Tag Archives: Coronavirus

School counseling in the time of the coronavirus

By Laurie Meyers September 28, 2020

“School counselor” is a deceptively simple title. In reality, school counselors play many roles, including social and emotional educator, academic adviser, conflict mediator, wellness coach, mental health therapist, student champion, educational collaborator and family liaison.

Now, with the advent of the pandemic caused by the novel coronavirus, many school counselors have become connectors and comforters-in-chief — not just to students but to parents and school staff.

Last spring, schools began closing in response to the pandemic. According to Education Week, 48 states; four U.S. territories; Washington, D.C.; and the Department of Defense Education Activity eventually ordered or recommended school closures affecting at least 50.8 million public school students. Suddenly, students, families, counselors, teachers and administrators all had to find a way to virtually re-create their in-person school routines. This already-challenging shift was complicated by the significant number of students who lacked access to high-speed internet or desktop, laptop or tablet computers.

Even before the pandemic, civil rights and education groups had been decrying what they had dubbed the “homework gap” because many teachers were increasingly assigning work that required internet access. Already at a disadvantage, these disenfranchised students — many of whom were Black, Indigenous or people of color (BIPOC) — now faced being completely locked out of school academic activities for the rest of the year.

According to “Students of Color Caught in the Homework Gap,” a recent report by organizations that include the Alliance for Excellent Education and the National Urban League, when the wave of school closures occurred, 16.9 million children lacked high-speed home internet access (a number that included 1 in 3 BIPOC families), and 7.3 million did not have a computer or tablet. Many schools spent the spring and summer scrambling to provide devices and internet access to students — a task that was still incomplete going into the new school year. Stories of students struggling to keep up with online instruction on cell phones are still not uncommon.

In addition, when the economy took a nosedive as the coronavirus spread, it made it hard to focus on anything but survival for many families. But even financially secure families found it challenging to provide the ideal learning environment as — in many cases — parents working from home with multiple children wrestled with carving out a physical space and a time for each person to be online. Students missed getting to see their friends and participating in extracurricular activities. Sports seasons were canceled. The theater curtains never went up on school plays. Rites of passage such as prom and graduation ceremonies largely fell by the wayside.

And now it is fall, meaning a brand new school year. Even so, in many parts of the country, the football fields and stands will remain empty, the marching band instruments will stay silent and there will be no homecoming dances. Things are decidedly not back to normal. For that matter, there is relatively widespread belief that “normal” will never return. No one knows what the future will hold.

So, it’s not surprising that parents, students and school personnel are all feeling stressed and overwhelmed. Continuing to hold classes online while simultaneously ensuring that students and families have the needed technological resources — or, in some cases, the absolute basics, such as enough food to eat — continues to be a team effort.

Because safeguarding the mental, emotional and physical welfare of students is the essence of what school counselors do, these professionals have typically been at the center of the problem-solving process since the arrival of the coronavirus. They have conducted check-in phone calls to make sure students had the necessary equipment and internet access; helped parents (or grandparents) with technological troubleshooting; arranged for families in need to receive gift cards and community resources; responded to requests from teachers to find out why students weren’t showing up for online class (and then worked to resolve whatever the barrier was); reassured stressed-out parents; coached families on how to set up a structured school day; made mental health referrals for students in crisis; and provided moral support to teachers, administrators and each other. All while finding ways to continue offering academic guidance, focusing on students’ emotional and social learning, and giving specific support to children who were struggling with various personal and school-related issues.

Counseling Today spoke to several school counselors at the end of the 2019-2020 school year and as they prepared for the new 2020 fall semester to learn more about the challenges of performing their jobs in the midst of a pandemic.

 

Linda Colón
Counselor for prekindergarten and kindergarten students, Bancroft Elementary School, Washington, D.C.

Bancroft is a Title I school (i.e., a facility that receives financial assistance due to a high population of students from families with low incomes) with a majority Latinx student body that also includes children of Ethiopian immigrants. Many of the families in the district live in poverty and often share relatively small living quarters with extended family.

Under normal circumstances, American Counseling Association member Linda Colón gives Bancroft’s youngest students their earliest lessons in social and emotional learning. By observing (and joining) students at play, reading aloud to them, incorporating toys, conversing with puppets and showing self-produced videos, Colón teaches prekindergartners and kindergartners basic social skills and how to recognize and regulate their emotions.

Getting to know students’ families and getting them invested in their children’s learning has always been an integral part of Colón’s counseling approach. She says that she’s “planting a seed” of awareness about the importance of education and attendance from an early age. Colón meets with parents to answer questions and, if requested, gives them advice on how to reinforce the social and emotional lessons that their children are learning.

Another benefit of establishing a relationship with families — and checking in regularly via phone or in person (during nonpandemic times) — is that Colón can get a better sense of the problems with which the families might be struggling. If they trust the counselors and teachers, she says, they will be more likely to reach out if they need help addressing emotional or mental health problems or accessing vital resources such as food and shelter.

Colón has been finding new ways to stay connected to her students and their families since March, when schools across the metropolitan region shut their doors and transitioned to online learning to finish out the school year because of the coronavirus. Schools in Washington, D.C., opted to begin the new year virtually as well, with an option to reevaluate in November.

“We can’t just say, ‘This isn’t going to work,’” Colón says. “We have to figure it out. We owe it to the kids.”

Before in-person learning ceased completely in March, Colón, knowing that the children were feeling anxious, created a lesson centered on “claiming strategies.” She reminded the children that when they were really afraid, it was helpful to talk about it, and she provided them with some age-appropriate safety information.

But the most important piece was the practical activity: washing hands. “We want to keep the germs away, so we wash our hands for 20 seconds,” Colón told the children, reinforcing the statement with videos and puppet demonstrations of hand-washing.

Colón also made videos so that the children’s social and emotional learning could continue virtually. The videos covered topics such as keeping a positive mindset, practicing breathing techniques and exercising mindfulness.

