Monthly Archives: July 2023

Voice of Experience: The gift of friendship

By Gregory K. Moffatt July 31, 2023

Silhouette of two people walking and talking on a forest path


July has been a hard month. My oldest and closest friend, Eddie, passed away. You didn’t know him, and he wasn’t a mental health professional. Far from it. He was a historian. But you benefited from him indirectly because he served as my editor for most of my professional life.

I met Eddie when I was only 22 years old. He was one of the first people I met when I moved to Georgia from Tennessee with my new bride, ready to begin graduate school. At the time, he was the academic dean at Point University — the university where I currently serve as dean of the College of Social and Behavioral Sciences and have worked as a professor of psychology for close to 40 years. Even though he was 16 years older than me, we immediately became friends.

We shared a love of birds, hiking and the outdoors, but I also valued his impeccable grasp of grammar and his love of scholarly pursuits. One of the first gifts he ever bought for me was a paperback copy of William Strunk and E. B. White’s Elements of Style, a writing style manual. It might seem like an odd gift, but it taught me a lot and showed me how much I still needed to learn about communicating clearly and effectively.

Around this time, Eddie also became my personal editor. He proofread every paper I wrote for graduate school, and I would often ask him to look over important emails as well. He edited every article I wrote for a newspaper column I hosted for 35 years, and he proofread each chapter of the dozen or so books that I’ve written.

I’ve also published several articles in various periodicals, including Counseling Today. And you guessed it: He edited them all. Before my Counseling Today editor ever saw a draft, it ran through Eddie’s editorial eyes. And until this past year, he edited my Voice of Experience column as well.

He provided this service as a friend and colleague, and he never once asked me for a dime. I cannot tell you how much he taught me along the way.

The readers of my column have also benefited because Eddie improved my quality of writing — a skill I often use when I write, speak in public or provide students and colleagues with feedback. I can’t recall how many times I sent him a draft where I thought I had used my words carefully and clearly, but then Eddie would suggest more subtle yet powerful wording or note places that needed to be clarified for readers who were not as well-versed in the subject as me.

My friend supported me in other ways as well. In my 2018 Counseling Today article “The hurting counselor,” I described a dark period in my life and how I was unprepared to handle it because of poor self-care. I didn’t have a counselor at the time — a mistake I admit in the article. The closest thing I had was Eddie. He walked me through those dark days and helped me pull myself up from the ashes. He made meals for me, drove me places, listened to me — for hours. Even though he wasn’t a counselor, he could have been.

But he wasn’t just there for the tough times. We also celebrated our children’s births, weddings and holidays. Eddie was the kind of friend that we all need — someone with whom we can experience and enjoy life.

It’s easy for counselors to get caught up in their work. Early in my career, I spent nearly all my time working. Although I don’t regret that hard work, it was a perfect example of “life imbalance.”

But life must be about more than work. Friends, like Eddie, are hard to come by, and as I matured — both personally and professionally — I realized that. So I started investing more in my relationships. Eddie and I traveled many miles together and had many adventures, hiked many trails and camped in many campgrounds. We had so many inside jokes that we began referring to them by number (e.g., “Funny story #12”). No other words were needed.

Anyone who has experienced grief knows there is a hole in my heart — a chasm that feels impossible to close. But I’m thankful I learned to appreciate my friend.

Friendship is a gift, so we must make time to find and foster it. And in the end, we discover that supportive friendships are what make us become better people, parents and therapists.


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

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.


Seasonal affective disorder and the summertime blues

By Samantha Cooper July 28, 2023

A worried, sad, depressed person sitting beside the seaside


For many people, summer is a happy time, filled with pool parties, barbeques, and vacations, but people who experience seasonal affective disorder (SAD) during the summer months often find themselves dreading the heat and longer days.

Dr. Norman Rosenthal, a clinical professor of psychiatry at Georgetown University School of Medicine, is credited with describing and naming SAD, a mood disorder that is most often associated with the winter months because of the link between reduced sunlight and depression.

Rosenthal sent out a survey to find out more about people with winter SAD and got thousands of responses. Many people reported that their moods dropped during the winter, confirmed his assumption about winter SAD, but he noticed that several people also reported their moods were affected in the summer. “That really made us realize there were other kinds of seasonal problems [than] winter SAD,” he says. And it led to him discovering summer SAD.

