Tag Archives: Coronavirus

Rev. Tutu delivers a message of hope and connection after crisis

By Lindsey Phillips April 8, 2022

The Rev. Nontombi Naomi Tutu delivers the keynote address at ACA’s 2022 Conference & Expo on Thursday, April 7. Photo by Lindsey Phillips/Counseling Today

Race and gender justice advocate Rev. Nontombi Naomi Tutu told the audience at the ACA 2022 Conference & Expo in Atlanta that a lot of her education stemmed from the wisdom and advice gleaned through African proverbs. Proverbs are not literal truths; they require people to consider the underlying meaning — something a literal-minded child like herself often found challenging to do, she joked.

The Rev. Tutu is the daughter of the late Archbishop Desmond Tutu, who resisted and helped end South Africa’s apartheid. She has served as the program coordinator on topics related to race relations and gender violence in education at both the African Gender Institute at the University of Cape Town and the historic Race Relations Institute at Fisk University in Nashville.

She delivered the keynote address on Thursday, April 7 to open ACA’s annual conference, held through April 9 at the Georgia World Congress Center.

During the first in-person ACA event in three years, Tutu shared with the assembled crowd an African proverb that deals with how one reacts during a crisis: “In the time of flood, the wise build bridges and the foolish build walls.”

She said her first thought when she heard this proverb as a child, of course, was, “Why would someone take the time to build anything? Why wouldn’t they just move away from the flood?” But eventually she learned that the true message is about how we need to build alliances and find new ways of doing things when faced with a crisis or challenge, she explained. Only the foolish cut themselves off from others and simply cling to what they have.

She then proceeded to connect this proverb to the current “flood” of crises that we face, including the COVID-19 pandemic and racial injustice. She told the audience she hoped these crises would provide us with an opportunity to do something different, to rethink how we approach situations and to forge a new path in the midst of the floods.

To successfully build these bridges, she said we must do two things. First, we have to accept and celebrate the fact that we are all different. For instance, she noted that her identities as an African, a woman and a first-generation immigrant to the United States differs from someone whose ancestors came over on the Mayflower. So, she urged those in attendance to create space for and welcome conversations around this diversity.

Second, we have to recognize one another’s humanity. “The truth of the crisis right now, our social crisis, our racial crisis, even our crisis around COVID has been truly based on some people questioning the humanity — the full humanity — of others,” she said. “In order to reach that place where we acknowledge and work from a basis of our shared humanity, we have to be willing to hear the other’s story, hear their story in their own voice, hear their story from their own perspective, hear their story in a way that makes sense to them.”

She acknowledged that recognizing this shared humanity is something that counselors are taught early in their career, but she reminded the audience that it’s also something that is so easy to forget.

She then underscored the importance of this second point by sharing a personal story about a presentation she gave at Vanderbilt University in the late 1990s on the potential dangers and opportunities of the 21st century. During her presentation, she spoke with enthusiasm about how this would be a century where women and people of color would be included and heard, which would reshape how we looked at the world.

When she finished, a white man raised his hand, and her first thought she admitted was, “Oh no, an angry white man!” And she was right: He was angry, but not for the reason she assumed, she told the audience. She discovered this man had spent a large part of his life homeless and in and out of mental health institutions, and he was a political activist. He was angry and wondered why she was having this conversation in a privileged white space, one where most of the people she was talking about would not feel welcome.

She then explained to the audience that this story illustrates how we often make up our mind about people before we allow them to share their humanity. We assume who the person is based on external factors such as what they’re wearing, where they worship or how they speak, she said.

“We decide that our knowledge of them is enough to make decisions about them and often for them. But if we allow ourselves just even for a minute to stop the tape that we have had playing in our heads, … to allow ourselves to stop and say, ‘Let me hear about you, from you,’ … then our whole process starts from a completely different setting,” she said. “We become open to actually learning something [not only] about the other but also from the other. And then we can think more about the bridges that we want to build.”

She concluded by reminding the audience that the current crises we face present an opportunity for us to listen to others and really forge connections and communities for all. “If we acknowledge that we are indeed in a time of crisis, that we are indeed facing a time of major challenge,” she said, “we could choose in this time of flood to build walls that separate us from those who think differently from us, separate ourselves from those who look differently, separate ourselves from those who speak differently.”

But “we are [also] given the opportunity in this time to build real bridges,” Rev. Tutu told the audience, “to open ourselves to sharing our stories, and hearing and taking in the stories and perspectives of those” who differ from ourselves.

Everyone in the room left that space a little wiser and filled with the hope that we can work together to build bridges, not walls.

The Rev. Nontombi Naomi Tutu delivers the keynote address at ACA’s 2022 Conference & Expo on Thursday, April 7. Photo by Lindsey Phillips/Counseling Today

 

****

Find out more about the 2022 ACA Conference & Expo at counseling.org/conference, and follow the hashtag #Counseling2022 on social media.

See more photos from conference at flic.kr/s/aHBqjzKfUB

****

Lindsey Phillips is the senior editor for Counseling Today. Contact her at lphillips@counseling.org.

****

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

Counselor burnout during COVID-19

By Carrie L. Elder, Elizabeth K. Norris and Leann M. Morgan March 8, 2022

As professors of counselor education at three separate universities, we share a vested and common interest in counselor wellness. When COVID-19 hit, we began researching burnout in counselors. There is a consensus in the profession that burnout is the gradual onset of emotional, cognitive and physical exhaustion related to work. Often there is a sense of dread and avoidance with completing work-related tasks.

Our thinking was that due to the demands on counselors and the heightened health scare during COVID-19, counselors would begin to burn out. We wanted to understand the relationship between the new pandemic and counselors’ levels of stress, burnout, resilience and self-compassion during this time. We asked ourselves how we could better understand this unprecedented phenomenon so that we could better support our students, our supervisees, our colleagues and ourselves. 

After conducting three independent research studies over the past year, we discovered some surprising results that could help us define — and rule out — what issues counselors may be facing and what can help keep us well during our parallel experiences with clients during the continued evolution of COVID-19.

Surprising Evidence of low burnout rates 

In the past year, we have been inundated with anecdotal information from online sources and peer-reviewed manuscripts that communicate how counselors are experiencing high rates of burnout while seeing clients during the pandemic. This is a fair and seemingly clinically sound assumption, except that our current research isn’t supporting this claim. Three independent research studies that gathered data from counselors across the country in 2020 and 2021 indicate that burnout rates in counselors remain low, which is consistent with reports prior to the pandemic.

Three months into the pandemic, we sampled 211 counselors and found an average burnout rate of 20.85, which fits in the “low” category. According to Henry E. Stamm, developer of the Professional Quality of Life Scale, a score of 22 or less indicates low levels of burnout; a “moderate” score ranges from 23 to 41. Most participants in our first study scored low on burnout (67%), with the remainder displaying moderate levels (33%). No participants reported high levels of burnout. In this first study, we found self-compassion and resilience predictive of lower levels of burnout.

Eight months into the pandemic, we conducted two additional independent studies looking at other predictors of burnout. In the second study, 252 counselors reported an average burnout level of 20.99, again in the “low” category. This study found compassion for self and others predictive of resilience, whereas empathy was predictive of burnout. 

The third study surveyed a national sample of 125 counselors who reported an average burnout level of 22.09, which again is consistent with that of the “low” burnout category. This study found that counselors’ negative perceptions of their working conditions, maladaptive coping styles, decreased levels of compassion satisfaction, higher caseload volumes of clients with trauma-related concerns, and lower levels of resilience were predictive of burnout. 

Low burnout rates are surprising and, again, seem counterintuitive, even when we take our own experiences into consideration. This isn’t to say that counselors aren’t experiencing burnout, however, because they are. They just don’t seem to be experiencing it any more than they did before the COVID-19 pandemic. 

