Tag Archives: Counseling Connoisseur

Counseling Connoisseur: Death and bereavement during COVID-19

By Cheryl Fisher June 2, 2020

“Grief does not change you, Hazel. It reveals you.”
― John Green, The Fault in Our Stars

Sarah pulls her black blouse over her head, trying not to smear her carefully painted makeup. The dark circles have settled beneath her puffy blue eyes, and she dabs another layer of cover up over top. She brushes her hair, overgrown with neglect, the color faded. The roots reveal her 52 years, and she covers them with a spray that is the deceptive color of her youth.

But none of this matters. Her father has died. Alone. Without family nearby. They will now gather to pay tribute to a man who was her everything. A man who taught her how to throw a softball and fish. A man who showed her what to expect in a partner by loving his wife wholly. Her mother grieves from afar. Phone calls, Facetime and Amazon packages bridge the miles–and the social distancing. No, no one will care that Sarah remains in the comfort of her jeans. Not really. No one will notice as she props herself on her couch with her laptop on a pillow and taps the “Start Meeting” button.

Rituals, memorials and funerals provide ways that those who survive a death have the opportunity to grieve. “We know that funerals date to at least 60,000 BC, and every culture and civilization has had funerals ever since,” says grief counselor and educator Alan Wolfelt, in the National Funeral Directors Association’s resource, 8 Talking Points for Funeral Directors, Crematory Staff, Cemeterians, and Other Death-Care Workers. “Funerals help us acknowledge the death, honor the person who died, and support one another. In other words, funerals help us mourn well and set us on a healthy path to healing.”

Wolfelt, who is the director of the Center for Loss and Life Transition in Fort Collins, Colorado, also advises finding ways to be with the body following death. Many funeral homes and crematoriums are finding ways to allow the immediate family to spend time with the deceased. One funeral home has created a particular time where family members can sit with the body one at a time. Another funeral home livestreams time when the family can be with the body.

The novel coronavirus that causes COVID-19 has changed the way we do many things in our daily lives. The need for social distancing has resulted in virtual meetings replacing physical gatherings. Zoom conferencing can be awkward, and online happy hour isn’t as satisfying as hanging out with friends at your neighborhood bar. But, the loss of one particular kind of in-person gathering has been completely devastating: shared mourning rituals. Grief is experienced in the support of community, often with hugs and handshakes. Now, some clergy and rabbis are making house calls, armed with sacred texts, masks and hand sanitizer. But it is not possible for extended groups of mourners to gather together. The final resting rituals that many communities of faith have observed for centuries are significantly altered. For example, during the Jewish mourning tradition of shiva, families, friends and the extended community offer comfort through condolence calls. These condolences are now taking place over the phone and via live streaming. Traditional Catholic funeral masses are now livestreamed with only immediate family present and upholding the six-foot rule. Absent is the physical contact so important in the grief process.

Even gatherings of immediate family and friends are restricted. According to Susan Coale, a clinical social worker and director of the Chesapeake Life Center in Pasadena, Maryland, even if people are able to gather following the death of a loved one, there is a 10-person limit–including the funeral director and any presiding religious figure, such as a priest, reverend, rabbi or imam.

“COVID-19 has complicated individual grief and community grief and loss,” Coale says. Not being able to participate in death and grief rituals can result in the experience of ambiguous loss, which can complicate the grief process leaving numerous loose ends, she explains.

According to family therapist and clinical psychologist Pauline Boss, who coined the phrase, ambiguous loss occurs when there is no closure or there are unanswered questions related to the death of a loved one. This can occur when people cannot be with the body or in community. Therefore, it is important to find ways to help families connect with loved ones. Coale says that some families are attempting to connect with loved ones through window visits or telephone calls at end of life.

People need community support in times of loss. Numerous technological resources have arisen to help fill the gap left by the inability to gather face-to-face. For example, grief support groups such as the Chesapeake Life Center’s Living with Loss are being offered online. The Life Center is affiliated with Hospice of the Chesapeake, but is available to anyone in the community who is grieving, whether or not they are using hospice services.

Thanatechnology sites such as Caring Bridge provide a virtual space to grieve in community. Yet, we must always be mindful of the disparities in both the availability of technology and understanding how to use it. Not everyone can—or wants—to replace in-person grieving with technology.