Diagnosing summer SAD

Winter SAD and summer SAD are each entities in their own right; aside from the time of year they occur, the two present differently, notes Rosenthal, author of the forthcoming book Defeating SAD (Seasonal Affective Disorder): A Guide to Health and Happiness Through All Seasons.

“With winter SAD, people are sluggish. They need more sleep. They overeat, especially sweets and starches, and they gain weight. In contrast, with summer SAD, people tend to eat less, and they may lose weight. Instead of [being] sluggish, they’re rather agitated and antsy,” he says.

In Defeating SAD, Rosenthal discusses two ways that summer SAD differs from winter SAD:

Summer SAD can often be confused with general depression, which affects people year-round, notes Ashley Lowe-Simmons, a licensed clinical social worker who has spoken about summer SAD previously and has worked with clients with this condition. She says that the best way to differentiate the two is by recognizing patterns in a client’s history.

In a blog post about summer SAD, Rosenthal lists symptoms that people with summer SAD are more likely to report:

  • Sleeping less
  • Feeling overactivated and easily agitated
  • Having a smaller appetite
  • Having increased suicidal thoughts
  • Being bothered by heat or light

Although some of these symptoms could indicate general depression, if they consistently occur around summer and are not an issue during the rest of the year, then it may indicate the person is suffering from summer SAD.

“It’s important for the mental health professionals to ensure that they get complete and thorough evaluations when assessing individuals,” Lowe-Simmons stresses.

The fear of missing out in the summer

People often have an idealized view of summer — one gleaned from pop culture and social media—and think they should be having nonstop fun. They imagine themselves enjoying the warmer weather and spending lots of time outdoors. But this perception can make it challenging for those struggling with summer SAD to recognize their condition, says Alyssa Mairanz, a licensed mental health counselor who specializes in depression.

Summer is often a time filled with vacations and outdoor activities. Kids and young adults are often out of school, and many people try to spend a little less time in the office. But people with summer SAD might not be able to enjoy the extra time off. Going to the beach may sound like a terrible time to them, for example, but avoiding it may mean spending less time with their loved ones, which can make them feel even worse, Mairanz notes.

They feel as though they’re missing out, she says. In the winter, many people stay inside and aren’t as active in the summer, so those with winter SAD don’t experience the same anxiety around missing out on activities, Mairanz explains.

Seeing people be more active during the summer can make those suffering from summer SAD feel like an outsider, and they often judge themselves harshly for not being able to join in, she adds.

Treating triggers for summer SAD

Temperature and light are major factors for those suffering from summer SAD. They feel as though they suffer from getting too much light in the summer. People “can’t bear the dazzling light,” says Rosenthal, to the point where the light is painful for them.

Counselors can help clients with summer SAD by helping them adjust their exposure to lights in the summer. Rather than adding more lights to their routine, they reduce some of the lighting in their homes by dimming lights, closing blinds or adding blackout curtains, Rosenthal says.

Heat in the summer may also be an issue. Some people who suffer from SAD in the summer have issues with heat regulation (i.e., they are less tolerant to hot weather), and others find themselves more irritable during the summer months.

Mairanz often recommends clients use air conditioning and cold baths or showers to help with temperature regulation. Going to the movies, where it’s dark and often much cooler, is a great way to have fun outside the home while still staying out of the sun, she says.

Although it might seem like a good idea to stay inside during the summer, Mairanz cautions clients against this because it could cause the person to further isolate themselves and worsen their mood. Instead, she advises clients to go outside and build up their tolerance to the sun and heat by taking short walk outside with a small fan and sunglasses, or if that isn’t a good fit for them, then she recommends they find things they can do indoors with loved ones, rather than spending time alone.

“It’s a matter of doing all the little things that you can do to help yourself,” Mairanz says. Having a support system can be extremely helpful, to ensure the person doesn’t fall into complete isolation, she adds.

Medications such as antidepressants may be helpful for some clients, Rosenthal adds. Counselors can work with psychiatrists and other medical professionals to figure out the best plan for the client and how clinical therapies can work in conjunction with any medication the client may need.

Rosenthal is concerned that issues related to heat tolerance and summer SAD might increase with rising temperatures worldwide. This summer has been one of the hottest on record, and experts agree that summer temperatures will continue to rise. “It’s becoming more and more of an issue so I think we have to be more cognizant,” he adds.


