Monthly Archives: March 2023

Preparing to be mentally fit for the future 

By Lindsey Phillips March 31, 2023

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headshot of Wendy Borlabi at ACA's 2023 conference

Wendy Borlabi delivers the keynote address at ACA’s 2023 Conference & Expo on Thursday, March 30. Photo courtesy of Alex Webster/Pinpoint National Photography.

Wendy Borlabi, the director of performance and mental health for the National Basketball Association’s Chicago Bulls, quickly energized the crowded room at the opening keynote for the ACA 2023 Conference & Expo in Toronto by discussing how counselors can help clients and themselves be fit — mentally — for their future. She explained to the audience that in her line of work, “the future” can mean the next few seconds or the next hour because with athletes, the future can happen quickly.

Connecting performance and mental health

Borlabi, who also serves as an independent consultant for the NBA and is the founder of the performance psychology firm Borlabi Consulting, said she uses two lenses when working with athletes: a performance lens and a mental wellness lens. Blending these two approaches helps athletes better understand the connection between their behavior on and off the court and field, she told the audience.

Borlabi described three aspects that fall under the performance lens:

  1. Self-awareness: You need to know not only what you are feeling about a situation but also how you are going to address it.
  2. Strength/superpower: You want to know your strengths as well as your weaknesses; it’s important to understand that sometimes a person’s strength can also be their weakness.
  3. Obstacles/goals: Life can come at you fast, so you need to figure out what obstacles are approaching and what you are going to do about them to make sure you still achieve your goals.

For the other lens, Borlabi said she teaches athletes to think of their wellness using a mental wellness wheel that contains eight dimensions: emotional, environmental, financial, intellectual, occupational, physical, social and spiritual.

“These eight aspects … are not all 100%. They all don’t need to be 100%. In fact, they’re rarely 100% all the time,” she stressed. “You’ve just got to be aware … of what you need at different times in your life.”

Borlabi shared a personal story to illustrate this point. For five years, she worked as a senior athletic consultant at James Madison University in Virginia, and she loved the job. Her occupational wellness was high, but it also meant she lived in a small town that lacked racial/ethnic diversity, so she said it negatively affected her social wellness, which in turn affected her emotional health. Because her mental health was affected, she decided to leave the job.

About 12 years later, after the birth of her twins, she again found her social wellness at zero, but this time it made sense given her current stage in her life. She didn’t expect or need to be social while caring for newborns, so it didn’t negatively affect her mental health.

“It’s important that you recognize what you need at different times, depending on what your values are, depending on where your life is, depending on what you want, what you need, where you want to grow, and then you shift,” said Borlabi, a former senior sports psychologist for the U.S. Olympic Committee. This process helps you move forward, she noted.

Preparing for challenges 

It’s natural for life to knock us down from time to time, Borlabi reminded the audience. When this happens, she said, the important question people need to ask themselves is, “Now what?”

To help athletes put this concept into perspective, she asks her clients to consider the following analogy: Imagine that the coach said they will buy you any car you want. You name an expensive car. Now, what if this dream car that’s coming in a month is a stick shift, but you can’t drive a stick shift? You have a month to learn, but you put it off, and then the car arrives and you still don’t know how to drive it.

With careful planning, people can learn to prepare for and overcome life’s challenges, Borlabi emphasized. She pointed to the COVID-19 quarantine when she, like many others, found herself stuck at home and unsure of what to do next. She was trying to figure out how to work with athletes and coaches remotely and struggling to learn how to teach her kids the new math at their school. And on top of it all, she was struggling with the news about George Floyd being killed by a Minneapolis police officer.

“I fell down,” she said. “I had to get back up. Now what? My ‘now what’ was that I needed to remember what I needed to do for me.” So, she created a schedule for her family and made time for self-care by taking a shower, exercising, and craving out 10 minutes to sit and enjoy a cup of tea alone. She said that reincorporating these aspects into her life enabled her to get back up and find a way to move forward despite the challenges.

Keeping it simple

Borlabi ended her keynote by reminding attendees to keep it simple when explaining the importance of wellness and mental health to clients. To do this, she often reads and discusses children’s books related to mental health with athletes. She recommended three children’s books to the audience. How Full Is Your Bucket and The Energy Bus both highlight the importance of filling one’s bucket (as well as others’ buckets) with positive energy. The third book, The Coffee Bean for Kids, presents the reader with a choice between three options:

  • Do they want to be an egg that is hard when boiled?
  • Do they want to be a carrot that turns soft and mushy when boiled?
  • Do they want to be coffee beans, which, when combined with boiling water, create coffee?

