Tag Archives: Coronavirus

Looking back, moving forward: COVID-19 and Indian Country

By Nicola A. Meade, Roni K. White and Carol ZA McGinnis November 10, 2022

Throughout American history, the United States government, despite well-documented treaties, has unjustly treated Native Americans. Treaties ratified in 1851 and 1868 were violated during the COVID-19 pandemic national emergency, which may be surprising to people who believe that the failure to uphold such legal documents is an outdated issue. 

As noted by the Substance Abuse and Mental Health Services Administration (SAMHSA), there are eight domains of wellness — physical, relational, occupational, mental/emotional, intellectual, spiritual, environmental and financial — and any domain can affect another. This article will highlight how COVID-19 disproportionately impacted several domains of wellness for Native people and how counselors can address increased mental health concerns. 

The physical toll 

In a December 2021 article published in The Princeton Review, Riis Williams reported about a study conducted by Princeton University researchers, which found that U.S. COVID-19 mortality rates of Native Americans were 2.8 times higher than white people. Comparatively, this study also found that mortality rates were 1.6 higher for Black Americans and 1.8 higher for Latinos than white people. Comorbid factors contributing to these significantly higher rates include lack of access to affordable health care, poverty, historical and current treatment by the U.S. government, and higher rates of high-risk health issues. 

Shortly after the pandemic began, Kolby KickingWoman highlighted a distressing problem in a June 2020 article published in Indian Country Today, writing that “tribal leaders are working to keep their citizens safe from the coronavirus while juggling attacks on tribal sovereignty.” For example, in April 2020, the Cheyenne River Sioux and Oglala Sioux tribes implemented highway checkpoints for the purpose of contact tracing to reduce the spread of COVID-19. According to a May 2020 article in Indian Country Today, Cheyenne River Sioux Chairman Harold Frazier said that vigilance was required because the health care system on his reservation had “only eight hospital beds and six ventilators,” which was alarming given the high rate of infection that was occurring in the United States at the time. Nevertheless, South Dakota Gov. Kristi Noem tried to stop these efforts by giving the Native nations a 48-hour timeline to remove the checkpoints. The Cheyenne River Sioux Chairman Frazier and Oglala Sioux Tribe President Julian Bear Runner ignored the order, stating that they would remove the checkpoints when they deemed that it was safe to do so. Gov. Noem then involved the Bureau of Indian Affairs and threatened legal action. In May 2020, an increased number of positive COVID-19 cases led the Rosebud Sioux Tribe to also implement checkpoints on tribal land highways. 

In an action of solidarity, a bipartisan group of state lawmakers wrote a letter in support of these tribal actions to Gov. Noem, and they cited the 1851 and 1868 Fort Laramie Treaties, which clarify that the state “has no jurisdiction over the highways running through Indian lands in the state without tribal consent.” Gov. Noem responded by sending a written plea to then President Donald Trump for federal intervention. Citing this plea, U.S. Sens. John Thune and Mike Rounds and U.S. Rep. Dusty Johnson sent a letter to U.S. Interior Secretary David Bernhardt requesting clarification on jurisdiction. The Association for Multicultural Counseling and Development’s Native American Concerns (NAC) group also wrote a position letter in support of tribal sovereignty. In the end, Native sovereignty was maintained, and the decision to have contract tracing checkpoints was applauded. 

This conflict, however, did not end with the unjust challenge over highway checkpoints. As predicted by Chairman Frazier, when members of the Cheyenne River Sioux Tribe and Oglala Sioux Tribe fell ill with COVID-19, they did not have sufficient medical resources to meet the needs of their communities. And despite having available hospital beds in South Dakota, tribal members were forced to seek medical assistance in other states, traveling as far as Denver and Cheyenne, Wyoming. This not-so-subtle form of discrimination led to an Eight Circuit ruling that supported the 1868 Great Sioux Nation Treaty, which requires the United States to provide “competent physician led-health care.” 