Samantha Cooper is a staff writer for Counseling Today. Contact her at

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.

Integrating psychological flow in counseling

By Laurie Marie Craigen July 21, 2023

A swimmer preparing to swim across Lake Memphremagog

Laurie Craigen training in the winter of 2022 for In Search for Memphre, an international cross-border marathon swimming event. Photo courtesy of Laurie Craigen.

Last year, I embarked on the biggest endurance swim challenge of my life: I was attempting to swim the length of Lake Memphremagog, a 25-mile swim that starts in Newport, Vermont, and ends in Magog, Quebec, Canada.

This decision led to many questions, especially among my non-swimming friends. The most common questions were, “Why are you doing this?” and “How can you swim for nearly 12 hours straight?” Two years ago, I would have asked myself these same questions. But since I started swimming more regularly, I found something in the water that I continue to seek: a synthesis between mind and body. I feel at one with the water when I am swimming, and I experience a sense of transcendence, a quietness in my mind and a perceived sense of control over the conditions that I am faced with (e.g., wind, waves, currents). It also helps me set mindful intention on reaching a goal.

At midnight on Aug. 20, 2022, I reached the sands of Magog, Quebec, Canada. As I stood upright for the first time in nearly 12 hours, I felt as though I “woke up” to a more confident, self-assured and empowered version of myself.

What I experienced in the water is referred to as “psychological flow,” a cognitive state where a person is completely immersed in an activity. Mihaly Csikszentmihalyi, a positive psychologist, discovered this optimal state of being through his research with a variety of different individuals, including artists, athletes and CEOs. Csikszentmihalyi argued that flow states can be induced in different contexts, including everyday life tasks such as cooking, cleaning, walking and drawing as well as more extreme and high-performance sports and activities.

The physical and mental effects

Psychological flow is sometimes referred to as being “in the zone” or “in a trance.” During a state of flow, one is fully engaged and focused on the task at hand; concentration is at an all-time high. This mind state leads to optimal performance and performing beyond one’s typical expectations, physical strength and sometimes what society deems as humanly possible. Serena Williams, who is considered one of the greatest tennis players of all time, often described herself as “being in the zone” after matches, and Danny Way, an American professional skateboarder, also found himself in this state of flow when he successfully completed a death-defying feat — doing a skateboard jump over the Great Wall of China with a broken ankle.

Csikszentmihalyi brilliantly describes the flow state as existing between the state of boredom and anxiety. In this sweet spot, a person can find a task that is personally challenging yet not so much that it causes frustration or anxiety. For example, if I had attempted the 25-mile swim when I was just starting out as a swimmer, then I would have found it too difficult or frustrating. But because I have been swimming most of my life and have increased my training in swimming long distances over the past few years, this event was a significant challenge for me, but it was also within my skill set.

Laurie Craigen swimming across Lake Memphremagog

Craigen swimming in the In Search for
Memphre marathon on August 2022. Photo courtesy of Laurie Craigen.

Psychological flow can also alter a person’s perception of time — causing time to feel like it is moving faster or standing still. When I was swimming the 25-mile stretch in Lake Memphremagog, I was in the water for nearly 12 hours, but it felt as though I was in the water for only two hours. I have also experienced this time warp in my private practice with clients. Some days, when I am focused and composed, I may see clients for eight straight hours, but it feels as though only an hour has passed.

Psychological flow can make people perceive that they have complete control over their environment, which, in turn, causes feelings of self-consciousness to melt away and be replaced with feelings of satisfaction, increased self-esteem and confidence. And this feeling often occurs regardless of the outcome because psychological flow is autotelic; the experience of the activity is the main goal, not the outcome or achievement.

Steve Kotler, an expert on human performance and the executive director of the Flow Research Collective, has researched the neurobiological impacts of psychological flow and found that the brain is also affected by the flow state. For example, individuals who are in a flow state also experience hypofrontality, a decrease in brain activity in the prefrontal cortex. When the prefrontal cortex is suppressed, the implicit brain (or unconscious memory) takes over, allowing more areas of the brain to communicate freely and more creatively. According to Kotler, states of flow also appear to alter brain waves and neurochemistry within the brain. These neurobiological changes prime the brain for the flow state to be activated.