The answer, of course, is coffee beans because it allows you to work collaboratively and create something new and useful.

Borlabi’s message to the audience was also clear and simple: Mental wellness affects all aspects of our lives (on and off the court), and we must be prepared to handle whatever life will inevitably throw our way.

 

Lindsey Phillips is the editor-in-chief for Counseling Today. Contact her at lphillips@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: Transition to private practice

By Gregory K. Moffatt March 24, 2023

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In years past, several of my associate licensed supervisees have transitioned into their own private practices right out of the gate after earning their full licenses. This wasn’t luck and it wasn’t accidental. Each of them invested a lot of planning — around 12 months — but it paid off with profitable businesses as quickly as three months afterward. A couple of them were even hiring staff within a year’s time.

Now is an opportune time if private practice is an aspiration of yours. COVID-19 changed our culture in two distinct ways that apply to our discussion. First, the pandemic magnified preexisting conditions. The effects of COVID-19 on mental health are still lingering today. Depression, addiction and marital issues that predated the virus only got worse as we went into lockdown, leading to more people seeking help.

Second, as I’ve written about several times in past columns, the virus pushed all of us into a digital world. Clinicians who had never previously considered telehealth were forced into it, and many subsequently realized how convenient it was and chose to continue offering telehealth services long after the heat of the pandemic was past. Many clients had similar revelations.

Telehealth has made it possible for a clinician to run a private practice without any brick-and-mortar office. Home offices are economical to operate and may also qualify for tax breaks. At home, you are already paying rent or mortgage, the electric bill, internet costs, etc. With a brick-and-mortar office outside the home, these costs are doubled. Plus, with home offices, there are no travel expenses and the child care options are potentially easier.

That being said, transitioning to private practice takes planning. The clinician must be willing to run all parts of the practice — scheduling, billing, taxes, etc. No more life of just showing up, seeing clients and then going home. But in exchange comes the freedom to carry whatever caseload you want, take vacation when you want, work whatever hours you want and specialize as you choose. Nearly all agencies take a percentage of client fees. In private practice, 100% goes to you — the owner.

There are several steps to launching a private practice. A first step is ensuring that you honor your current contracts and the limitations that might come with them. The Risk Management for Counselors column in the March issue of Counseling Today recently discussed noncompete clauses that are common in both public and private agencies. Transitioning to private practice will require honoring the specifics of any existing noncompete clauses. This can be onerous in some cases. For example, “No practice within 25 miles” might require the clinician to move or to rent office space outside of the noncompete distance.

A second step is marketing. How will people find you? Why should they choose you? You have to earn a reputation, but that takes time. The biggest key to marketing a private practice is having a referral stream. My most successful clinicians have built relationships with churches, schools, psychiatrists, physicians, the courts or other agencies that channel clients their way. Unless you already have a client base that you can take with you, starting out without a referral stream can be challenging.

Marketing will also require the clinician to examine the type of practice they want to run. Each practice will look a little different depending on whether it is a general practice or whether it is focused on marriage and family, trauma, children or any other specialty. This will also determine the direction the clinician takes for pursuing referral streams.

Licensing, certifications and specialties must be considered. Counselors are ethically bound to present themselves accurately to the public, but certifications such as eye movement desensitization and reprocessing for trauma workers or Gottman training for marriage and family therapists can improve your marketability.

Many clinicians have found success with rather inexpensive marketing through websites such as Psychology Today’s “Find a Therapist” tool. A website is critical and cost-effective. Other social media outlets might work for advertising, but clinicians need to ensure that they are complying with ethical standards regarding social media.

One last issue to consider is whether your practice will be cash-pay only or whether you will accept insurance. Most insurance boards have a standard pay scale. This means that while you might be able to charge $125 an hour in a cash-only setting, you might make only $85 an hour on an insurance board. Boards also require more time to manage in billing.

I’ve had a private practice for decades and have been cash-only since the mid-1990s. I don’t do any advertising at all because I don’t need to, but when I started out, I followed the suggestions in this article. I’ve never regretted not working in an agency. If this is something you would find meaningful, now is a great time to begin working toward the independence of private 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.

