Tag Archives: Coronavirus

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.”

 

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

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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.

Three steps to rediscover hope during the holidays

By Esther Scott December 8, 2021

As the seasons change from fall to winter, the rollercoaster of emotions we’ve experienced in dealing with the COVID-19 pandemic for the past two years continues to affect us. Some people are planning holiday celebrations that will make up for the ones they missed last year, whereas others are still dealing with a range of emotions triggered by the pandemic and the state of our global community. But this time of the year also presents a great opportunity to fortify our mental health by rediscovering the hope this season brings.

We saw our lives change rapidly during the holidays last year: We canceled plans, put relationships on hold, moved celebrations to later in the year and modified our traditional celebrations to uphold new social-distancing guidelines. In addition, we experienced a great deal of emotional pain caused by the death of friends and relatives from COVID-19. We also witnessed social problems, relationship struggles, and the loss of jobs and important plans. These experiences are not trivial, and they have had a real impact on our mental health.

In fact, studies show that our experience with this pandemic is already shaping behavior, and some project it will have lasting effects on the basic ways in which we interact with each other and the world. If people are socializing less often, for example, it could affect how they view themselves and how they relate to their community.

Just as nature plans for difficult times — with trees letting go of leaves to conserve energy and ants and squirrels gathering resources to sustain them through the winter — we must also prepare emotionally as we enter this holiday season. For us, planning ahead could mean organizing our thoughts and emotions, which not only allows us to grow in our ability to overcome the emotional and psychological effects of post-COVID-19 changes but also helps us prevent situational depression and be ready to face unexpected turns confidently.

The following mental health plan, which consists of three steps, serves as a valuable resource for emotional protection as we face both the physical and emotional change of seasons, and it can help us turn these experiences into opportunities for growth and rediscovering hope.

Anshu A/Unsplash.com

 Step 1: Understand your emotions.

Our emotions, even the uncomfortable ones, are always telling us something. The Pixar movie Inside Out does a great job at highlighting some of the emotions that help keep us safe: Disgust motivates us to stay away from germs. Anger helps us react to something we consider unjust or threatening. Fear and anxiety increase and prompt us to fight or escape something dangerous. Sadness encourages us to withdraw for a while to rest and heal, and tears signals to others that we need care.

Understanding our emotions helps us realize that what we are currently experiencing is a natural and expected reaction to the present situation. We have lost many things during the pandemic: social skills, connection, income, relationships and loved ones. Our emotions are, therefore, natural responses that appear when we lose something of value to us.

The pandemic has caused many people to reevaluate what is really important in their lives and to make changes. In psychology, this is called posttraumatic growth — a phenomenon in which positive change occurs as a result of struggling with challenging and stressful lives events. Studies have shown that a happy life starts with emotional well-being, and emotional well-being is a result of a healthy mind. That is why it is important to learn to be aware of our emotions, listen to them, take care of them and accept them.

Step 2: Focus on your resilience.

According to a recent U.S. Census Bureau’s Household Pulse Survey, about 41% of U.S. adults reported symptoms of anxiety or depressive disorder during the pandemic. A KFF Health Tracking Poll from July 2020 also found that many adults are reporting specific negative impacts on their mental health and well-being, including difficulty sleeping (36%) or eating (32%) and an increase in alcohol consumption or substance use (12%).

Although these statistics can be discouraging, it is also important to remember that you can focus on your resiliency and ability to overcome difficult situations. In fact, resilience is a psychological trait that can help keep you safe. Resilience can boost your immune response by providing you with an optimistic and hopeful view of the future; you believe your future will be better than your present and that you have the capacity to make that happen.

Psychological studies have found that our physiological immune system can help us not only detect and fight infectious disease but also detect and defend against “emotional infections.” In a similar way to how our body produces serotonin to help us heal from infections, our body can release dopamine, the “feel-good” hormone, to help us heal emotionally.

Throughout the pandemic, counselors, psychologists, pastors and community leaders have all offered advice on how to handle stressful situations and reduce cortisol levels. The most important ones to remember during the holiday season are

  • Have self-compassion and avoid demanding so much out of yourself
  • Stop constantly reading and watching news
  • Keep your internal emotions in check

Step 3: Use a rationalization technique.

Studies have shown that people are prone to overestimate or underestimate situations based on their emotions. For instance, people who are anxious about flying tend to overestimate the risks of flying when compared to driving, even though statistically flying is safer.

But just as fear can spread, hope can also be spread. Be a holder of hope. Make sure you remind yourself of your strengths, confidence and abilities. Crises are usually viewed as negative or dangerous, but they can also bring opportunities for improvement. The COVID-19 pandemic, for example, allowed individuals to find innovative ways to work from home and celebrate birthdays and weddings under social-distancing guidelines. And infidelity may cause a couple to reassess how much they value their relationship, which leads them to form a stronger bond and develop better boundaries.