A similar discriminatory health care policy occurred at the Lovelace Women’s Hospital in Albuquerque, New Mexico, where pregnant Native American women were singled out for COVID-19 testing based on their race and zip code. In a June 2020 article in ProPublica, Bryant Furlow unveiled that this hospital’s secretive policy resulted in some Pueblo Nation mothers being separated from their newborn babies for up to three days. No other hospital in the area enacted a similar policy for new mothers, and the practice was finally identified and stopped months later. This egregious practice is evocative of the 1860 U.S. cultural genocide policy to separate Native children from their parents and place them in government boarding schools, which ceased in the 1970s. Policies of this nature are reminiscent of historical traumas, and they also create new traumatic experiences and contribute to negative mental health outcomes. 

The financial toll 

The pandemic also severely hurt Native Americans economically when public commerce restrictions led to a significant economic downturn. Many of the revenue streams Native nations rely on are in the hospitality and service sectors, gaming industry and public-driven enterprises, such as the Hualapai Tribe’s Skywalk over the Grand Canyon. Generally, these enterprises were either closed or experienced significant revenue losses during the pandemic, which decreased the economic health of the community-based tribes. 

Although many Americans experienced financial hardship due to the ramifications of the pandemic, the Native American circumstances were compounded due to the intersection of the high percentage of COVID-19 deaths with tribal economic interdependence for survival. According to the 2020 report by the National Center for American Indian Enterprise Development, more than two-thirds of Native-owned businesses suffered significant revenue losses. 

As noted in a 2020 report by the Federal Reserve Bank of Minneapolis, Native American employment had the biggest drop in April 2020 of any racial group. This decrease in employment was also highlighted by Robert Maxim, Randall Akee and Gabriel Sanchez in a 2022 Brookings article that exposes the vast differences in unemployment rates across Native American, Asian American, Black and white populations. In January 2020, the unemployment rate for Native Americans was 7.5%, Black Americans was 6%, Asian Americans was 3%, and white Americans was 3%. In March 2020 the unemployment rate drastically increased, with 28.6% unemployment for Native Americans, 16% for Black Americans, 14% for both Asian Americans and whites Americans. The unemployment rate in January 2022 displayed improvements, with 11.1% unemployment for Native Americans, 8% for Black Americans, and 4% for both Asian Americans and white Americans. The authors of this article acknowledged a prolonged disparity, noting it was the “first time the government published monthly unemployment data on Native Americans.” This former exclusion has had negative effects on economic recovery efforts, supports and research, which was highlighted in a 2022 Journal of Counseling & Development article by NAC members.  In addition, as noted in a 2021 report by the Food Research and Action Center, the pandemic also exasperated food insecurities in a unique way for Native communities, resulting in locations running out of basic supplies at unprecedented rates.

On a positive note, Mark Trahant, in a May 2022 article published in Indian Country Today, noted that members of Congress intended to use a recent U.S. Congress report that detailed persistent structural barriers that have limited economic opportunities within Native communities to inform public policy. The American Rescue Plan’s investment of $31 billion into Indian Country is an attempt to bridge these gaps. The U.S. Congress report highlighted the interconnectedness of economic status and resources in relation to health outcomes. Much is still unknown, including the investment’s impact, yet the hope is that these positive movements can make a tangible difference.

The mental health toll

The loss of multiple family members and tribal elders who were the carriers of traditional knowledge and language can be especially difficult to bear, given the depth and breadth of such cultural information on personal and tribal identity. This can be especially devastating when the elder was the last living person with knowledge that predated the U.S. policy of boarding schools, which systematically removed Native American youth from their families and was an intentional form of cultural genocide.  

These losses were experienced by Native Americans in various geographical areas, including rural, suburban and urban areas, and on reservations. Native clients living in urban areas away from their Native communities, which have suffered great losses, might have faced barriers and restrictions that prevented them from participating in grieving rituals, thus complicating their grief. These clients may have also experienced isolation and disconnection from ceremonies, cultural practices and community support due to limitations caused by the pandemic, adding further emotional challenges. 