Admittedly, it is hard to define an experience when it is one the current generation of counselors has yet to practice and live through completely. The trajectory of COVID-19 variants is still unknown, so further defining the struggle that counselors may be facing can be beneficial in increasing our ability to maintain personal wellness.

So, what is preventing counselors from experiencing higher burnout rates given the added stressors we have all faced this past year-plus, both at home and at work? Our research indicates that counselor resilience during the pandemic is moderately high. These findings suggest that counselors may be uniquely suited to cope with the additional pressures of a pandemic. By utilizing skills taught in counselor training programs and supervision — including maintaining adequate self-care, maintaining healthy boundaries, practicing ethical decision-making and responding to crises — counselors seem to be able to maintain enough resilience to keep burnout levels low.

Pandemic fatigue

If we aren’t experiencing burnout, then what are we experiencing? Here’s what we think: The phenomenon of providing counseling during a pandemic has produced an outcome unique to COVID-19 — pandemic fatigue. It is time that we talk about what this means for counselors. 

The World Health Organization defines pandemic fatigue as “a reaction to sustained and unresolved adversity which may lead to complacency, alienation and hopelessness, emerging gradually over time and affected by a number of emotions, experiences and perceptions.” Pandemic fatigue is dissimilar to burnout in that the exhaustion being experienced isn’t related only to our work as counselors but is woven throughout the tapestry of our lives as a whole.

To us, this makes good sense. Counseling during a pandemic means that we cannot leave all of our clients’ material at the office. Because we are all experiencing the pandemic — clients and counselors alike — we, as counselors, carry our own experiences of the pandemic home with us. Often, we are transitioning from holding space for our clients’ concerns related to the pandemic to going home and doing the same for ourselves and our families. In this context, we can start to see that it’s not necessarily the tasks related to counseling that are increasing burnout but rather the increasing demands on our personal lives that are leading to pandemic fatigue.  

Fortunately, counselors are trained to respond in crisis situations. When the pandemic hit, we continued to provide care to the growing numbers and needs of clients, most likely by shifting to a new telehealth business model to safeguard our health and the health of our clients. We prepared for a sprint instead of pacing ourselves for a marathon. Although access to vaccinations has provided some health care workers an increase in psychological resilience, counselors are still in the race with no known finish line in sight for themselves or their clients. 

When humans are confronted with a crisis, they draw on short-term survival instincts and systems. When circumstances drag on, new coping strategies need to be implemented to prevent or reduce behaviors that cause fatigue and demotivation. 

Pacing ourselves

So, what can counselors do to pace themselves for the marathon we find ourselves in? Here are three suggestions:

1) Utilize parallel processes in supervision. Counselors shouldn’t be afraid to discuss fatigue, lack of motivation or other symptoms of pandemic fatigue with a clinical supervisor or colleague. Regardless of years of experience, talking about the exhaustion of providing care during the ongoing pandemic can have a dual benefit. 

First, counselors can work with their supervisors to identify and discuss any guilt, demotivation, and lack of energy with clients, and ways of improving resilience in these areas. In doing so, the counselor participates in a parallel process that may trickle down to how the counselor identifies and treats pandemic fatigue in clients. Using the parallel process may increase new coping strategies and resilience in both counselor and client.

2) Practice compassion more and empathy less. According to neuroscientists Olga Klimecki and Tania Singer, empathy activates the pain network within the brain. In contrast, compassion activates nonoverlapping brain regions. In a subsequent study of counselors, increases in compassion (compared to increases in empathy) were associated with increases in counselor resilience. This means that counselors may benefit from practicing compassion to self and others. It also means identifying causes of suffering and working to alleviate them. 

This contrasts with our practice of empathy. Empathy requires the counselor to take the perspective of the client by “trying on” their pain. When we practice empathy by putting ourselves in our clients’ shoes, our brains have difficulty distinguishing what is “ours” and what is “theirs.” Taking the client perspective requires an additional process of emotional regulation to distinguish others’ suffering from our own, which may add to counselor fatigue. 

fizkes/Shutterstock.com

Practicing self-compassion may also aid in identifying and decreasing guilt associated with the counselor’s inability to treat as many people in need as possible throughout the pandemic. Recent literature has captured the moral challenges of counselors when they are unable to provide more services to the increasing numbers (and overwhelming needs) of clients. When we practice self-compassion, we address our desire to help others and the guilt that arises when we cannot do so, while offering lovingkindness toward ourselves in the midst of that guilt. 

By engaging in this self-compassionate process, counselors are better able to extend the same care and consideration to their clients. After all, we cannot effectively lead our clients to a place we have yet to discover or experience ourselves. 

3) Define personal space and time. Remember, slow and steady wins the race. It looks like we are in a fluctuating pandemic that has the potential to affect us and our clients for some time to come. Intentionally carving out time and space to come back to center so that we can choose what we do with our time (instead of ceaselessly dedicating it to work) can provide balance. 

No, this doesn’t necessarily mean taking a spa day, getting our nails done or binge-watching reruns. Those coping strategies are good only in the short term to distract from stress. They might have been effective coping strategies during the first months of COVID-19, but they can quickly turn into maladaptive behaviors that prevent us from being in our feelings and really assessing what we truly need. Instead, we are asking counselors to pay attention to their thoughts, bodies and feelings and prescribe leisure time (and purposeful aloneness) accordingly. Healthier coping strategies may enable us to remain resilient for the long haul.

Summary

Why is this important? Yes, we have available vaccinations and boosters, businesses are back up and running for the most part, many children and adolescents have returned to school for in-person learning, and more counselors are seeing clients face-to-face. Even so, we have such little information about how professional counselors remained well during pandemics and crises prior to COVID-19. Because little can be gleaned from the past, we hope to provide additional context centered on counselors’ experiences during global crises. Based on our research, we have a better understanding of what is keeping us well and what we may need to do to maintain that level of wellness. 

As a profession, it is easy to focus on the needs of clients and not to focus on our own needs. The truth is that by keeping ourselves well, we are better positioned to help our clients reach and maintain their own wellness. Additionally, when we are well, we are more likely to make ethical decisions. 

Our mental health is not separate from that of our clients. When they are suffering more, we are more likely to feel its effects, much like a shared experience. Conversely, when we are suffering more, our clients too are more likely to feel it. During the pandemic, when both counselors and clients are experiencing the same challenging phenomena, our symbiotic relationship needs to be addressed.

Given the ongoing nature of COVID-19, the unpredictability of its variants and an undetermined end point for the pandemic, understanding counselor wellness during this time is imperative. Counselors have described feeling burned out, and this is mirrored in current literature. When tested, however, we did not find counselors to have higher rates of burnout than before the pandemic. Instead, counselors may be experiencing pandemic fatigue marked by chronic stress that impacts perceptions of events, increased exhaustion and decreased motivation. 

To mitigate these symptoms, counselors can use parallel processes in supervision to reinvigorate both the counselor and the client, practice compassion toward self and others, and carve out time for intentionally addressing needs. Using new coping strategies may help counselors to pace themselves during the COVID-19 marathon and mitigate pandemic fatigue.

Considering the gradual onset of burnout, it is plausible that counselor burnout rates will climb as the pandemic continues. However, many of the coping strategies we recommend using to reduce pandemic fatigue should also help prevent increases in burnout.

 

****

Carrie L. Elder is a visiting assistant professor and clinical coordinator at Mercer University in Atlanta. She is a licensed professional counselor (LPC), national certified counselor (NCC), certified professional counselor supervisor and registered art therapist. Contact her at elder_cl@mercer.edu.

Elizabeth K. Norris is an assistant professor of counseling at Denver Seminary in Littleton, Colorado. She is an LPC, NCC and board certified telemental health provider (BC-TMH). Contact her at elizabeth.norris@denverseminary.edu.

