Tag Archives: Counseling Connoisseur

Counseling Connoisseur: Nature therapy and brain science in children

By Cheryl Fisher April 20, 2022

Alfred Adler purported that all behaviors have a purpose. Behaviors are often the way the body responds to life’s stressors, especially for children. Yet, many therapeutic treatments for children focus on the modification, remediation and even elimination of a behavior without addressing the underlying cause. This approach suggests that once a behavior is corrected, the child will experience general wellness.

Brain science, however, indicates that the physiological state of children must be attended to before one addresses behavioral change. In Beyond Behaviors: Using Brain Science and Comparison to Understand and Solve Children’s Behavioral Challenges, Mona Delahooke, a licensed clinical psychologist, argues, “When we see a behavior that is problematic or confusing, the first question we should ask isn’t ‘How do we get rid of it?’ but rather ‘What is this telling us about the child?’”

Therefore, behavior is adaptive and a response to the internal and external experience of the child.

Autonomic response refresher

The human body responds to perception of threats to safety by creating a biochemical and physiological state prepared to move the body to fight, flight or freeze. In this state, the body increases the production of adrenaline, norepinephrine and cortisol. The amygdala and the limbic system become activated and temporarily lead brain functioning over the prefrontal cortex, which is responsible for higher order thinking and executive functions. The child is now functioning in survival mode, and the child’s behaviors may manifest in a variety of ways, including distraction, withdrawal, irritability or fidgeting, fearfulness, regression, and aggression.

Rather than blindly rewarding or punishing the child’s behaviors, neuroscience suggests that we seek out the cause of the behaviors before addressing them. It begs us to answer the questions, “Why is the child acting this way? Is the child perceiving a threat to safety?”

As I have addressed in my book Mindfulness and Nature-Based Therapeutic Techniques for Children, counselors must consider if the child is functioning from an underdeveloped kinesthetic system (our sense of our body in space) or vestibular system (associated with the inner ear and balance) resulting from lack of free-form movement. So much of children’s time is spent sitting at their desks or in front of devices, or in structured activities. They lack nondirected, unstructured play and movement. What is the underlying cause? How is the behavior serving to protect the child? Most important, how can we, as counselors, help the child resume a sense of safety and balance and experience a calm and alert state?

Brain science

Several models have emerged over the past few years that emphasize the role of the physiological state of children when treating their behaviors. All these models assume that the behaviors are an attempt to cope with internal or external stressors.

Stephen Porges, the founder of polyvagal theory, proposes that mammals have two neural pathways. The first, the social engagement state, is accessible when the child feels safe and can trust the environment, promoting a calm state accompanied by prosocial behavior. The second pathway is engaged when the child feels unsafe.

Porges introduced the term neuroception to describe the body’s way of scanning the environment for threats to safety. At times, the body miscalculates the risk of safety. According to Porges, the symptoms of faulty neuroception are translated to psychiatric labels and disorders. In other words, a child who has experienced trauma may have a vulnerable nervous system that detects threats that do not exist. Resulting behaviors may include hypervigilance, insomnia, paranoia, bedwetting or a host of other regressive or safety-seeking responses. On the other end of the spectrum, the child may ignore actual risks in the environment, resulting in greater threat to self and psyche.

Therefore, based on neuroscience, Porges recommends providing children with individualized cues of safety that allow social engagement behaviors to emerge spontaneously. According to Porges, three situations must be present to feel safe. First, the autonomic system must not be in a defensive state (fight, flight or freeze). Second, the social engagement system must be activated, which results in the downregulation of the sympathetic nervous system and promotes prosocial behavior. Finally, there must be cues for safety (vocalizations, gestures and positive facial expressions) detected via neuroception. The assumption is that cues for safety can only be exhibited and detected in human-human interaction. However, research continues to support that human and more-than-human interactions also afford meaningful connection.

Brain science and nature

Engaging in the natural world has long been known to have a calming effect on the body. A biochemical exchange occurs in the natural world that results in by-products that, when inhaled or absorbed by the human body, produce a calm and alert state. The earth’s core is like a battery that emits negative ions. Blue spaces (oceans and waterways) offer ionic by-products. Additionally, green spaces (forests and parks) produce phytoncides and terpenes.

