Tag Archives: Coronavirus

Overcoming free-time boredom during COVID-19: Combining a home-based optimal leisure lifestyle with behavioral activation

By Rodney B. Dieser July 7, 2020

As a licensed mental health counselor, I am hearing many of my clients tell me that they are ready to go stir-crazy because of an abundance of free time combined with greater stress during the COVID-19 pandemic. Although many states are reopening their leisure industries, many of my clients feel the safer route — and more thoughtful route toward health care workers and preventing the spread of COVID-19 — is to follow epidemiological and scientific advice by staying home.

Some of my clients are experiencing depression because they have lost their jobs, spend most of their days bored and ruminate on fear-based thoughts. The purpose of this short article is to suggest two interrelated ideas about how to create a psychological breather of positive emotion during your day that can also distract you from worry and stress.

First, develop a home-based optimal leisure lifestyle (OLL), which consists of one serious leisure activity, supplemented by casual and project-based leisure. Serious leisure is centered on acquiring and expressing special skills, knowledge and experience that take months, and sometimes years, to develop. Often, in everyday life, this is known as developing a hobby and is based on mastery gained through hard work and much effort.

My youngest son has taken the extra free time he now has and developed a serious skill-based hobby: He has purchased a watch repair kit and is tinkering away at repairing old watches. I am learning how to play the harmonica to Bruce Springsteen songs.

The Wikipedia page on hobbies identifies hundreds of skill-based hobbies to pursue, many of which are home-based. The internet can help with education and skill development. Often, there are online communities full of people who will welcome and mentor you toward your new serious leisure pursuits.

Casual leisure involves short-lived activities that require little or no specialized training. This type of leisure is based in hedonistic pleasure that requires little effort. For instance, my wife and I are currently watching comedies and documentaries on Netflix and enjoying it.

Project-based leisure is a short-term, one-shot or occasional creative undertaking. My wife is serving her community through her sewing projects and is serving a local nonprofit agency. When our kids were young, they picked a project of leisure learning each week (often it was insects), and we all had fun as we learned together. Just like with serious leisure, you can use the internet to find projects in your community. Often, nonprofit organizations are more than ready to link your personal strengths, passions and skills to a project they are working on.

Developing an OLL will provide transient moments in your day for positive emotion — a psychological breather from going stir-crazy and experiencing brain-numbing boredom. To learn more about OLL and the three forms of leisure I have just described, visit the Serious Leisure Perspective website. There you can learn about Robert Stebbins, who pioneered the academic work over a span of 40-plus years that led to development of the serious leisure perspective and the OLL framework. In addition, this website lists hundreds of studies that provide evidence of how individuals’ positive emotion is increased when involved in serious, casual and project-based leisure.

Research demonstrates that people can remedy stress if they laugh more (casual leisure), find a hobby (serious leisure) and engage in meaning-making activities such as volunteering in their communities or toward social causes (project-based leisure).

Behavioral activation involves having people/clients become more active and involved in life by scheduling activities with the potential to improve their mood. Counselors can help those clients who have an abundance of free time on their hands, whether due to unemployment or wanting to continue self-quarantining, by working with them to create a daily schedule based on developing an OLL. This involves using free time to engage in one serious leisure activity (e.g., starting a new hobby such as digital art, nail painting, cartoon drawing or bird watching), one casual leisure activity (e.g., reading, exploring new musical genres, watching comedies, hanging out with friends virtually) and one project-based leisure activity (e.g., sewing high-grade face masks for health care workers, volunteering at the Humane Society or with a political party, helping a nonprofit with fundraising efforts, creating a family history book by interviewing uncles, aunts and cousins) every day.

Behavioral activation is an evidence-based treatment for depression that has been found to be very effective. In everyday language, it is simply getting people more active and involved in life by scheduling activities that can improve mood. Cultivating an OLL and getting involved in serious, casual and project-based leisure when homebound is one way to create a psychological breather of positive emotion during your day that can also distract you from worry and stress.

 

Self-disclosure of my OLL

The following is a self-disclosure of my OLL during a three-month-plus self-imposed lockdown at home during the COVID-19 pandemic. It is provided so that readers can gain a gestalt of how an OLL can be inserted into everyday life that now may feature much more free time.

Serious leisure: Developing and expressing special skills, knowledge and experience; acquires much effort and is linked to enjoyment.

My daily activities

  • Learning to play harmonica to Bruce Springsteen songs
  • Studying creative writing and attempting to write short stories

Casual leisure: Low skills set focused on distracting; linked to pleasure.