After the difficult holiday season, we experienced last year in quarantine and isolation, you may feel relief this year because you can celebrate with your family and friends again, or maybe you feel you have personally grown and have a renewed perspective and appreciation for what matters most. This renewed perspective, along with realistic expectations, can be helpful as you move forward. Expect that you will miss the things, experiences and people you have lost during the pandemic. Expect to be emotional as you continue to adjust to the “new normal.” But you can also expect that you can overcome and improve your situation.

Remember that the beauty of the diamond comes from the extreme pressure and heat it experienced. The same is true for us. Just like diamonds, we may have gone through extreme conditions of pressure and heat last year. But we can emerge stronger from this crisis if we focus our energy on finding the positive lessons it gave us and hold on to one another this holiday season.

 

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Esther Scott, LPC

Esther Scott is a licensed professional counselor and solution-focused therapist in Arlington, Texas. Her specialties include relationship counseling, grief, depression, anxiety and teaching coping skills. Contact her 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.

Counseling Connoisseur: Trauma-informed return from COVID-19

By Cheryl Fisher July 6, 2021

“What lies behind us, and what lies before us, are tiny matters compared to what lies within us.”

— Henry Stanley Haskins

Jo Panuwat D/Shutterstock.com

[NOTE: This is this third piece in a COVID-19 recovery series. See the first and second installments.]

The sun shining in my windows rouses me before my alarm clock goes off, and I roll out of bed. After navigating around Elsa, my 3-year-old poodle, who is now sprawled across both sides of the bed (neither designated as hers), I make it to my dresser and pull out my workout clothes. I am a creature of habit and my workout routine is consistent. During the height of the COVID-19 pandemic, I constructed a home gym and participated in Zoom and YouTube classes. Body Pump on Mondays and Fridays. Step on Wednesdays and Saturdays. Yoga in between. The only class I did not do from home was cycle which was replaced with outdoor cycling during good weather. It was not perfect, but it kept my body moving and my mind clear. Following the Center for Disease Control and Prevention (CDC)’s recommended two-week wait after my last COVID-19 vaccination, I resumed my gym workouts, now masked and physically distanced.

That was until this week. I entered the gym, swiped my membership fob, and grabbed a towel. However, I noticed that the people behind the desk were smiling. SMILING! I realized that no one (except me) was wearing a mask. I looked up sheepishly and asked, “Are we clear to take off the mask?” The smiles and head nods continued. The CDC’s latest recommendations indicate that fully vaccinated people can meet both indoors and outdoors without masks. In twenty-four hours, my gym responded by lifting all capacity and mask restrictions. I took off my mask and walked to my class, where the taped Xs on the floor to promote physical distancing had already been removed. I set up my equipment in my usual location and waited as others trickled into class, each with a smile — and reservation. “I feel naughty not wearing my mask,” one person stated. “Is it weird that I still feel I need to stand 6 feet away from you?” another inquired. Even the instructor acted a bit disoriented around the new mandate. I watched as everyone navigated the change — such an abrupt turnabout from a year of fear, spent masking, distancing and washing to protect ourselves from a virus that changed our lives as we knew them.

Trauma-informed re-entry

The past year has been one of unprecedented circumstances. We have navigated lockdowns, a toilet paper shortage, remote work and virtual school. We have experienced loss—disconnection from family and friends, total disruption of routine and the loss of loved ones (see “Counseling Connoisseur: Navigating the losses of COVID-19”). Holidays and vacations were replaced with Zoom gatherings and staycations. The politicizing of the pandemic amplified confusion and fear.

There appeared to be some reprieve with the lifting of restrictions afforded by the distribution of the vaccine (see “Counseling Connoisseur: Hope in action and mental health“). However, we are far from being “back to normal.” Vaccination distribution continues with simultaneous bipartisan banter. Mask mandates have been relaxed, and we are left feeling both relieved and vulnerable. School and work are returning to brick-and-mortar spaces but with jubilation, but also reservation. As we return to some semblance of pre-COVID-19 life and routines, we are left with the fallout from the chaos of not only the pandemic but also the heated struggle against racial injustice and the violent insurrection on January 6.

As trauma therapists, we recognize that we cannot be expected to resume pre-COVID activities at full capacity. It will take time and work to re-integrate to the increase in sensory demand, schedule capacity and social engagement. We can help our clients and one another understand the changes and aid in a trauma informed re-entry. Here are a few tips:

  • Prepare for sensory demand: I was astonished at how even a drive on a major highway seemed daunting after a year in which my commute consisted of walking down the hallway to my makeshift office and an occasional outing to the park. I had basically stayed in a one-mile radius: grocery, gas station, home. Now I was traversing several lanes of traffic at high speeds and getting re-acquainted with reading road signs along the way. Allow the time and space to re-acclimate to the sensory demand.
  • Pace schedule capacity: A common conversation topic of late has been how the pandemic allowed us to rethink our schedules. Limited were the board meetings, book clubs and sports events. Optional activities were removed from our often-overbooked planners. Many people have commented on how the pandemic reinforced the importance of downtime that allowed people to spend time with their household members, take leisurely hikes in nature or simply reboot at home. With the excitement of re-entry comes the anticipation of the return to overloaded schedules. Now is the time to rethink those commitments. Set boundaries. Say no and give someone else an opportunity to make that bake sale cake or lead that community project. It is OK to step back from or choose not to re-enter the climate of busyness.
  • Plan for social re-engagement: I am currently writing this on my first airplane flight in a year and a half. I am heading to see my daughter, son-in-law and grandson. Fully vaccinated (yet still masked for travel), I cannot wait to hug my kids and enjoy just being with them. Yet, I know there will be momentary awkwardness as we remove our masks and re-engage. Oh, it will only be for a nanosecond, then I will kiss their whole faces — but that nanosecond is real! Except for virtual gatherings and get-togethers with our small bubble of family and friends, most of us have not witnessed real smiles and received real hugs in over a year. It may take time to adjust to social engagement. If you are returning to your workplace and encountering clients or co-workers, prepare to take time to just re-connect. Smiles, greetings, small talk. Allow for mask-wearing as you and others feel the need (or are still mandated). The art of connection is the counselor’s bailiwick. However, even we may need to allow additional “warm-up” time as we resume face-to-face sessions. Consider continuing to offer telehealth/virtual gatherings as you can allow for a safe return.

It has been a challenging time. While we are moving in a direction of healing, we are not there yet. There is still so much more to be cognizant of and prepare for as we return to our work, school and social lives. We are resilient and as counselors, we can help our family, friends and clients better acclimate in a trauma-informed way by helping them to prepare for sensory demand, pace schedule capacity and plan for social re-engagement.

 

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Cheryl Fisher

 

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is director and assistant professor for Alliant International University California School of Professional Psychology’s online MA in Clinical Counseling.  Her research interests include examining sexuality and spirituality in young women with advanced breast cancer; nature-informed therapy; and geek therapy. She may be contacted at cyfisherphd@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.

White House: Counselors have role to play in fostering trust of COVID-19 vaccine

By Bethany Bray June 24, 2021

At an online event for mental health practitioners earlier this week, U.S. Surgeon General Vivek Murthy emphasized that professional counselors’ role as “trusted healers” in their communities affords them an important opportunity to support clients — and clear up misinformation — as they’re making decisions regarding the COVID-19 vaccine.

“The name of the game right now is trust. This vaccine campaign will move at the speed of trust,” Murthy said. “And it will depend on what people who are trusted in their communities do.”

Roughly two-thirds of eligible Americans who have not yet elected to receive the COVID-19 vaccine believe common myths regarding the vaccine, Murthy said. These myths, including those that claim getting the vaccine alters your DNA, causes infertility or will give you the COVID-19 virus, are false, Murthy stressed.

The vaccines, the first of which the Centers for Disease Control and Prevention (CDC) greenlighted for adults in December 2020, reflect the culmination of years of research on the mRNA vaccine platform, he said. As with any vaccine, there are risks of side effects with the COVID-19 vaccine, but they are rare — and the risk of getting the COVID-19 virus “far exceeds” the risks of side effects from the vaccine, Murthy said.

The June 21 event, organized by the White House, was part of a larger push by federal health officials in recent weeks and months to close the gap between the number of vaccinated and unvaccinated people in the United States. The forum, held over Zoom, was meant to equip mental health practitioners with information to answer clients’ questions surrounding the COVID-19 vaccine.

The American Counseling Association was a partner in Monday’s event, along with the American Association for Marriage and Family Therapy and the American Psychological Association. ACA members Suzzette Garcia, a licensed professional clinical counselor in California, and Rufus Spann, a licensed professional counselor in Maryland, were included on the event’s panel of mental health practitioners.

Garcia and Spann noted that some of the most important tools counselors can wield to support clients are empathic listening and validation of their uncertainties regarding the COVID-19 pandemic, including vaccine-related concerns. They also acknowledged that clients’ mistrust of the vaccine can dovetail with deeper and long held cultural mistrust of the medical system of a whole.

Garcia said she has role-played with clients during sessions to focus on distress tolerance and challenge their cognitive distortions regarding the vaccine. It’s also important for mental health practitioners to familiarize themselves with accurate information about the vaccine and local resources with which they can connect clients, Garcia said.

Navigating COVID-related uncertainties “is a question that a lot of ACA members have had to deal with,” said Spann, a past president of the Maryland Counseling Association. “We are part of the front-line experience. When these conversations come up, we allow [the client to talk through] life pressures, stress and anxiety. … It has been an opportunity [for clients] to talk to counselors who are able to listen to their stresses, fears and hopes, allowing space for clients to talk about what they’ve experienced and what they hope for the future.”