Fifteen to twenty minutes of being in a natural setting affects the body by decreasing cortisol, norepinephrine and adrenaline (hormones released when the body perceives threat); increasing serotonin; and reducing blood pressure and respiratory rate. The body responds to the natural space by engaging the relaxation response. Additionally, the immune system is enhanced by both an increase in number and activity of natural killer cells. These effects are sustained for up to a week following single exposure to forests and as long as a month following two days of engagement in green space.

David Clode/Unsplash.com

The earth communicates through the production of these chemicals, and the human body responds to many of the messages (safety cues) by reducing the body’s defensive state, activating the social engagement system and promoting homeostasis (i.e., a calm and alert state).

Research is conclusive that children who engage in natural settings experience greater well-being, are calmer and demonstrate more prosocial behavior. For example:

  • In their article “The role of urban neighbourhood green space in children’s emotional and behavioural resilience,” Eirini Flour and colleagues found that children impacted by poverty and living in urban settings experience improved emotional well-being when exposed to neighborhood green space.
  • Diana Younan and colleagues noted in their article “Environmental determinants of aggression in adolescents: Role of urban neighborhood greenspace” that exposure to greenspace within 1,000 meters surrounding residences is associated with reduced aggressive behaviors in youth.
  • Andrea Faber Taylor and Frances Kuo discovered that, in general, children who play regularly in green play settings are calmer and more alert than children who play in concrete outdoor and indoor settings. Their study, “Children with attention deficits concentrate better after walk in the park,” also found that children with attention deficit/hyperactivity disorder who play in green open areas versus areas with trees and green grass show milder symptoms.

Although it is becoming increasingly important to integrate outdoor activities into clinical practice, routine access to green and blue spaces may be hindered by many factors. In this case, we turn to indoor alternatives.

Nature therapy indoors

Ecotherapists are capitalizing on the research by integrating nature-informed practices and activities into their work. My own research examines the use of nature-informed sensory “time-out/time-away” stations in the emotional and behavioral regulation of school-age children. Historically, time-out has been used to remediate unwanted behaviors in children. This often involves using a corner of a room without windows or distractions. Once the child has calmed down, they may return to the group setting.

However, if (as Adler suggests) all behaviors have a purpose, then the child has learned only that the presenting behavior is unacceptable and to suppress their natural response to whatever triggered it. They have not learned to self-regulate and address the underlying emotional or physical state.

A nature-based sensory time-away station, however, is imbued with items such as plants and herbs that emit terpenes. The station may have a tabletop sand garden that provides tactile exposure and promotes mindfulness. Additionally, nature soundtracks may play in a headset to allow the brain to register these soothing frequencies.

The preliminary data continue to demonstrate that children are able to use this time-away station as a self-regulating tool to allow for the relaxation response, calming of the amygdala and engagement of the prefrontal cortex. Children engage with the natural material, feel more grounded and (depending on developmental stage) are better able to articulate their underlying state verbally or through expressive arts. They return to their previous activity feeling calm and alert.

Here’s some advice on how to create and introduce a nature-based sensory time-away station:

  • Create the station. A nature-based sensory station may be created indoors or outdoors. It includes physical elements that engage the senses. Items may include edible plants and herbs to promote exposure to terpenes. Cotton balls soaked in essential oils also can provide exposure to terpenes through smell. Small containers of rocks, sea glass, pinecones, feathers and shells can provide the child with different tactile experiences. A small tabletop sand garden with miniature rakes can be purchased or created for a tactile and mindful activity. A betta fish or small fish tank may also add biodiversity to the space. Nature sounds can be streamed through headphones. Additionally, paper and tools to write, color or paint may aid in the communication of triggers once the child begins to enter a calmer state. And items can be rotated to capture seasonal changes to your nature-based sensory station.
  • Introduce the station. Because this is a novelty, everyone in a group setting such as a classroom will want to play at the station. It is important to allow each child a chance to explore the space. Using a timer, have children take turns engaging in the station. When the time is up, they may return to the classroom activity. If introduced as a tool, children will soon learn that this space can be accessed to help regulate emotions and behavior in a productive manner. In essence, the children will learn that they feel better after spending time interacting with the space.

In the home setting, the child can help create the space and be taught that it is a place to go to reboot. Show the child how to engage with the multisensory space and then leave them to their own processes.