Expanding the conversation on international perspectives and practice in counseling

By Nate Perron & Sujata Ives March 22, 2023

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As counselors, we are in the business of listening. All the theories, techniques and applications of our training enhance our abilities to listen to stories and narratives with great skill and make a difference in the lives of others as a result. The International Committee (IC) of the American Counseling Association is committed to heightening our listening ability across cultural, national and other identifying differences. It is the elements of listening to stories and dialoguing toward understanding that lead to shared intercultural experiences.

Although you may not have heard of the IC, ACA’s rich history reveals an IC that has taken an active role in professional advancements within the organization over the past 25 years. Our hope is to enhance our active listening as professionals so that we may boost ACA’s ability to grow while contributing to global conversations regarding counseling and mental health.

The IC is composed of nine committee members, an associate chair and a chair, all of whom are ACA members with a passion for international issues in counseling. The committee chair is appointed annually by the incoming ACA president, the associate chair is appointed by the incoming and outgoing chair, and committee members are appointed to serve three-year terms. Policy 1110.1 of the ACA Policy Manual describes the IC’s responsibilities in detail: “The International Committee shall promote, respect and recognize the global interdependence among individuals, organizations and societies. The Committee shall build bridges and promote meaningful relationships between ACA and other organizations outside the United States. The purpose of international professional collaboration shall be to promote the commonalities across these international organizations and their missions.”

Counselors commonly embrace a commitment to lifelong learning and development as an ongoing professional process. In combination with the occupational posture of listening, lifelong learning offers counselors a vast well of knowledge from which to draw indefinitely. By exploring the development of counseling internationally, and among international professionals within the United States, we have a tremendous opportunity to acquire diverse skills and knowledge that can support our work domestically through application of multicultural best practices. This learning is optimized through relationships formed among colleagues. As the field of counseling continues to grow, so does the valuable input available from around the world. Hence, growth in our profession requires both active listening and lifelong learning.

Finding just the right word in English to convey the diversity of opinions, beliefs and systems of thought by which counseling may benefit from global contributions is likely impossible. While our committee focuses on international interests, the expansive growth of counseling might also be recognized as transcultural, intercultural, cross-cultural, intersectional, multicultural, and the list goes on. International dialogue provides exciting opportunities for counselors to make an impact in a variety of spaces and places.

Committee activities

The members of the International Committee at the 2023 ACA Conference & Expo in Toronto

The International Committee members at the 2023 ACA Conference & Expo in Toronto. Photo courtesy of Rong Huang.

The passionate professionals who make up the IC are committed to expanding the conversation from the starting place of international counseling to touch the real experiences of those providing and needing services all over the globe. In recent years, the IC has taken steps to increase collaboration across associations and raise awareness of international needs and issues within ACA, including among ACA divisions that have much to contribute to overall conversations surrounding transculturalism, interculturalism and belongingness.

Here are a few of the committee’s recent achievements:

  • Toolkits: Our immediate past chair, Mariaimeé Gonzalez, facilitated the development of toolkits to address specific counseling needs expressed around the world. The international toolkits will be made available on the ACA website as resources for increasing skills and awareness regarding international counseling needs and issues. ACA members and divisions will have opportunities to incorporate this toolkit information into their current practices. The toolkits address a variety of counseling issues with an international lens, including somatic symptoms of domestic violence, broaching, global trauma, obsessive-compulsive disorder across cultures, and global adolescent mental health. Another toolkit discusses how ACA can incorporate the United Nations’ sustainable development goals for 2030.
  • Professional developments: The IC collectively reviewed updates to the Council for the Accreditation of Counseling and Related Educational Programs (CACREP) standards. We subsequently offered a list of recommendations to include with the changes that may enhance an international perspective.
  • Strategic advisement: As the Governing Council proceeded to develop the strategic planning process for ACA, the IC contributed further input for developing global mental health and community actions from an international perspective.

Ongoing ambitions

The IC remains committed to advancing the influence of international realities, both within ACA and beyond. The following items reveal the ongoing ambitions of the IC to continue making progress in these areas.