Leann M. Morgan is core faculty in the School of Counseling at Walden University. She is an LPC, BC-TMH and certified career counselor educator. Contact her at leann.morgan@mail.waldenu.edu.

 

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, visit ct.counseling.org/feedback.

****

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.

Two years in: Reflecting on counseling during a pandemic

Compiled by Bethany Bray March 1, 2022

This month marks two years since the World Health Organization (WHO) declared the outbreak of the SARS-CoV-2 virus, more commonly known as COVID-19, a pandemic. At the time, there were more than 118,000 recognized cases of the coronavirus in 114 countries and just under 4,300 deaths attributed to it. Those numbers have now climbed to more than 430 million confirmed cases and close to 6 million deaths worldwide.

Pandemic is not a word to use lightly or carelessly,” said WHO Director-General Tedros Adhanom Ghebreyesus in his March 11, 2020, announcement. “This is not just a public health crisis, it is a crisis that will touch every sector — so every sector and every individual must be involved in the fight. … Let’s all look out for each other, because we need each other.”

His prediction that the virus would touch “every sector” has proved true for the counseling profession. Counselors have met challenge after challenge brought on by the pandemic, including adopting and adapting to telebehavioral health, supporting clients’ and students’ shifting needs and managing overbooked caseloads as a surge of new clients sought help. In addition to these professional challenges, clinicians have had to attend to other needs in their personal lives such as caring for family members or recovering from the virus themselves. 

The past two years have demanded creativity, advocacy, flexibility, compassion and a seemingly endless list of other qualities from counselors. And for all counselors, it has been a learning experience. Counseling Today recently contacted an assortment of professional counselors from around the country to ask what the pandemic has taught them. In this article, they share their reflections and their lessons learned in their own words.

 

****

It takes a lot to be a person today.

There have been times over the past few years when I’ve wondered: Who am I to be sitting in the therapist chair? When I decided to become a counselor, I never expected to live and work through a global pandemic. COVID-19 has left me feeling vulnerable and grateful, with many other emotions pulsing within me at various times. As I’ve heard others exclaim quite passionately these past few years, “This was not on my vision board!”

As a therapist, I believe the most important aspect of my job is to simply hold space for others. Holding space implies creating a safe platform between individuals that fosters empathy, compassion and healing. It says that each person welcomed into the dialogue is so incredibly special that time is invited to stand still while they process life together. Therapeutically, holding space empowers a client with the opportunity to feel all of their feels and process life experience(s) with empowerment and confidence.

Today, I find both myself and my clients collectively sharing the same trauma. A global pandemic impacts each of us on every level of our experience, from our basic needs to existential thoughts of “Why are we here?” and “How did this even happen?”

Sometimes I feel like we’re in this strange paradigm of history and science fiction colliding into our actual experience. Despite our global situation, all of our individual anxieties and fears still exist as life continues to flow, even during worldwide crises. It takes effort to separate the individual from the collective experiences, as life is truly merging on every level, from how we work and go to school to how we communicate with our peers at our most intimate levels.

There has never been a time when I have needed to be more present and honest with my own vulnerabilities, both personally and professionally. While holding space for others, I have often felt safe being held in the space of my clients. We are walking each other through these uncertain times, and I am grateful for the many hands I have held and [for] those who have
held mine.

Jen Monika McCurdy is a licensed professional counselor (LPC) in St. Louis who owns and operates a private practice, JM Wellness. Her passion is to empower her clients to live the life they most wish to live.

****

I remember sitting at home as a new mom holding my baby as the world shut down and COVID-19 changed everything. Nobody knew what to expect, but it was the beginning of a collective experience that has forever changed us.

We have been forced to grieve unimaginable losses, change many plans and accept our lack of control at the same time as we suffered other hardships like job losses, closed schools and being unable to visit relatives. Clients who already felt behind in the relationship world had to grapple with an extended break from dating.

Simple decisions, like spending time with family or friends, were suddenly filled with complexity. At times we thought we were safe, excited to drop our fear and feel more normal, and then a new variant or surge hit. We have learned to pause more, not take things for granted and recalibrate our expectations.

In the past as a counselor and coach, I’ve related to my clients and their experiences, but through COVID-19, we were all experiencing similar anxieties and hard decisions simultaneously. I’ve also had to adapt professionally and learn to put my own pandemic stress and anxiety aside to hold space for my clients.

There is something empowering about remembering we can adapt and be resilient; I believe we underestimate our ability to change. Somehow, through some very dark, isolating and scary moments, we have found our path. Pre-pandemic, we might not have believed we could, but we have confronted the illusion of control and learned to live with more ambiguity.

Professionally, I have grown to love working from my home office and speaking to clients from their homes. Many of my clients who used to be out and about 24/7 have soaked in the benefits of solitude. Through healthy self-care habits, creating structure and routine at home, and staying connected, we have all changed in ways we would have never predicted. Watching these lessons play out in therapy has allowed me to feel just as connected to my clients, even though it has been years since we have sat together in the same office.

Personally, although I grieve the lack of normalcy in my daughter’s early years, I will be forever grateful for the extra time we have had together.

Rachel Dack is a licensed clinical professional counselor (LCPC) and dating and relationship coach who owns a private practice in Bethesda, Maryland, and specializes in dating and relationship issues and anxiety.

****

The counseling world we once knew has been shaken by COVID-19 in ways no one could have imagined. Our routines, no matter our age or stage, have been shattered, and we’ve only ever been given the option to pick up and make sense of the pieces. The one thing that all healers and journey goers alike have in common is the uncertainty married to the pandemic, which doesn’t allow for normalization. “Normal” already had a loose definition to begin with, but COVID-19’s reign has shaken up every case of normalcy. Even with everything upside down, we’ve all been striving to find a new normal, and one thing we’ve learned from COVID-19 is to keep going.

The clients — journey goers and brave souls — were forced to face challenges alone, but they were able to hear and validate their own opinions in the process. People learned they could be their own biggest support system and how to really take care of themselves. With extra time placed in their laps, they learned that they deserve more.

In regard to clinicians, if anything, we’ve learned to focus on what matters. This pandemic forced a shift in our thinking and redirected our perspectives, but ultimately, we’ve become undeniably resilient. We’ve made meaning of struggles — our own and of others’ — and found a way to show up every day.

As far as me, I’ve learned to trust the process and honor not only the struggle but also the strength we’ve had no other option but to find. We don’t have to find a new normal when we can help to create it. I was able to fall in love with this profession all over again, but this time in a different shade of light.

And to my fellow colleagues and all healers alike, keep showing up. You are needed, you are valued, and you are necessary. With that said, make sure you’re saving some of that care, concern and love for yourself because you deserve it too.

To quote Maya Angelou, “You may not control all the events that happen to you, but you can decide not to be reduced by them.”

Mykia Hollis-Griffith is an LPC, licensed marriage and family therapist associate (LMFT-A) and owner of a private practice, The Mindful Life Company, in Killeen, Texas.

****

When the COVID-19 pandemic began, the world was overwhelmed with fear for themselves [and for] loved ones and fear of what was to come. All the while, mental health workers, doctors, nurses and other “essential” workers were dedicated to ensuring their needs were met. It was during this time that I learned the most about myself, my clients, the counseling profession and mental health overall.

Although I live and work in the small town of Erie, Pennsylvania, I realized that our struggles and fears were the same as the world’s struggles and fears. Living in a smaller town did not mean that I or my fellow Erieites were exempt from the issues plaguing the larger cities, but instead it meant that I could make a larger impact on the lives of those around me. I began to reflect on who I was professionally and what type of environment I wanted to provide to my clients, specifically those struggling with the weight of the pandemic.

I decided that I needed and wanted to provide a safe space for people to be who they are and to have open conversations about the pandemic, past traumas or other concerns. As my practice began to flourish, I noticed that people needed an outlet and found themselves at my office. Clients wanted to share, they wanted to feel better and, most importantly, they wanted
to grow.