Colón also spoke to some of her students and their families one-on-one, either on the phone or via Microsoft Meetings, to find out how they were coping, to offer a sympathetic ear to stressed-out parents and to provide a reassuring presence for anxious children. She has given her phone number to parents and encouraged them to call or text her if they need help. As distance learning continues, she has been encouraging teachers to reach out as much as possible too. In addition, Colón has worked directly with parents to help solve technological problems.

This year, one of her initiatives is to help parents find a way to provide a space for children to take a break from their surroundings — a relaxation bubble. Many of her students live in small spaces, so the “bubble” might be something as simple and small as a blanket draped over a chair to make a mini tent.

Even at a young age, children are more aware of what is going on around them than most people realize, Colón says. They know that people are sick and dying, and at this age, children are less able to process the fear, which leaves them at risk of getting stuck in fight-or-flight mode. When they are at school, they can see their friends on the playground and have other opportunities to get away, but at home, exposure to trauma — even if only through the television — may be inescapable.

Activities such as drawing, watching a fun video or escaping to their relaxation bubble can help relieve the agitation, Colón says. The staff at Colón’s school has requested that markers, crayons and paper be sent to all the families.

Research also shows that when people are experiencing trauma, simply making a connection with a sympathetic presence can help, Colón says. So, she believes that keeping in contact with students and families is one of the most important things school staff can do right now.

“It’s finding a way to establish that connectedness,” she says. “When you’re in school, you’re waving to them [students and families], saying ‘Hi, good morning,’ singing a silly song. You’re doing something to make a connection that doesn’t have anything to do with academics.”

“I think our [school counseling] services are needed more than ever,” Colón says. “We’re the ones who are getting the pulse [of the community].”

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Natasha Griffith
Counselor for first through sixth grades and homeless coordinator, Dorothy I. Height Elementary School, Washington, D.C.

Height is also a Title I school, with many of its families living at or below the poverty level. Most of the students are Black — primarily first-generation Ethiopian. Approximately 20 to 30 percent of students are Latinx.

“I think this year, I’ll feel proud and accomplished if I can master Microsoft Teams and have whole class sessions,” says ACA member Natasha Griffith, whose school — like Colón’s — will be all virtual until at least November. She has modest goals for kicking off the school year, including holding a few smaller group sessions with students in fourth through sixth grades. Griffith’s role as the school’s homeless coordinator — which involves helping families in transitional housing find financial and community resources — can make that goal challenging. “I have to focus on the barriers that children and their parents face,” she says.

Griffith says she and her co-workers “hit the ground running” last spring when school buildings closed, distributing gift cards from the city’s public services department and money from a GoFundMe campaign to the neediest families and making sure that students had computers. But there will be an ongoing need for assistance during the current school year. In fact, although Griffith wasn’t officially working over the summer, she heard from families in search of additional gift cards and did some interpreting for the school’s technology contact, who doesn’t speak Spanish. Most of the students received computers or iPads in the spring, but stable internet access was a persistent problem, so the school has been setting families up with mobile hotspot devices (routers connected to a cellular data network that provides Wi-Fi connectivity).

Griffith will also continue to call families to check in on students who aren’t showing up online. If their absence is due to technological problems, she will make sure they get the resources they need. If the absence is because the students and families aren’t adapting well to virtual learning, then Griffith will do her best to help them navigate the unfamiliar territory and highlight how important it is for students to participate so that they don’t fall behind. “So many students weren’t participating [last spring],” she says. Even if families aren’t experiencing technological difficulties, many of them still aren’t sold on virtual learning, Griffith says.

Unfortunately, as is the case in many communities across the country, there will be cases in which Griffith isn’t able to get in touch with families. The counseling staff at Height does work closely with a social worker from Washington’s department of public health who is responsible for connecting families with resources, and Griffith says that she has been able to accomplish a lot. Even so, the reality is that educational continuity is incredibly difficult for schools to provide during the pandemic.

As she did last spring, Griffith will continue to help bridge the gap between parents and teachers. Many parents are feeling overwhelmed, and coping with online learning is yet another source of frustration for them. Griffith provides a listening ear and works toward helping families see that the school staff is there to help, not to judge. She is also concentrating on developing lesson plans that help students navigate the virtual landscape and encouraging them to ask for help when they need it.

Another challenge Griffith is facing is that she has no designated “classroom time” online. To present lessons, she has to be flexible and grab any spare time that teachers have in their class schedules. To supplement, she is planning on developing videos covering the social and emotional learning topics that make up the core part of her counseling curriculum, including managing anger, building self-esteem, learning to identify emotions, developing resilience and using tools for academic success. She has been rearranging her apartment to carve out a space for filming. The videos will be posted on Microsoft Teams for the students to access on demand.

In the spring, Griffith created a few virtual “lunch bunches” for small groups of students. She and the children would play games such as self-care bingo; squares included actions such as taking a shower, eating breakfast, listening to your body, taking a break, meditating, calling a friend and saying something good about yourself. She would also ask students about what they were doing outside of their classroom lessons. “It gave them a place to talk about missing their friends,” she says. “It was also something social that wasn’t related to school.”

Griffith is starting up the virtual lunches again during the current school year. She would also like to find a way to virtually re-create the in-person restorative circles that she used to hold in school. The activity, which usually involved 20-22 students, was focused on building community. Griffith would ask open-ended questions (usually focused on having respect for fellow students) and present students with a talking piece to pass around the circle. Students could choose to keep the piece and speak, or pass it on.

“I think restorative circles work well because they allow students to express their feelings about various social and emotional learning topics,” she says. “It allows students to take ownership and be an involved participant in the classroom community.”

Griffith will continue to connect with students any way she can while her school is held online, but she believes there is no substitute for face-to-face interaction. “Especially for these kids,” she says. “Saying in person, ‘You’ve got this. You can do this.’ That’s what I live for as a school counselor … [to] make a difference and tell them they matter.”

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Judy Trigiani
Counselor for kindergarten through sixth grades, Spring Hill Elementary School, McLean, Virginia.

Spring Hill has a large population of international students, many of them the children of diplomats and business people from around the world. Some of these families temporarily relocated to their home countries to wait out the pandemic and have not yet returned to the U.S.