Local, state and federal policies that have racial disparities can add exponentially to bio-psycho-socio-spiritual aspects of the presenting problem with severe implications that reach beyond the non-Native pandemic experience. Due to these distressing impacts, practitioners should be aware of the historical trauma that the pandemic has triggered for Native American people who have suffered multigenerationally from U.S. betrayal and a failure to support Native interests. In a November 2021 NPR article, Adrienne Maddux, executive director at Denver Indian Health and Family Services, and Spero Manson, director of the University of Colorado’s Center for American Indian and Alaskan Native Health, shared that the pandemic had heightened

Ruslana Iurchenko/Shutterstock.com

historical trauma and the “sense of pain, suffering of helplessness and hopelessness” for Natives who have endured oppressive circumstances for generations. These observations dovetail with Allyson Kelley and colleagues’ findings in a 2022 article published in the American Indian and Alaska Native Mental Health Research that confirm significantly higher rates of American Indian and Alaska Native (AI/AN) children experiencing orphanhood as a result of the pandemic. 

The shelter-in-place orders and other mandates contributed to disturbances in physical and mental health due to the disruption in social, cultural, and economic practices and norms that are at the core of what it means to identify as a Native American. These circumstances contributed to increased rates of depression, suicidality and other pandemic-related stressors. A post-pandemic poll conducted by NPR, the Robert Wood Foundation and Harvard T.H. Chan School of Public Health found that Native Americans now suffer from increased depression, anxiety, sleep problems, stress and posttraumatic stress disorder. 

Before the pandemic, 50% to 88% of homes on tribal lands lacked internet, broadband and even phone services, so it is easy to see how these disparities elevated difficulties for Native Americans to transition to shelter-in-place orders, virtual opportunities and telemedicine. In a 2022 article published in American Indian and Alaska Native Mental Health Research, Amanda Hunter and colleagues reported that some Native American researchers used funding and advocacy to improve technological infrastructure, yet this help was limited to a few areas. These honorable efforts, however, were not able to mitigate the long-term effects of the technological disparities. 

A 2022 article in Shift Nursing reported that the depression rates for people in North Dakota had risen from 19.2% in 2020 to 33.3% in fall 2021. And of particular concern, the 2019 Fargo Cass Public Health Assessment found “a suicide rate of 45.1 for Native Americans in North Dakota, compared to the national average of 13.4.” This article also highlights access to insurance and costs as barriers to mental health treatment. 

On the positive note, mental health practitioners benefit from knowing that protective cultural factors can serve as a resource for Native American clients. Amanda Hunter and colleagues detailed how the protective factors of community, relationality, abundance, strength and resilience found in AI/AN communities have improved outcomes during the pandemic. These protective factors may exist for Native American clients who are struggling with post-pandemic issues and help them to pave a way forward through their struggles with anxiety, stress and depression. Many Native communities executed resilience during the hardships, disparities, challenges to sovereignty and disruptions to protective factors. Continued mental health support is essential to sustain resilience. 

Clinical considerations

Mental health practitioners demonstrate ethical care by incorporating how the aforementioned tolls affect Native clients while also seeking knowledge and understanding to maintain cultural competency. Counselors can learn more about current events within Native American communities by reading Native news resources such as Indian Country Today, IndianZ and Native News Online. Along similar lines, it is culturally responsible to understand that each tribe has its own culture and to be aware of tribal resources. Here are a few tribal resources that might be helpful depending on location: Northwest Portland Area Indian Health Board, Native Hope, Indigenous Story Studio, One Sky Center, We R Native, Center for Native American Youth at the Aspen Institute, First Nations Development Institute, and Centers for American Indian and Alaska Native Health. More general resources can also be found at the Indian Health Service (an agency under the U.S. Department of Health and Human Services) and SAMHSA’s Tribal Training and Technical Assistance Center websites.