I too wanted to grow. I found myself wondering if the counseling field was where I needed to be full time. As a professional counselor, witnessing the dedication shown by my clients was nothing short of amazing, particularly as the pandemic became scarier and more unpredictable.

It was then that my question was answered. I knew where I needed to devote all my professional time and why it was important to my growth as a person and a professional. The constantly changing landscape of the world due to the pandemic has forever changed how I view mental health. I have found that people are more honest about their struggles, more open to seeking help and more committed to themselves.

Throughout my counseling career, a major focus has been on helping clients build healthy, positive relationships [and] a foundation for the life they dream of, and grow into the person they want to become. The experience of counseling people through the COVID-19 pandemic has reaffirmed that my therapeutic approach is necessary and relevant.

Chelsea Curlett is an LPC and has been the owner of a private practice in Erie, Pennsylvania, for six years.

****

We found ourselves in over our heads without a view of what was ahead. The rapid change and uncertainty forced us to adapt.

The first lesson I learned during the pandemic was that crafting masks out of whatever material I had on hand was difficult but doable. I assembled the first COVID-19 masks for my family with the help of a dusty sewing machine. At first, there was only one mask per person, which was not sustainable since they needed daily washing for repeated use each day. As the pandemic deepened, the skills of those artisans who crafted and sold masks permitted us to order and obtain multiple masks custom-fitted for each person. I was grateful.

This creative connection to the people making the masks around the world set the stage for many of the lessons I learned [that were] continually reinforced during the pandemic.

All life centers around relationships and is impacted by connection, location, choice and privilege. Relationships that I reflected on during this time related to the human condition and the context in which shared human experiences exist. Consequently, my own experience has been informed by my relationship to myself and how I relate with others. All relationships occur in context.

This notion had me consider how I relate to the past, present and future — through experiences and expectations [and] within the context of what is known and unknown. Throughout this process, I embraced stillness, commotion, loss, gain, choice, understanding and peace.

Change is difficult, but like making masks with whatever scattered materials are available, it is doable. I encourage all to consider how you have changed and adapted and found ways to connect your relationships to meaning and purpose, goals and aspirations, grit and determination, hope and healing.

Carrie B. Sanders, an assistant professor of counselor education at Radford University in Virginia, has a background in school counseling.

****

I used to have a competition with myself on the drive home from my office. Cranking up the music, I’d dance in my car and tally how many other drivers I could get dancing when stopped at red lights. It was my way of shaking off the heaviness of the day. When COVID-19 hit and I got sick with it [the virus], I lost both my commute and the energy to dance.

When going through similar experiences as our clients, we need to take care of ourselves and our own reactions first. I know this is an obvious one, but I had to truly dig through this lesson in a different way during the first year of the pandemic. This past year, I completed my internal family systems Level 1 training. In learning to care for my own internal parts and helping clients to care for theirs, I gained a lightness that allowed me to better care for clients without carrying their burdens.

I continue to learn, repeatedly, how to say no in order to say yes. This means saying no to more work. Time off — and truly away from the responsibility of mental health care — is not just for fun; it’s a necessity. It also means setting boundaries. I sometimes need to say no to bids for my compassion by those outside my immediate circle in order to continue to say yes to my clients.

I continue to see fewer clients than I did pre-COVID, which I acknowledge is a privilege of working in private practice. To balance out the impact of my clinical load, I also prioritize other parts of my career, such as writing and freelance editing, and other nonclinical ways to share my expertise. 

Last week, I walked out my front door with my dog after closing my laptop, bundled up against the cold, dancing as I shook out the day. Whatever you do to shake out your day, I hope that you find a way to do it in the midst of the pandemic. And if you dance in your car or on your sidewalk after your final client today … let me know because my competition is back on.

Johanna Bond is a licensed mental health counselor (LMHC) in private practice in Rochester, New York. She is also a writer with prior work appearing in The New York Times, HuffPost and Psychology Today.

****

I have learned the importance of presence on a deeper level during the pandemic. Being able to show up during this time as an anchor for clients’ nervous systems has been a powerful tool. Utilizing coregulation and resonance has been pivotal in working with clients with trauma.

In order to show up more fully in this way even across digital platforms, I took a course on mindful awareness and resonance in eye movement desensitization and reprocessing (EMDR) and completed rapid resolution therapy training, both of which focus on the connection between the client and the therapist and working within that relationship to shift the client’s experience, even if it’s brief therapy. Although the two trainings are very different, they both rely heavily on therapeutic presence.

The theme of learning about presence also flows into my personal life, as I’m so grateful to the people in my life supporting me so that I can support others.

Hillary Cook is an LCPC who owns and operates Idaho Trauma Therapy in Boise, Idaho.

****

March 2020: A defining moment in our lives. There is before COVID-19 and after COVID-19. While there have certainly been other defining moments in our lifetime, none has lasted as long or affected as many individuals as this pandemic. The astonishing breadth, width and depth of this pandemic feels fictional — except that we are all living this collective trauma.

Having been a counselor and counselor educator for over 35 years, I felt competent to continue to assist my clients through this time. My basis for working is systemic, so incorporating an extended system did not seem difficult. I was wrong in many ways.

It seems to me that there were stages that we all went through during this time. Beginning in spring 2020, clients seemed to be optimistic about the length of time and severity of the virus. We continued to focus on the challenges they presented for counseling with a mention of the limitations that lockdowns, etc., were creating. However, some felt the isolation more than others.

The second stage, I believe, began around fall 2020. Schools were or were not reopening, work was still from home, [and] counseling was mainly on virtual platforms. A sense of frustration, fatigue and losing control of their environment began to appear in sessions. Many [clients] started with concerns about their external world — the pandemic, the political environment, climate changes. These challenges blended into their own personal work. In fact, in some cases, they overshadowed their personal issues. Feeling that they had no control over the world “outside” left some of them with an attitude of defeat.

The next stage came with the delta and omicron variants. My clients express not only frustration but [also] a sense of hopelessness in changing the world situation that is impacting each of us. This, of course, impacts the changes that are available for them in their personal choices. Lack of extended support, entertainment, travel and most interactions creates a loneliness that is nonrelated to their personal or relational challenges.

My professional journey has been somewhat the same as my clients’. I have learned to use virtual counseling, and while adequate, it lacks the connection of in-person work. I have dealt with the same feelings of frustration, isolation and lack of “normal” social interactions that support my sanity.

My work has become even more focused on mindfulness as well as other techniques and skills to quiet anxiety and relieve depression. Further[more], I endeavor to assist clients in understanding what they can control, what is beyond their control and how to advocate for what they deem worthy in order to make a difference, thereby gaining a sense of control.

Patricia W. Stevens is an LPC and private practitioner in Louisville, Colorado, who is a clinical fellow of the American Association for Marriage and Family Therapy.

****

As a professional counselor, I have learned how important connection truly is. Both in private practice and within a university setting, young adults fear loneliness more than the virus itself.

I never thought I would adjust to telehealth, but to my surprise, I felt connected to my clients. Connecting remotely, whether from a bathroom, basement, car or the client’s own bed, allows for a more vulnerable experience. The client isn’t coming to your office, but rather you are meeting them in their space. I have found that clients open up more readily when they are in their own space. Vulnerability breeds connection.

During this time, I am reminded of how much we need people rather than “stuff” to make us happy. It’s amazing how much active listening, eye contact and empathy can transfer online.

In nearly 20 years of experience, I am seeing loneliness and loss of motivation as top reasons young adults seek help. The pandemic is also intensifying symptoms of anxiety and depression. People want to see each other. In America, isolation is a punishment.