My daily activities

  • Watching more documentaries and comedies on Netflix
  • Reconnecting with “forgotten musicians” of my past (what I used to listen to as a young man). Includes learning about and appreciating musical narrations and sonic arrangements of different genres of music. Examples: Chris de Burgh, James Taylor, Al Stewart, April Wine, Bachman-Turner Overdrive, Thin Lizzy, Supertramp, Triumph and Neil Young. I extended this to the music that my father and mother (both deceased) liked. This included Hank Williams, Waylon Jennings, Stompin’ Tom Connors, Hank Snow and Freddy Fender.
  • Reading the “classics” in literature, such as Mary Shelley’s Frankenstein, Cervantes’ Don Quixote and Arthur Miller’s Death of a Salesman

Project leisure: Short-term activity focused on completing a project

My daily activities

  • Cleaning out parts of the house that have not been cleaned out for years and donating much to Goodwill Industries
  • Gardening
  • Weekly project of exercise for health: Taking a 5- to 15-mile bike ride three days a week; running sprints at an outdoor track one day a week; working out on a Bowflex twice a week

Note: I used my stimulus check to purchase a Bowflex online and set it up in the garage. That piece of exercise equipment, gardening plants/seeds and used books (also bought online) are the only leisure resources I have purchased during the pandemic. Many of my leisure activities, such as playing the harmonica, engaging in creative writing and developing my appreciation of past musicians, have been learned or enhanced through resources on the internet.

 

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Related reading, from the Counseling Today archives (co-written by Rodney B. Dieser): “The serious leisure perspective in mental health counseling

A USA Today opinion piece written by Dieser: “Coronavirus pause: People need people, but it’s risky to resume social activities so soon

 

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Rodney B. Dieser is the author of five textbooks and more than 100 articles on the topic of leisure. His writing about leisure has appeared in USA Today and the Mayo Clinic Proceedings journal. He is a professor of recreation, tourism and nonprofit leadership and an affiliate faculty member in professional counseling at the University of Northern Iowa. He works 10 hours a week as a licensed mental health counselor for Covenant Family Solutions in Cedar Falls, Iowa. Contact him at rodney.dieser@uni.edu.

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

Putting first responders’ mental health on the front lines

By Lindsey Phillips July 6, 2020

A firefighter/emergency medical technician (EMT) in Maine answers an emergency call. He grabs his gear and performs a job he knows well. The next day, he discovers that the person he helped has tested positive for COVID-19. He immediately starts worrying not just about himself but about his wife and young child, who have respiratory issues.

Amy Davenport Dakin, a licensed clinical professional counselor in Maine and a licensed clinical mental health counselor in New Hampshire, has been working with this firefighter/EMT for several years now. Before this incident, he had struggled with anxiety, depression, suicidality and posttraumatic stress disorder (PTSD), but with Dakin’s help, had successfully worked through many of these issues. This latest experience of being exposed to the virus that causes COVID-19 adds another layer of stress and anxiety that could negate his previous progress, Dakin says.

As the name implies, first responders such as EMTs, police officers, firefighters, paramedics, dispatchers and others are trained professionals who are the first to respond in emergency situations. Unless people happen to be facing an emergency themselves, this service often gets taken for granted, and little thought is generally paid to the accumulating toll on first responders’ mental health.

That calls for a reality check. “Our worst day is first responders’ every day,” points out Drew Prochniak, a licensed professional counselor (LPC) and licensed mental health counselor (LMHC) in private practice in Portland, Oregon. “Their days are filled with accidents, pain, grief, loss and trauma.”

According to a 2018 supplemental research bulletin from the Substance Abuse and Mental Health Services Administration’s Disaster Technical Assistance Center, depression and PTSD affect approximately 30% of first responders. In addition, 37% of fire and emergency medical services professionals have contemplated suicide, which is nearly 10 times the rate of American adults in general. In fact, in the United States, more firefighters die from suicide than from fires, Dakin notes.

It is easy to surmise that this population could benefit from therapeutic interventions, yet its members are often the last to ask for help. By getting to know the first responder community and tailoring approaches to match this population, counselors can break down some of the barriers that prevent these heroes from prioritizing their mental health.

 

Getting to know the culture

Dakin, a member of the American Counseling Association, acknowledges that it can be difficult for counselors who do not have previous experience with first responders to get a foot in the door with the community. Someone initially referred a firefighter to Dakin for counseling services, and the experience piqued her interest in working more with first responders. But first she had to earn their trust.

For approximately seven years, she attended labor union meetings, conducted trainings and presentations, rode along with first responders on calls, and hung out at their stations. This exposure allowed her to build relationships and trust within the first responder community and helped her determine that it was a population with which she wanted to work full time. Today she owns New Perceptions Inc. in Kingston, New Hampshire, a private practice that focuses on trauma and mental help treatment for first responders.

Prochniak, a former search and rescue professional and author of the book Addiction & Recovery for First Responders, agrees that establishing a relationship with a first responder department or agency is an important step toward overcoming community members’ belief that clinicians don’t understand their culture. “There’s this mystique about clinicians that we only want to talk about emotions and get in people’s heads,” Prochniak says. Building relationships with first responders outside of counseling sessions will show them that therapists are just regular people too, he says.

Prochniak, who specializes in the education, training and treatment of first responders, says there is a personality type that goes along with being a clinician who works with this population. Counselors must be able to handle hearing about grotesque experiences and communicate respect for the work that first responders do, he explains. With clients in law enforcement, this often means that counselors must be comfortable with clients having guns in session, he adds.

Prochniak cautions counselors against asking first responders about the worst thing they have seen, what type of gun they carry or whether they have ever shot someone. Instead, counselors should be curious about them as people: How long have they done this work? What led them to get into this line of work? How does their work affect their family? What kind of social network do they have? Do they hang out only with people from the first responder community? What else do they do outside of work?