The plan for ACA member Judy Trigiani’s school district is to operate exclusively online through at least the first quarter of the school year and then to reevaluate. But as Trigiani noted at the end of the prior school year, one of the biggest burdens of the pandemic for people is not knowing when it will end. Or, in the case of schools, when bringing students back in person will not carry the threat of widespread community spread. “We are trying to plan for the unknown. We don’t know when we’ll go back yet,” Trigiani says.

In the meantime, Trigiani and the rest of the staff at Spring Hill continue to try to keep things as “normal” as possible. Traditionally, the school’s year starts with an open house and a new family and student orientation. This year is no exception; however, the events will all be virtual. Families and students will connect via Blackboard Collaborate, where staff will introduce themselves and talk about the school community, scheduling and resources available to parents. A question-and-answer session will follow. The school is also hosting town hall meetings and a kindergarten orientation to present new resources and answer questions.

This year, there will also be a technology orientation to demonstrate Blackboard features such as the icons for accessing the microphone and video and “raising” your hand; how to magnify the screen; agreeing, disagreeing and reacting to the teacher and fellow students with emojis; and where to find the chat box, Trigiani says. The technology orientation will also cover some of the other programs the school will be using. Blackboard Collaborate enables staff to post videos and PowerPoints and share their screens. The tech session will also demonstrate how to access the website and the asynchronous learning area (video sessions that students can watch on their own schedule). Trigiani has also been preparing PowerPoint presentations for parents on topics such as setting up their children’s workspaces and how to talk to children about COVID-19.

Trigiani and the rest of the counseling staff will continue to visit the virtual classrooms every morning to check in and say, “We’re here if you need anything.” There are 18 classrooms per counselor, and counselors go into one classroom each day, she explains. Sometimes, they conduct a lesson. Other times, Trigiani will show up early just to chat with the kids, asking them to use the emojis to let her know how they are doing. If a student expresses distress or Trigiani hears or sees something that causes her concern, she meets with the student individually online and works to address the issue.

Individual counseling, social skills instruction, school counseling programs, parent meetings, the identification and sharing of resources — all of the normal work of school counselors also continues virtually. In addition, Trigiani works with parents who are struggling to cope with their children’s behavioral, social and emotional issues. If necessary, the counseling staff makes referrals to outside mental health resources.

The key, Trigiani says, is something that one of her former bosses used to say: “Keep your community and people informed, and stay as positive and flexible as you can.”

Trigiani believes that technology will continue to become more and more critical to school counseling, even after schools decide to return to the in-person model. Not only will retaining a virtual element allow medically fragile students better access to education, but it will also help counselors prepare students for 21st-century jobs by enabling them to give students training in online social skills, Trigiani asserts.

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Randi Vogel
Counselor for sixth grade, Thomas Pyle Middle School, Bethesda, Maryland.

Pyle also has a significant number of international students, which means that the student population is somewhat transitory.

“This pandemic has really brought to light the social-emotional needs of our students,” ACA member Randi Vogel says. “Even students who we considered very solid are having difficulties.”

In the spring, several students who were already struggling with mental health issues deteriorated further with the loss of a structured school environment and ended up needing to be hospitalized, she says. But even students who had no history of mental health issues were experiencing anxiety and stress.

After school moved online, Vogel and her team put out an announcement on the school portal that they were available via email and Zoom. They also sent out regular surveys asking students how they were feeling, if they needed anything or whether they just wanted to share.

One girl replied that she needed a Chromebook laptop to keep up with her school assignments. Another student said, “I miss you — and I fell and broke my arm.” Some students expressed that they just really wanted to talk, so Vogel and her team connected with them individually via video chats.

The surveys also asked students what they were doing to take care of themselves and to whom they had reached out. Every time that Vogel spoke to a student, she would ask them what they were doing for themselves.

Vogel’s district is starting the new school year with virtual-only instruction and will reassess in November. Although many students may have initially enjoyed the novelty of learning from home, that sentiment generally seems to have worn off, Vogel says. “I have heard from several parents and students that they truly miss the school experience — chatting in the halls with their friends, switching classes, the cafeteria, after-school activities, the bus rides to and from school.”

Although her school can’t re-create those experiences, the days will be more structured and organized for students this year, she says. There will be more live and interactive instruction, in contrast to this past spring, when teachers primarily gave lessons via “asynchronous learning,” which involved using previously recorded videos that students would watch on their own. Teachers then offered online “office hours” to field follow-up questions.

“Parents definitely want more ‘live’ instruction and for more of the day to mimic what occurs in the building,” Vogel says. Although this may help virtual lessons to feel more like regular class, she anticipates that students will have difficulty being on their screens for so many hours, despite the breaks that have been built into the schedule.

“We, as counselors, will continue to reach out to our students to see how we can help them virtually,” she says. “This might look like lunch bunches or initiating one-on-one Zoom calls as check-ins.”

Vogel says her counseling department really prided itself on always being available to students during the day. In fact, they had several students who were issued “flash passes” so they could come to the counseling office anytime they needed a break. “Once we are back in the building, I expect that to resume,” she says. “However, it is much more challenging to establish relationships with middle schoolers via Zoom.”

Because so many students are struggling or just need a little extra help coping, Vogel and her colleagues will be incorporating more mindfulness and stress-reduction activities and class meetings into the virtual day for students. “I think it will be very beneficial to have the students hear from one another how they are managing and that they are not alone with their feelings,” she says.

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

ACA School Counselor Connection (counseling.org/membership/aca-and-you/school-counselors/school-counselor)

ACA Mental Health Resources (counseling.org/knowledge-center/mental-health-resources/)

Books & DVDs (imis.counseling.org/store)

Books

  • A School Counselor’s Guide to Small Groups: Coordination, Leadership, and Assessment edited by Sarah I . Springer, Lauren J. Moss, Nader Manavizadeh and Ashley Pugliese
  • Critical Incidents in School Counseling, Third Edition, by Tarrell Awe Agahe Portman, Chris Wood and Heather J. Fye
  • Developing and Managing Your School Guidance and Counseling Program, Fifth Edition, by Norman C. Gysbers and Patricia Henderson
  • Solution-Focused Counseling in Schools, Third Edition, by John J. Murphy

DVDs

  • Acute and Severe Behavior Problems presented by Dave Scott
  • Bullying in Schools: Six Methods of Intervention presented by Ken Rigby
  • Managing Conflict in Schools: A New Approach to Disciplinary Offense presented by John Winslade
  • Quality Circle Time in the Secondary School presented by Jenny Mosley

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Laurie Meyers is a senior writer for Counseling Today. Contact her at lmeyers@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.