Coale has begun providing her clients with guided imageries that include detailed descriptions of physical touch. She has clients imagine the specific details of a hug experience. The warmth of arms wrapped around the person. The tickle of arm hair. The scent of the body. The brain responds to imagery in comparable ways as to a real experience and Coale is capitalizing on this phenomena in offering “hug imagery.”

Coping with loss during COVID-19

Grief can be an isolating experience and now, more than ever, it is important to have strategies to stay connected to family and friends. We can still be together while observing physical distance and small group limitations.

Connect

  • Check in with one another by calling, texting or through webcam or social media and don’t forget the virtual hug! This does not require an in-depth conversation. Just a reminder that you are thinking of the person and while they are isolated, they are not alone.
  • Drop off food or groceries while observing physical distancing. Send a care package or shop online to send items. Many restaurants offer curbside takeout and Amazon and Instacart will deliver groceries directly.

Observe virtual rituals

  • Offer or attend virtual group funerals, burials and memorials. It is important to honor the lives of our loved ones and to experience this in community. While we are limited in the number of people who can be gathered physically, we can use technology to host larger gatherings that include friends and extended family members. Photos and memories can be posted on virtual platforms and viewed by many to celebrate the life of the beloved member.
  • Plan an in-person memorial for when physical distancing guidelines are no longer in place. Sometimes the act of creating can be comforting even if the end result is delayed. Plan the memorial in great detail — to be hosted after travel and physical distancing restrictions are lifted.

Seek support and professional help  

  • Bereavement services are available. Many providers are offering their services by phone or webcam. You do not need to soldier this burden alone. There are virtual support groups, as well as individual counseling.
  • Check in with faith communities about online services and support. Faith communities are offering innovative alternatives to traditional worship.

This is a difficult time complicated by the inability to participate in traditional death and grief rituals and activities. Yet, we are a resilient people, capable of innovation as we craft creative ways to connect with one another during times of grief.

“As many challenges as the pandemic presents, it illuminates the hard stuff that causes us to grow…offering us as individuals and communities to do some work,” says Coale.

People are being intentional in how they connect. Some families are re-discovering family time. There are many things to be grateful for during this unprecedented time. People are complex, as well as resilient and we have the capacity to experience both grief and gratitude at the same time.

 

Further reading:

Counseling Connoisseur: Thanatechnology – Grief and loss in a digital world

Counseling Connoisseur: Children and grief

Grief: Going beyond death and stages

Grieving everyday losses

 

****

Cheryl Fisher

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

 

 

 

****

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 Counseling Connoisseur: How to talk to children about the coronavirus

By Cheryl Fisher March 17, 2020

The novel coronavirus, which causes the respiratory disease COVID-19, has made headlines for several weeks and has drastically impacted life as we know it. The outbreak, which the World Health Organization recently labeled a pandemic, has disrupted global commerce, shaken the United States stock market and led to travel restrictions and international border closures. Here in the United States, in an attempt to slow the coronavirus spread, major events have been canceled, educational systems are resorting to online forums, and organizations are recommending that employees telecommute. Medical providers are offering telehealth services, and places of worship are examining alternatives to in-person worship services. As of March 13, President Trump declared a national emergency, which may bring additional restrictions.

The coronavirus and children’s mental health

Global anxiety is high, and our clients are negatively impacted as they stockpile supplies and prepare for the unknown. Meanwhile, in the midst of the chaos, children struggle to make sense of all that they are seeing and hearing. Overwhelmed with information, children are responding in a variety of ways. Professionals who work with children report an increase in insomnia, rumination, intrusive thoughts, nightmares, and acting out behaviors.

“After twenty years of successful classroom management, I am finding it hard to command the attention of kids whose energy is so amped up,” says Steff Linden, an educator and children’s mindfulness yoga instructor in Annapolis, Maryland. “They are running around, tripping over themselves, and bumping into each other. These behaviors are examples of children who are overstimulated. They know something is going on, but they don’t know how to react, and they feel helpless and stuck.”

Children can’t escape the tension created by the viral crisis, so they begin creating an understanding which is often complicated by misinformation. “I had a kid poke his finger in my arm and yell, ‘You’ve got the coronavirus! I touched you!’” Linden reports.

Children are acting out their fears through behavior and play. Therefore, it is vital to address their concerns in a way that is reassuring and honest. Here are some tips for talking to children about the coronavirus: The acronym CAPES.