  • Association collaborations: The IC remains dedicated to solidifying collaborations with associations, whether they exist internationally or internally within ACA. Upcoming webinars and trainings are expected to reveal focused collaboration and development in addressing international needs relating to mental health and well-being. The IC has facilitated conversations with the International Association for Counselling (IAC) to advance one of these collaborative webinars in the upcoming months, with the intent of expanding discussion about international issues that affect people around the globe on a daily basis.
  • 2023 ACA Conference celebration: The international reception has long been a consistent element of ACA Conference proceedings. While these events have not always been widely known about or understood, the IC is working to use the international panel and the reception as tools to advance the discussion further within the ACA membership. Many people can be involved in efforts to increase transcultural awareness and practice, so anyone interested in growing their perspective will benefit from these conference events.
  • Establishing a stronger presence: To attract international professionals and increase the attention paid to international issues, the IC is developing procedures to advance the status of the committee to an organizational affiliate of ACA. This would provide further recognition to address some of the IC’s same goals but with expanded support and involvement from interested members of the overall ACA body. Many other international subgroups exist within ACA; providing a centralized point of connection so that people can expand their involvement has become a top priority of the current IC. This will also be a valuable opportunity to recognize foreign-born ACA counselors that practice in the United States and beyond.
  • Ongoing association recommendations: Additional projects remain on the horizon for the IC to contribute to ongoing efforts to integrate international counseling into the fabric of ACA involvement. The IC plans to expand the toolkit focused on sustainable development goals to promote the United Nations’ proposed goals within the policies of ACA and its divisions. Another activity will involve contributing recommendations to the universal declaration of counseling principles that IAC is currently drafting. These efforts and collaborations will enhance the recognition of ACA’s focus on global needs and issues.

Path forward

In continuing to carry a keen sense of “where we have been,” both as an association and as a committee, the IC plans to help lead the conversation within ACA about “where are we going” as a collective group of global professionals. To sum up all the efforts taking place, the IC recommends we engage in the three following activities to create an international impact within our locus of control.

  • Posture of listening: A wise proverb reminds us, “Remain quick to listen and slow to speak.” So often our initial response may carry a list of assumptions that have not been presented. Taking the time to step back, give others the benefit of the doubt and consider another perspective is essential for advancing our knowledge and awareness. If we are unsure which direction to move in any of our professional decisions, we might let our ears do the walking by receiving support and insights from colleagues, especially when they can provide cultural consultation. Counselors are encouraged to maintain a healthy posture of listening to explore ways that we can each make a greater difference in the development of international counseling. Teachability and openness can define our culture of listening in profound ways.
  • Intentional learning: In conjunction with the earlier value of lifelong learning, the IC has a unique opportunity to model how counselors might seek out opportunities to hear the narratives and experiences of others. Pursuing learning opportunities for counselors in other cultural contexts will provide the type of growth that may enhance formulation of theory and practice in new avenues. This may include opportunities to seek international training specifically or it might involve increasing efforts to support international awareness in the work and educational institutions where we now serve. Being intentional about learning requires active systems that amplify the voices of those less represented. Seeking learning opportunities outside of our comfort zones offers an extended expression of cultural humility that can benefit everyone involved.
  • Symbiotic development: Growth for the counseling profession in one area of the world is growth for us all in the counseling profession. Regardless of the differences we possess and the ways in which counseling may be practiced in different settings and cultures, there are commonalities that unify us in the profession and enhance our ability to address mental health and well-being needs all over the world. Refining our collaboration and learning offers hope for improving our abilities to respond to people from a variety of backgrounds in our own communities. A focus on developing collectively and interconnectedly as a profession globally presents great opportunities to expand our minds, enhance our knowledge and refine our practices alongside colleagues all over the world. Counselors who strive to achieve the same basic goals can help foster professional development that will serve to make a difference among individuals, families and groups worldwide.

Conclusion

Three members of the International Committee at the 2023 ACA Conference & Expo in Toronto

The International Committee members at the 2023 ACA Conference & Expo in Toronto. Photo courtesy of Rong Huang.

The IC is excited to embark on the goals ACA has established to enhance connections and collaborations around international issues. Simply by taking the skills already “baked in” to the ingredients of professional counseling, we have discovered rich opportunities to learn from one another and to develop both individually and collectively. It all begins with listening, which leads us down a road of learning and developing so that we may expand the conversation even further and make a difference with even more individuals through the blessing of counseling worldwide.

We hope the descriptions of past, present and future IC endeavors will inspire further interest and involvement for developing greater awareness and skill to support the most people we possibly can.