In addition to the many ecotherapeutic homework assignments and interventions available, counselors utilizing this space as a co-therapist in the field can introduce the benefits of nature-based multisensory engagement and help their clients learn to self-regulate outside of the therapy session.

In conclusion, behavior is a response to interpretation of internal and external stimuli. A child who feels unsafe may experience physiological arousal and respond in a defensive manner. As counselors, we can help educators and parents learn to address a child’s physiological state by creating safety cues for the child. By introducing a nature-based multisensory space, children can learn ways to reduce defensive states, increase homeostasis and activate their social engagement system.

 

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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 master’s in clinical counseling. Her research interests include examining sexuality and spirituality in young women with advanced breast cancer, nature-informed therapy and geek therapy. Contact her at cyfisherphd@gmail.com.

 

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

Counseling Connoisseur: Reconnection — Healing the embodied self

By Cheryl Fisher January 6, 2022

“Everything we know, everything we do, and everything we are is mediated by the body.”

– Joan C. Chrisler and Ingrid Johnston-Robledo, Woman’s Embodied Self: Feminist Perspectives on Identity and Image

Livefocus/Shutterstock.com

Embodiment is a concept originating with the French philosopher Maurice Merleau-Ponty, who noted that we experience our humanity through and with our bodies. This is not an isolated experience but one that is impacted by interactions with others. The embodied self is a psychospiritual concept that hosts existential questions of “Who am I? What am I? Where does my value lay?”

In addition, we experience our bodies in a cultural context. Body parts and experiences may be objectified (e.g., breasts, buttocks) or medicalized (e.g., pregnancy). Furthermore, there appears to be social sanction around when a body or body part is acceptable and when it is not, and the resolve is a lifelong relationship of self-projects and self-loathing. For example, Marilyn Yalom, a feminist author and cultural historian, described the psychosocial and political history of the breast in her book A History of the Breast. As stated in the book’s blurb:

Through the centuries, the breast has been laden with hugely powerful and contradictory meanings. There is the “good breast” of reverence and life, the breast that nourishes infants and entire communities, as depicted in ancient idols, fifteenth-century Italian Madonnas, and representations of equality in the French Revolution. Then there is the “bad breast” of Ezekiel’s wanton harlots, Shakespeare’s Lady Macbeth, and the torpedo-breasted dominatrix, symbolizing enticement and aggression.

Therefore, there are sociocultural prescriptions to the body, including that of gender. In their 1987 article “Doing Gender,” Candace West and Don Zimmerman argue that gender is a performance that people “do” that is based on social norms. A person may choose to perform gender in a normative way (cisgender), with their preferred gender that may differ from the one assigned at birth (transgender) or in a way that feels more genuine.

Our relationship with our bodies is complex. It is informed by society’s view of our bodies. The size, shape, skin color and hair texture inform our experiences, along with the gender we perform. Additionally, illness and injury to the body affects our image of self in the context of society’s understanding of ableness. An attempt to “fit in” to normative standards may result in efforts to alter our physical appearance or disregard and disconnect from our embodied self.

Disconnection

Our relationship with our bodies can be fraught with neglect and dissociation as we learn to ignore the many messages it sends to us. We ignore the hunger and push through lunch. We hold our bladder until we are dizzy with urge. We shiver or sweat, ignoring the clear signals. We pull all-nighters when our body is begging for rest. We discount and dismiss the value of our physicality and dissociate from our embodied self.

The embodied self can be experienced in a positive or negative manner, and it is strongly related to self-esteem, self-image, and one’s satisfaction with personal and sexual intimacy. A positive sense of an embodied self is associated with autonomy, functionality, joy and fulfillment. However, chronic illness, disability and accidents, and negative social sanctions can result in a sense of disembodiment. For example, a former track athlete loses his legs during combat, the neurological impact of a stroke leaves a brilliant novelist unable to write a sentence, or a 17-year-old African American girl asks her parents for plastic surgery to “make her nose more normal” (i.e., conform to an unrealistic, Western beauty standard).

In my own research, I encountered a 35-year-old woman who had been diagnosed with metastatic breast cancer, and she described her body after a complete double mastectomy and oophorectomy in the following way:

I felt like a freak. I had lost my hair from the chemotherapy. What was left from my 34C cups were scars and lopsided breasts with tattooed nipples. I didn’t recognize the body in the mirror.