Although people may experience positive emotions and physiological relief when performing the activity, the psychological benefits of flow exist far beyond the completion of the task. Csikszentmihalyi has noted several long-term benefits of flow, including increases in skill development, overall wellness, life satisfaction, emotional regulation, motivation, and intrinsic motivation and decreases in anxiety and depression. Kotler has also found that individuals who regularly engage in flow states are happier overall, and he believes that for some individuals, flow states can also serve as a major component to healing trauma.

Using flow in session

Although there are several benefits associated with psychological flow, there is not much in counseling literature on this concept or ways to use psychological flow as a counseling technique or intervention. I believe the counseling profession would benefit from taking a deeper look at how to integrate psychological flow within the counseling arena.

As a practicing professional counselor, I have introduced the concept of flow to a range of clients from different backgrounds. I have found that integrating flow-based work is also beneficial for clients struggling with depression and anxiety, and it can serve as a healing mechanism for clients with a trauma history. The flow state often creates a phenomenon where time slows down and allows anxious, intrusive thoughts or painful memories from the past to decrease or diminish. There is also a heightened focus on the present moment within a flow state, which can be soothing for clients struggling with these mental health issues. In fact, when using clinical exercises that stimulate this flow state, I have often heard clients says, “This is the only time when my brain shuts down and my thoughts are quiet” or “I have never felt so calm, and I want to experience more of that.”

The following paragraphs provide suggestions on how counselors can incorporate psychological flow into their work with clients who may benefit from its physical and mental effects. These suggestions are informed by the literature and my own clinical work.

Provide psychoeducation. Counselors can educate their clients on the concept and benefits of flow, including how it helps decrease levels of anxiety and depression and is beneficial for trauma work. I often recommend clients read Kotler’s The Rise of Superman: Decoding the Science of Ultimate Human Performance or Csikszentmihalyi’s Flow: The Psychology of Optimal Experience. There are also several online resources that describe and define flow, such as Ryan Howell’s “Finding ‘flow’ this week” (published in Psychology Today in 2012) and Kendra Cherry’s “5 things you can do to achieve flow” (published on the Verywell Mind website in 2020).

Introduce activities with your client around focus/concentration. One integral component of flow is learning to completely focus on the task at hand to the point that the surrounding world and the concept of time melts away. Thus, mindfulness activities, including meditation, could help prime the client’s brain to be ready to induce states of flow. Additionally, helping a client find or create the right environment — one free of distractions — can help to induce flow. For example, if a client is working on a drawing or painting, the counselor can help them purposefully and intentionally find a space in their living environment where they aren’t consistently interrupted by noises, people or other distractions.

Brainstorm activities to induce flow. According to Csikszentmihalyi, flow can exist between the space of boredom and anxiety. So counselors can brainstorm with clients and find an activity that is both within their skill level and challenging for them. If the activity is too easy, then the client may experience a lack of interest and focus, and, conversely, if the task is too difficult, they may experience feelings of acute stress and anxiety, which would prevent their brain from getting into the flow state.

Choose activities that provide immediate feedback. Csikszentmihalyi said that to activate the flow state, we must choose tasks that have a clear goal and provide us with immediate feedback. Therefore, the activity the client chooses cannot be passive; it needs to be something they can actively participate in, such as drawing or running. Counselors can work with clients to help them find an activity that works well for them. Often, this process takes time and trial and error. After selecting an activity, counselors can also help clients create attainable and realistic goals. For example, if a client chooses to paint a picture, then the counselor could ask them, “What did you learn from engaging in this activity that caused you to change how you are approaching it?” Or if the client chooses to go running, then they could ask, “Was there any time in your run when you changed your gait or the way you approached the activity based on your experience while running?” In our results-driven culture, many of our clients will come to us with an outcome-based mindset, meaning that success is marked by the achievement of a task or by meeting particular benchmarks or expectations. Therefore, as counselors we must be careful not to conflate psychological flow with goal-based achievements.

Create space in the session for flow-based activities. During the counseling session, a drawing or writing activity may help induce flow. Counselors can spend part of the session educating the client on the concept and psychological benefits of flow and then spend the latter part of the session reflecting on the process that emerged during the activity.