(Left to right, top to bottom) Bechara Choucair, White House vaccinations coordinator; Suzzette Garcia, a licensed professional clinical counselor in California; Robin McLeod, a licensed psychologist in Minnesota; Kelly Roberts, a licensed marriage and family therapist in Oklahoma; Rufus Spann, a licensed professional counselor in Maryland; Neetu Abad, a behavioral scientist at the CDC; and U.S. Surgeon General Vivek Murthy speak at at June 21 event titled “White House Virtual Conversation: Mental Health Professionals and the COVID-19 Vaccinations Effort.”

Murthy noted that the COVID-19 death rate in the United States is now the lowest it has been in a year. However, thousands of cases are still diagnosed each day, and variants have emerged that pose particular danger to the unvaccinated.

“We have a lot more work to do, and this is where we need your help,” Murthy told the mental health professionals participating in and watching the online event (dubbed “White House Virtual Conversation: Mental Health Professionals and the COVID-19 Vaccinations Effort”).

The key to increasing vaccination rates is for people who are uncertain about the COVID-19 vaccine to hear from people they trust, including professional counselors. No amount of advertising can match that power, Murthy said.

Bechara Choucair, the White House vaccinations coordinator, acknowledged that it is not within mental health professionals’ scope of practice to encourage their clients to get vaccinated. However, the White House wants to ensure that practitioners are well-equipped to answer clients’ questions surrounding the vaccine and talk through any potential fears they may have, Choucair said.

Those fears and hesitancies might include a phobia of needles or medical offices, a lack of trust in the vaccine and its development (or in the medical establishment as a whole), and resistance to government influence.

Murthy noted that mental health is a priority of President Joe Biden’s administration and that mental health-related topics come up often in Murthy’s regular COVID-19 briefings with the president.

The COVID-19 vaccine is “our most reliable pathway out” of the pandemic, Murthy asserted. It’s “one giant step toward getting back to normal” so that people can once again gather in person and find social connection — “which we know [is] so important to mental health,” Murthy said.

 

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Watch the full video of the event on the White House YouTube channel: youtu.be/tzFS63G5sP8

 

Visit the CDC’s COVID-19 page at cdc.gov/coronavirus and ACA’s page of COVID-19 resources for counselors at counseling.org

 

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

 

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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.

Pandemic telehealth: What have we learned?

By Bethany Bray April 27, 2021

Last year, safety precautions and restrictions brought on by the COVID-19 pandemic in early spring caused most counselors’ in-person interactions with clients, colleagues and students to come to an abrupt halt. To continue treating clients, many clinicians shifted to conducting counseling sessions through video or other digital media. For some practitioners (and clients too), it was a “like it or not” change with a steep learning curve, especially if they had not been offering any telebehavioral health services prior to the pandemic.

Now, some counselors are beginning a return to in-person sessions or a blend of in-office and virtual sessions. What did practitioners learn — about themselves and the process of counseling — while using and adapting to telebehavioral health over the past year-plus? Did counselors pick up anything that they might apply to in-person work with clients if and when they return to a traditional office setting? From Zoom fatigue to eye-opening lessons in resilience and humility, there are stories to tell.

Counseling Today recently collected insights from American Counseling Association members who have used telebehavioral health to counsel clients through some or all of the past year. Read their thoughts (in their own words) below.

 

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Gale Brunault is a licensed mental health counselor (LMHC) with a private practice, Honoring Endings After Loss (HEAL), in Amesbury, Massachusetts.

When the pandemic first hit and all physical contact with the outside world came to a screeching halt, I remember asking myself, “How am I going to continue serving clients in a meaningful and productive manner?” After all, I only knew one way to conduct business, and that was face to face. 

Using telehealth for the first time and/or phone calls as a vehicle for serving clients was extremely challenging in the beginning. I no longer had the physical presence of observing the individual, which meant I couldn’t “time” my response effectively. Between that and dealing with technical strains, my focus shifted, and I found myself distracted by issues that had nothing to do with client needs. Not only did it become a challenge for me to stay on task, but I was expending more energy than I wanted to each session.

Over time, the program I chose became more efficient and user friendly, which afforded me the chance to focus more on improving my skill set. I no longer had concerns that telehealth was diminishing the client-therapist relationship. In fact, the process was proving to be encouraging. 

Using telehealth has taught me that anything is possible. Though initially I had concerns that it may not be a favorable vehicle for working with grief and loss, telehealth proved to be a solid match for those unable or unwilling to leave home, particularly following a major loss. One of the most difficult tasks for bereaved individuals is living in a world without their loved one. Being able to stay home and receive therapy can be extremely helpful, particularly when initially all you want to do is isolate and hide. 

Many of my clients have asked to continue using telehealth. Some look forward to coming back to the office. Either way, I will be available. 

Some of what I’ve learned since using telehealth is that while the body reveals a lot about a person, so too does the face. There is a certain level of intimacy involved when you are only focused on someone’s face. I have become more in tune to a client’s eye movement, the pauses they take, how they play with their hair, the thinking process and word choice, etc. Though all of these pieces were evident during face-to-face time, having less to look at can deepen one’s observation and assessment of client patterns and behaviors.