After someone experiences a sense of disembodiment, the sociocultural context of healthism (e.g., I have cancer.), medicalism (e.g., my body is subject to scans and treatments making it a medical object), sexism (e.g., I am a female but now I do not have breasts and reproductive organs), ageism (e.g., I am only 35 but my treatments caused me to have early menopause) and ableism (e.g., I cannot do the things other 35-year-old women can do) further challenges their ability to reconnect with their body.

Reconnection to self

Researchers Niva Piran and Tanya Teall describe positive embodiment in their article “The developmental theory of embodiment” as one with “agency, self-care, and joyfulness.” Therefore, healthy connection, reconnection and adaptation to the body requires the experience of physical and mental liberation and social empowerment. This has implications when working with marginalized populations. For example, the 17-year-old African American girl who wanted to change her appearance due to negative social constructs must cultivate an appreciation and a liberation of her embodied self.

Learning to adapt to the alterations of the body is greatly impacted by the previous connection to body. If a person’s self-worth was associated to the objectification of body as beautiful, then a disfigurement may attack one’s self-worth — “I am not ‘pretty’ therefore I am no longer valuable.” However, befriending the body in a way that affords compassion can be empowering. For example, the metastatic breast cancer survivor previously mentioned said during counseling,

I don’t want lopsided breasts and tattooed nipples. I am a seventh-degree black belt in karate. I want to remove these false pretenses and replace them with a tattoo of a warrior’s breast plate. This is how I see my body now. This is empowering!

Counselors can encourage clients to engage in physical approaches such as yoga, breathwork, martial arts or free-form dancing (e.g., Nia — a holistic fitness practice that combines dance, martial arts and mindfulness) to help them reconnect to their physicality. And because being in nature is a multisensory approach to engaging the body, counselors can recommend clients to spend time in the natural world either in green spaces (e.g., forests, parks) or blue spaces (e.g., oceans, lakes, rivers).

Reconnection to others

A chronic diagnosis or injury can alter not only one’s physicality but also their social connections. The new diagnosis and treatment often test previous social supports and challenge friendships. For example, the combat vet who returned with a double amputation of his legs noticed his priorities were different from his civilian friends. “I was struggling to learn how to walk,” he recalled, “and they [his friends] were complaining about gas prices. We just didn’t have anything in common any longer.”

Clients can reconnect with their embodied self by finding others who share similar experiences and bodily appearances. I connected the combat vet with other soldiers with amputations who also identified as athletes and trained regularly. The physical connection to his body in an empowering way was part of his healing.

In addition to social supports, it is important to become reacquainted to intimate partners. This can be a difficult task because few clinicians or providers invite discussion around sexual and personal intimacy in the recovery process. However, it is important to begin this exploration to discover new and creative ways to experience the new body in a sensual and sexually satisfying way. Counselors can begin the dialogue by normalizing and validating that when we are disconnected from our bodies we are often disconnected from others and this lack of intimacy crosses into our personal and sexual intimacy behavior. Counselors can also provide insight into this connection and refer to sex therapists and sexologists when needed.

Reconnection to sacredness

Counselors can help clients learn to experience their bodies in the present moment by bringing their attention to their physicality in the here and now. When we fully embrace and experience this physicality of our bodies, we allow for opportunities of awe and wonder. The first snowflake melting on our tongue. The smell of homemade gingerbread. Crossing the finish line of that first 5K race. Reaching the highest peak of a hike and overlooking the terrain below. Pausing a moment after a strong paddle to the middle of a lake. The pain and pleasure of birth and then skin-to-skin contact that warms this precious body.

Our bodies are beautifully made, and our embodied experiences can be transcendent. Rediscovering the body in this way is not only empowering but also sacred.

Role of mental health providers

As mental health providers, we have the privilege of entering this vulnerable world of recovery and rediscovery. We can validate and normalize the incredible losses (both visible and invisible). We can create a space for the tasks of grief.

In addition to addressing the grief and loss, we can cultivate a bottom-up approach to recovery. Rather than emphasize the cognitive reprisal of the experience and the resulting new body, we can create a multisensory therapeutic space that emphasizes the physical self, the embodied self.