In September, Kristi Taylor-Bond, a nationally certified addictions counselor and a chemical dependency clinical supervisor in Alaska who works with Alaskan Native populations, shared the following description of how the pandemic has affected the Alaska Native community with the NAC group: “COVID has halted in-person gatherings, which are essential to Native communities. It is common for Alaska Native crafters and artists to gather at the Native hospital and other corporation-run locations to sell crafts [and] traditional foods and to visit with friends. With these activities ceasing, many elders have been more isolated and unable to earn income from selling their art. Elders are especially vulnerable to mental health decline when they are not able to connect with loved ones.” This statement reverberates how important it is for counselors to access clients’ understanding of culture and their sense of belonging to culture as well as how disruption from this culture affects mental wellness. 

AI/AN clients benefit when counselors include the following spectrum factors for cultural consideration during sessions:

Connection/disconnection: Explore how AI/AN clients are experiencing connection to their community and cultural practices.

Contributor/burden: Ask AI/AN clients how they perceive their community is experiencing their needs. Does the client see their needs as a burden to others? Is there balance to how the client views their own contribution and needs? 

Collective/isolation: Determine AI/AN clients’ degree of connection to elders. This is important because elders hold wisdom for healing and challenging times.

Balance/imbalance: Guide AI/AN clients to reflect on what is working and explore the balance of wellness from the client’s cultural perspective. 

Cultural responsible therapeutic services also include the method in which counseling is offered. Telehealth is becoming a more widely used modality, so additional considerations are important to keep in mind. Taylor-Bond also shared the following with the NAC group: “While telephonic and video sessions may be a very successful alternative for urban and younger folks, Alaska Native elders and those living in more rural settings are not finding the same success, in my opinion. There is a really beautiful part of building rapport with AN elders that I have found, and that is just being with them. … Lots of the rural kids and adults I’ve worked with first get to know you by experiencing you.”  

SAMHSA and the U.S. Department of Health and Human Services have shared research informing how cultural disruption is a risk factor for suicide and mental illness in AI/AN communities. 

What counselors can do

Policy informs funding and laws, and funding delivers resources to initiate change. Counselors can engage in local and federal advocacy to improve facilities, research, treatment and access. There are many ways counselors can advocate and encourage changes. Understanding how local laws affect mental and behavioral health allows clinicians to discuss the impact and needs of Native American clients and practitioners with legislators. It is essential for counselors to know the systemic barriers that create limitations for Native American clients to obtain mental health care in order to inform elected officials on ways to improve access to these services. Identifying methods to deliver culturally appropriate services will improve the quality of service and access to care. 

When counselors advocate for efficacious culturally appropriate services, policy makers can pass legislation that protects vulnerable communities, builds access to culturally competent services and designates funding to increase equitable services and research. Supporting scholarship through funding is necessary to increase culturally appropriate interventions for therapeutic services. Currently, the funding for AI/AN research is 0.01% of the mental health research budget of the National Institutes of Health. In their article, Hunter and colleagues revealed how the pandemic has disproportionately affected Native communities, and more research is needed to explore the underlying factors and impacts of COVID-19. 

In their 2022 article, Kelley and colleagues shared how communities across Indian Country established policies, adapted services, created education and service delivery strategies, and developed resources to keep individuals and families safe. Many of these communities partnered with federal agencies, including the Centers for Disease Control and Prevention, Federal Emergency Management Agency, and Indian Health Service. 

Advocacy and progress take time and can provide healing to Native American communities. It was not until the passing of the American Indian Religious Freedom Act of 1978 that Native Americans could more freely worship in the United States. In 2021, Deb Haaland became the first Native American to serve in the presidential cabinet as the U.S. Secretary of the Interior. In August, Mary Peltola became the first Alaskan Native elected to the U.S. House of Representatives. In July, more than 1,000 acres of land were returned to the Onondaga Nation in New York, acknowledging them as the original stewards of the land. This recognition allows for healing and restoration as it further emphasizes sovereignty.  There remain numerous injurious land policies fueling advocacy efforts, including the Dakota Access Pipeline and national monuments such as Bears Ears and Grand Staircase-Escalante.