Counselors will also need to be able to tolerate a dark, almost morbid, sense of humor because first responders often use that as a coping mechanism. “One of the ways we cope with trauma is with humor. And it can be really upsetting for people who don’t experience [what first responders do],” notes Carrie Whittaker, an LPC and LMHC in New York and Connecticut.

Prochniak points out that counselors must also be savvy about managing dual relationships. In addition to being a clinician in private practice, he is also a trainer and educator. At the start of every new client relationship with a first responder, he prepares them for the possibility of also bumping into him at trainings, briefings, meetings or ride-alongs. He makes it clear to these clients that he will not initiate acknowledgment of them in such circumstances out of respect for their confidentiality. “One wrong slip in acknowledging that you see someone [in counseling] or that you know someone else could cost you a client,” he explains.

In addition, counselors have to be flexible when working with first responders because they have irregular schedules, Dakin says. This might mean needing to conduct telehealth sessions or meeting with these clients outside of the typical 9-to-5 workday. There will also be last-minute cancellations, she points out. Dakin typically has a 24-hour cancellation fee, but she waives it for first responders who are stuck at work or otherwise have a good reason for not making their appointments.

In many ways, counselors may need to be on call themselves when working with first responders, Dakin says. When there is an emergency such as a line-of-duty death or an explosion, Dakin has to be prepared to drop everything, including her current caseload for that day, to respond. And if a client who is a first responder has a bad call on a Sunday, then she is also working that Sunday. Although it has happened infrequently, she has even had the labor union or clients call her as late as 10 p.m. because of an emergency.

Prochniak and Dakin both emphasize the importance of being humble when working with this population. “Although you are the professional in mental health, you’re not the professional in their field,” Prochniak explains. “Just because you know trauma or just because you know stress doesn’t mean you know this population. It shows up very differently … because this is a unique culture. So, get to know the culture. Spend time with them.”

No shame in needing help

The biggest barrier to first responders seeking help is the attached stigma — a false belief that if they need counseling, it means they are weak or unfit to do the job, Dakin says.

People often assume that because first responders signed up for the job, it means they are prepared to handle the associated trauma. But that’s not how the brain works, Dakin stresses. “The brain can only handle so much exposure to traumatic images before it’s on overload,” she says.

Joel Smith, an LPC in private practice in Denver, concurs that as a society, we do relatively little to acknowledge vicarious trauma among first responders. Although these professionals do generally possess an enhanced skill set to cope with trauma, they are still vulnerable to burnout, he says. Smith tries to normalize this reality for clients who are first responders by asking, “Has your stress been building up for a while? Is it exploding? How are you handling your stress?”

Whittaker, an ACA member who has a private practice in Manhattan and Westchester, New York, puts this idea of “being tough enough to handle it” into context for her first responder clients. She explains that being tough doesn’t mean that they never get upset or that nothing bothers them. It means processing those feelings to help themselves do their job better.

“It’s important for counselors to remind them that being tough enough to handle it doesn’t have to mean being hardened to it. It doesn’t mean that you don’t break down and cry sometimes,” she says.

First responders also have a tendency to not want to burden others with what they have experienced. Some of Dakin’s clients have said to her, “It’s a really bad call, and I don’t know if I want to put those thoughts in your head.”

Clinicians have to reassure these clients that counseling is a safe space for them to talk about their issues and experiences. When hearing difficult stories, Dakin says, counselors should refrain from sounding alarmed and making statements such as, “I can’t believe that happened! That must have been horrible.”

“While [that statement] is validating and has the best of intentions, that’s not what these people want to hear,” Dakin says. “They basically want to talk. They want to tell their story.” Counselors can validate that the client’s experience was tough without being too reactionary, she says, and that largely involves listening carefully.

Counselors should also remain aware of their facial expressions, Whittaker adds. If counselors look shocked or terrified, these clients will notice and be more likely to shut down.   

Smith, a therapist at Jefferson Center (a community-focused mental health care and substance use services provider in Colorado) and an associate at Look Inside Counseling, finds motivational interviewing an effective technique when first responders are hesitant to accept help from others. For example, Smith says, counselors can ask these clients, “How can you receive help yourself?” or “How can you model receiving help?” The technique allows first responders to develop some healthy discomfort with the fact that they are simultaneously heroes who help others and people who need help with their own problems, Smith explains.

“One of the best ways they can help themselves is to feel like they have a role in helping someone else,” Smith continues. That’s one of the reasons he encourages first responders who have benefited from counseling to tell colleagues about how it has helped them.

These clients could share an effective coping skill they learned in counseling with the rest of their team, or they could model self-care at work. “If you see someone struggle, that’s one thing. But if you see them struggle and overcome it, it builds the idea that it’s possible [for you too],” Smith notes.

Tailoring counseling to fit first responders

Prochniak, the mental health professional for American Medical Response in the Portland/Vancouver metro areas, finds that mindfulness, focused breathing and meditation techniques all work well to reduce first responders’ anxiety and stress levels and build their stress resilience. Sometimes, however, these clients can be hesitant to try such techniques, either because they perceive some stigma attached to the techniques or because of the way that counselors present them.