Use guided reflection. After a client chooses an activity with goals, it would be helpful to have them reflect on the process. For example, counselors can ask their clients the following questions:

  • How did you feel during the activity?
  • What barriers, if any, got in the way of you achieving a flow state?
  • What was your experience of time?
  • What was your experience of yourself during the activity?
  • What level of control did you feel you had over the task?
  • Was the task too easy or too hard? If so, what changes (if any) would you need to make to help you attain a flow state?
  • Can you think of ways you can consistently induce states of flow into your everyday life?

Helping clients achieve flow states

I often use these techniques of incorporating flow states with my clients, including Julia (a pseudonym). Julia started counseling because of her high levels of anxiety and depression. She described herself as a “neurotic person who cannot get out of her own head.” Often, her anxiety would be paralyzing and prevent her from completing tasks at work or making simple decisions such as what kind of toothpaste to buy or what she wanted to eat for lunch. She seemed to oscillate between moments of extreme anxiety and depressive states where she said her “brain was tired” from working too hard.

Early in our work, I presented the concept of psychological flow to Julia and assigned readings for her to learn more about the topic. She said she was open to trying anything to help her feel better, so we started doing regular meditation exercises during sessions and reflected on the experience and the challenges that the activities presented for her.

As Julia became more comfortable with meditation, we then talked about selecting an activity to practice flow-based work. She defined herself as a creative person who liked to “doodle,” so to induce a flow state, I presented her with various drawing activities that matched her skill level yet were also a bit challenging for her. Together, we found that drawing mandalas allowed her mind to slow down, which eventually let her get into a flow state. In addition to drawing during her counseling session, Julia also chose two nights a week outside of session to draw.

After several weeks of drawing regularly, Julia reported that she looked forward to having time in the evening to relax her mind and that she was “not feeling trapped” in her head like she was before. Although the flow-based activities were not a panacea for her anxiety and depressive symptoms, we found that psychological flow became an effective and useful coping strategy for her symptoms.


Laurie Craigen celebrates finishing the In Search for Memphre marathon

Craigen celebrates with her support crew after successfully swimming 25 miles across Lake Memphremagog. Photo courtesy of Laurie Craigen

Research shows that flow states often help create a positive mental state for people, and it can also be a creative and helpful antidote for depression and anxiety and an effective way to treat clients with a history of trauma. The benefits for our clients are multifaceted.

In addition, because the demands of the counseling field are ever-changing and constant, counselors can benefit from incorporating flow in their own lives to help combat the potential for burnout, stress and vicarious trauma. Psychological flow has made a big impact on improving my psychological health and well-being.


Laurie Marie Craigen is a licensed mental health counselor, an associate professor of psychiatry at Boston University Chobanain and Avedesian School of Medicine, and an endurance athlete. Her clinical work focuses on trauma, grief, anxiety and depression, and high-performance athletes. Contact her at

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.

Treatment strategies for race-based traumatic stress

By Portia Allie-Turco July 18, 2023

A close-up of a Black person staring off to the side


Black Americans often face increased risk of health and mental health conditions because of systemic and structural racism. For example, they are more likely to face discrimination in employment, schooling, housing and health care or to be exposed to and die from preventable or manageable illnesses (such as the COVID-19 virus) because of medical neglect. Exposure to life stressors exacerbated by oppression and chronic socioeconomic disparities leads to higher rates of illness and death. In fact, across most health metrics, Black Americans have increased chances of physical deterioration and early death.

These physical experiences compound Black Americans’ risk for emotional and mental health challenges because they all contribute to the suffering and complications of trauma. In addition, these experiences with discrimination and oppression can result in race-based traumatic stress, a term used to describe the stress Black Americans experience because of cultural, individual and institutional encounters with racism.

Although Black Americans experience mental illness at rates similar to or higher than other populations, research shows that they face multiple barriers to effective mental health treatment. For instance, Black Americans are more likely to terminate counseling prematurely when they do initiate counseling services because of prohibitive cost, limited health insurance, limited numbers of facilities in stressed neighborhoods and transportation issues, among many others. Often, inadequate care is associated with mental health providers’ lack of cultural competence, which exacerbates these mental health inequities.

As the ACA Code of Ethics stipulates, counselors have the ethical obligation to develop the awareness, knowledge and skills related to cultural competence to eliminate barriers effectively for Black Americans. For mental health professionals, that means understanding how to treat Black American clients who are affected by racial trauma. Counselors have a role to play in dismantling racism and its complicated, corrosive effects within our society.