The American Counseling Association began its 2022 Conference & Expo with a land acknowledgment. This acknowledgment is essential in the collective healing process and promotes an understanding of the compounding historical and current trauma many Native people endure in their lived experiences. This understanding provides counselors with a window into how the complex traumas may present in symptomatology and offers insight to healing pathways. It truly takes all of us to create a representative government and institute change to heal and progress together.



AMCD Native American Concerns group

The Native American Concerns group is one of seven focus group for the Association for Multicultural Counseling and Development (AMCD), a division of the American Counseling Association that works to promote ethnic and racial empathy and understanding. AMCD encourages changing attitudes and enhancing understanding of cultural diversity. The Native American Concerns group actively supports Native voices in research and provides advocacy for Native counseling issues. It is a resource and community base for Native counselors and those who serve Native populations. Learn more by visiting multiculturalcounselingdevelopment.org.



Nicola A. Meade is a national certified counselor, a licensed clinical professional counselor in Maryland, a licensed professional counselor in New Jersey, the co-vice president for the AMCD Native American Concerns group, and an assistant professor of counseling and psychology at Georgian Court University. Her extensive work includes serving as a domestic violence advocate for Native women, increasing counselors’ understanding and awareness of Native voices, and researching counselor identity and workplace-based racism. Contact her at nicolaameade@gmail.com. 

Roni K. White is a national certified counselor, a licensed clinical professional counselor in Maryland and a co-vice president of the AMCD Native American Concerns group. She founded Apricity Wellness Counseling, a small private practice in Gaithersburg, Maryland, focusing on trauma, spirituality, minoritized women and relationships. Visit her at apricitywellness.com. 

Carol ZA McGinnis is a certified spiritually integrated psychotherapist, a board-certified telemental health practitioner, a national certified counselor, a licensed clinical professional counselor in Maryland and a current member of the AMCD Native American Concerns group. She is an associate professor of counseling in the graduate counseling department at Messiah University. Her research interests include functional anger, spirituality in counseling, and Xbox video gaming. To learn more, visit www.anger.works.


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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.

Building resilience in children after a pandemic

By Celine Cluff October 13, 2022

A lot has changed for adults and children since the onset of the COVID-19 pandemic. People’s social and work lives have been turned upside down. Children had to unlearn the behavior to touch and explore the world around them, and with an overall uptick in anxiety, they have also had to learn to cope with increased stress levels in their environments. The toll that this has taken on youth remains to be explored.

Psychological resilience represents the ability to mentally or emotionally cope with a crisis or to return to the original precrisis status. According to the research of Michael Ungar, founder and director of the Resilience Research Centre at Dalhousie University, and Kristin Hadfield, an assistant professor of psychology at the Trinity College Dublin, factors that improve a young person’s life change depending on whether they live in a community that is stable and safe or one that presents them with a challenging environment. This means that we have to pay attention to a child’s environment to understand what factors help them build resilience. COVID has certainly had a negative effect on peoples’ environments, and it may have even caused surroundings that were stable and safe to turn into ones that are not.

With the implementation of four simple steps, the connection and trust between children and caregivers can be strengthened, which, in turn, can lead to the mitigation of some of that angst still lingering from the pandemic.

Step 1: Have a conversation during a meal. Dinners are a great proxy for connecting. At a minimum, sharing a meal serves as a way to catch up and reconnect. Admittedly, dinners with young children don’t tend to last long, but often a quick check-in will suffice if done regularly as a part of a daily routine. For example, a family could set an egg timer for ten minutes of “family time” and then take turns talking about their “rose and thorn” of the day; the rose is something positive that happened that day, and the thorn represents something less desirable that may have occurred. This exercise works to strengthen the interpersonal connections between family members and helps them stay on top of things that require attention that may otherwise slip through the cracks.