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2022-2023 International Committee Members:

Nate Perron (chair), Sujata Ives (associate chair), Mary DeRaedt, Hulya Ermis, Katherine Fort, Ester Imogu, Sandy Kakacek, Peggy Mayfield, Benjamin Okai, Lisa Rudduck, and Keiko Sano

 

Headshot of Nate Perron

Nate Perron was appointed chair of the ACA International Committee for the 2022-2023 academic year and is also a core faculty member at the Family Institute at Northwestern University in Evanston, Illinois. He remains actively involved with international counseling research, education, service and practice in a variety of ways. Contact him at nate.perron@northwestern.edu.

 

Headshot of Sujata Ives

Sujata Ives is associate chair of the ACA International Committee, mentor to IC intern Anniesha Lyngdoh, an avid presenter at ACA conferences and a private practitioner of employment counseling. Contact her at sujata.ives@gmail.com.

 

 

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 power of counselor advocacy

By Brian D. Banks March 17, 2023

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We are three months into the calendar year 2023, and counselors are beginning to realize how much power they hold in their state legislature and the federal government. If for any reason you do not believe this, allow me to remind you that licensed professional counselors continue to make progress that affects not only the counseling profession but also the entire country.

You are changing the way counselors can provide services to clients. Here are just two major feats we accomplished last year with your help:

Your efforts have already made a difference and will continue to make a positive impact in this country, and they serve as examples for other countries and health care organizations to follow.

How can counselors improve their advocacy efforts?

Despite our notable success, there is more work to be done. Your Government Affairs and Public Policy (GAPP) team is working hard for you. As we move forward to accomplish our legislative goals, counselors also must make advocating for the profession part of their regular routine.

Compared to other mental health professionals, counselors are more likely to advocate and educate legislators about counseling and the clients they serve. However, there are still many ACA members who are not advocating on behalf of the profession, so we know counselor participation can continue to improve. The GAPP team will continue working with our members and conduct training to help you become confident grassroots advocates.

In short, we need you. Our success is because of your efforts and commitment to ACA. To learn more about how to effectively advocate, please visit GAPP’s Advocacy Resources page. You can also email the team at advocacy@counseling.org, and we will gladly take the steps necessary to help you become the advocate you aspire to be.

To get involved, please sign up for our advocacy alerts. Visit our Take Action page, scroll to the bottom of the page and sign up today. Then you will be among the first to receive alerts.

What’s next in counselor advocacy?

ACA has a robust legislative agenda for 2023, which includes continuing to focus on Medicare reimbursement as we work with the appropriate agencies to implement the program. We will also continue working with state legislatures to ensure more states pass counseling compact laws, which will increase opportunities for counselors to care for clients throughout the country.
In addition, we are focused on the following five issues:

  • School-based mental health services: We want to improve access to mental and behavioral health services in schools and increase funding for resources to help counselors effectively assist their in-school clients.
  • Career counseling: We want to increase investments in college and career counseling programs.
  • Telehealth expansion: Our goal is to make telehealth permanent beyond the two-year federal extension.
  • 988 implementation: Although 988 is active throughout the country, we still need an increase in funding to maintain these programs in each state. ACA will work with our colleagues to increase funding for 988.
  • U.S. Public Health Service (USPHS) Commissioned Corps and Army Medical Corps officers: Licensed professional counselors are the only mental health profession not allowed to work as an officer in the USPHS Commissioned Corps or Army Medical Corps despite the need for increased access to care in the military. ACA will continue working with the appropriate committees and the Department of Defense to make this career option available to counselors.

These five focus areas are just the tip of the iceberg for the work the GAPP team plans to perform on behalf of the profession this year. Please visit the ACA website for more information on other GAPP initiatives.

We also need your eyes and ears. Despite our fancy tracking systems, you must help us monitor policy in your state to make sure we do not miss anything. We need you to let us know what is going on in your state that could potentially affect the profession. It does not matter if it is positive or negative news; we need to hear from you. Together we can fight the battle to improve the profession in each state. It takes a village to make progress, and as you can see, the progress we have made was undoubtedly a group effort.

Counselors are needed

Not many people would disagree with the statement: “We need counselors.” But I do think counselors may not realize that there is more they can do to support the profession beyond their trained duties.