One approach that can help break through this hesitation is finding concrete ways of translating clinical speech into first responders’ everyday language, Prochniak says. For example, if he’s working with a paramedic, he will discuss how mindfulness techniques strengthen the parasympathetic nervous system. If he’s working with a client in law enforcement, he will reference combat breathing, which is how these professionals already describe the use of deep breaths to calm down or reduce stress.

Dakin frequently convinces first responders to give mindfulness and yoga a try by explaining the science behind the exercises. She often compares how the brain processes trauma with what happens with diabetes: Just as elevated levels of glucose in the body worsen when the pancreas does not work correctly, experiencing too much trauma causes an overload of chemicals to be dumped into the brain. Then the brain responds by releasing cortisol. Breathing and mindfulness exercises help reduce that response and regulate chemical levels.

Similarly, the traditional way of presenting and explaining yoga doesn’t match with the culture of first responders, Dakin notes. When she first encourages these clients to try yoga, the response is typically along the lines of, “I’m not going into a studio wearing spandex and meditating.”

To counter this negative perception, Dakin recommends a yoga program designed specifically for first responders (yogaforfirstresponders.org). The program gears its language to fit the culture, she says. For example, it renames child’s pose as a warrior’s pose, which is a more strength-based term. Dakin now knows some first responders who practice yoga on the job to regulate their breathing and avoid going into fight-or-flight mode as quickly.

Smith has discovered that some of his clients find it helpful to conceptualize grounding techniques as a workout. They have a “grounding buddy,” and together they work on their awareness, he says.

Dakin also uses familiar language to help first responders get more comfortable with mindfulness. For example, rather than having firefighters use a numerical scale to describe how upset they are, she uses the fire danger warning scale, which estimates the existing and expected fire risk for an area. The scale is color-coded, moving from red (extreme danger) to green (low danger).

If a client says they are in the red, then Dakin has them breathe deeply while imagining their arrow moving into a safer level. She explains how each breath is calming their nervous system. This skill has become a special language that she shares with her clients. A client may start a session by saying, “I was in the red a couple of times this week, but I breathed and at least got myself into the yellow.”

Dakin also explains to clients that mindfulness doesn’t have to be limited to sitting still and taking deep breaths. It can take the form of something they normally enjoy doing, such as fishing, taking a walk, kayaking or hiking, as long as they are doing it mindfully.

Managing anxiety

First responders often get anxious anticipating what their day might hold. “Schedule and routine are the enemy of anxiety,” says Smith, who specializes in trauma, mood management, addiction, and LGBTQ-specific needs. First responders can incorporate comforting activities such as walking their dog or calling a family member at certain times throughout the day. “Having that kind of expectation in life leaves less room for anxiety to happen,” he explains.

He encourages his clients to make grounding a part of their daily routine. They can ground themselves when they wake up, when they shower or when they go to bed. They can also ground themselves on the way to work, Smith points out, taking a few minutes when they are at a red light and noticing what’s happening around them: “I’m stuck in traffic. A kid is riding a bike beside me. It’s raining. A song I like is playing on the radio.”

Smith advises clients to set phone reminders to ground themselves. Even if they can’t check their phones that minute, they will be reminded later. Then they can take two minutes before going back to work to breathe and be aware of the way their body feels, their surroundings and their emotions.

Grounding can also be a preventive measure, Smith adds. “If you walk into an emergency and you’re already grounded, then you’ll be better off on the back end of that emergency,” he says.

As clients progress with their grounding skills, Smith asks them to visualize grounding themselves during an emergency on the job. This involves visualizing the person in front of them who is having the emergency, as well as all the chaos and turmoil unfolding around them, while also being aware of their body and their role in the situation.

“It sounds counterintuitive to have them visualize chaos, but first responders are going to experience that during their day, and then they can ground themselves in the midst of this chaos,” Smith says. This is an advanced grounding skill and not appropriate for first responders who have just started therapy, he points out.

Processing the trauma

Trauma is no stranger to first responders. They see people die and watch people suffer, all while working long hours. And they often feel unable or powerless to help, Smith says.

Some first responders also wrestle with guilt over choices they made during an emergency. “When you have to make a decision in a split second, that’s something that can be really haunting. It might mean saving your life or saving someone else’s life but sacrificing something or someone else,” says Whittaker, who specializes in working with trauma.

“Trauma makes us think horrible things about ourselves and our own abilities,” Smith says. For example, a highly skilled emergency room nurse may suddenly doubt their skills if multiple people die during their shift one week. The nurse may suddenly feel out of control or useless.

Smith finds trauma-processing therapies such as eye movement desensitization and reprocessing (EMDR) and trauma-focused cognitive behavior therapy effective with the first responder population. These therapies help clients process their feelings about the trauma while learning to separate themselves from unhealthy thinking.

Because emergency situations are filled with chaos and unpredictability, it is often difficult for first responders to slow down and think about what they can realistically control, Smith says. He often has clients journal about what they can and can’t control.