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Julie Hine is a licensed professional clinical counselor at a private practice in Albuquerque, New Mexico.

Having been in the field of counseling for almost 30 years, telebehavioral health has not only offered another opportunity for professional and personal growth, I also believe it has served as a catalyst to break down barriers for access to mental health services. While an entire world lives through a pandemic, common themes have risen among almost all persons. People are experiencing a gamut of emotions, often while they feel alone and alienated from loved ones and the world around them. People are feeling hopeless and helpless, riddled with feelings of nervousness. So, what happens when the entire world is feeling like this? Telebehavioral health (or telehealth) has provided an answer.

Telehealth has given access to mental health services to all persons … where [they] live. Especially in rural communities, such as those in New Mexico. Many people who live in smaller communities or on reservations do not always have access to mental health services, whether it’s because there are no counselors in their area, or they have no means of getting into an office on a regular basis. Telehealth has opened the doors for people to access services, no matter where they live, no matter if they have a car and no matter if they have gas for that car. If a person has access to a phone or computer, they can get in-person help, without actually being [there] in person. I can now provide counseling for someone who lives four hours away without even leaving my home.

Throughout all of this, communities of people have recognized the importance of positive mental health, and I have realized that self-care is a crucial gift to ourselves as counselors. If you’re a counselor providing telehealth, remember to stand up frequently, sit up straight, take breaks, rest your eyes, eat healthy snacks and, most of all, be kind to yourself. During sessions, encourage your clients to also be kind to themselves. Emotions are heightened, so remind them not to overanalyze everything, to ask for support when needed, learn to be proactive instead of reactive, and remember to laugh because nothing is permanent, and we will get through this. People are resilient.

As a clinician in the mental health community, I plan on continuing to provide telehealth services, even when returning to an office becomes a reality. That way, I can continue to help individuals, no matter the circumstances. However, I must admit, I look forward to leaving the chair in my home office and sitting in the same room, face to face, with the individuals I serve. Nothing beats human contact and smiles of hope.

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Justin Jordan is a licensed professional counselor (LPC) and certified substance abuse counselor who treats mental health issues and substance use at his private practice in Salem, Virginia. He recently completed his doctorate in counselor education and supervision at Virginia Tech and will join the faculty in the mental health counseling program at University of Wisconsin-Parkside this fall.

Transitioning to telecounseling in the spring of 2020 was an easy decision based on my family’s situation. I learned very quickly that my biases had limited my ability to see the potential of telehealth software in connecting with my clients and reducing barriers to attending sessions [prior to the pandemic]. I never intended to use telehealth software for counseling and strongly believed that direct presence with clients was essential for the relationship and perceiving my clients’ needs. While I would still prefer to safely be in their presence, I now see that with the loss of presence, what is gained is a flexibility for both the client’s and counselor’s home/work lives and a chance to see clients where they are most comfortable.

In the context of COVID-19, clients felt safer meeting online, and so did I. Beyond the context of the pandemic, clients with children had [fewer] barriers [for] adapting their child care for sessions. Clients were able to meet more easily during their lunch breaks at work without commuting. And some clients who were very anxious about going into public were able to be seen in the comfort of their home. Many of these benefits will hold true once physical distancing is less of a concern, which is why I would continue telecounseling if I were not closing my practice to start a faculty position this fall.

Additionally, as a humanistic counselor, I have always tried to diminish power dynamics and have relationships based in mutuality with my clients. Telecounseling taught me that asking clients to enter my office [in person] always comes with some authority, as having to log in to sessions from my office/bedroom, often with the sounds of young children in other parts of the house, erased that [imbalance]. I had to relinquish some of the boundaries I have worked hard to create with my physical counseling space, which came with discomfort but also a beneficial humility on my part that I was in less control — of technology glitches, distractions in my home and the state of the world. I also see that my clients often feel freer expressing themselves when meeting with me from the comfort of their own couches or other parts of their home. I have consistently received feedback from my clients that there are aspects of telecounseling that have improved the process.

One of my main suggestions to counselors and students who must choose to integrate telecounseling into their practice is to have a solid plan for backup communication when technology issues occur. Realize that host platforms have issues sometimes, clients’ hardware can have problems, your hardware can have problems, and software or internet connections can crash. Also, many clients need to be coached on how to use the technology properly, and they need to have access to a usable digital device (which most clients in my private practice do).

I also think that humility, honesty and authenticity remain key counselor traits with telecounseling, which means acknowledging when the technology is creating a barrier or problem in communication.

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Stephanie Brookins is an LPC in private practice in Columbus, Georgia, who specializes in the treatment of posttraumatic stress disorder (PTSD).