C: Create a calm setting. Children pick up on the emotions of the adults around them. Adults need to manage their anxiety before attempting to address the concerns of children. It is essential to provide a calm setting before talking with children about COVID-19.

A: Ask what they already know. Children are already talking about the virus. They may have misinformation that needs to be corrected. Ask children what they have heard about the virus? Ask them about their concerns and fears. Children tend to worry about their own safety and those in their immediate world such as friends, family members, and even pets.

P: Provide age-appropriate answers. Answer children’s questions with honest, factual and age appropriate answers. Provide answers that are bias-free. Explain that COVID-19 is caused by a new virus and makes people feel sick with a cough and fever. Help battle stigmatizing any particular population by emphasizing that the coronavirus is no one person or country’s fault.

E: Empower them with tools. Children feel powerless over this big virus that has people buying out toilet paper and Clorox wipes. Provide them with actual tools to use that will be empowering by teaching them to wash their hands using soap and water while singing a happy tune for twenty seconds, cough or sneeze into their elbows—not their hands—or a tissue that they immediately toss in the trash and use no contact greetings such as jazz hands or Namaste.

S: Safety. Children turn to adults for a sense of safety and well-being. Assure children that it is not their job to worry about the virus and that you have a plan in place to care for them. Explain ways that you are keeping them safe by making sure they get enough sleep and providing them with nutritious meals. Tell them that their regular visits to the pediatrician and daily vitamin (if they take one) help keep them healthy. Even with school closings, provide daily structure that includes time for non-directed play to help children act out and process feelings. Help them make a list of ways they are healthy and safe. There are a lot of unknowns with COVID 19, so focus your conversation on what is known.

 

As counselors, we can help parents and our child clients better manage the plethora of information that is available. We can assure children that the adults in their lives are up for the task of taking care of them. The acronym CAPES can remind us how to be superheroes in an effective way to the young members of society who are powerless.

And, as always, we must remember our own self-care during this challenging time. Take a peek at my thoughts around a counselor’s guide to surviving flu season my column from February 2018, “The Counseling Connoisseur: Compassion and self-care during flu season.”

 

****

Important links:

COVID-19 update and resources from Counseling Today

COVID-19 related resources from the American Counseling Association

 

****

Cheryl Fisher

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

 

****

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

Counseling Connoisseur: Autumn lessons in turning inward and letting go

By Cheryl Fisher November 27, 2019

“At first we do not know what deeds or misdeeds, what destiny, what good or evil we contain, and only the autumn can show what the spring has engendered; only in the evening will it be seen what the morning began.” —  C.G. Jung

The leaves rustle in the trees as the wind grazes the tops, now bleeding color from the stems. Golden, russet and brown shades color the tips of the horizon as the seasons move from summer to fall. The earth begins to bring its energy toward its center as it prepares for the cooler months.

I begin my rituals of nesting. I cover the herbs and berry plants with straw and fill the feeders—assuring my feathered friends will have seeds and full bellies. Salads and light fair are replaced with soups and stews. The house is filled with the alchemy of savory and sweet spices.

I don shawls and pashminas and shuffle around in fleece-lined footwear. The shift toward autumnal consciousness brings quiet and an inward focus that is forgiving of extra pounds hidden under tunics and capes. I welcome the harvesting and gathering by all creatures as we prepare for the often-dreaded winter months that lie ahead.

Nature’s seasons offer guidance and are witness to the phases of change in our human experience. The first half of our lives—the spring and summer of our youth and young adulthood fade into the beginning of the second half—an autumnal middle adulthood that can offer peace and solace as we learn to turn inward. Just as the last of the leaves gently fall to the ground, we learn to let go of that which we no longer need. We let go of judgment and self-loathing, external validation and the defenses of the ego of youth.

The arrival of autumn

Our early years are characterized by quick growth and the establishment of our own separate identity. We build our sense of self from numerous factors: I am female. I am tall. I am a writer. I am a helper. I am a hard worker.

Once we have established our place in the world—one that centers on our individuality—a shift in perspective occurs. Autumn has arrived and we begin to look for greater meaning.