“They can have control over their own beliefs about themselves and what their own purpose is. And that can be enormously helpful in a trauma environment,” Smith says. With EMDR, clients are able to look at a task that gives them anxiety, reduce that anxiety, and feel more confident to perform that task, he adds.

Behavior patterns can be telling

Dakin often detects PTSD and emotional problems by looking for behavioral shifts or irregular behavior patterns with first responders. For example, a first responder who has been working in the department for 20 years without any issues may suddenly start yelling at the fire chief and refusing to follow rules. When this happens, the labor union often asks Dakin to perform an evaluation to figure out what might be going on.

Counselors should also be aware of behavior patterns around substance use. “There’s a huge co-occurrence of substance abuse and trauma,” Smith says. “So, if you work in an environment where you’re going to see and experience trauma, then … you’re more likely to develop a substance abuse problem.”

First responders might not necessarily be battling a long-term addiction or engaging in binge drinking, Prochniak says. They might just be spending their days off work each week casually drinking because they find their home life less exciting than their work life, he observes.

Both Prochniak and Smith encourage counselors working with first responders to ask about their substance use, including amount, frequency and any changes over time. “If that problem exists, then it’s usually helpful to manage substance abuse habits before working on trauma,” Smith advises.

Prochniak also encourages clients to notice when they experience the itch to have a drink or use drugs and to think about what that itch (the substance use) is trying to scratch. Are they anxious, bored, unsettled? Together, they then figure out a plan to address the underlying issue. “Breaking it down into this smaller view of what’s behind the drinking [or substance use] can be helpful,” he notes.

Developing transition plans

All the stress and trauma of the job can spill into first responders’ personal relationships. “People who are going through trauma can be emotionally up and down, so a first responder may be angry or irritable, if not explosive, sometimes,” Smith says. “Maybe they will cry a lot or be super anxious and not be able to really be in a room with [family or friends] because they have pent-up energy.”

First responders often need help learning how to transition from work to home, where the rules may be different, Prochniak says. For example, if a firefighter works a 24-hour shift (followed by 48 hours off), their partner is in charge of the house for those 24 hours. When the firefighter returns home, they may be upset because they expect the house to be clean and organized like it is at work.

Prochniak and Smith help these clients develop transition plans to better manage the boundaries between work and home. Smith encourages his clients to perform self-checks before heading home from work. They can ask themselves, “Where am I right now? How am I feeling (angry, sad, anxious)? What do I need before I go home?” His clients often discover they need to take 30 minutes for themselves. They may go for a run, sit in the car and listen to music, read a book or grab a bite to eat before they are ready to take on the demands at home.

Prochniak recommends that first responders use the following transition strategies:

  • If they’ve had a rough day at work, text or call their partner to provide a heads-up.
  • Take 30 minutes to exercise either at a gym or on equipment they keep in their garage to process the cortisol and neurotransmitters that have accumulated over the course of their shift.
  • Change their clothes at work so that they don’t wear their uniform home. Prochniak often advises clients to look at the shoes they’re wearing. If they are wearing their duty or work boots, then they are at work. If not, then they are at home. This serves as a reminder of the role they are in and what their expectations should be.

Helping first responders support themselves

First responders operate in a close-knit community. “They protect each other, but they also don’t know what to do [to help one another],” Dakin says. She recalls a client who found his co-worker’s behavior troubling, but he wasn’t sure how to provide assistance because he didn’t want to get his friend in trouble or for his friend to get mad at him.

One of the best things counselors can do to support this population is to educate them on healthy ways to help one another. Dakin works with a program (offered by the International Association of Firefighters and the Professional Firefighters of Maine) that trains firefighters to look for warning signs that a co-worker may be struggling and to intervene before it turns into a mental health crisis.

According to Whittaker, peer support often works better than group therapy for this population. Group therapy places people who have been taught to swallow their feelings and just “deal with it” in a setting where they may fear what a therapist will push them to say and how their peers will react, she explains.

Peer support, on the other hand, “takes the therapist out of the room,” Whittaker says. “It is led by people who have been through it and people who can find that common ground. It feels less like therapy and more like people just hanging out and talking, which is a much safer experience for them.”

Dakin recently helped some firefighters/EMTs launch a peer support recovery group. Even if she is present in the group, she lets the first responders lead. She is there not as a counselor but as moral support, she says. If the group asks for her clinical advice, she provides a quick blurb on how the brain works or offers tips such as how to get better sleep. She then fades into the background and lets the group take control again. The goal, she says, is for the first responders to support one another.

Responding during COVID-19

The “invisible threat” of COVID-19 currently looms over first responders, Prochniak says. When they pull up on scene or respond to a call, they no longer know what to expect. They have to assume that everyone is sick or symptomatic, so they wear protective gear and practice physical distancing as best they can while still performing their jobs.

Clients have told Prochniak that although the number of emergency calls has decreased, the overall intensity of those calls has increased. More calls have been made related to suicide and domestic violence.

Most first responders are anxious about what the future holds, Dakin says. They worry about the health of their families and co-workers and their own health. They are concerned about people in the community who often rely on their services and who aren’t calling right now. And they are anxious about the types of calls they will receive once call volumes return to normal.