Using existential-humanistic psychotherapy in the treatment of COVID-19 survivors

By Audrey Karabiyik September 22, 2020

To say 2020 has been an unusual year would be quite an understatement. As a collective human society, we have all experienced significant alterations to our once normal lives. One factor, COVID-19, has played the predominant role in this process, and some individuals have been affected more than others.

My personal experience with COVID-19 has prompted me to write this article so that my fellow counselors will have guidelines for helping other COVID-19 survivors. It is important to note that no evidence-based therapy practices are currently available as the pandemic continues to unfold. Before this, we had not experienced a worldwide pandemic in 100 years.

What is existential-humanistic psychotherapy?

Existential-humanistic psychotherapy helps clients discover their own uniqueness through acquiring a greater awareness of themselves and the world around them. The therapist assists clients by teaching them to see their resistance so that they can have a more meaningful existence. Clients are free to explore which aspects of their lives support their journey and which can be discarded to live a fuller existence. This approach avoids labeling and diagnosing, so the focus can be placed on self-searching and meaning.

There are five key goals in existential-humanistic psychotherapy.

  • Develop the capacity for self-awareness and understanding the ramifications of freedom of choice
  • Create a personal identity and be present for quality relationships
  • Search for the meaning, purpose, values and beliefs of life
  • Accept normal anxiety as a natural condition of living
  • Become aware of death and nonexistence

Where to begin

The COVID-19 symptomology and experience are unique to each individual, so it is important for existential-humanistic psychotherapists to encompass a number of traits.

The therapeutic alliance must be established during the initial visit. First, by adopting an I-Thou relationship with the client, you establish a relationship in which the client is the authority of their personal illness experience and life. Second, by providing unconditional positive regard, your acceptance and support will allow the client the important opportunity to share their subjective experience and reflect upon it. Third, by utilizing empathy, you will permit your client the freedom to share a fuller range of feelings and emotions with you, thus creating a space to deepen their authenticity.

Stages for COVID-19 exploration

Stage One: Life before COVID-19. This is an excellent entry point to begin the I-Thou therapy relationship. The client will start to gain an understanding of your existential-humanistic style.

Simultaneously, you have the important opportunity to explore your client’s communication style and level of expressiveness. You will acquire an understanding of your client’s typical lifestyle, level of functioning, and what values and beliefs existed for them prior to the COVID-19 pandemic. Additionally, you can establish the client’s goals and what they wish to achieve during therapy.

Questions that may be of help could include:

  • Who were you living with?
  • What was your typical day?
  • Were you actively employed? How important was your job to you?
  • How did you spend your free time?
  • How was your general health?
  • Did you take time for yourself?
  • What was your “normal”?
  • What did you value most at that time?

My normal was living with my husband and son. My husband had endured six months of cancer treatments in another country the year before, and we were finally able to live together again. I was working in a counseling capacity. Our spare time was usually spent being with family and friends, traveling and enjoying our personal hobbies. 

Stage Two: Understanding the client’s early illness. In this stage, each client recalls and shares their unique symptomology and experience. At this point, your client may have greater comfort in the therapeutic relationship as a result of you engaging in active listening and empathetic techniques. You teach the client to explore their problem to develop insight by sharing physiological and psychological feelings related to their early illness.

Questions that may be of help could include:

  • How did the disease manifest itself?
  • What were your early symptoms?
  • Where do you think you came into contact with the disease?
  • When did you realize you were seriously ill?
  • What action did you take to address your illness?
  • What were you thinking and feeling about your symptoms?
  • What were your concerns at that time?

My symptoms — dizziness, cough, a heightened sense of smell, kidney pain and extreme fatigue — started in late March. My doctor prescribed an antibiotic and suggested I avoid the emergency room because it was believed that all in-house patients were positive for COVID-19 at that time, and if I did not have COVID-19, I would surely acquire it when I arrived. (It was days later that I understood her logic).

So, I spent a few days in bed, sleeping most of the time. I made every attempt to avoid the kitchen because the cooking odors were overwhelming to me. I had a desire to indulge in very hot baths, but each one seemed to make me weaker than the one before. I was feeling unsettled at this point because of the inconvenience of missing work. I also had feelings of fear that things would worsen. 

Stage Three: Determining the client’s level of illness. This stage involves the realization of a more serious illness, worsening symptoms and the eventual need for a higher level of care. Ideally, your client will be able to express a broadening range of feelings and thoughts as they reveal how they came to terms with their level of illness. As the therapist, you can begin to introduce the concept of freedom of choice in their decision-making.

Questions that may be of help could include:

  • How long had you been sick by this point?
  • What were your worsening symptoms at this time?
  • What made you decide to seek additional care?
  • How did you discover that you actually had COVID-19?
  • How long were you in the hospital?
  • What were you thinking and feeling when you realized what was happening?
  • What were your concerns at that time?

As part of four days of deepening symptoms, I had ceased all eating and drinking. I was unable to consume anything, mostly due to my heightened olfactory symptoms. Simultaneously, I was beginning an insidious decline in my ability to oxygenate my lungs, so I finally had my husband take me for the inevitable drive to the emergency room.

We were met outside the hospital by a front-line health care worker in complete personal protective equipment. My husband was required to leave before I was permitted to enter the emergency room. In these early days of the pandemic, with only a limited number of cases being discussed in the media, the seriousness of the disease was not yet widely known, but the possibility existed that I might never see my husband again. Although we had both experienced the fear and sadness of my husband leaving for cancer testing and eventual diagnosis the prior year, I believe we both inherently knew that my departure was unlike anything we had encountered before.