The best way to help clients is to encourage connection, but how do we do this in the midst of a pandemic where we are told to refrain from in-person social interactions? I have found that people are amazingly resilient and adept at connecting. Netflix movie dates, FaceTiming, online gaming groups, working remotely, virtual coffee breaks — it’s amazing how technology is helping us stay united.

Three years ago, after working in a university for 16 years, I decided to open up my own private practice. Six months later, the pandemic hit, and my appointments went from in-person to 100% virtual. I think I learned more in the last two years than I ever would have without being forced to go online. In a sense, I was learning and adapting with my clients. Shared experiences breed connection.

Life surprises us. I was surprised that I am able to connect and ignite change in clients who are not sitting right in front of me. I am humbled by the resilience I see in my clients and myself. My advice is to go into things with an open mind. You may be surprised at what you find.

Nicole Lowry is an LPC with a private practice in Erie, Pennsylvania, and is the assistant director of the Personal Counseling Office at Penn State Behrend.  

****

In these last two years, I have learned several valuable lessons, [the most important of which is that] telehealth can be a viable and accessible way to provide therapy. As a clinician practicing in a remote and rural part of the country, I valued the ability to provide flexible appointments to clients who often have systematic barriers that limit their access to counseling services. [This work has] reminded me of the importance of hope in managing life’s challenges and facilitating posttraumatic growth. It reoriented me and a lot of my clients toward appreciating the mundane and ordinary parts of life, which coincidentally were the most noticeably absent during the pandemic.

The analogy that “we are all in the same storm but not in the same boat” has been a valuable reminder regarding the differential impact of the COVID-19 pandemic throughout the global community. It emphasizes the diversity of outcomes within these collective experiences by reminding us that while we may all be in the middle of the same storm, we are impacted in a different way. Either we have a sailboat of skills and resources, a lifeboat of support, or we are out in the middle of the ocean with neither. During this time, I witnessed clients navigate challenges related to isolation, health, finances, child care, transportation, food, employment, education, racial disparities and mental health. I was often reminded about the importance of a strong therapeutic alliance and how it was nurtured and strengthened by the shared commiseration of dealing with uncertainty and the collective empathy of navigating existential fears while managing everyday stressors. 

While dealing with the mishaps and challenges of technology has required patience, telehealth has been invaluable in allowing me access to clients’ lives in ways I may never have been able to from the confines of my office. Some of my clients lacked resources to engage in sessions privately and would use their vehicles [for sessions]. Others — often younger clients — were more at ease in the virtual platform and enthusiastically shared their relief [of] not being in-person. I am grateful for those clients who invited me into aspects of their lives that are not often visible in a clinical office. Sharing virtual spaces required a vulnerability that further deepened my understanding of who they are as people.

As a BIPOC [Black, Indigenous and people of color] clinician, it is not unusual that I find myself managing the parallel experience of racial injustice with my clients. This became magnified during the pandemic and required me to lean toward social justice advocacy while also prioritizing radical self-care to continue providing ethical counseling services.

Portia Allie-Turco is an LMHC and counselor educator in Plattsburgh, New York, who specializes in the treatment of historical, racial and complex trauma. 

****

In April 2020, I was hospitalized for 11 days with COVID-19, pneumonia and sepsis. I sought advice from a colleague about what details to provide my patients, keeping in mind that their physical health was not at risk because of telehealth. She was shocked that this was my concern.

The next day, I was scheduled to present at a virtual conference. I called the organizer and gasped, two words at a time, that I could … still do … the presentation. Baffled, she forbade me, demanding I take care of myself. When I was discharged, I told patients I’d return to teletherapy the following Monday. Without exception, they said they wanted me to focus on my recovery.

I didn’t want to disappoint anyone and was committed to fulfilling my duties to my patients and colleagues. It took weeks to understand that I was the only one with these worries and the only one who wasn’t putting my health — physical and mental — first. That experience launched a self-care journey that altered my clinical outlook and practice.

A few weeks after I was discharged, I started trauma therapy to stave off posttraumatic stress disorder. I disclosed this to my patients, hoping their takeaways would be that a person in therapy isn’t broken or incapable of thriving — and being proactive can sometimes prevent problems.

Now, I have firm work-life boundaries. My patients don’t always like them, but they recognize the value in having a therapist who takes care of herself. I model this behavior because it’s what’s best for my patients — whether it’s them doing it for themselves or me doing it to be at my best for them. They understand the need for “me” time, and several have commented on their increased distress tolerance when they can’t get an appointment [at] the exact time they want or [when] I don’t immediately respond to an email.

In my practice, all clinicians — myself included — are required to take a minimum number of days off annually, which don’t carry over. I want therapists [on my staff] who take breaks and prioritize what matters to them, and, honestly, it leads to greater work enjoyment.

Because COVID-19 has increased access to care via telehealth, I’ve found boundaries to be more critical than ever. If we want to provide our patients with the best resources, then we as their therapists need to be at our best — and that’s not possible without time away from our work.

Stephanie Woodrow is an LCPC and owner and clinical director of the National Anxiety and OCD Treatment Center in the Washington, D.C., area. She was an inaugural recipient of the Emerging Leader Award from the Anxiety and Depression Association of America and is an active member of that organization as well as the International OCD Foundation.

 

****

Keeping up with telehealth regulations

The laws and regulations that govern counselors’ use of telebehavioral health are, for the most part, decided at the state level — and that can make it difficult to keep track of changes during extenuating circumstances such as the COVID-19 pandemic, says Lynn Linde, the chief knowledge and learning officer at the American Counseling Association.

However, the exemptions that many states enacted to loosen regulations at the start of the pandemic to expand the use of telehealth have mostly expired, Linde says. This is the case not only for professional counseling but also for many other health-related professions. 

Today, telebehavioral health may no longer be an option for some professional counselors — especially if a client is not physically located in the same state as their practitioner. Rules vary widely, and what is allowed for telehealth in one state may not be allowed in a neighboring state, Linde notes.

Telebehavioral health regulation “is still all over the place, but it’s much more limited than it was. Most states have gone back to their ‘old’ regulations” that were in place before the pandemic, says Linde, who is also a past president of ACA. “It’s not what counselors want to hear, but it’s the reality of where we are.”

Now more than ever, it’s incumbent on individual counselors to stay up to date on telehealth regulations in their respective states. One silver lining to the pandemic is that many state licensing boards are putting more information, details and updates on their websites — much more so than before the pandemic, Linde says.

“Telehealth is a wonderful way of working with clients, but we encourage [counselors] to ensure that they have the skills and are qualified to do it, are observing appropriate security and confidentiality measures such as using encrypted programs, etc., and [are] ensuring that they can legally do it by continually checking with the licensing board where their client lives,” Linde emphasizes.

One measure aimed at alleviating some of the disparity between states regarding telebehavioral health is the interstate Counseling Compact project that continues to gain momentum. The compact, an initiative that would allow counseling practice across state lines in those states that have adopted the compact, is finalized and will take effect once 10 states pass legislation to adopt it. Language in the agreement ensures that any state that adopts the compact will allow counselors to use telebehavioral health permanently.

Two states, Georgia and Maryland, passed legislation in 2021 to adopt the compact. This year, more than 20 states are in the process of introducing or furthering legislation to adopt the compact. Leaders involved in the project, including Linde, expect that the compact will reach the 10-state threshold before June 30, when many state legislatures end for the season. Ohio and Florida are making good process on such measures, and bills have been sponsored in more than 15 other states, Linde says. 

[Update: Alabama became the third state to sign the Compact into law in early March.]

Launched in 2019, the compact project is a partnership between ACA and the Council of State Governments’ National Center for Interstate Compacts. Once a 10th state adopts the compact, the compact will become live, and those 10 states will form its governing body. Counselor practitioners should be able to begin submitting applications roughly six to nine months after compact commissioners are named and a commission is established, Linde notes.