Step 2: Teach choice-based behavior. Caregivers can boost confidence levels in children by inviting them to practice autonomy. A simply way to do this is for a caregiver to offer the child options when they want them to do their chores or help around the house. For example, if the caregiver wants the child to help with dinner, they could say, “It is your turn to set the table for dinner. You can do this now, or you can choose to clear the table after dinner instead but you’ll have to load the dishwasher too.” Caregivers can also discuss and acknowledge how important their contribution is. Praising the child for accomplishing the task and letting them know that their help is valued delivers a confidence boost and strengthens the connection to their caregiver. After all, everyone appreciates being valued for their efforts!

Step 3: Teach initiative taking. Initiative taking — completing a task or chore without being prompted to do so — is a skill that can be taught. The most effective way to encourage this independent behavior is to model it, encourage it through positive reinforcement and let it happen organically. Sometimes this means biting one’s tongue instead of telling the child to stop doing what they are doing (if what they are doing is safe). Initiative taking is a skill that can be developed in early childhood and will serve children well into their adult years. It promotes a sense of self-worth by making children feel capable to make decisions and execute tasks. Letting children explore what they are capable of in a safe environment can boost confidence and encourage independent behavior down the road.

Step 4: Be present. Children have a universal talent for demanding attention. Sometimes, it is possible to give them the attention they crave and other times it’s not. Here’s a common scenario: A child demands attention when their caregiver is in the middle of something that requires their neurons to fire at full capacity. Although it may seem daunting, taking one minute out of their busy work schedule to make eye contact with the child and hear them speak will not negatively affect productivity levels or work outcomes. But what it will do is show the child that they are valued and heard, which boosts their confidence. In addition, modeling good listening skills will strengthen the caregiver-child bond and will help to ensure continuous respectful exchanges in future interactions.


In summary, a resilient child will have at least one continuous, resilient interpersonal relationship with a parent, caregiver, close relative or even friend. Nurturing these relationships plays a pivotal role in the maturation of a child’s psychosocial development. The four steps mentioned previously are suggestions on how to nurture these connections. Research from the realm of positive psychology continues to underscore the mental health benefits of having fulfilling interpersonal relationships. According to Mark Holder, a psychological researcher and former associate professor at the University of British Columbia, nurturing interpersonal relationships also contributes to people’s happiness, and it is the quality, not the quantity, of the relationships that brings people the most joy.

The concept of increasing happiness levels by nurturing interpersonal relationships also applies when children interact with other children. It is important to let children engage with each other on their own terms (interfering only if necessary), enjoy outdoor playtime, act out different scenarios with peers (e.g., playing cops and robbers, which is a variation of tag) or simply enjoy the company of like-minded youth. Children’s social and emotional repertoires are developed during these early years. Although extracurricular activities are also valuable, they cannot replace the social/interpersonal exchange in early childhood development. It is important to keep in mind the need for both when raising resilient kids.

In their research, Ungar and Hadfield emphasize people’s social ecologies (or preservation thereof) when it comes to their development and level of resilience during times of crisis. Because creating a stable and safe environment plays a pivotal role in laying the groundwork for this development, staying open minded about ways to parent during times of crisis is also important. A simple exchange about what the caregiver’s day was like or how they are feeling (happy, sad, etc.) will often go a long way. It is always a pleasant surprise to learn how much children can give in return if they are shown that adults are vulnerable too.



Celine Cluff

Celine Cluff is a registered clinical counselor practicing in Kelowna, British Columbia, Canada. She holds a master’s degree in psychoanalytic studies from Middlesex University in London and recently completed her doctorate in psychology at Adler University in Chicago. Her private practice focuses on family therapy, couples therapy and parenting challenges. Contact her at celine.cluff@yahoo.com.





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: Our new world

By Gregory K. Moffatt July 18, 2022

I’d like to say we are in a post-pandemic world, but I know that isn’t exactly true yet. Even so, I can’t believe how much our world has changed in the past three years.