Stage Four: What were the client’s experiences during their care? While this stage addresses what was happening physiologically with the client, it is also giving birth to several key existential concepts for early exploration. As COVID-19 patients spend time in the required isolative ICU, anxiety rises and universal themes such as freedom of choice, isolation, meaningless and death are thrust upon them, becoming inescapable.

First is exploring the meaning of illness itself while having to grapple with giving up control. Second is finding meaning in the aloneness they are experiencing. Some clients may find that this is the first time in their life they have ever been alone or had an opportunity to focus solely on themselves. Third is finding meaning in the emptiness of their surroundings. Fourth is dealing with finding meaning in life itself and coming to terms with potential death.

You (as the therapist) can openly discuss the reality of death at this stage. Active listening and unconditional positive regard are of the utmost importance during this stage because this is where the transformation ultimately begins. The client deserves to have the complete freedom to share all of their thoughts, memories and feelings, no matter how irrational they may seem to you.

Questions that may be of help could include:

  • Did you understand what was happening medically?
  • What were your emotions during early care?
  • Was this your first experience with emergency care?
  • How did you feel when you realized that you had to give up full control to the medical staff?
  • What treatments did you receive?
  • Did you require the use of a ventilator?
  • What was your length of stay?
  • What emotions and feelings came into play? Were you frightened? Bored?
  • How did you feel being all alone?
  • What were you thinking and feeling when you realized what was happening?
  • What were your concerns at that time?
  • Did you think you were going to die?
  • How did you deal with that thought?
  • Did you draw any conclusions?

During my first career, I spent many years as a front-line health care worker. Therefore, in the hospital setting, I was returning to my roots and was fully aware of what was happening. With that said, too much knowledge can also prove frightening. I was quickly made aware of the gravity of the situation, and I was well aware that the best approach was to instantly give up control so the staff could make every effort to save my life.

I spent the next two weeks in ICU, continuously receiving 15 different medications, mostly intravenously, and 24-hour-a-day oxygen therapy, as well as undergoing many venous blood and several arterial gas tests and portable chest X-rays. My oxygen levels were very low and not responding to treatment.

The realization had long since set in for me that I would not have visitors and that death was a possibility. My entire focus went to one thing: continuing to inhale and exhale repeatedly, even as COVID-19 played tricks to convince me to stop breathing. A ventilator was considered, but I knew there would be an 85% chance of never breathing on my own again. Each labored breath represented many things — avoiding the ventilator, returning to the presence of my husband and son, lying in my own comfortable bed, not dying alone.

Despite my desires to return home, I spent many hours in the ICU contemplating the life I had lived and the possibility of death. I reconciled my life with God and was in a place of total peace. I came to terms with all of the relationships in my life, feeling sorry for those individuals incapable of making true connection. I was filled with extreme gratitude for what I had been provided throughout my life, including family, special friendships and the ability to connect with others.  

Stage Five: Post-hospital healing and meaning. Checking out of the hospital left me with immense hope. I had achieved what I had set out to do there. At this point, I was still on oxygen 24 hours a day and was able to walk about 24 feet before exhaustion set it. Because little information was available, the doctors required me to quarantine alone for another week, then another. I came to the realization that all one can do for the sick or terminally ill is to provide sustenance and let the person know they are loved.

Two weeks alone in my bedroom and my perspective had changed again. My wonderful bed had become my new prison. But, finally, I was set free of isolation and able to experience smiles, laughter, human touch, hugs and togetherness again.

Stage six: Where do we go from here? Certain clients will benefit from cognitive behavior therapy at this point to explore any distortions that may exist and will become content with their progress, thus ending their therapy at this time.

Others, having been given the opportunity to unleash their personal COVID-19 journey, will begin to open to possibilities for the future. First, you can explore anxiety with the client. You can provide psychoeducation to help the client understand the purpose of anxiety and to distinguish between existential, normal and neurotic anxiety. You can then explore how freedom of choice is used in decision-making and relates to the future and discuss the reality of death in greater detail. Introduction of Maslow’s hierarchy and self-actualization can provide the client psychoeducation to increase their self-awareness in the present and give them a road map for the future.

Questions for possible exploration can include the following:

  • Do you see yourself differently since your illness?
  • What things did you learn about yourself?
  • Are you more comfortable with yourself at this time?
  • Have your values or beliefs changed in any way?
  • Have your thoughts or fears changed related to death?
  • Are there any changes you would like to make in your life?
  • How would you like to spend your time in the future?
  • Will you handle situations differently?

Lingering COVID-19 symptoms, including bouts of low energy, occasional low oxygens levels and the unfortunate loss of a great deal of hair, still plague me. However, they are insignificant compared with my desire to help recovering COVID-19 survivors and front-line workers find meaning in their personal experiences.

 

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I would like to thank Ayala Winer and Arlene Gordon for their gentle guidance in encouraging me to share my story.

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Audrey Karabiyik is a graduate of Nova Southeastern University and is currently a registered mental health counselor intern in Florida. She is starting several COVID-19 groups geared toward survivors, front-line workers and others wishing to process the “new normal.” She is associated with Systemic Solutions Counseling Center in Plantation, Florida. Contact her at AudreyKarabiyik@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.

Voice of Experience: The miracle of 28 days

By Gregory K. Moffatt September 17, 2020

When I began my life as a mental health worker well over 30 years ago, the words “managed care” weren’t even a blip on the radar. Almost everyone had personal insurance. People who had an HMO were mostly factory workers, and to have an HMO or a PPO was generally not regarded as a good thing. Otherwise, you could go to whatever doctor you wanted, there were no “referrals,” and both physicians and counselors had immense latitude in the first few weeks of treatment.

In those days, there was a joke in our profession that went something like this: “How long does it take to treat [fill in the blank with any issue]?”

The answer: “Twenty-eight days.”

The reason for 28 days is that insurance companies would reimburse for up to 28 days of treatment — even in-patient care — without question. After that, lots of other documentation was required. So, miraculously, in-patient care was often — you guessed it — 28 days.

Of course, no responsible therapist planned their treatments based on that 28-day ceiling, but we had tons of latitude on treatment plans. But the late 1980s brought us major changes in health care. Managed care (HMOs and PPOs) changed the way we did business. I was too new in the field to have an opinion at that time, but I remember the outrage among my supervisors and other veteran counselors.