I was initially resistant to the idea of telehealth and would not have imagined that it might become a permanent part of my practice. I realize now that much of my negative view was shaped by the discomfort of the unknown and not having considered how the initial stress might resolve. My first experience with telehealth was several years ago with a client who had temporarily moved to another part of the state and wished to continue individual therapy with me. Issues regarding privacy and internet connection and overall discomfort with the technology led to a negative experience for [me] and the client, and I referred her to another provider. 

What I’ve found in the past year is that after the initial adjustment to technology and change, it’s relatively easy to forget that we are connecting via technology. However, that’s not always the case. Due to schools being closed, some clients have issues with child care and will have to interrupt their session to help their child with school or manage some parenting crisis. Other clients have plumbers dropping by or pets that want attention. Initially, some clients would attend telehealth sessions in bed, half awake and dressed in pajamas. This necessitated discussions about boundaries and structure that could be uncomfortable. 

There have been some unexpected benefits of telehealth. Clients with chronic health issues and periodic flare-ups would have to miss appointments in the past [because] they were unable to drive and physically get to appointments. Now we’re able to meet online and just limit the amount of time if needed. This has led to a decrease in last-minute cancellations. Some clients are able to access care now when transportation or time have presented limitations for them in the past. 

As an eye-movement desensitization and reprocessing certified therapist, I’ve had to adapt the mode of bilateral stimulation used in processing. I’ve been surprised at the work clients have still been able to do, even [with us] being physically apart and using self-tapping in place of eye movements or theratappers. 

With environmental safety precautions, I’ve been able to maintain in-person counseling as an option for clients during the past year. Some people are not comfortable with using technology, need the human connection of seeing a therapist face to face, or do not have reliable internet connection, so it’s been important to me to continue to offer that option. I imagine I’ll continue to adapt to my clients’ needs and will continue to provide both telehealth and in-person therapy.

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Nicole Sublette is a licensed clinical mental health counselor and certified hypnotherapist who also serves as a social justice advocate, as a public speaker, and as an anti-racist educator for the state of New Hampshire.

I have learned that telehealth makes treatment more accessible to people who might not otherwise be able to engage in treatment due to scheduling or distance. I have not found too many differences between telehealth and in-person [counseling] in my practice. However, I will have increased gratitude for in-person sessions in the future. There will not be trouble with sound or video. There will not be the interruption of therapeutic flow due to technical difficulties.

Through the past year, I have learned about my own resilience and adaptability. This was momentous for me, specifically in these uncertain times. Previously, I would not qualify myself as tech savvy. Using telehealth and adapting to an online format for treatment has expanded my growing edges and helped me to also lean into my own capacities. In uncertain times, it helped me to also learn my strengths and ability to adapt. Also, techniques that I previously thought could only be done in person, such as cognitive processing therapy for PTSD, can also be done via telehealth.

I have adapted [to telebehavioral health] by asking more somatic questions of clients and discussing how the body is handling symptoms. Asking questions about what I was previously able to observe with my eyes has opened up dialogue in ways I would not have imagined. Asking increased questions can decrease the potential for avoidance for both the therapist and the client.

To my counseling colleagues, I would say conducting sessions via telehealth gets easier with time. Utilizing the same rapport techniques that one uses in person can be very helpful with telehealth, such as asking open questions and conveying authentic curiosity. Also, address the elephant in the room about any discomfort for both the therapist and the client. Share about how you can learn together. Process together any discomforts one might have with using telehealth, then work together to create a plan to ease discomfort. Humor is also a great way to ease tension.

I absolutely plan to use telehealth in the future. It is my hope to do a mix [of telehealth and in-person counseling]. Currently, I am one of the very few BIPOC (Black, Indigenous and people of color) therapists in my state. Nationally, BIPOC [constitute] about 4% of practitioners in the mental health field. Telehealth has made therapy accessible to BIPOC folx around the state. I am able to provide treatment to clients who would otherwise not be able to travel to my office due to the distance. With continued escalating events of police brutality, therapy for BIPOC has been very critical.

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Laura Sladky is an LPC and licensed chemical dependency counselor who works as a school counselor in Dallas.

Through video/telehealth as a school counselor, I have learned that being able to quite literally see into someone’s world offers such insight into the way they organize and carry out their daily lives (pets, plants, family relations) as well as their sense of self. In short, telehealth offers the opportunity to know clients differently and inadvertently know their world beyond my office.

Throughout the past year, I have been acutely aware of my sense of justice and desire for equality. Of course, these traits are essential when developing a therapeutic alliance and conveying unconditional positive regard to a client, but on a systems and global scale, I have become painfully aware that individual problems do not exist in a vacuum, and change requires advocacy. In sum, this year was the “real life” representation of many theoretical concepts like Maslow’s hierarchy of human needs. Humans cannot be thoughtful, insightful and self-reflective if their basic needs (food, shelter, safety) are not met. Individuals’ autonomic nervous system becomes activated under threat and chronic stress (winter storms, unemployment, death of a loved one, fear of contracting a disease) and, consequently, higher-level thinking at the prefrontal cortex level is inaccessible. Moreover, I have learned about the inextricable link between humanity, trauma and the imperative nature of sensory integration. While the past year has been exceptionally disruptive and devastating in a variety of ways, our ability to make sense of our experiences and enact pro-social connection predicts our ability to recover — and not become further traumatized — by our experiences.