 

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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 master’s in clinical counseling. Her research interests include examining sexuality and spirituality in young women with advanced breast cancer, nature-informed therapy and geek therapy. Contact her at cyfisherphd@gmail.com.

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

Counseling Connoisseur: Trauma-informed return from COVID-19

By Cheryl Fisher July 6, 2021

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

— Henry Stanley Haskins

Jo Panuwat D/Shutterstock.com

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

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

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

Trauma-informed re-entry

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

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

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

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

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

 

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Cheryl Fisher

 

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

 

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

Counseling Connoisseur: Navigating the losses of COVID-19

By Cheryl Fisher March 22, 2021

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

Elsa, my 2-year-old poodle, and I enjoy our routine walks in the neighborhood. It has become more frequent since the onset of COVID-19, and we both look forward to the fresh air, change of scenery, and connecting with the neighbors as we pass by (socially distanced, of course). On this day, we approached the home of my new neighbors. They are a young couple, and during our last encounter, they indicated they were pregnant and expecting their first child. They had just pulled up in their driveway and were disembarking the vehicle as we walked toward them. “I’ll get him,” the husband called to his wife as he exited the car. “Oh, they had a boy,” I thought. “How wonderful.” I slowed my pace to see if I could get a peek from across the street where Elsa and I dawdled. He opened the back door to his vehicle and proceeded to unbuckle his son. Imagine my surprise when a toddler jumped out of the car! When did that happen?!

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I have heard it said that 2020 is the year that wasn’t. As we all stayed safe in our homes, socially distanced from friends and family, an entire year went by — without us. Oh, things happened, but many of us were not able to participate in the regular encounters that add richness to our lives. Weddings, births, celebrations, graduations and even funerals took place in non-traditional and much more private ways. Gatherings consisted of virtual or outdoor activities. Basic shopping was outsourced to delivery services, and additional errands occurred with faces shielded and six feet apart.

To make matters worse, the arrival of 2021 did not magically remove the pandemic or correct the social injustices and political tensions experienced. The losses have been and continue to be great. At the time of this column’s publication, the World Health Organization reports over 116 million confirmed global cases of COVID-19, and over 2.5 million people have died.

Navigating death during a pandemic is beyond challenging, as I experienced when my father-in-law died recently. He had contracted COVID-19, along with other residents in his assisted living community. He had recovered, but never completely. On Friday, Jan. 30, we received a call that his health was failing. My husband and I rushed to the facility where he resided. After testing negative to a rapid COVID test, we donned mask, shield and bodysuit to enter into my father-in-law’s room. Other than visits where we spoke through his window while we stood outdoors, it was the first time we had seen him in several months. He was unresponsive but resting peacefully. My husband asked me to set Pandora to Glen Miller (one of his father’s favorite musicians) and proceeded to tell his father about all that we had experienced since we last saw him. We rambled about the holidays (that we were unable to experience together), the home renovations we were starting and our hope to have family gathered as soon as safely possible.

Because only two people could visit at a time, we had to wrap up our visit when my brother-in-law and his wife arrived. My husband and I stood on either side of my father-in-law, rubbing his arm and holding his hand, and told him we would see him soon. We left knowing it would be our last time with him. He died early the following morning.

The grief associated with this loss is profound. As I discussed in an earlier article, “Counseling Connoisseur: Death and bereavement during COVID-19,” the traditional rituals that help in grief recovery are often altered or absent due to pandemic safety protocols.

In addition to the loved ones we have lost, there have been a plethora of other losses, actual and symbolic. Symbolic loss is often intangible. Sometimes it accompanies death but is not acknowledged as a loss. For example, my father-in-law’s memorial service is delayed until it is safe to gather, thereby preventing the emotional closure that funerals and memorials provide in the grief recovery process.

Other tangible losses include the millions of lost jobs due to the economic impact of the pandemic. The loss of community and social support during isolation and quarantine may be unquantifiable and thus “intangible,” but its effects are significant. Additionally, life happened — without us gathering to record or mark it. The loss caused by our inability to gather for significant events will become more and more evident as we begin (in time) to reconnect with friends and family.