In “Falling Upward: A Spirituality for Two Halves of Life,” Richard Rohr, a Franciscan priest and founder of the Center for Action and Contemplation, says that the shift [to the second half of life] “… feels like a return to simplicity after having learned from all the complexity.” According to Rohr, life’s second half offers the understanding that peace and tolerance far outweigh an air of judgment and righteousness. Knee jerk reactions are replaced with contemplation and discernment. We begin to welcome the wisdom gained from many years of experience and coaching from others. We have started to cultivate our own sense of internal guidance and others may look to us for mentorship. We may recognize a sense of power — a force acting from within that we know is not our ego, and we begin to trust it.

 

A time of change

As we enter our middle to later adulthood, we may find judging people more difficult and that accepting people as they are is more in keeping with our heart’s desire. We no longer have to prove that our ethnicity, religion or socioeconomic group is superior to another. We have a greater understanding of our narrative and the mistakes we’ve made and are more able to view the errors of others in the context of humanity. According to Rohr, “Creating drama has become boring!”

During this time, we may begin to see love as something to be offered unconditionally, rather than given only for what we receive in return. Erik Erikson theorized that in middle adulthood — by his definition a span encompassing the ages of 40 to 65 years old — people begin to develop concern for others that extends beyond self and family. He called this need to nurture others—particularly the next generation—generativity. Erikson believed that this desire to give back to the world is so strong that if we are unable to contribute to the greater good, we feel a sense of failure and “stagnation.” Alfred Adler wrote extensively on the value of Gemeinschaftsgefuhl, or social interest — extending beyond oneself to creating a useful lifestyle. As counselors, we can help clients identify their gifts and find ways to make offerings to the world.

A different compass

According to Rohr, the first half of life is constructed through “impulse controls; traditions; group symbols; family loyalties; basic respect for authority; civil and church laws…”

However, in the second half of life, rules as a basis for action give way to authenticity and power directed from an internal moral compass. With age comes the understanding that there can be a difference between what is legal and what is moral. For example, there was a time in the not-so-distant past when it was illegal for black Americans to eat in the same restaurants as white Americans. While this was the law, it certainly challenges my moral compass. Throughout history, many activists—such as Martin Luther King, Jr.; Mother Teresa; Mahatma Gandhi; and Jesus Christ—have broken the laws of their time to move society toward higher moral ground.

The test of time has provided us with the experience of knowing to pick our battles. No longer feeling the need for competition and keeping up with the Joneses, we are able to enjoy just being in the general dance. We feel at peace more often with what is, and we appreciate things the way they are in the moment. We look to simplify our lives—making space for relationships and pleasure. Much needed playtime re-enters our calendars that have suffered years of overcommitment. We turn inward and welcome the peace.

As we work with clients who are transitioning from the summer of their youth to the autumn passage of middle adulthood, we can remind them of their strengths and the gifts they have cultivated throughout their lives. We can promote their generous offering of time and talents in service to their communities. We can help them identify their beliefs and values, and challenge the dissonance between their internal moral compass and the life they live. We can encourage their inner dialogue and the wisdom that they possess. As counselors, we can promote these changes by offering affirmation of their strengths and the beauty of coming into one’s own self in a way that is authentic, liberating and powerful.

Perhaps this is what the poet Jenny Joseph intended to capture in “Warning,” written in 1961 when she 29.

When I am an old woman I shall wear purple
With a red hat which doesn’t go, and doesn’t suit me.
And I shall spend my pension on brandy and summer gloves
And satin sandals, and say we’ve no money for butter.
I shall sit down on the pavement when I’m tired
And gobble up samples in shops and press alarm bells
And run my stick along the public railings
And make up for the sobriety of my youth.
I shall go out in my slippers in the rain
And pick the flowers in other people’s gardens
And learn to spit.

You can wear terrible shirts and grow more fat
And eat three pounds of sausages at a go
Or only bread and pickle for a week
And hoard pens and pencils and beermats and things in boxes.

But now we must have clothes that keep us dry
And pay our rent and not swear in the street
And set a good example for the children.
We must have friends to dinner and read the papers.

But maybe I ought to practice a little now?
So people who know me are not too shocked and surprised
When suddenly I am old, and start to wear purple.