For example, have you ever thought about running for office or becoming a member of your state’s licensure board? Do you participate in your school board or hometown congressional town hall events? Are you registered to vote? Do you provide your expertise in state regulatory or legislative hearings?

These questions show that there are multiple ways to get involved and stay involved. I know that not all of these choices listed here are going to interest you, but I guarantee there is one action from this list that you could take advantage of, and in the process, you could make a positive difference for your profession.

ACA has held virtual sessions on running for office in the past and continues to conduct training and support member testimony efforts in the state legislatures. If any of the previous options to get involved sparked your interest, please email the GAPP team, and we will provide you with the information that you need to start your journey.

We will continue updating you on our progress as well as on how you can help us, especially in areas where we may need additional support. To learn more, read our monthly column in Counseling Today, visit the ACA homepage for updates and check the emails from our Member Engagement team for useful information.

You can also reach out to a member of the GAPP team by emailing advocacy@counseling.org. We are here for you, we believe in your work, and we want to do whatever it takes to ensure your success. From the bottom of our ACA hearts, thank you for your past efforts and for all that you will do in the future on behalf of the counseling profession. It only takes a little extra to make a difference, so thank you for the extra you give.

Stay tuned and stay involved because there are greater things to come.

Brian D. Banks the chief government affairs and public policy officer for the American Counseling Association. Contact him at bbanks@counseling.org.

 

Why, when and how to talk with grieving clients about sex

By Kailey Bradley and Victoria Kress March 14, 2023

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Grief is an experience that everyone navigates at different points in their lives. For the past three years, the COVID-19 pandemic has impacted peoples’ lives in myriad ways and left many experiencing significant grief.

Loss can also deeply affect one’s sexuality, a concept referred to as sexual bereavement. Any form of loss, not just the loss of a sexual partner, can alter one’s sexual desire. As noted in Alice Radosh and Linda Simkin’s 2016 article published in Reproductive Health Matters, both sexuality and grief are stigmatized, which creates a double-barreled taboo. This double stigma can result in someone not feeling comfortable or confident addressing the topic.

When working with clients who have experienced loss, counselors must consider the interplay between grief and sexuality. There are few spaces where clients can address their grief and even fewer safe spaces where they can discuss their sexuality, so it is important that counselors consider how they can approach this subject with clients. This article discusses why this topic is important and when and how counselors can address the intersection of grief and sexuality with clients.

Why is this topic important?

Radosh and Simkin noted that some bereaved clients want to discuss how their sexuality has changed as a result of grief, yet they are often hesitant to do so. Clients may perceive that sexuality and grief cannot coexist. If this is the case, then they may feel shame if they have sexual feelings while grieving. Clients may also believe it is inappropriate to admit that they miss intimacy or that their sexual desire has changed. Other clients may perceive sexuality as distant and remote — something that may never again feel accessible.

The complexities of this topic, combined with counselors’ and clients’ personal discomfort, may cause counselors to avoid addressing it. This discomfort can arise because counselors are uncertain about how to broach the topic, counselors are uncomfortable with the topic of sexuality in general or the client is hesitant to bring the topic up. Although we do not know a lot about how various aspects of sexuality are affected after a loss, it is clear this is an issue that people experience as part of their normal development and growth, so counselors must be prepared to address this topic.

When to address this topic?

Although there is no right time to address this topic, counselors can introduce conversations related to the topic early in the counseling process. They could include questions about how grief has impacted the client’s sexuality on the intake form and then use the information the client provided to gently broach the topic during the first session. Counselors may also need to go slow and consider if it makes sense to bring up the topic during one of the initial sessions. For example, it may not be a good idea to discuss it in the first session if the client has a lot of shame around the topic of sexuality. In this situation, clinicians need to establish therapeutic trust and rapport before mentioning the topic. This approach will help clients feel safe enough to share their experiences.

Counselors can also ask clients to describe the various realms in their lives that have been affected by loss and grief, and they can mention sexuality as one possible area. And throughout the counseling process, clinicians can validate and normalize their clients’ experiences regarding grief and sexuality.

Because clients will move at their own pace and some may want to revisit the topic throughout counseling, regular check-ins with clients can be helpful. Counselors can encourage clients to engage in these difficult conversations by asking them to create “permission slips” to attend to forgotten or challenging dimensions of grief. Clinicians can give clients a scrap piece of paper and ask them to write out an area in their lives that is affected by grief that they find difficult to discuss. Another option is for counselors to write down overlooked topics related to grief and sexuality — such as dating, desire and arousal, physical changes, ways to talk about grief with a partner — on a sheet of paper and then ask clients to choose a topic from the list they want to discuss.

