people — many hiding behind the anonymity of screen names — said some of the meanest things on occasion. I couldn’t imagine anyone saying in person some of what they said online. In person, the speaker would have to defend themself and see the effects of their hurtful words firsthand.

Social media has allowed thoughtless people to quickly find one another. One mean comment or post can seemingly serve as a ready-made invitation for other equally thoughtless people to add mean posts of their own.

Online, a thoughtless or cruel post requires absolutely no thought and no exposure to the pain being caused. I would like to think that the bullies in the Adriana Kuch case felt remorse for their behavior following her suicide, but if she had not done that, they would never have known the tears she shed and the pain she bore in the privacy of her personal life.

A 2021 study by the Centers for Disease Control and Prevention (CDC) discovered that 30% of the teenage girls surveyed had considered suicide — a rate twice as high as among boys. That number was 50% for girls in the LGBTQ+ population. The study proposed that these rates were rising prior to the COVID-19 pandemic but that the isolation of the pandemic accentuated them.

Even before the pandemic, teens spent much of their time staring at their phones. For some teens during the pandemic, their devices were the only link they had to their social worlds. Like it or not, young people live much of their lives in a digital world. Bullying through text, video, Snapchat, Instagram or any of the other social media options is easy and quick — and the one doing the posting doesn’t have to face the hurt they are causing. What’s more, those hurtful words or images can be viewed over and over, not only by the rest of the world, but by the victim, leaving teens such Adriana feeling isolated, humiliated and hopeless.

These issues are not exclusive to teens, but the CDC study should ensure that those of us in the mental health community are alert to these frightening statistics for the teen female and LGBTQ+ populations in particular.

I encourage my clinicians and supervisees who work with these populations to include suicidal ideation as well as an overview of a client’s social media footprint in the intake process — something that was not even an issue 40 years ago when I started my practice.

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

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

The benefits of a multisensory experience in therapy

By Ashley Heintzelman February 14, 2023

a child points to drawings of shapes on a whiteboard and a woman sits in the chair watching the child

Studio Romantic/Shutterstock.com

Since the beginning of the pandemic, I have been providing and receiving in-person and virtual therapy. Initially, my own therapy was 70% virtual and 30% in person, and my client schedule averaged about 60% in person and 40% virtual. Being on both sides of the couch gave me a unique perspective to consider the advantages and limitations of virtual therapy.

I have always viewed my own therapy process as staying active at the “mental gym” to help me cope with anxiety and for self-care. My anxiety symptoms manifest with challenges regarding perfectionism and being cognitively inflexible during times of change. Unsurprisingly, the COVID-19 pandemic triggered my anxiety.

Although it was not an initial goal of my own therapy, I relearned something I had known about myself and human nature: our need to use all our senses and connect the mind with the body. Throughout this process, I discovered that in-person therapy best meets my needs (and most likely my clients’ needs) because virtual therapy often lacks a multisensory experience.

Finding the right fit

I have attended therapy throughout my professional life, but moving to a new home, raising children and other life challenges have led to periods without therapy. When the pandemic began, I was not currently engaged in counseling, but I recognized the added stress of these circumstances for everyone, including me, made this a good time to continue therapy again.

I had several goals this time. First, I wanted to process coping with the same issues many others faced as the pandemic progressed (e.g., school closings, vaccination decisions). Second, I explored how the pandemic affected me professionally as a therapist. Clients typically do not know much about the lives of their therapists unless mental health professionals choose to self-disclose. The idea that the pandemic and telehealth might lead to added exposure of my personal life to clients triggered a fear of loss of competently managing the potential changes in the therapeutic relationship. I wanted to ensure I found a good balance of self-disclosure for my clients.

When I decided to reenter therapy in 2020, I found a counselor who offered only virtual appointments. Telehealth was more accessible for me with my responsibilities at the time, and it also made sense given the uncertainties of life and the shifting work schedules during the pandemic. I was lucky to find Sophia (pseudonym). She was a good fit for me. She is soft-spoken, nonjudgmental, gently challenging and intelligent. She conveyed support and understanding and shared additional perspectives. Sophia appropriately self-disclosed about her experiences as a clinician and working parent of young children during the pandemic. I felt she understood my anxieties. Her compassion and shared experiences helped normalize and diffuse my fears. And she helped me set realistic expectations of myself.

Even though I was making good progress with Sophia and most of my own work as a therapist was virtual, I felt something was missing from my virtual sessions with her. I just couldn’t put my finger on it yet. It wasn’t until I experienced multisensory engagement in therapy again that I realized that was what was missing.

A multisensory experience

In the spring of 2021, I decided to transition to a new counselor — one I could meet in person. A good friend and colleague recommended I see Lily (pseudonym), a therapist my friend thought would be a good fit for me. When I started with Lily, I felt immediate comfort and ease with her.