Prochniak is helping his first responder clients manage their anxiety over the COVID-19 pandemic by having them focus on what is in their control. They may not be able to reduce their threat of being exposed to the virus, but they can develop a plan for what they would do should they be exposed. Would they live in the garage, in a tent in the backyard, in a hotel? How would they handle child care?

Whittaker admits that listening to first responders’ experiences can be difficult, but she also appreciates that they are willing to share something so personal with her. She makes a point of ending each session on an uplifting note. They might talk about how the client demonstrated bravery, how much the client has improved at using a particular counseling skill or how an experience worked out better than the client expected.

“When you see change in somebody’s life,” Whittaker says, “it’s easier to hear these difficult stories because you have a role in making it a little better for them.”

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

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

The power of virtual group therapy during a time of quarantine

By Scott Gleeson July 1, 2020

In our newfound world of physical distancing, the idea of six to eight people in a confined space might feel counterintuitive to the six-feet-apart mission we still find ourselves trekking in wake of the coronavirus pandemic. Yet the power of a group is exactly what could provide a profound healing method for so many in times of intensified life anxieties and social isolation.

Mental health clinicians everywhere have been thrust into virtual counseling scenarios because of shelter-in-place restrictions, with telehealth numbers skyrocketing in March, April and May, according to the Department of Health and Human Services. Although in-person individual sessions are poised to become more feasible this summer, physical distancing practices and safety precautions are likely to keep group therapy sessions at a minimum.

That’s where virtual group therapy can be essential.

As a facilitator for a small men’s group at a private practice in Downers Grove, Illinois, I was hesitant about virtual group sessions temporarily replacing our biweekly meetings back in mid-March. By now, even with FaceTime and Skype temporarily being deemed HIPAA-compliant, I am guessing that we all can relate to the technical and natural difficulties that can ensue with any virtual session.

Is the Wi-Fi spotty to the point that the client’s responses are delayed, leading to talking over each other? Is a client’s body language difficult to read on-screen, or are they tenser and more reluctant to open up? Is privacy a never-ending challenge? The task of organizing a successful group session over a virtual platform was certainly daunting to me.

Despite my apprehension, our first quarantined men’s group session was one of the best we have had in the nearly two years the group has been running. The reason? There was a true need to connect.

Our meetings are facilitated as an open group, and we recently welcomed a few new members virtually, but it takes the life of a closed group because of the culture of camaraderie. The men in our group are all going through something different, and we cover topics ranging from marriage and parental struggles to loss and relationship dynamics. The demographic makeup of the group is diverse, but because of the support the guys feel when sharing their current life stressors (sometimes in great depth), there is often a sense of inhabiting common ground. Once we got used to the Brady Bunch-looking setup of the virtual platform, we didn’t skip a beat in this regard. The synergy we had developed over time carried over to make the virtual group setting still feel organic and comforting.

Irvin Yalom has popularized 11 therapeutic principles for high-functioning groups, and among those key principles are universality and instillation of hope. In these emotionally turbulent times, the cohesiveness felt in group therapy can take on new meaning because of the umbrella of uncertainty we are living under. And the need to foster optimism during a global crisis has been catapulted to the forefront.

What follows is a look at three important ways virtual group therapy can bolster clients’ mental health during unprecedented challenges.

Addressing uncertainties: One ripple effect of the COVID-19 pandemic has been the hit to the economy that left many workers jobless, furloughed or taking significant pay cuts. That’s where the power of catharsis comes in.

Throughout our group’s spring meetings, one common theme the guys shared was how discombobulated they felt by the uncertainty of everything, especially economically. Upon soliciting feedback, many group members shared that it was helpful simply to air out those feelings and connect with others universally.

Checking in on self-care: Quarantining drastically complicates the goal of maintaining proper self-care. The World Health Organization (WHO) has suggested a rise in depression as a result of routines and livelihoods being altered.

Of course, standard self-care practices for many men (going to the gym, drinking beers at a bar, playing contact-centric sports) quickly fell out of the picture as the pandemic escalated. That pushed our group members to get more innovative and imaginative.

One of our guys ramped up from-home workouts. Another started calling one new friend each day. Another started a Star Wars marathon. Another began virtual guitar lessons. Another started baking for the first time ever (desperate times indeed!). This is where the altruism offered by group becomes an emotional springboard. In sharing their strengths and creative ideas, each member’s self-esteem received a boost.

Creating much-needed positive connection. The Centers for Disease Control and Prevention has recommended connecting with others and “talking with people you trust” during times of quarantine. Participating in happy hour with co-workers over Zoom or hosting informal college reunions over Facebook Messenger can undoubtedly offer a great morale boost.

The difference between those types of meetups and a therapeutic group can be found in the layers of emotionality present. Raw feelings of “I miss my kids” or “Nothing I do is ever enough for my wife” take on a different tone in a group that fosters emotional processing vs. another round of drinks.

One important element to consider is the idea of connection provided by social media and how an overconsumption of that medium can actually be detrimental to well-being. That’s especially the case when it comes to ingesting news that often has negative headlines. The WHO recommends limiting news consumption and taking in at least one positive story each day. To honor that guidance, consider starting or ending virtual group meetings by having each group member share a positive story.