How can counselors help clients?

There is limited research on how to support clients’ sexuality in the context of grief. Formal interventions, however, may not be as important as the compassionate environment and empathic presence a counselor provides. Empathic presence can help clients introduce difficult conversations at their own pace and on their own terms.

Psychoeducation can also play an important role in counseling this population. For example, counselors can share that for some clients, sexual desire and arousal increase after a loss while others have the opposite experience. Providing education around the different reactions people have to grief can validate clients’ experiences and help them connect with the ways they may be experiencing grief. Counselors can also teach clients that grief is not just relegated to the cognitive or emotional domain; our bodies carry and process grief as well, and in this way, our bodies grieve. Providing this education to clients may allow them to feel relief that their somatic reactions surrounding sexuality after a loss are valid.

Another area of psychoeducation that could be valuable to clients is the identification of their grieving styles. The Grief Pattern Inventory is a tool that can help clients gain insight into how they are approaching the grief process. (For more, see Kenneth Doka and Terry Martin’s Men Don’t Cry, Women Do: Transcending Gender Stereotypes of Grief.) Understanding how a person is grieving can help the client and counselor gain valuable insight into the client’s grief process. Intuitive grief is an emotional style of grief in which emotional expression is valued, whereas instrumental grief is a cognitive style of grief in which problem-solving is valued. According to Doka and Martin, a client who identifies as having an intuitive style of grief will prefer a space to emotionally express the wide range of feelings that emerge when considering the intersection of sexuality and grief. In contrast, a client who identifies with an instrumental style of grief may prefer using specific techniques to reengage with their sexuality because they may view the changes in their sexuality after a loss as a problem to be solved. Counselors can introduce this concept to clients and invite them to consider how their grieving style may be affecting how they approach their sexuality after loss.

Finally, creative interventions can be a powerful way to help clients navigate these issues. Counselors can invite clients to write themselves a permission slip to engage with their sexuality in whatever way feels appropriate to them. For example, they might write, “I give myself permission to lean into the feelings that arise when I consider how my sexuality has changed in the following ways.” Clinicians can also encourage clients to create a grief playlist in which they share songs that help describe or capture the feelings surrounding the areas of their life that are affected by grief (including sexuality). Clients could share their grief playlists with their partners and identify how their grief experience is similar or different. Overall, outward expression of loss can help validate the complexity of feelings that arise when navigating this double-barreled taboo.

Addressing personal biases

When working with this population, it is important to be mindful of biases that both the client and counselor may have about grief and sexuality. Some common biases include the assumption that sexual desire disappears after a loss, sexuality is not appropriate to discuss after a loss or having sexual desire after a loss is wrong. To address these biases, counselors can use reflective questions and journaling prompts that ask individuals to reflect on what they have been taught culturally about grief etiquette, sexuality and scripts surrounding what is normal after grief. Again, some might feel judgmental of a griever whose sexual desire and/or arousal has increased after a death. However, addressing our own biases will help create a hospitable environment where a client is met with nonjudgment.

Conclusion

Counselors play an important role in empowering clients who are grieving. Even though we live in a grief-avoidant culture where we shy away from pain, counselors can create a refuge of hospitality where we can openly acknowledge what is uncomfortable. It is in our power and our scope of practice to gently remind clients that it is OK to talk about the intersection of grief and sexuality and to meet our clients with compassionate curiosity and encourage them to grant themselves permission and space to grieve and embrace their sexuality after loss in whatever way makes sense to them.

 

Kailey Bradley is a licensed professional counselor with supervision designation in Ohio, a national certified counselor and a certified thanatologist. She specializes in the intersections of grief and sexuality as well as issues surrounding chronic and terminal illness. She has a background in hospice work and feels that advocating for grievers is her life’s passion. Contact her at kailey@allrefuge.com.

Victoria Kress is a distinguished professor at Youngstown State University. She is a licensed professional clinical counselor and supervisor in Ohio, a national certified counselor and a certified clinical mental health counselor. She has published extensively on many topics related to counselor practice. Contact her at victoriaEkress@gmail.com.

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