The lockdowns, mask requirements and financial issues of the COVID-19 pandemic, to name a few, added stressors to our world that I have never seen in my lifetime.

I am a college professor and some of my students finished their third year of college never having seen a classroom without masks, screenings, quarantines and other precautions brought on by the pandemic. My wife teaches 4-year-old prekindergarten, and some of her former students from three years ago, who are now going to the second grade, have never seen their teachers’ faces unmasked.

The pandemic also magnified mental health and social problems that were already present, including addictions, anxiety, depression, marital discord and a host of other issues. The last thing my clients struggling with addictions or depression needed was to be locked down at home for weeks on end with nothing to do. That doesn’t even begin to touch the magnitude of clients with obsessive-compulsive disorder who struggle with the fear of germs or autistic spectrum clients who need routines.

A few months ago, I wrote in my column that burnout could be managed, at least sometimes, by reframing. One reader criticized that statement by noting that the pandemic has been so overwhelming that reframing isn’t a panacea. I can’t argue with that criticism. This situation is just so different, I suppose.

For over a year, I didn’t eat out and I found myself anxious every time I wanted to go to a store. I’d wonder if it was open, if they had the items I needed and what restrictions they might have. I found it easier to just stay home.

Like all of you, I’ve shared the stress of relatives who worked in jobs that couldn’t easily be done remotely, especially in the retail and the restaurant industry. I saw some of them lose their financial stability and some even lost their jobs, which only added stress to the other preexisting stressors.

Most of us have been affected by this pandemic in one way or another. So many of us have been sick. Nearly all my family has had it, including me, despite vaccinations. And then, of course, there is death. Like others, I lost a close friend to this virus.

This doesn’t even include the political and social divisiveness surrounding issues related to this pandemic. Families have been divided — maybe even permanently — over the question of vaccines and boosters.

People are seeking help from counselors in numbers I’ve never seen before. I don’t know a single counselor who isn’t operating on a full schedule right now, and it has been that way for months.

But the pandemic has caused us to grow as well. Three or more years ago, most counselors didn’t do telemental health. Even though I had the credentials for telehealth as well as telesupervision, I rarely used it before the pandemic. But now, I don’t even accept an intern who hasn’t had telehealth training. It wasn’t even on my radar three years ago to require telehealth training for an intern, and I don’t know of any graduate programs that required or even offered it.

I’ve also grown to appreciate telehealth as a client. Because I live in a rural area, I’ve always had a hard time finding my own therapist who wasn’t 50 miles away in Atlanta. Now, I can manage my self-care in a one-hour telehealth session rather than spending three or four hours driving to and from my therapist’s office in Atlanta.

We’ve seen changes in continuing education requirements as well. In my state, prior to the pandemic, only 12 hours of distance learning could be counted for recertification. Now nearly all of them can be as long as they are synchronous — a term that few of us even knew three years ago.

In addition, telesupervision hours now count toward license requirements in Georgia. This gives clinicians in remote areas options for training far beyond what they could have accessed three years ago.

I often wonder why I wasn’t offering my clients the option of telehealth before the pandemic. I had clients who drove two to three hours one way to see me. Why hadn’t I thought to help them by offering distance work? Today, although my caseload with children is still largely in person, I use distance counseling with nearly all my other clients and supervisees.

As we come out of these troubling pandemic years, it is clear we will never be the same. But telehealth has been a positive change for the counseling field and offers a silver lining in the new post-pandemic world.




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.


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.

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

By Lindsey Phillips April 8, 2022

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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

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


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


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

Counselor burnout during COVID-19

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

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

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

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

Surprising Evidence of low burnout rates 

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

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

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

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

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

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

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

Pandemic fatigue

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

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

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

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

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

Pacing ourselves

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

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

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

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

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


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

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

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

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


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

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

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

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

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

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



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

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

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


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


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