Creating a safe environment

To address race-based traumatic stress, counselors first need to prepare to broach issues of race in session. When counselors are comfortable discussing racial issues in counseling, they reduce the likelihood that Black American clients will water down their racialized experiences to make them palatable to the counselor. It is also important for counselors to emphasize to clients that the responsibility for inclusive counseling rests solely on the counselor. A counselor could approach this by saying, “I know that it’s not your job to educate me about race and racism, and I want you to know that I’m doing my part to keep learning and growing in this area.”

Counselors can acknowledge the difficult issues that are present due to systemic racism and broach the topic in session by saying, for example, “Do I have your permission to point out and talk about what seems to be a racially based survival strategy in the discussion we are having right now?” or “I’m wondering if you are feeling like I get it when you are sharing your experiences with microaggressions at work.”

Black American clients have developed several strategies to deal with racial trauma and stress, including double consciousness and code-switching. Double consciousness, a term coined by W.E.B. Du Bois, describes how Black Americans face pressure to embrace their Black American identity to distance themselves from the presumption that Black people are culturally inferior, while also being aware of the need to internalize a Eurocentric identity and value system to gain respectability. Thus, Black Americans constantly scan and make decisions about whether their Black American identity can be acceptable in white spaces. Living with this double consciousness results in increased stress and hypervigilance.

Code-switching, or alternating between two or more languages or varieties of language in conversation, is a protective strategy that Black Americans use when responding to environmental stress associated with being Black in white spaces. In therapy, a Black American client might change their vernacular when expressing themselves to a non-Black clinician. For example, a client might not use the phrase “do you feel me,” which is a phrase commonly used in the Black community to establish relatability and check for cognitive and emotional connection and understanding, with a racially different counselor. Instead, they may say, “Do you understand what I mean?” to ensure that the clinician understands them. But this change in phrasing causes the counselor to lose the richness of the client’s desire for connection and relatability.

Code-switching also applies to appearance. A Black American client, for example, might feel pressure to conform to white norms of beauty or dress rather than embracing an Afrocentric aesthetic in how they style their hair or what clothes they wear. This constant switching is mentally and emotionally exhausting and prevents Black American clients from fully engaging in therapy as their authentic selves.

It is the counselor’s responsibility to unburden the Black American client from having to code-switch for the counselor’s benefit. Clinicians should develop awareness and address the pressure their clients feel to code-switch by saying, for example, “I wanted to let you know that I’m familiar with the phenomenon of code-switching and why it may have been necessary. In this space, I would like to support you in feeling safe to be fully yourself without fear of encountering microaggressions or being stereotyped.”

Treating race-based traumatic stress

Individuals with race-based traumatic stress can experience psychological and physiological symptoms similar to posttraumatic stress disorder, including avoidance, hypervigilance, flashbacks, nightmares and physical pains. They may also experience grief, loss, anger, shame and self-blame. Counselors who do not understand race-based trauma symptomatology, however, may overlook signs of this type of trauma, which further limits Black Americans’ ability to receive adequate treatment. (For more on assessing racial trauma, read the online exclusive “Conceptualizing and assessing race-based traumatic stress.”)

After assessing for race-based traumatic stress, counselors can use the following treatment approaches to ensure they are addressing the underlying mental health issues related to racial stress.

Disenfranchised grief. Effective trauma treatment universally requires acknowledging and addressing losses that have occurred as a result of the trauma. The treatment considerations are similar when the trauma is caused by racism. Living as a Black American means dealing with pervasive impacts of systemic and structural racism stemming from slavery. It is no wonder then that Black Americans suffer from a profound sense of grief that often manifests as a loss of trust and safety on every level in both social and personal life. Furthermore, this type of grief is disenfranchised, meaning that it is not openly acknowledged, mourned or publicly supported as being legitimate.

To address the profound grief of racial trauma, counselors must recognize that single-incident racist experiences are compounded by collective racial trauma. This larger narrative of disempowerment, which is part of a whole history of trauma inflicted on people of African descent, needs to be recognized and validated as part of the process of healing.

When a Black client expresses grief related to their own racialized experience, or the cultural grief they carry, a counselor can ask the client to name the specific grief, and they may also need to situate the grief in the context of historical losses, such as the long-lasting impacts of slavery. It may be helpful to offer a validating comment such as “What you are experiencing is called disenfranchised grief because the grief that you feel is not always acknowledged or recognized by others.” In addition, the counselor can facilitate a grief ritual, or suggest that the client develop one that will have meaning and healing potential for them, such as sharing with other Black clients in group therapy.