Every class I took for my online master’s program at Northwestern University’s Family Institute was over a virtual platform. So, in many ways, I was trained in a digital arena, with case conceptualization and role-plays constructed in Zoom breakout rooms. One of my biggest takeaways from that experience was how close I actually became with my classmates. We had met in person maybe once before graduation, yet there was a potent bond that was fostered through the intimacy of a computer screen.

I feel a similar sense of unity now in virtual counseling groups. In a day and age when physical touch is less plentiful, togetherness has never been more vital for all of us.

 

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Scott Gleeson is a licensed professional counselor at DG Counseling in Downers Grove, Illinois, and Chicago. Contact him at scottmgleeson@gmail.com.

 

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

For such a time as this: A plan of action for moving forward

By Esther Scott June 30, 2020

[Editor’s note: This is the fourth article in a series on action plans for different areas of life during the COVID-19 pandemic.]

During this period of physical distancing, a new norm of limiting touch was created. Although touches are often few and brief in American culture compared with other cultures, these brief touches contribute greatly to our emotional well-being. Many have missed the small touches of friends and family that connected them at a deeper level, or the social courtesy of a handshake during introductions.

Social distancing, although necessary, has been a big challenge. But after a period of quarantine and isolation from friends and family, perhaps a bigger challenge will be returning to normal interactions of touching one another without fear and anxiety. There are mixed emotions involved. Some people are feeling relief and gratitude as restrictions are gradually loosened, while others are experiencing frustration with the “new norm” or are fearful that others could still infect them with the virus.

Whichever side you come out on, it is important to remember that touch creates a human bond that is particularly necessary for building a healthy, more connected community. Studies show that we need to touch and be touched. Human touch is vital for well-being. It leads to the release of oxytocin, also called the “love hormone,” which helps regulate your fight-or-flight system and calms your body in times of stress.

Studies also show that lack of touch can be harmful to health. In experiments with monkeys, researcher Harry Harlow demonstrated that young monkeys deprived of touch did not grow and develop normally. We must now work at getting back to where we can touch each other without anxiety or doubt.

In the meantime, learning to express warmth and affection through words will help us move forward. Here is a plan of action for that.

Images from the United Nations COVID-19 Response page at unsplash.com

1) Focus on the future.

Every storm passes. And this too shall pass. After a period of quarantine or isolation, you may feel emotions that include relief and gratitude, or even feelings of personal growth and increased spirituality. Just as fear was once spread, hope and security can be transmitted socially too.

Looking at crises as opportunities to rethink and reorganize our priorities will prove beneficial. Crises bring opportunities for improvements that are not always possible in other conditions. The analogy of a diamond may apply here. The beauty of the diamond comes about from the extreme experience of pressure and heat. The same is true for us. We will emerge stronger from this situation and the complex challenges we have faced and are still facing. Let’s focus on a future that is filled with hope.

2) Prioritize your mental health and be flexible.

Things may get worse before they get better, but we are still here. Human beings have great capacity for adapting in times of suffering.

Prioritizing your mental health can be one of the best steps you can take at this time. For many, this will mean continuing to see their therapists or booking online sessions to talk through things and being intentional about practicing self-care.

Feeling anxious as we reintegrate as a society will be normal, but if you experience symptoms of extreme stress such as constant sleep problems or an increase in alcohol or drug use, a visit to your health care provider or mental health professional can make a positive difference. Mental health is essential to everyone’s overall health and well-being, especially during difficult times. Focus your attention on your strengths and abilities, and imagine yourself coping and adapting successfully.

Flexibility is adaptive. It is imperative that we build a foundation of healthy coping and stay connected to our values and to one another. Gratitude is a good first step toward opening the door to flexibility. In fact, the more you practice gratitude, the better your brain gets at recognizing positive things.

Start by thinking about one thing or person for which you are grateful. Focus on the feelings that arise, and hold them in your heart. Know that you can return to that thought of appreciation anytime as you move forward.

3) Be optimistic and resilient.

Optimism is the tendency to see and judge things in their most positive or favorable outcome. Resilience is our ability to overcome difficult circumstances and grow in the face of adversity. These qualities will be key in our efforts to recover. When we are anxious, we tend to overestimate and exaggerate the impact of a negative event and underestimate our chances of recovery. Resiliency gives us a realistic balance.

The ability to handle adversity will be another critical component to our success moving forward. Even if you or someone you love has been diagnosed with the coronavirus, maintaining an optimistic attitude is essential to supporting recovery. Being optimistic will help you make your thoughts and emotions much more positive, which in turn gives your immune system a boost.

The experience of the coronavirus does not have to become a traumatic and overwhelming experience that marks us for life. On the contrary, it can be an excellent opportunity to exercise our resilience — that is, to grow in the face of adversity.

Religious individuals involved in tragic circumstances often report finding peace, hope and even increased faith in the midst of the experience. Consequently, they tend to report high satisfaction in their lives. “We are hard pressed on every side, but not crushed … Struck down, but not destroyed” (2 Corinthians 4:9).