During my third session, we explored whether I needed a shift in work-life balance and discussed the potential barriers that made that change difficult. Lily responded saying, “I need to draw this out.” She then drew a model concept of what we discussed regarding my shame, anxiety and boundaries on a whiteboard. We were in sync concerning the model; it made sense to me.

The model created one of those powerful moments in therapy where I felt understood and validated. The use of the whiteboard also highlighted the multisensory experience that I felt was missing during my virtual sessions with Sophia. I could now better articulate how I felt after seeing what she was saying drawn out. The model also contained the trigger point where my anxiety would begin to ramp up, so it allowed me to gain a new coping strategy that I could use moving forward when I felt anxious because I could better understand what started an irrational thought loop. The visual display of my feelings and fears helped me gain a new perspective about my emotions. After Lily finished the whiteboard model, I took a picture of her drawing using my cell phone, which allowed me to view it whenever I felt overwhelmed.

Lily continues to use the whiteboard in session with me, and every time, I process even more sensory details from the experience. I have noticed, for example, that Lily is left-handed, and the slant of her wrist reminds me of my left-handed daughter. I have often watched her dangly earrings bounce while her arm moves when writing, and I have observed how her nail colors change with the seasons.

Being in person also engages my senses in other ways. I sometimes contemplate the exact shade of the moody dark gray paint in her office. I have noticed how the office smells of mint and vanilla, and I wonder if the scent is the remains of essential oils or a candle. I hear the hum of the white noise machine in the hall. Lily’s calming energy permeates the room — a full in-person experience matters in many ways. And I feel safe on her couch, sitting next to a soft blanket in her warm office.

The exposure of all my senses to the surroundings helps me stay grounded during our sessions. The multisensory engagement creates a calming effect on my whole body — one I could not have experienced remotely from a screen. In addition, the surroundings and in-person contact enhance my ability to fully take in Lily’s feedback. Although a multisensory experience is not necessary for change, this experience with Lily reminded me of what I often miss when doing virtual therapy: the benefit of engaging the mind and body.

My knowledge and experiences are consistent with research on the science of calm approach to emotional well-being and the neuroscience of learning, which emphasizes that we learn best when multiple senses are stimulated. For example, Dr. Daniel Siegel, a prominent mindfulness researcher, explored learning to focus and become more aware via practices using our five senses and feeling of connection to other people in his 2020 book Aware: The Science and Practice of Presence — The Groundbreaking Mediation Practice. Dr. Siegel found that sensory experiences and feelings of connection to others promote the growth of neural connections, leading to less stress and anxiety. Thus, the lack of a three-dimensional experience that activates all the senses and helps to stimulate novel ideas could hold clients back from powerful and lasting breakthroughs.

The whiteboard exercise that Lily used during our session symbolizes the strength of the therapeutic alliance. It instantly reminded me of my vulnerability as well as Lily’s unconditional positive regard and brilliant conceptualizing skills. And the experience also helped me learn a new cognitive and emotional framework for coping. This opportunity was therapy at its finest.

Incorporating sensory elements with clients

Drawing on my personal experience in therapy, I continue to think about how to incorporate multisensory experiences during my own professional sessions with clients. In the past, I mapped out client conceptualizations of presenting concerns or coping strategies on paper during sessions. But based on my experience with Lily, I realized how I was underutilizing multisensory engagement as a therapeutic tool. Using the large windows in my office and pens made for writing on glass, I can map and draw out concepts to help clients have more sensory experiences, which will help them visual it better.

I am also seeking to experience my senses and body movements in the presence of clients and recognize the clients’ bodies and movements and verbal descriptions of sensory and emotional experiences. For example, I am now more attuned to clients’ and my own body language after observing Lily’s body language when drawing on the whiteboard.

Clinicians can also explore how to increase multisensory engagement virtually and consider if certain clients may benefit more from multisensory and in-person sessions. For example, clients with anxiety who have a treatment goal of calming their overactive sympathetic nervous system may benefit more from in-person counseling than a client who is primarily working on improving depressive symptoms.

Because the pandemic is ongoing and our lives are demanding, we must be realistic. The convenience of virtual sessions will likely continue to create demand among clients. It’s important to remember that having a therapist who is a good fit is always a better choice than not going to counseling because of a lack of in-person opportunities. Therefore, the best-case scenario might be a hybrid model, depending on the clients’ and therapists’ joint decisions. But no matter if counseling is virtual or in person, I encourage other clinicians to find ways to emphasize the sensory experience in session, including visually mapping concepts.

Ashley Heintzelman is a licensed psychologist who specializes in the treatment of eating disorders. She is the founder of the Ampersand Psych Clinic in Overland Park, Kansas, and co-author of the book Free to Be: The Non-Diet Path to Peace With Food and Body. Her other clinical passions include mentoring early career professionals and supervising graduate students in training to become counselors. Contact her at heintzelman.ashley@gmail.com or through her website at ampersandpsychclinic.com.

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