 

 

****

 

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

 

*****

 

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 Counseling Connoisseur: Picnicking as a therapeutic tool

By Cheryl Fisher August 29, 2019

“A picnic is a state of mind and can be made anywhere.” — Author Unknown

 

A few years ago, I purchased a beautiful, fully furnished wicker picnic basket from Ireland. It is lined in moss green fabric with leather straps that hinge the basket lid and latch the top closed. The lid lifts to expose beautiful porcelain plates with huge sunflowers painted on the creamy surfaces. Moss and golden linen napkins are folded neatly to the side, and crystal wine glasses are nestled against the fabric basket wall. Silver salt and pepper shakers hang in leather straps alongside the carefully arranged silverware and wine opener. A dark green corduroy container is perfect for holding a chilled wine bottle and a larger, insulated, corduroy covered cooler holds containers of varied sizes — perfect for holding nibbles and tapas to enjoy with the beverage du jour. A matching moss green blanket is neatly rolled and strapped against the side of the basket with leather ties. It is just lovely and evokes the promise of fun family gatherings, evenings under the stars, romantic dinners and quiet solo outings with an enticing book.

This is what I love about picnics. They can be as casual as a peanut butter sandwich devoured while lying on a blanket in your backyard or as adventurous as the promise of a chilled shrimp cocktail thawing in the warmth of the hot boulders that hold kayaks after a rapid run down a stream. Or as elegant as lobster rolls and blueberry lemonade consumed while overlooking the Bay of Fundy. What picnics all possess is the promise of a satisfying sensory experience with good food, great company, and a setting that soothes the mind, body and spirit.

The history of picnicking

Picnicking has evolved over time. Although early picnics consisted of medieval hunting feasts of the wealthy, over the centuries they have become more egalitarian. The location of picnics has also evolved. Early European picnics took place indoors and in the city where the elite would promenade fancy foods and fine dining. However, picnicking eventually shifted to outdoor pastoral settings and became a custom common to people of all classes and socioeconomic levels. Picnics have been captured in art and literature, epitomizing leisure and social gathering.

Some picnics occur in seemingly strange places. For example, during the 19th century, Americans regularly picnicked in cemeteries. Although this is no longer a common custom in the United States, other cultures continue to picnic among the dead. Picnicking in a graveyard can provide an opportunity to honor deceased loved ones while enjoying a peaceful green space.

In many countries, specific holidays, events and forms of attire are celebrated with picnics. For example, Japan’s Cherry Blossom Festival is often accompanied by a hanami (cherry blossom viewing) picnic. In Argentina, after their official celebration on Christmas Eve, Argentines often spend Christmas picnicking outdoors—in some cases on the beach. Australia’s Northern Territory has an official Picnic Day celebrated on the first Monday in August. Picnic Day was first observed by railway workers, and the town of Adelaide River honors this history by celebrating with a Railway Heritage Picnic Day event. In Finland, a traditional May Day celebration includes a “herring picnic” in which pickled herring and other salty foods play a starring role, and Greece ushers in the beginning of Lent with kite flying and family picnics.

Unusual attire—or the lack thereof—accompany picnics in some countries. Nude picnicking may not be an official activity in Germany, but nudity is more widely accepted there and is common in some popular locations for picnics such as parks and the beach. While Germans may not have established nude picnicking as a tradition, in France, nudists hope to do just that. In June of 2018 and 2019, naturists held a public nude picnic in a park in Paris.

However, picnics are not just a pleasurable leisure activity—they can also be therapeutic.

 

Five ways in which picnicking can be therapeutic

  1. It is a form of nature therapy

Most picnics are accompanied by an outdoor setting. In a lush field, by a babbling brook, on a sandy shoreline, at a park table, or at the peak of a mountain top, picnics encourage outdoor dining.

As I have discussed in previous columns, research suggests that natural settings can help decrease cortisol levels and blood pressure while increasing serotonin levels. Spending time in the outdoors also exposes people to more sunlight. Light therapy can be an effective treatment for certain types of depression—particularly cases caused by seasonal affective disorder.

Simply being in nature is healing.

 

  1. It can cultivate positive social experiences

Rather than the isolating experience of eating in front of a digital device (TV, computer, smartphone), picnicking promotes personal interaction and engagement that can result in a satisfying social experience as well as a meal. Communication is enhanced as friends and family enjoy a meal amidst the slower pace of natural settings.

 

  1. It provides an opportunity to practice acceptance and commitment (ants and bugs cohabitating)

Picnics offer an excellent opportunity to lean into the reality of outdoor dining — which includes those creatures who may not have been invited. Bugs join the party, and unless you are going to spend the time swatting them away, it is an opportunity to learn patience and tolerance while enjoying the many other aspects of outdoor dining that are less of a nuisance.