In retrospect, the change in how insurance worked actually helped us (forced us?) to become better in how we provided services. For example, brief solution-focused therapy, which was something that didn’t exist when I was a graduate student, is a result of this change.

You may be asking yourself whether there is a point to this interesting trip down memory lane. Well, I think we may be seeing something just like I described above happening right now.

Americans are innovative. I am confident that the coronavirus pandemic has created a scenario that will permanently change much of our culture. In the 1980s, therapists didn’t have to think about being “brief” or efficient, but the rise of managed care forced our hands, and we got better because of it.

This virus has forced us into telemental health and other ways of offering services that, prior to March of this year, we didn’t have to think about unless we wanted to. I have encouraged all of my supervisees to pursue the telemental health credential in our state, and I have done so myself, both as a clinician and supervisor, but I suspect that lots of veteran therapists just didn’t want to mess with a new modality.

Imagine that. Once again, here is something that we were forced to do that we should have been doing already because it provides options and helps our clients. In my early years, I learned to be efficient — to do in one session what my teachers might have had the luxury of doing in five or 10 sessions. I did things efficiently because managed care forced me to do so. But shouldn’t we have been doing that anyway?

I’m not belittling my predecessors. My teachers and supervisors didn’t have to do something they weren’t accustomed to doing, so they only did it if they felt like it. Now I’m realizing that this current pandemic is changing the way we do business, and that change isn’t going away when the virus eventually fades away. I predict that some of our clients will never choose to go back to the way it was. And maybe they shouldn’t. Young therapists will probably look back on this time in history and say, “Why did my teachers need a virus to get them to routinely offer services that benefited their clients? Crazy!”

This will also affect me as a college professor. My students undoubtedly will be asking, “Why do I have to come to the classroom?” long after the pandemic is history.

My clients will be asking something similar: “Why do I have to drive all the way across Atlanta and deal with traffic every week when I can see you from the quiet of my home office (in my slippers and jammies) if I wish?”

So, in our very near future, I suspect that graduate programs will not offer telemental health as an optional certification. Instead, programs will be adjusted to provide telemental health as an expected option for clients who fit well with this modality.

If any of you reading this are holding your breath until things “get back to normal,” don’t hold your breath any longer. We have a new normal, and this will almost certainly, in some ways, be very good for us, good for the counseling profession and, most importantly, good for our clients.

 

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Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.

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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.

Solution-focused tools to help school counselors in a pandemic

By Mark M. Jones September 14, 2020

Counselors in schools are facing unprecedented challenges during the COVID-19 pandemic. School buildings across the country were closed this past spring, and as we transition to the new school year this fall, some students will attend school only remotely through online learning. Others will be in school part time with reduced capacity, whereas still others may return to a full-capacity school but urged to keep physically distant and with their faces covered throughout the long days.

In addition, because of pandemic management measures, students have been spending an unusual amount of time with their families, some of whom are under new and severe emotional, health and financial stress. The pervasive spread of COVID-19 is associated with higher unemployment and poverty, greater use of illegal drugs, and new and sustained trauma experiences. On top of all this are the ongoing string of horrific news stories reporting White on Black violence and ethnic hatred, which are compounding societal stresses.

School counselors must be prepared to support a wide array of student concerns associated with COVID-19 and the accompanying social isolation. Counselors who can assist many students with significant needs in a brief, flexible way in both remote and in-person venues will be particularly valued.

Fortunately, the solution-focused model of counseling is highly adaptable to a wide range of problems, including grief, trauma and anxiety. It is appropriate for suicide prevention efforts, classroom lessons and even brief check-ins with students who are not demonstrating any outward sign of struggle. Instead of a deep dive into problem origination and causation, this form of counseling targets clients’ hopes, resources, exceptions to problems and descriptions of a preferred future. It also fosters vicarious resilience, which will help counselors who may have their own diminished stamina arising from personal struggles related to the pandemic.

Solution-focused counseling was pioneered by Insoo Kim Berg and Steve de Shazer from their work at the Brief Family Therapy Center in Milwaukee in the 1980s. It has evolved and become widespread over the ensuing decades through the work of many advocates in counseling, therapy and coaching. It is sometimes called “brief counseling” because it can be highly effective in a few 20- to 50-minute sessions, or even during a short hallway or classroom conversation.

Counseling in a modern, virtual world now means counseling through video calls without guarantees of confidentiality because students may be in only semiprivate or even public environments. Solution-focused counseling is not problem-phobic, but because of its embedded focus on goals, preferred futures, assets, resources and exceptions to problems, it poses less risk of revealing private, sensitive information that might be overheard by a family member at home.

Three-minute check-ins

Given the long absence from school and the limited amount of time students can be with school counselors, short three- to five-minute check-ins offer one practical way of providing support to students and gauging their emotional state. School personnel are key reporters of child abuse, and there are serious concerns about whether students could be enduring abuse because of having limited access to these trusted adult advocates.

Consider the following eight check-in questions:

  • What is your best hope for this year?
  • On a point scale of 1 to 10, where are you if 10 means that things are going as well as you could hope and 1 is the opposite?
  • What are you most proud of in how you handled being at home for so long?
  • If this turns out to be a really good year, what is something you will have done to make it that way?
  • Who will notice?
  • Do you feel safe at school and home?
  • Who is a trusted adult you can talk with if you are upset?
  • Is there anything else you would like me to know?

These types of questions allow students to express their preferred future, their resources to help them get there and a description of what that future will be like, including who will notice. Humans are social animals, and having students describe what others will see in them when they are successful helps make the path visible to them.

Even if there is not time to ask all of these questions, getting students to describe their preferred future, their resources and their social supports will help them move in small steps toward something hopeful. It will also allow the counselor to gauge students’ emotional states and resources.

Grieving students

Helping students cope with grief does not have to focus only on challenges and sadness. It can also effectively include conversations about joys and happiness. Students first need a counselor who will actively listen to their story of pain in losing a loved one (or a different loss), but a solution-focused counselor will also ask questions that seek descriptions of what the loved one liked to do and the positive aspects of the relationship.