Compacts are “the way of the future” to best treat clients, she says, and many other health professions — from social work to dentistry — are working on similar compact projects to make licensure and regulation more uniform and responsive.

  • Stay updated on the progress of the Counseling Compact by visiting counselingcompact.org.
  • Find out more about the ethical standards for telebehavioral health and other important information at counseling.org/COVID19.
  • See Section H, “Distance Counseling, Technology, and Social Media,” of the 2014 ACA Code of Ethics at counseling.org/ethics.

Flamingo Images/Shutterstock.com

****

Learn more

 

****

Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

****

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

Behind the book: Counseling Practice During Phases of a Pandemic Virus

Compiled by Bethany Bray February 10, 2022

“We are all having a normal response to an abnormal critical event,” says Mark A. Stebnicki, author of Counseling Practice During Phases of a Pandemic Virus.

The COVID-19 pandemic has been a “soul wounding” event for many people, he notes. The stressors from the past two years, including loss of social connections and career opportunities, political divisiveness, the rapid spread of the virus, and loss of many lives, he argues, have created “a unique type of historical trauma.”

Stebnicki, a licensed clinical mental health counselor, certified rehabilitation counselor and professor emeritus at East Carolina University, draws upon his vast experience in the realm of disaster mental health to explore methods that counselors can use to support clients during this unprecedented time.

 

Q+A: Counseling Practice During Phases of a Pandemic Virus

Responses by author Mark A. Stebnicki

In the book, you talk about how Americans are facing both a pandemic virus and a mental health crisis. In your opinion, why are professional counselors well suited to respond and make a difference during this highly stressful and unprecedented situation?

Professional counselors are a vital resource to the COVID-19 generation, which has reached a mental health “tipping point.” This virus has killed more than 900,000 in the U.S. By comparison, the Spanish flu of 1918 killed approximately 675,000 Americans.

There are clinically significant mental health symptoms related to stress, traumatic stress, grief, loss, anxiety, depression, substance use disorders and other co-occurring conditions that are chronic and persistent. We have a viral contagion that has not only killed more persons than the Spanish flu but also critically strained our health care system and medical resources. We have a scarcity of goods, services and basic materials required for daily living.

Additionally, we are confronted with an irrational political ideology spreading disinformation that the 2020 election was stolen from the former president. There is a rise in white nationalism and hate crimes, such as seen in the killings of George Floyd, Ahmaud Arbery, Breonna Taylor and many other people of color. All these are critical incidents that impact our mental health and wellness. Thus, the COVID-19 pandemic has been a soul wounding experience for many.

Professional counselors are trained to provide therapeutic interventions to a variety of individuals and specialty areas. Medical and mental health care professionals now utilize telemedicine and telemental health technology to coordinate natural resources, supports and therapeutic opportunities with other allied health professionals to address the client’s medical, physical, psychosocial, mental, behavioral and career health.

The generations that emerge from this nuclear winter are planting seeds so we can have a bountiful harvest of coping and resiliency. The harvest will be cultivated in the fields of counseling and psychology so that we may rediscover the basic human instinct: how to survive and thrive simultaneously while in the face of adversity.

 

What would you want counselors to know about borrowing from and adapting disaster mental health response methods to support clients during the pandemic?

It helps by first acquiring the awareness, knowledge and skills to work with the unique characteristics of a multitude of natural (e.g., floods, hurricanes, tornadoes, earthquakes, wildfires) and person-made disasters (e.g., gun violence, physical violence, social and civil unrest). We begin by recognizing the unique medical, physical and mental health differences in a pandemic disaster, which is pervasive and permeates all life areas, [including] family life, career and educational opportunities, our social-emotional health, and … our mind, body, and spiritual consciousness.

Epidemiologists, virologists and other medical health care experts understand how to identify, assess and treat a viral contagion. I believe counseling and psychology are trying to understand how to do the same but may be too concentrated on the individual’s mental health symptoms. It is my opinion that we are all having a normal reaction to an abnormal critical event — a pandemic virus with over 900,000 souls that have perished. We need to clearly understand how the virus impacts all life areas (e.g., jobs, education, family, social, emotional and recreational life) and the unique losses and grief experienced by individuals, groups and cultures. Reviewing the literature in psychosocial aspects of chronic illness, disease and disability is a good place to begin.

There are some similarities in the assessment, diagnosis and treatment of the mental health and psychosocial symptoms related to a life-threatening illness and a pandemic virus because many of these conditions are a life-long challenge to individuals. Counseling Practice During Phases of a Pandemic Virus connects theoretical models that delineate the adjustment and adaptation phases of a pandemic virus. My work will assist readers to identify untreated, undertreated and unrecognized issues that precipitate fear, anxiety, mood dysregulation and irrational behaviors that may lead to the harm of self and others. The book offers an integrated psychosocial approach to identifying, recognizing, and intervening in critical life areas that have been imprinted on our mind, body and spirit.

The pandemic risk and resiliency continuum (PRRC) theoretical model [outlined in the book] also offers support to identify, prevent and prepare clients for the medical, physical, psychological, psychosocial and behavioral resiliency required to thrive under adverse conditions. The PRRC model has been reviewed and critiqued by a panel of eight experts in disaster mental health, epidemiology, medical and psychosocial aspects of chronic illness and disability, and behavioral health. Thus, the contributions of other researchers and practitioners are a foundation for this work.

 

What would you want counselors to know about helping clients adjust their coping mechanisms to deal with the different phases of the pandemic?

The most common and frequently reported psychological and behavioral issues reported by epidemiologists and public health experts during a pandemic virus relate to the individual’s fear, anxiety and behavioral health concerns. There are also the clinically significant mental health symptoms related to major depressive, anxiety, posttraumatic stress and substance use disorders, as well as suicidality reported within qualitative and quantitative studies.

When I discuss “phases of a pandemic virus,” I use the traditional public health model and generalize this for professional counselors. Natural disasters are typically organized in three phases: (a) disaster preparedness, (b) disaster response, and (c) post-disaster recovery. Unfortunately, there is no beginning, middle and end to a pandemic virus because many times they morph into another mutant variant which creates an endemic disease. So, post-disaster recovery looks much different than a North Carolina hurricane, Texas tornado or a California wildfire.

It is my opinion that we are challenged with a unique type of historical trauma because of the relentless spread of infection; mortality; loss of educational, career, and job opportunities; loss of financial resources; decreased interpersonal and intimate connections with friends and family members; political and social divisiveness; and many other life areas. These are soul wounding experiences for many, and therapeutic post-disaster recovery requires transcending the mind, body and spirit for optimal health in the “new normal.”

[In the book,] a conceptual model – the pandemic phase rehabilitation (PPR) – is offered to readers. This comprehensive model is applicable for practitioners and researchers providing guidelines in four phases (a) preintervention, (b) acute intervention, (c) post-acute intervention and (d) adjustment and adaptation. Consequently, the “new normal” requires some level of personal existential and spiritual growth as we adjust and adapt to an endemic virus.

 

In the book introduction, you argue that mental health professionals “should never again delay a disaster mental health response as we did during the summer and late fall of 2020.” How can counselors make a difference in this realm?

We cannot delay the mental health disaster response of a virus that has killed over 900,000 and infected over 63 million Americans. The human spirit and soul are at stake for professionals at the therapeutic epicenter of disaster relief.

The stench of death in hospitals, [in] tent cities and on the battlefield of a coronavirus pandemic reminds us of how fragile human life can be. Scientists have identified over 12,000 coronaviruses. Fortunately, most do not have the same transmissibility, infectious spread and mortality rates as COVID-19. Pandemic viruses have been with us since the beginning of time. They are naturally occurring events that have potential to be a public health crisis and morph into a natural disaster. In fact, diseases like rabies still exist today despite Louis Pasteur’s development of a successful vaccine in 1885. The tetanus vaccine was developed in 1927, yet we still have this shot available today to reduce infection. Measles, mumps and rubella are diseases with no treatment or cure, yet in 1971 shots were widely distributed for children. Hepatitis A and B all have potential to be a public health crisis in certain occupational settings.