Emotional processing and regulation. Clients who have survived racially charged incidents often present to counseling with complex emotions surrounding these experiences, which require processing in therapy. Several emotions that can be challenging for counselors to work through with Black American clients are anger, shame, humiliation, and internalization of stigma and racist attitudes that stereotype Black Americans as threatening, explosive, dangerous or impervious to pain.

Counselors need to acknowledge that Black people spend a lot of time managing their emotions in white spaces to protect against potential backlash resulting from stereotypes of aggression and violence. Part of this protection is to self-silence and push down emotional responses, such as anger. Dealing with anger and underlying hurt, however, is necessary for the recovery process. Therefore, counselors must work to elicit truthful expressions of anger that may be suppressed by the clients. For example, a counselor might broach this topic by saying, “I’m noticing that you seem agitated when we talk about this certain topic. I’m wondering how it feels to express your emotions in this space. I’d like you to know there is no need to self-silence here.” The counselor can also encourage the client to identify and deal with the underlying emotions, including hurt, injustice, and generational pain and oppression, and they can validate that these emotional expressions are justified considering the historical and ongoing racial issues.

When a counselor can sit with and hear the client’s anger, it creates a safe space for the expression of painful emotions. Thus, the ability to remain grounded when a Black American client expresses anger is an important skill for counselors to have when working with this population and requires an inner posture of non-defensiveness, particularly for white counselors who may experience their own discomfort with the interaction. Counselors need to practice being grounded before entering sessions with clients experiencing racial trauma. This may mean taking time to regulate their own breathing, thoughts or body tension; cultivating a curious and open mind; and seeking supervision with mentors to explore biases and process emotionally charged sessions.

Counselors can also support Black American clients in expressing anger in healthy ways, such as through journaling, music, dance, art and social justice activism.

Internalized racism. Trauma undermines the sense of self and the belief in one’s worthiness, so in racial trauma treatment, counselors must also directly address shame and self-blame. The humiliation that is associated with experiences of trauma often results in a sense of shame that leaves the person feeling intrinsically unworthy. These feelings are related to self-blame where a client might internalize a violator’s view of them and believe that aspects of themselves are responsible for the racial trauma they have experienced, rather than holding the violator alone responsible. Black American clients who internalize racism might speak derogatorily about themselves as a member of the Black American community.

Clinicians can address internalized racism with clients by using culturally adapted cognitive behavioral approaches that focus on restructuring the cognitive distortions that result from trauma and false beliefs. By holding those who violated them accountable, Black American clients can begin to heal and move toward healthy trauma integration.

Focusing on cultural strengths

Counselors must also challenge the notion that Black Americans live in communities that are riddled with problems that can only be solved by adopting Eurocentric solutions. That approach is based on deficit models, in which systemic and structural challenges due to oppression are assigned to Black people and their responses are pathologized. Instead of applying a Eurocentric lens to try to understand an Afrocentric culture, counselors should incorporate an Afrocentric worldview as an antiracist and culturally responsive approach to the treatment of Black American clients. Although largely ignored in counselor training, professional development and even scholarship, an Afrocentric worldview supports the development and maintenance of cultural pride, which research has found increases resilience as a buffer in the continued struggle against oppression. An Afrocentric worldview includes an awareness that Black Americans have retained elements of the ancestral wisdom of Africa, passed down generationally. This ancestral wisdom is reflected in many aspects of their cultural worldview, including:

  • An understanding that spirituality is central to many Black American clients
  • A focus on community connection, as opposed to individualism
  • A holistic view of life experiences that includes natural rhythms and cycles
  • A circular thought pattern that goes beyond a linear approach to include broader contexts
  • An understanding of the importance of relational storytelling

Counselors can become knowledgeable about Black American culture through social justice initiatives such as Nikole Hannah-Jones’ The 1619 Project, which highlights the legacy of slavery in the United States. Counselors must be willing and able to listen to their clients’ stories and be mindful that storytelling may be fuller and more detailed and does not immediately “get to the point” in a way that they are used to. In addition, counselors must be comfortable exploring spirituality with clients and encourage them to use their cultural identity to care for themselves, their families and their communities as a part of healing.