Questions about what the decedent did for the student, enjoyed about the student and how the student knows these things can draw out memories of the relationship and help the student see their own assets and strengths through that relationship. Asking what students sees in themselves that the decedent saw can create rich descriptions of the strength of that connection.

Grief involves coping, so a solution-focused approach may include questions of how the student has managed to get out of bed and arrive at school, and what the decedent would be most pleased to see regarding how the student is getting along. For those students who are less verbal, allowing them to draw their coping skills or positive aspects of their relationship can supplant, or support, the dialogue.

Suicide prevention

All school counselors must be prepared to assess suicide risk in students. Unfortunately, given the diverse demands of school counseling, sometimes single meetings with students in the near term are all that are possible.

Fortunately, solution-focused counseling offers a framework to go beyond just assessing suicide risk; it paves the way toward fostering hope and engaging in critical prevention work. In addition to the classic questions surrounding scaling (e.g., “What keeps you from being one number lower? What will you be doing when one number higher?”) and questions about best hopes and a preferred future, more nuanced questions may elicit additional solution-oriented thinking. Some examples include:

  • If we asked the version of you that has been happier, what would that version tell you to do?
  • What would that version remind you that works for you?
  • How have you made it this far?
  • When in the last week were things a little better?
  • Who is on your support team?
  • Who could we bring into this conversation?
  • What job should we give that person?
  • What would that person advise right now with how you are feeling?

According to John Henden in Preventing Suicide: The Solution Focused Approach, one of the most powerful interventions is having the student imagine being a witness at their own funeral and describing who would be most upset, what advice that person would wish they had given, and what options other than suicide would the student wish they had tried.

Group counseling

Group counseling in schools is often based on themes such as anxiety regulation, social skill development or anger management. In the midst of a pandemic, school counselors may want to expand groups beyond narrow themes to include more students.

Taking a solution-focused approach allows a single group to include individuals with a variety of social and emotional needs. In the first group session, ask students about their best hope for how the group could help them. They can address their preferred future by describing what life would be like if things were better. Describing instances when this has happened and exceptions to the problem allows them to envision the change that is possible. Group members can then scale their current position, followed by questions of what idea they would be willing to try between now and the next session to move one step closer.

Subsequent sessions would start with each member reporting what is better since the last meeting, scaling their status and whether there were setbacks, describing how they coped and detailing what signs they will see when there is progress. To take advantage of the group dynamic, some of these questions could come from fellow members, or members could offer suggestions for what has worked for them. Ensuring that the group includes compliments from the leader and fellow members will help ensure that it is a positive and rewarding experience.

In addition, incorporating activities into groups helps children express themselves in a variety of ways. Fortunately, there are abundant solution-oriented activities to employ. An excellent resource for solution-focused activities with children is Pamela King’s Tools for Effective Therapy With Children and Families: A Solution-Focused Approach.

The following activities may be particularly useful:

  • Cartoon panel: Ask students to draw their miracle day using a six-panel cartoon or, alternatively, six resources/strengths they possess or six challenges they overcame with the names of the people who supported them and the skills they learned.
  • Mock interview: Prompt students to record a video interview of another student, or have them interview one another in a live video group stream. Prompts might include: What strengths did you use to overcome your challenge? How did you keep going and not give up? What advice do you have for others struggling with what you struggled with? Today, when you are being your best self, what are you doing well?
  • Rainbow questions: Have students pick three different Lego pieces that you supply (if meeting in person), or just ask them to name their top three specific color choices. Then, based on the colors selected, have them answer color-coded questions. For example:

Green: Imagine you are talking to your 5-year-old self. What is the wisest advice you would give yourself on how to handle being quarantined?

Orange: What did you do to help yourself get along with your family during quarantine?

Yellow: What is the nicest compliment you have received since the COVID-19 outbreak?

Dark Blue: Who supported you best during the quarantine? what did they do?

Black: What will your friends notice when you are your best self?

  • List it: Ask students to take a piece of paper and draw a line down the middle. On one side write challenges, and on the other side list strengths, resources and trusted advisers who help them with those challenges.
  • Face mask: Have students draw an outline of their face (or body) on each side of a page. On one side, ask them to draw or list what others see in them. On the opposite side, have them draw or list the strengths and resources they possess that others don’t know about.
  • News reporter: Have students interview key people in their lives and learn what those individuals see as their strengths, skills and resources. Ask students to elicit examples and stories, then write up the information as a newspaper piece.

Morning meetings

According to the Responsive Classroom approach, the goal of a class morning meeting is to “set the tone for respectful learning, establish a climate of trust, motivate students to feel significant, create empathy and encourage collaboration, and support social, emotional and academic learning.” Morning meetings are an easy opportunity to incorporate dialogue about the crisis in a way that can make evident to individual students their best hopes, personal resources, and instances of the preferred future being present.

Best hopes for the school year can be asked individually or as part of a group, such as, “What do we need as a group to end this school year well?”

Questions about resources and strengths could include, “When things were difficult, what was most helpful? What is something you tried that helped you to cope that you had never done before? Imagine you get in a time machine, go one year in the future and COVID-19 is finished. Look back to right now and describe something you are proud of in how you handled all of this Who was helpful to you? What would that person say if they were here describing something you did well? Whom do you admire and why? How are you like that person?”

Lessons

Solution-focused lessons can incorporate scaling as well as movement. Best hopes or goal setting can include floor spots that are numbered 1 to 10 (or write numbers on separate pages). Students can take turns standing by their number and then taking a step forward and describing what they will be doing when they are one number higher. Alternatively, a number line from 1 to 10 can be drawn and hung on the wall in class, and students can put a Post-it sticker on the line where they are. For a video chat, they can simply say their current number.

Picturing their preferred future and their resources can be done through letter writing. Students can be asked to think about what they would like to be doing in their career and life in 20 years. Have them imagine they are living that life and they find out that they can get messages back to the past. Ask this successful adult who is living their hoped-for life to describe to their younger self the challenges they faced, the internal assets that helped most and the people who were supportive. Then have them give their best advice on how to navigate the next 20 years.