Using the epidemiological example of the H1N1 flu virus, which has no cure, the best-case scenario is that COVID-19 and its mutant variants will someday be classified as an “endemic disease.” Counseling Practice During Phases of a Pandemic Virus addresses multiple areas of concern for the early identification, prevention and preparation for the next disaster.

 

What prompted you to write this book?

Jerry Corey [professor emeritus of human services and counseling at California State University at Fullerton and ACA fellow] states that most individuals “have a book within them” to write. The book within me, Counseling Practice During Phases of a Pandemic Virus, my 10th professional work, was influenced by my personal and professional experiences. I have been a mental health and rehabilitation counselor, counselor educator and researcher for more than 30 years. My research and clinical practice have focused on working with persons with chronic illnesses and disabilities, stress, traumatic stress and disaster mental health response in a variety of settings. My work has guided me to work with active-duty service members, veterans, veterans with disabilities and military families.

So, these are the things I have written about, professionally, since around 1993 and have not stopped. My interest in writing has most often been motivated by communities where I lived and worked and [that] have been at the epicenter of natural and person-made disasters: school shootings, workplace violence, hurricanes, floods, tornadoes and earthquakes. So, I placed the old disaster mental health hymnal on my bookshelf and decided to write a new anthem describing the medical, physical, behavioral and mental health characteristics of this new disaster, a pandemic virus that is relentless [and] never sleeps or takes a day off.

Epidemiologists and public health experts have been researching pandemic viruses for decades. However, there has been very little written in counseling and psychology to guide our profession in addressing the unique medical, physical, behavioral and mental health opportunities to thrive, not just survive, during a pandemic virus.

Thus, as a writer, I reviewed the current literature in mental health disaster response, applied my experiences in the field and then offered guidelines and models to provide a unique perspective concerning mental health characteristics of this new natural disaster. My primary intent is to offer recommendations for the preparation, prevention, [and] psychosocial and mental health treatment of individuals living through phases of a pandemic virus.

 

It’s been roughly six months since the book was published and conditions regarding the coronavirus continue to evolve and change. Is there anything you’d like to add or emphasize for readers since publication?

Since the beginning of the pandemic, there was a familiar phrase echoed by politicians and other public figures that “we are all in this together.” To the contrary, we are not “all in this together.” This statement implies that we all enjoy the same benefits and privileges in terms of socioeconomic status, access to quality health care, jobs [and] civil rights as well as adequate support systems and basic resources.

Many Americans still do not recognize and acknowledge the seriousness and lethality of the COVID-19 pandemic based on their questioning [of] the use of vaccines, mask-wearing, social/physical distancing and other virus hygiene protocols. I would like to offer a reframe [of that phrase]: “We are all our own best support system.” It is only when we can come together in the present moment that good things will unite our communities and regions.

The adaptation and adjustment (AA) theoretical model I propose [in the book] may assist practitioners in the identification, early intervention and triage, prevention, and preparation for therapeutic interventions during a pandemic virus. The stages of the AA model include [the] first wave of [the] pandemic virus, initial impact, fear and anxiety, denial, depression, anger and hostility, acknowledgment of the pandemic, [and] adjustment and integration.

Pandemic viruses are multidimensional in nature. They are not only biological entities; rather, the side effects of a viral contagion carry multiple medical, physical, psychological, social, emotional and occupational consequences. So, it is essential that we take a multidisciplinary approach in applied research to predict, anticipate and prepare for the next wave of a viral contagion.

 

 

****

Counseling Practice During Phases of a Pandemic Virus was published by the American Counseling Association in 2021. It is available both in print and as an e-book at counseling.org/store or by calling 800-298-2276.

 

****

 

Watch ACA President S. Kent Butler’s conversation with Mark A. Stebnicki in a recent episode of the “Voice of Counseling” video podcast: youtu.be/eyrgUj_R0bc

 

****

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

Reintegrating into a changed world amid an ongoing pandemic

By Katie Bascuas January 12, 2022

Samuel Bearer, a licensed professional counselor in St. Louis, remembers hearing a podcast interview back in fall 2020 with sociologist and author Brené Brown in which she described how the initial shock of the COVID-19 pandemic and its effects on people’s day-to-day lives had helped many individuals push through the early stages of the crisis, but after several months of pandemic living, people were starting to wear down. 

“When there’s a sense of ‘I’ve been dealing with the unknowns for so long,’ there’s more and more energy it takes to maintain that level of hypervigilance,” Bearer says. “That comes at a high cost.” 

At that point in the pandemic, many counselors began witnessing an increase in anxiety and depression among their clients. Some providers shifted their practice from one that had focused on supporting clients with self-actualization to one that supported clients with learning survival skills. 

“You can’t self-actualize if you don’t have your basic needs met,” says Ashleigh Jackson, a licensed mental health counselor in Melbourne, Florida. “So, if there was a job loss or a partner’s job loss, money and paying bills became the priority.”

Fast-forward 12 months, and the levels of exhaustion and stress felt by many were even higher. The need for further decision-making and risk assessment turned a new corner as people started returning to work and school amid a surge in COVID-19 cases resulting from the delta variant.

As breakthrough cases mounted, dampening some of the initial excitement about the vaccine’s promise to significantly slow the virus’ spread, many people were left to wonder when or if the pandemic would end. Add to that the heated political debates around mask wearing and vaccine mandates, as well as a deluge of negative media coverage, and you get a recipe for increased levels of anxiety, depression and fatigue. 

Counselors were faced with supporting clients as they navigated even more change, with added layers of uncertainty, during this reentry phase. Despite the challenges and the continued strain on many individuals — including counselors themselves — some providers began to identify opportunities for growth, both for clients and the profession.  

Reassessing values around work and home

For some people, the initial reentry phase was an exciting time — a chance to return to old activities and familiar ways of life. But for others, it presented added stress for any number of reasons, including individual health concerns, the complexity of navigating a “new normal” and, for some, the realization that they were now very different from the person they had been 18 months earlier when the pandemic began.

To help clients manage some of the uncertainty around the reentry phase, Bearer says he tried to help clients see the opportunities in the transition. “The reentering is also about ‘Do I want to go back to doing what I was doing, or do I want to make a switch?’” Bearer says. “Anytime we face a crisis like that or we lose a piece of our identity, which might have been part of the work that we did — and all of that might have gone up in the air — there’s a sense of ‘Has this fundamentally changed me or not?’”

Some of those changes might include minor adjustments, such as changes in appearance or office attire. “I’ve seen several clients transition back to work and wonder, ‘Do I have to do my hair again?’” Jackson says. “But you don’t have to do these things. Those were all things that we thought that we had to do, and now we learned that we don’t.”

Some shifts that people were experiencing were more significant, however, such as deciding whether they wanted to return to working in an office setting or whether they even wanted to keep their jobs. Both Jackson and Bearer say that being a sounding board for clients to explore alternative work or employment scenarios became an important part of their work. Bearer also used the opportunity to help clients assess their values around work. 

For example, Bearer found that for various clients, 18 months of teleworking had different effects on their work-life balance. Whereas some found the extra time valuable to devote to personal or family needs, others struggled with delineating their work and home lives and subsequently felt overwhelmed. 

“To whatever degree that we have been affected by the pandemic, there may be moments that we come to where we can clarify for ourselves, to say, ‘Hey, if I’m feeling the tension between the value of work and the value of home, how do I clarify that for myself?’” Bearer says. “It’s normal that we fluctuate through life, but now we are learning more how to recognize which stage we’re in and what we need to prioritize.” 