This year, with the social/political climate, I have asked more intentional questions to check in regarding media coverage/social media and how that has impacted the individuals I work with. Whether we are consciously aware of it or not, our brains become easily biased. Hearing a negative headline can begin a downward spiral and, before you know it, everything can seem awful. It helps me understand the level of distress knowing how much screen time people are exposed to.

In addition, helping individuals sift through what is in and out of their control (acceptance vs. change skills) and actionable steps to take to alleviate distress has been paramount. Asking questions is so important because you don’t know what you don’t know. In equal measure, not having the client in full view can impact nonverbal cues (bouncing leg, posture, etc.) but further reiterates the importance of tracking, asking questions and helping clients be aware of their bodies/ feel safe in their bodies.

It is so refreshing for those we work with to understand that we also experience undesirable situations (Zoom glitching, our pets interrupting calls, when we miss the client’s meaning) and witness how we cope in the moment. Radically open dialectical behavior therapy tells us that making mistakes is pro-social, helps us feel connected to others and eases our nervous system. For counselors who are working to connect or finding this challenging, I think briefly self-disclosing your own minor inconveniences helps build rapport with clients.

Our lives were unceremoniously upended, leaving us to confront grief and ambiguous loss daily and, in fact, it is weird even after a year. However, weird does not inherently mean bad. One of the best ways to work through the weirdness of Zoom life is to acknowledge it. In doing so, counselors can validate this experience, give it a name (awkward, different, etc.) and help facilitate the client management of these feelings.

I think offering a variety of mediums for therapy is the future of our profession, and I plan to make myself accessible through a variety of settings.

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Michael T. Greelis* is an LPC, licensed marriage and family therapist and approved clinical supervisor in private practice in Herndon, Virginia, who has seen adolescents and adults with mood and anxiety disorders and other life challenges for 25 years.

On March 17, 2020, I made a complete transition from in-person, face-to-face [counseling] to videoconferencing for my practice — about 30 sessions per week. The change was immediate for all clients from March 18 on. Based on the Centers for Medicare & Medicaid Services and [National Institute of Allergy and Infectious Diseases Director] Dr. Anthony Fauci’s statements, we either converted to virtual visits or risked our health and that of our clients if we continued in-person meetings. I saw that my clients and my colleagues reflected a high value on treatment by making this complete transition on very short notice. I learned that therapists and clients can make a major transition work with commitment and flexibility and that the work itself — face to face in person or on video — is what matters.

I immediately adapted my approach so that I focused on content rather than the medium and avoided incorrect assumptions (some cognitive behavior therapy on my part). I assumed that my clients and I would make teletherapy work and that we’d pick up on the requirements for that. What works is a focus on substance over style and letting [your counseling] style evolve as necessary.

My overall impression of videoconferencing for therapy (we call it teletherapy in Northern Virginia) is very positive. Prior to the COVID-19 crisis and emergency measures, I was a skeptic. On March 17, 2020, it was clear that I had to either migrate to teletherapy entirely or stop practicing. My ability to adapt to that change and the receptivity of my clients to make the change had a reciprocal positive effect. Every client in the transition remained in treatment, and clients who started during the virtual-only period followed a course of treatment similar to that expected during in-person times.

Post-COVID-19, I plan on a hybrid approach combining in-person with teletherapy based on client conditions and needs. This is both my preference and that expressed in very clear terms by my clients.

My advice to counseling colleagues is to focus on the work and client needs, pay extra attention to your experience of videoconferencing at the outset with each client, and ask clients how they think treatment is progressing. Also, use the special features of the medium. I’m always surprised to see that none of my colleagues use a green screen to project backgrounds more appealing than the same wall, office, etc., for every meeting. I am pushing myself to have a set of images, videos and text passages on hand [to use in sessions], if they’re beneficial. And I’m learning how to insert materials from the internet or from my files in real time during sessions.

*Greelis is advocacy chair for the Northern Virginia Licensed Professional Counselors and was involved in NVLPC’s recent survey on the use of telehealth by LPCs during the COVID-19 pandemic. See the survey results here.

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Rob Freund is an LMHC and an assistant professor at Nova Southeastern University in Davie, Florida, who also works in private practice with couples and individuals.

Prior to the pandemic, I had received training in telehealth counseling and conducted it across state lines in Florida and New York, where I was dually licensed. The format therefore wasn’t too strange for me, but the frequency of my utilizing it was more challenging. I, like many, experienced “Zoom fatigue” from using telehealth communication platforms exclusively. I learned that more so than usual, pandemic notwithstanding, I needed to separate myself from my workspace and engage in deep, deliberate self-care in order to bring my best self to the therapy space. Spending time in meditation and communication with nature became essential for me. I also realized just how much value there is in shutting off the computer and disconnecting so that I can better reconnect with my clients.