 

  1. It encourages reflection

The naturally slower pace of outdoor dining promotes a more mindful experience. It is one that creates the space for quiet and reflection. I love to begin my mornings by eating breakfast on my patio. It’s a mini-picnic just beyond my back door that embraces an appreciation of the morning sun and is enhanced by the fragrant herbs from my garden and the morning activity of the birds and small animals. As I sip my tea, my mind clears, and I have the mental bandwidth for reflection of gratitude–for the beautiful day, my health or the fullness of my life (translation: busy schedule). My practice is just one example of how picnics can offer opportunities for reflection.

 

  1. It can promote healthier eating

Recently, I packed up my beautiful picnic basket with a variety of foods. As I nibbled on the fresh vegetables that I had harvested from my home garden that morning — dipped in warm lemon-infused hummus — I honestly could not imagine anything tasting as splendid. The fresh air, green space and gorgeous food made for an exquisite sensory experience. While it is true that a quick visit to a fast-food drive-through could fill a picnic container (basket, backpack, bucket), people often select foods that promote healthier eating.

 

 

So, the next time you are faced with clients who could benefit from a mini-break that would include a therapeutic experience that will encourage positive interactions and reflection, suggest they pack their favorite goodies and head for an outdoor space. Inviting clients to participate in a picnic promotes their connection with self, others and natural settings. Picnicking can help enhance engagement, interaction, and reflection. It also encourages the development of more tolerance and may even lead to healthier eating. As the summer wanes, prescribing a picnic is a traditional, creative and therapeutic way to ease the stressors found in a skim, scan and scroll world.

 

 

 

****

Cheryl Fisher

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

 

*****

 

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

 

Counseling Connoisseur: Revisiting the Spoon Theory

By Cheryl Fisher July 1, 2019

“If opening your eyes, or getting out of bed, or holding a spoon, or combing your hair is the daunting Mount Everest you climb today, that is okay.” – Carmen Ambrosio

 

Tara, 36, wakes up and rolls out of bed. Her pain factor is a five out of 10. She feels well rested after spending the past two days in bed–the result of working an 8-hour day and going to dinner with friends. Today she will try to finish her laundry and run errands. The lupus flare-up appears to have subsided–for now.

Kevin, 28, a graduate student, is not as fortunate. He struggles to keep up with the demands of a full-time job and graduate school. Kevin has weeks when he is able to manage both. However, today, he has become physically and emotionally paralyzed by his autoimmune disorder and struggles to bring even his thoughts together. He is contemplating taking an academic leave of absence until his health improves.

Carmen, 57, has been living with multiple sclerosis (MS) for over 20 years. Each day she wakes up and takes inventory of her physical and emotional well-being. Some days are better than others. However, the uncertainty of her health has prompted her to seize the moment and engage fully in her craft as an author.

For Tara, Kevin, Carmen, and thousands of others, the challenge of managing their chronic conditions while also meeting the demands of daily life can be daunting. To those around them, they look perfectly healthy. Smart and ambitious, they excel when they are feeling well. However, without warning they can be thrust into the throes of physical, emotional and cognitive dysfunction, rendering them unable to get out of bed, let alone handle professional, academic or personal responsibilities and obligations.

The Spoon Theory Revisited

In an attempt to help her dear friend understand what living with lupus feels like, writer and activist Christine Miserandino crafted The Spoon Theory to explain how energy is limited by chronic illness. Miserandino uses spoons as a metaphor for energy. According to the theory, a person has a certain number of spoons representing energy each day, and each activity depletes a portion of those spoons. In this way, individuals are encouraged to ration and pace their spoon/energy usage in order to accomplish their daily activities. This theory has become widely accepted, and some individuals have even coined the name “Spoonies” for those with conditions that restrict energy. However, the Spoon Theory relies on myths about chronic illness and energy.

Myth 1: There is a set number of spoons each day.

The amount of energy (spoons) needed to function is not prescribed in a daily dose. Clients may wake up and feel that they are armed with a picnic basket filled with spoons. Then a few hours later, they crash and burn and are entirely depleted of whatever resources they thought they had. It is as if the bottom fell out of the basket without warning.