Bearer hopes that as more people reenter the workplace or return to pre-pandemic commitments, they get the opportunity to identify a new balance among all of their responsibilities, whether that’s at work, school, home or with family. He encourages people, where possible, to recognize this as an opportunity not to default to the broader culture, but rather to make individual choices that better resonate with their unique goals and lifestyles.

Halfpoint/Shutterstock.com

More people taking risks

In addition to decisions around work and how to return to an office or workplace, Jackson says she has noticed more clients taking large leaps of faith and making significant life changes as things began to open up more. “People are learning that life is short and everything can be gone in a moment,” she says, “so some are taking drastic risks, moving across the country, ending relationships, ending careers.”

The combination of those life changes with the physical reentry process can be a lot to manage at one time, adds Jackson, who compared the reentry phase during COVID-19 to reentering the world post-divorce or after the loss of a loved one. “We’re not the same,” she says. “But we have to figure out ‘Who am I now?’ integrating everything that’s happened, and then determine ‘How do I show up?’” 

Jackson says that encouraging clients to reintegrate slowly and giving clients “permission” to not be awesome at reintegrating right away was helpful in her work with individuals feeling tension around the reentry process. She also helped to normalize clients’ fears and concerns, taught grounding and mindfulness strategies, and recommended that clients take advantage of collective resources, such as meditation and breathing apps. 

Managing added stimuli

Those techniques are also helpful when dealing with the overstimulation that can come with reentry, says Emily McNeil, an LPC who owns the Mariposa Center for Infant, Child and Family Enrichment in Denver.

“Meeting all the demands of work and family and extracurriculars … it’s a trigger for a lot of depression and anxiety because people went from very low stimulation, in a lot of ways, to incredible stress and more demands, on top of the fact that we’re not out of the pandemic,” McNeil says. She incorporated a healthy dose of mindfulness, breathing and somatic techniques to help clients focus on the present moment and encourage them to take one day at a time. 

McNeil and other clinicians in her practice also began referring clients to other providers, including acupuncturists, psychiatrists, massage therapists and craniosacral therapists. Given that she primarily works with children, McNeil and her colleagues also found themselves reaching out to schools more frequently. “We’ve been creating community with schools to make sure that the schools and the family and the community-based providers are all on the same page with how to support children who might be struggling,” she says. “So, our amount of case management at this time is really high.”

Not only are people being barraged with added stimuli from the physical reentry process, but many are also feeling overwhelmed with the noise coming from the media.

“It seems like we’re constantly being bombarded with breaking news and information and opinions right and left, and this can often take us out of the present space and into a pseudo reality,” says Kristin Prichard, an LPC in Houston. “Then you compound that with a novel worldwide pandemic and the restrictions and lockdowns, and it can cause our brains to go into survival mode and trigger a recurrent fight-or-flight response.”

Prichard also noticed that some clients began to create rigid opinions or reactions to try and compensate for and feel safer amid the influx of information and differing opinions. “They want to go to an extreme and say, ‘I’ve weighed it, this is my decision, and I’m not going to waiver from it,’” Prichard observes. “It’s like a protection mechanism.” 

To help clients manage this type of fixed thinking, Prichard says she tries to meet clients where they are and model flexibility. “Something that I’ve tried to help individuals navigate in therapy is being more open-minded and taking in that information, but finding a way to process it before just automatically going to an answer,” she says. “[It’s about] exploring options.” 

Encouraging flexibility was helpful when supporting clients as they navigated interpersonal relationships at a time when more people were gathering but not everyone was on the same page about risk and safety precautions. Prichard urged clients to have an open dialogue, as much as possible, with those they were involved with. “The best thing to move forward is to recognize that nothing is set in stone, and you really need to have open communication with others and have patience and a general level of respect,” she says.

Recognizing resilience

Despite the increase in mental health disorders and the challenges centered on navigating a new normal, another theme that many counselors noticed as the pandemic wore on was a rise in demand for therapy services. This can be interpreted as a sign of resilience, according to some providers.

“While at times it is difficult to navigate, and there are lots of challenges and setbacks as we progress and then take a step back and then progress forward, overall I’ve recognized that more people are reaching out for help,” Prichard says. “You’re seeing the resiliency of individuals and people wanting to reach out for support.”

The reentry phase provided yet another pivot point — or opportunity, depending on how you look at it — to help reframe people’s mindsets from one of discouragement and frustration to one of strength and adaptability.

“There are so many times when I’ve felt, and when I’ve heard from colleagues, clients and supervisees, that I can’t take one more thing, and then there is [one more thing], and people keep going,” McNeil says. “They figure it out.” 

McNeil began using examples of people’s resilience to help validate their strengths. “A lot of people who are coming to counseling say things like ‘I’m broken,’ and I never agree with that, but this has been an opportunity for people to look within themselves and see all the things that they continued to do over the last year and a half and hold the mirror up and say, ‘Actually, you’re not broken. Look at how resilient you are even as hard as this has been. You’ve gotten through it, or at least to this point.’”

While counselors were helping clients recognize their personal resilience in the face of one more hurdle, many professionals were also recognizing their own limits and fatigue. Thus, a potential side effect, or benefit, of the pandemic’s longevity was the realization among some counselors of the need for greater personal and professional well-being to ensure effective and sustained practice.

“I’m a huge proponent and advocate for therapists having their own therapy,” says Jackson, who realized a greater need to engage in personal therapy during the pandemic. “Everyone was in crisis, as opposed to a few [clients] every week, so I had to enlist my own support to process how this was all affecting me.”

In addition to therapy, some counselors found themselves reaching out more to colleagues and others in the field who were facing similar experiences. 

“I think it is really helpful to build a community of support,” McNeil says. “So, having colleagues who have your back, whether you work with them or whether they’re peers who you get coffee with or connect over Zoom with. [Having] other people who really get what you do and can share notes with you about what it’s like to work in a virtual world when we’re a relational profession.”

A new balance?

The reentry phase also presented an opportunity to assess the value of teletherapy, which became a necessity in the early stages of the pandemic but less imperative once the vaccine became widely available.

“At first I, as well as some of my colleagues, were leery of telehealth,” Prichard says. She explains that the fear of losing a sense of physical presence and connection with her clients, as well as the potential difficulty of picking up on clients’ nonverbal cues, initially made her question the effectiveness of teletherapy. However, after several months of providing virtual services to clients, Prichard says she came to respect the benefits that telehealth provides. 

“What it does offer is a sense of calmness or peace for the client to know that at any time, they can check in for a therapy session from wherever they are, and they can do it in their own space, feeling comfortable, and they don’t have to deal with all the stressors and ins and outs of going into a session like traffic and parking,” Prichard says. “From that standpoint, I think it’s been a unique but rewarding thing to realize that we can provide good service care in different forms than we first recognized.”

While there are very real benefits to teletherapy, in-person therapy continues to have its benefits as well. So, what will the future delivery model for professional counselors look like? Maybe a mix of both. 

“You can move forward with the new technology and a new way of doing things while still respecting other ways that you’ve done things before and finding a balance between the two,” Prichard says. 

This balanced approach may also present the opportunity to serve more clients, especially if licensure portability can keep track with the technology, Jackson adds. (To learn more about the Counseling Compact effort that the American Counseling Association is supporting, visit counselingcompact.org.)

“I am encouraged that the pandemic has brought a lot of counselors to virtual,” Jackson says. “It has increased accessibility for so many people who otherwise would not get therapy, and I’m really hopeful that this will carry over into more portability for us so that we can see people in different places. We will be dealing with the effects of this for a really long time, so we need to be able to help as many people as we can in the ways that are ethical.”

 

****

Katie Bascuas is a licensed graduate professional counselor and a writer in Washington, D.C. She has written for news outlets, universities and associations.

****

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.