One aspect of this work that I do plan to bring to my in-person therapy is the utilization of technology in the therapy space itself — using my tablet to bring up materials for discussion, real-time sharing of resources, using digital drawing tools to portray and invite collaboration with the client. It has provided an opportunity to evolve the tools I bring into the space.

We rely so much on being in the room with clients that the absence of many shared experiences of the space — behavioral cues of seeing the full body, the opportunity to have natural eye contact patterns, smell and other sensory cues — is at times disorienting. What’s fascinating is to experience the human capacity for adaptation. I noticed myself beginning to have heightened attention to the sensory information that I did have access to — facial cues, speech patterns and nonverbal speech cues — and adjusting my work accordingly. We can be remarkably resilient, and I found clients to be the same.

I do think there are concrete things that counselors can do to facilitate adaptation to this new model of conducting therapy. Firstly, developing grounding strategies and preparatory work for before and after the session is personally important to the clinician, particularly if you are working/living in a smaller space. Secondly, I would encourage counselors to pursue training in emotional communication and recognition of nonverbal behavior. The Paul Ekman Group has excellent training resources for recognizing micro- and subtle expression displays, and books like Unmasking the Face: A Guide to Recognizing Emotions From Facial Expressions (by Paul Ekman and Wallace V. Friesen), Emotions Revealed: Recognizing Faces and Feelings to Improve Communication and Emotional Life (by Paul Ekman) and What Every Body Is Saying: An Ex-FBI Agent’s Guide to Speed-Reading People (by Joe Navarro and Marvin Karlins) are excellent for expanding one’s nonverbal/emotional acumen.

Like any tool, telehealth has its pros and cons. The portability and absence of commute often benefited [me] and my clients. However, I noticed that for some, there is increased value in experiencing therapy outside of the home environment.

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Grace Hipona is an LPC at NeuroPsych Wellness Center P.C. in Fairfax, Virginia, who holds a doctorate in counselor education and supervision.

The pandemic has challenged me to view the counseling process from a different perspective. It has challenged me to be more flexible and to reassess my own coping strategies. It has tested my resiliency and ability to continue helping others while I navigate my own circumstances. The process has given me the opportunity to truly connect with clients, since we are all experiencing the pandemic at the same time. Even though we may not discuss the pandemic directly, I am aware of how we may be impacted. I also continue to evaluate and monitor my own thoughts and emotions so the client’s perspective is primarily front and center, and I help support them based on their lived experiences.

Prior to the pandemic, my overall impressions of telebehavioral health were neutral to negative. However, since March 2020, I have only used telebehavioral health to provide counseling services. Through this time, I have shifted my thoughts and feelings, and I now have a more positive outlook on telebehavioral health. I appreciate the convenience and flexibility it provides. My clients appear to have similar feelings and thoughts about telebehavioral health. I have had several mention that they likely wouldn’t have participated in counseling if this opportunity was not available.

Our practice continues to assess and reassess the role that telebehavioral health plays in counseling. We have a provider meeting at least once a month, and since the beginning of the COVID-19 pandemic, we consider all the benefits and challenges. However, we have not made any long-term decisions about the role of telebehavioral health. Being able to partner with health insurances will be a guiding factor. If health insurances continue to cover telebehavioral health, it will provide flexibility. Moving forward, I believe in our field, and across other fields, providing opportunities for either or both [in-person and telehealth] will be one of the lasting impacts of the pandemic.

To better connect with clients, my counseling approach has shifted over the past year to being more directive or straightforward. In other words, if I am at all uncertain about how I am interpreting a client’s thoughts or feelings, I directly ask. For example, I say, “I am not sure how you are feeling or what you are thinking right now. Do you mind explaining it to me further?” Generally, clients have been appreciative of the opportunity to clarify their perspective.

To emit levels of sympathy, empathy and understanding, I find myself amplifying my facial expressions, nonverbal cues and verbal statements in general. For this reason, I believe remote counseling can be more exhausting. Reflexively, I place more effort in self-care so I can recover and refuel for future sessions.

The use of formal assessments or evaluations has also become more integral in my counseling process. Aside from the initial intake, I found using formal brief assessments intermittently beneficial to help support my clients. I also verbally make a concerted effort to ask evaluation-related questions such as “How are you feeling today — better, worse or about the same?”

 

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The future of telehealth

Insurance coverage has expanded and regulations regarding telebehavioral health have been relaxed in many states out of necessity during the COVID-19 pandemic. Will these changes remain as pandemic restrictions are loosened and many helping professionals return to in-person office settings? Find out more in our online article “The future of telehealth: Looking ahead.”

Also be sure to read this month’s “Risk Management for Counselors” column on page 8 of the print version of Counseling Today‘s May magazine, available for ACA members to download here.

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Action steps to learn more

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

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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.