Students can also interview each other to learn about one another’s recent challenges and resources, including who has helped them, what was most helpful and advice they have for others.

The ongoing pandemic requires that school staff members adjust how learning occurs. Solution-focused techniques allow school counselors to be brief, flexible and powerful in their support of students facing an array of social, emotional and learning challenges.

 

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Mark M. Jones has been an elementary school counselor in Arlington, Virginia, for four years. Before that, he was a trial lawyer for 30 years. Contact him at mark.jones2@apsva.us.

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

The costs of COVID-19: Parental anxiety syndrome

By Rebekah Lemmons September 8, 2020

As counselors in the age of COVID-19, we have seen a lot. We have been on the front lines of treating a new wave of counseling crises, from broad-reaching trauma symptoms to an increase in panic attacks.

One such example is related to parental anxiety. This is a term that stems from an increase in parental stress and accompanying anxiety related to the reopening of states, businesses and schools.

COVID-19 has changed the day-to-day lives of many parents and caregivers. These individuals have been forced to make adjustments in major areas of life, including child care, schooling for children, work dynamics and social supports. These changes create deeper concerns and uncertainties for many adults.

To best help clients effectively manage parental anxiety, we need to understand this phenomenon, who is at risk, what contributes to higher risks, how to effectively cope with these issues, and how to maintain overall health as the pandemic continues.

What is parental anxiety?

Clinically, parental anxiety is comparable to separation anxiety. It includes a high level of anxiety around opening up schools, day cares and related activities in which parents leave their children in the care of others. It has added components of stress and worry that derive from our ongoing transition to a new normal.

For some parents, this leads to increased panic attacks, decreased stress tolerance, sleeplessness, irritability, head and body aches, and exhaustion. It can also lead to increases in family conflict or parental conflict, largely based on disagreements about parenting in a pandemic. Conflicts about transitioning back into school, work or social situations can create tension and magnify existing areas of disagreement.

Who is at risk?

Any parent or caregiver is at risk for parental anxiety. From full-time working parents to stay-at-home parents, any caregiver can develop symptoms of this condition.

Parents who have been keeping their children at home and are preparing to transition children back into child care or school settings outside of the home are at higher risk. Parents and caregivers are also at risk for parental anxiety if they are preparing to return to the office themselves and transition children out of the home.

Any additional stressors or traumatic events can further complicate this condition. For example, if clients have lost a loved one during the pandemic or known someone with COIVD-19, their symptoms of parental anxiety may become stronger. In addition, Black, Indigenous and people of color (BIPOC) may be at increased risk for parental anxiety because civil rights violations and racial trauma from current events have a layered impact on the effects of the pandemic.

What creates these risks?

Collectively, we have all experienced a crisis. This has been described using many terms, including “collective grief” and “collective traumatization.” As we look at how individualized coping is in general, it is no surprise that during major societal shifts and global-scale issues, there is no one way to manage all that is being thrown at us. Even those with higher supports and increased levels of stress tolerance can struggle with parental anxiety.

For this reason, counselors need to be attentive to clients who appear to be doing well despite the circumstances as we transition to normalcy. As with other types of trauma and toxic stress, it is common for people to release feelings when they are in a safe space. With the transition back to routines and schedules, some parents and caregivers may feel increased stability and become able to release deeply suppressed feelings related to the collective grief and traumatization from recent events.

Clients may have been put in positions in which they had to push through difficulties to continue working, parenting and performing in the various roles they played. Even parents and caregivers who report being ready to return to work or to have children return to school can experience this unexpected flood of traumatic symptoms.

How can we help parents manage these symptoms?

In one sentence, healing from collective trauma requires collective compassion. It is important to promote connection and healthy attachments to recover from the negative impacts of compounded events and societal issues.

We can provide a safe space for clients to unload difficult emotions and worries by being empathic, demonstrating patience and providing psychoeducation about trauma. Counselors can also assist clients with increasing their awareness of feelings related to these issues and provide them with stress-reduction interventions.

Additionally, empowering clients to talk to their employers, child care providers and children’s schools about transition plans can help to alleviate fear of the unknown. This also assists parents and caregivers in making informed choices that will best work for meeting their needs and the needs of their families. With education on transition plans and safety precautions in place, parents and caregivers can focus on areas that they can control.

In response to the array of physical, psychological and sensory impacts from this symptomology, integrated psycho-sensory therapy may be beneficial. This therapeutic model includes using aspects of physical wellness such as recommending and referring clients to engage in yoga, exercise classes and related supportive services (e.g., physical therapy/occupational therapy, chiropractic care, massage therapy). It includes aspects of psychological wellness (the theoretical model of choice). Then it adds sensory considerations based on the client’s needs. These considerations may be related to lighting and colors (low lights, wearing and having a background with calming colors or nature), gentle music, and the presence of calming smells (lavender, lemongrass, etc.). See the visual (below) for model components. The diversity of each component added to the next assists clients in minimizing the impacts of how trauma is felt in the body and how it affects our functioning.

Even with telehealth sessions, counselors should consider creative ways to engage clients by giving them options to move around throughout sessions.

Click on the image to see it full size

Other considerations

For many clients, feeling prepared and having a plan can help to eliminate some of their added stress and anxiety. However, it is crucial that counselors continue to help clients maintain flexible thinking and increase adaptability because much about life today is unpredictable.

On a final note, counselors have experienced this pandemic too. We have also taken on the brunt of addressing mental health needs in a time unlike any other. Furthermore, many counselors are also parents or caregivers. It is vital that we take care of ourselves and commit to our own overall wellness. We must embody the level of integrative and holistic self-care that we communicate to our clients.

One thing I have encouraged others to do in these times is to give grace — to themselves and to others. We must have grace as we navigate these challenges so that we can rise above our circumstances and emerge resilient.

 

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Rebekah Lemmons strives to improve outcomes for children, emerging adults and families. For the past decade, her practice and research primarily has been based in the nonprofit sector, with an emphasis on program evaluation, teaching, service leadership, consulting and providing supervision to clinicians. Contact her at rebekahlemmons@yahoo.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.