We can all benefit from this kind of optimism. Therefore, let us start filling our world with music and songs of hope in preparation for the great celebration that awaits us. We will meet again. We will celebrate again. Let’s get started.

 

 

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Esther Scott, LPC

Esther Scott is a licensed professional counselor in Arlington, Texas. She is a solution-focused therapist. Her specialties include grief, depression, teaching coping skills and couples counseling. Contact her through her website at positiveactionsinternational.com.

 

 

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

For such a time as this: Plan of action for young adults, adolescents and parents

By Esther Scott June 22, 2020

[Editor’s note: This is the third of four articles in a series on action plans for different areas of life during the COVID-19 pandemic.]

To young adults, the risk of contracting the coronavirus or suffering a negative outcome may feel remote. Research studies show that when young people talk about risk reduction, they tend to be referring to reducing social or reputational risks. As a young adult, you may be in the same boat. While the individual risks of COVID-19 may seem low for young people, it is worth stating that becoming infectious could worsen the health and financial security of your community and make it much harder for you to find work, especially if you are just graduating.

Remembering that your youth and health give you “superhero” powers will help you take a more active role in this crisis to protect yourself and those you love. As the line from the Spider-Man comics and movies reminds us, “With great power comes great responsibility.” You have the power of good health, and it is your responsibility to help solve the problem by protecting yourself and others.

Here is a plan of action for young adults, adolescents and their parents.

 

1) Obtain reliable information.

A deep understanding of how people view risk is crucial to stopping the spread of disease. Gathering a similar understanding of COVID-19 can help young people to participate willingly instead of resenting authority. It is important that you see breaking physical distancing guidelines as being risky not only for yourself and those you love, but risky for your entire community.

The same is true when it comes to understanding your economic risks. Analysts believe that young workers and new grads may be hit harder because they tend to work in the food, retail and hospitality industries — places that are experiencing harsher impacts as consumers stay home more. Obtaining reliable information will help you navigate the expected upcoming changes.

2) Control peer pressure. Prioritize safety over reputation.

One obvious reason for the prioritization of social reputation over health risk is peer pressure and the need to fit in socially. In the wake of COVID-19, there were numerous stories in the media highlighting young people who continued to gather despite social distancing guidelines. There were also reports of young adults violating shelter-in-place and social distancing orders to meet lovers and potential hookups because they felt pressured by friends to do so.

One way to evade social pressure is to plan your response ahead of time. Hosting remote meetings and parties could be one such response. With the rise of social media, distant hangouts are trending.

 

Plan of action for students and adolescents

In this difficult situation, it is best to look at the positive side: We have unbelievably valuable time to spend at home. This unprecedented situation that we are experiencing affects everyone. Adolescents too can learn to manage what they can control so that they emerge from this stronger. We can use this crisis to help them grow as resilient, autonomous human beings. Here is plan of action that can help students and adolescents make the most of this situation.

1) Keep a structured routine — a time for everything.

It is particularly important to keep a predictable routine. Develop a schedule that includes activities such as family sports, reading books, and collaborating with the rest of the family. It is important that students, especially teenagers, spend time in productive physical activities. Go out and throw the ball, shoot some baskets, go for a walk around the block or simply do some jumping jacks.

2) Continue education by reading and writing.

Two other important activities for students and adolescents during this crisis are reading books and writing thoughts. This time at home is the perfect opportunity to dedicate yourself to reading books and stories that have been on the shelf for a while. If possible, we recommend reading together as a family, including reflecting on the content of the story or answering questions that come up after reading it.

Writing thoughts or a diary with the events of the day or a gratitude journal about things you enjoy will continue to help you put these circumstances in perspective. If you graduated from high school or college this year, consider staying in school to pursue the next level of education. It could help you land a higher-paying job in the future.

3) Get involved.

Participating in household chores and taking responsibility for “their things” (their room, their clothes, etc.) is especially motivating for older children and adolescents. Allowing them to collaborate in the kitchen by researching new recipes or cooking (especially when personal assistants such as Google Assistant and Alexa are available for recipes) can also help develop growth and autonomy.

There are various ways that students and adolescents can take their place in this moment in history and make this time more enjoyable. They can write letters to the older adults in their families or communities and show appreciation for health personnel by sending prayers to them and those who are sick. It is good for young people to develop a sense of belonging in their communities and to know that their actions make a difference.

 

Plan of action for parents

Sticking to a routine is essential to keep your sanity (just as it is for your children). Maintaining a schedule can be helpful in creating a bit of normalcy in this unexpected situation and in reducing your anxiety level because your brain will feel in control.

Be a team. Keep it balanced. If you have a partner, try alternating who is looking after the kids or making meals. But most importantly, communicate your needs to your team. Remember that flexibility is key in times of crisis. Be kind to yourself; you are doing the best you can.

Although we have yet to see the full extent of the economic slowdown induced by COVID-19, analysts currently expect that we will recover once the virus is under control. So, hold on.

 

 

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Esther Scott, LPC

Esther Scott is a licensed professional counselor in Arlington, Texas. She is a solution-focused therapist. Her specialties include grief, depression, teaching coping skills and couples counseling. Contact her through her website at positiveactionsinternational.com.

 

 

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