As Jennie, a blogger for The Mighty, an online support community for people facing health challenges, describes in her post, “Why the spoon theory doesn’t fit my life,” what seems like a high energy day can suddenly turn into total depletion:

“Often I wake in a morning and think, ‘Yes! Today is a good day!’ Then, within hours, or even minutes, the tides have turned. Maybe my spoons are ninjas? Maybe the borrowers have been rifling through my stash? Whatever it is, I can go from having just enough energy to less than zero quicker than a scrambling fighter jet. Sometimes it’s due to a weather change; sometimes it’s stress. Often I have no clue whatsoever what happened.”

Myth 2: Spoons can be banked for another day

The Spoon Theory suggests that rest will help bank energy for the next day. This sounds like it makes sense, right? However, chronic illness doesn’t play fair. Resting for a day or two may result in feeling even more fatigued the following day. This makes it difficult to plan activities for the day, week or month. For example, my own daughter, who was recently diagnosed with lupus, confided that some days she wakes up feeling energized only to crash within hours and be wholly depleted the remainder of the day or even the next few days. It is frustrating to both the person who has the illness and those around them who may want to make plans. At times, life is only manageable in chunks of minutes versus days.

Myth 3: Activities require a specific number of spoons

One of the challenges of the Spoon Theory is that it is impossible to quantify (in spoons) the amount of energy it takes to accomplish any given activity. The amount of energy expended is influenced by other variables, including pain threshold. For example, getting dressed for the day may be as easy as slipping into an outfit one day, but feel like donning a suit of armor the next. So, although the activity for both days is identical, the depletion of energy is vastly different. Therefore, preparing for energy expenditure can feel like a futile effort.

 

How counselors can help

Living with the day-to-day uncertainties of a chronic illness can be isolating, alienating and frustrating. Making plans with friends and family must be spontaneous and depends on the illness effects du jour. Counselors can assist clients and families who are impacted by chronic illness by validating their experiences, providing psychoeducation, and stepping up to advocate on local, regional and national levels.

Validate

By nature, counselors are exceptional listeners who are able to hear and identify the concerns of the client. Additionally, we can validate the challenges experienced by the client. Clients may feel anger and resentment at how their condition may restrict activities. They may feel isolated and alone. Friends and family who were present at the initial diagnosis may have returned to their busy lives. This often may leave the client feeling abandoned and alienated. Validating the difficulties of navigating chronic illness allows the client to feel heard and understood.

Educate

While we are able to sit with the client and the emotional, cognitive and physical pain of chronic illness, we can also provide psychoeducation that may promote strategies for better self-care. For example, helping clients grieve the old lifestyle and create a new normal that is shame-free and includes strength-based coping skills that allow them to deploy greater flexibility in the face of those “not-so-great days.”

Counselors can also help clients locate resources in the community, such as support groups or career assistance. They can provide education to family and friends about the uncertainty of living with chronic conditions that tax energy. For example, helping significant others understand that staying in bed all day is not indicative of a character flaw or laziness but a real depletion of energy (those spoons again!).

Advocate

Counselors can contribute to efforts for institutional changes that will benefit clients by participating in legislation and signing petitions. We can attend hearings and provide testimony to the needs of our clients. Finally, counselors can use their voice and power to advocate for clients by participating in any number of activities to increase awareness or fund research.

Conclusion

The Spoon Theory attempts to explain the energy consumed by chronic illness. In reality, it oversimplifies the complexity of day-to-day functioning. Perhaps one of the gifts of counseling is to provide a relationship without conditions where the client is valued beyond the constraints of the illness and a place that welcomes vulnerability and recognizes the courage of showing up each day in spite of the challenges. Perhaps the act of counseling is — as Brené Brown suggests — joining the client in the “arena” and experiencing their pain and disappointment. Perhaps even in the complexity and uncertainty of living with chronic pain and illness, the counselor can help clients recognize that showing up each day if worth the challenges.

Finally, perhaps in the midst of the discomfort of the seeming betrayal of the body and mind, the best gift counselors offer to their clients is as author Hannah Brencher says in her book,  If You Find This Letter: My Journey to Find Purpose Through Hundreds of Letters to Strangers, “… the permission to feel safe in their own skin. To feel worthy. To feel like they are enough.”

 

****

 

Related reading, from the Counseling Today archives:

The tangible effects of invisible illness

Assessing depression in those who are chronically ill

 

****

 

Cheryl Fisher

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

 

*****

 

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.