Cultural beliefs and practices are protective for people who have experienced historical trauma. Counselors can use narrative counseling approaches to help Black clients facilitate a strong connection with Black American culture, which can help buffer them against racial harm, as noted in the literature. Viewing Black American culture as a rich source of strength and power can promote wellness by leveraging existing resources within the culture that have endured despite overwhelming and systemic oppression. Researchers have identified six primary cultural resources that operate as forms of wealth or capital for communities of color:

  • Aspirational capital: the ability to pursue hopes and dreams even in the face of barriers
  • Linguistic capital: the language and communication skills that a person has acquired throughout their life, including core expressive concepts such as virtuosity, originality, creativity and beauty, which are reflected in dance, music, poetry, theater and art
  • Social capital: the ability to develop and maintain supportive relationships and networks
  • Navigational capital: the ability to adaptively negotiate social institutions that are unwelcoming and exclusionary
  • Familial capital: using kinship connection to build on generational knowledge and intuition
  • Resistance capital: the endurance, perseverance and skill to stand firm in one’s cultural identity and engage in actions that protect and promote equality

Counselors can tap into all these expressions of cultural strengths when working with Black American clients to support them in healing and in using cultural buffers to shield against the ongoing onslaught of racial trauma. Working from this framework and accessing each empowering aspect require counselors to identify, affirm and incorporate them in treatment planning. This is crucial because cultural strengths have provided the bedrock for Black Americans’ survival and enable their ongoing ability to persevere.

Promoting healthy coping strategies

Trauma recovery involves learning effective coping strategies. In counseling sessions, counselors can teach emotional regulation and stress tolerance skills, such as breathing techniques, somatic therapies and other trauma-responsive care, all with the understanding that these efforts are necessary to address the unique and ever-present racial stressors. Other coping strategies include inviting Black American clients to create a space for rest and restoration, exercise, movement and dance, self-expression and spiritual practice.

Counselors can also explore how Black American clients have coped in the past, including engaging with community support. Research shows the benefits that communal healing has for Black Americans, so group counseling can improve the well-being of survivors of racial trauma. Racial healing circles, for example, offer a supportive healing environment for processing racial wounds. Similarly, sister circles — a sacred space that Black women create to accompany one another as sisters on their healing journeys — is another example of communal healing that also draws from ancient African wisdom. Counselors can facilitate similar types of support through traditional group counseling that is modeled after healing circles or by referring clients to locally run racial healing circles within their community.

Another mental health strategy is to empower and support Black American clients’ need to self-advocate for social justice. Research shows that Black American clients benefit from resistance strategies that encompass activism, such as non-violent confrontation with racism, lobbying for anti-racist policies and other actions that support the client.

When counselors adopt an anti-racist stance and communicate it consistently, they join the client in actively challenging the status quo. In learning about culturally inclusive care and applying strategies for treating race-based traumatic stress, counselors can fulfill their ethical responsibility and make significant advances in addressing the existing mental health inequities for Black Americans.


Learn how to access for race-based traumatic stress in the companion article “Conceptualizing and assessing race-based traumatic stress.”


headshot of Portia Allie-Turco

Portia Allie-Turco is an assistant professor, clinic director and program coordinator in the Counselor Education Department at the State University of New York at Plattsburgh. She is also a licensed mental health counselor who specializes in healing racial, generational and complex trauma. Contact her at

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

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

Counseling Today recognized with five awards

APEX publication award logo for 2023


The Counseling Today staff won a total of five awards in APEX 2023, the 35th annual awards program recognizing excellence in publishing.


Grand Award

cover image of August 2022 issue of Counseling Today. Features a young child wearing a backpack going up steps to school.

Awards of Excellence

  • Award of Excellence in the mental health/mental illness writing category for editor-in-chief Lindsey Phillips’ January 2022 feature “The emotional and social health needs of Gen Z.”
  • Award of Excellence in the health and medical writing category for senior writer Lisa Rhodes’ October 2022 feature “Finding hope after surviving suicide.”  
  • Award of Excellence in the feature writing category for former senior writer Bethany Bray’s October 2022 feature “Disarming anger.”
  • Award of Excellence in the category of best WordPress sites for the magazine’s website, CT Online.

Counseling Today has been published by the American Counseling Association since 1958. Counseling Today staff have received 67 awards for writing, design and website excellence over the past 18 years.