For example, after becoming fully inoculated with the Pfizer vaccine and continuing to follow the Centers for Disease Control safety protocol, I returned to a couple of my favorite group fitness classes (now small, ventilated, physically distanced, and masked). It felt like a homecoming after a yearlong hiatus. The four or five of us in attendance spent the first few minutes of class just catching up. “So, what did you do this past year?” It was uncanny how life had continued for each of us apart. There had been cancer remissions, divorces and retirements, along with weddings and babies born. Except for what I like to term the “COVID cushion” of a few pounds of weight gain for some of us, everyone looked the same. They looked great. I had not realized how much I had missed this community of women I have sweated with side by side for over twenty years!

There have been so many losses this year, and the eager anticipation of a return to some semblance of normalcy is palpable. However, things have changed, and it is important to prepare our clients and ourselves with tools to navigate the losses resulting from the pandemic.

Navigating loss

Prepare for change: Life has continued, and things have changed. An entire year has passed in the lives of our family and friends. While you may have remained in contact, it will be different when it is safe to resume getting together this year. People may have died or moved. New members may have joined the family or friend group. Expect change.

Acknowledge loss: Recognize the changes. Honor the losses. Gatherings may be bittersweet. So much time has passed. So much has been missed. So much economic hardship for so many individuals. Talk about it. Journal. Seek therapeutic support.

You can’t go back, but you can move forward: The truth is that even when it is safe to resume previous activities, it will never be the same. It can’t be. Too much has happened. While we may mourn the past, maybe that is not a bad thing. Perhaps, we can use our experiences and create a better future with what we know now. As C.S Lewis suggested, “You can’t go back and change the beginning, but you can start where you are and change the ending.”

 

The pandemic has brought a lot of loss. While we are more cognizant of the actual losses of death, we must also be aware of the symbolic losses we have experienced. We can acknowledge the sadness of missing out on life experiences, the inability to give comfort in person when family and friends struggle with health or economic distress, or the loss of group celebrations. We can recognize the cumulative grief and fear caused by the pandemic and political injustices. We can prepare ourselves for the shock and mourning that may accompany our re-entry into our post-lockdown lives over the next year, brace for the changes that occurred while we remained sheltered in place, and ready ourselves for life to continue.

 

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Cheryl Fisher

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

 

 

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

Counseling Connoisseur: Hope in action and mental health

By Cheryl Fisher February 16, 2021

Hope is being able to see that there is light despite all of the darkness. – Desmond Tutu

 

[NOTE: This is this first piece in a COVID-19 recovery series]

Without a doubt, 2020 was a challenging year. Many of us greeted the New Year with arms wide open in anticipation of better days ahead. Out with the old and in with the new. The months of isolation, social and physical distancing, masking up and suffering so many losses has taken their toll on our mental health. Public surveys and reports from mental health authorities show that rates of depression and anxiety have increased exponentially as people attempt to navigate remote work, virtual classrooms or even worse — unemployment. Election fatigue, inaugural distress and racial injustice continue to plague society. Coping strategies are restricted with the closing of gyms, places of worship and many other gathering spaces due to COVID-19. Reports of Zoom fatigue have blanketed media. People who have access to resources are reaching out to mental health providers who are also feeling the exhaustion from a year of unprecedented circumstances. My own practice has been booked months in advance, and I am turning away new client inquiries and referring to colleagues whose schedules are also full.

Yes, 2020 was a year like no other for many of us. Only time will tell if 2021 will be as chaotic, but we already face challenges such as continuing political unrest, the attack on the U.S. Capitol, the presence of new, more transmissible COVID-19 variants and the snail-paced vaccine distribution process. As we forge ahead, recovery from the trauma will take time, patience and work. Yet, there are signs of change. Glimmers of hope. Flickers of light from the shards of a very broken year.

The New Year promised a fresh start, and the appearance of the “Christmas Star” on the Winter Solstice was a beautiful way to usher in 2021. The “star” is actually an astronomical event during which Jupiter and Saturn align so closely that they look like one radiant light.

Although Saturn and Jupiter align with each other every 20 years, it has been 400 years since they were this close to each other and nearly 800 years since the “Great Conjunction” occurred at night. Some have speculated that the star described in the Bible as leading the three Wise Men to the site of Christ’s birth in Bethlehem was, in truth, a Great Conjunction. Whatever the explanation, it was a sign of hope and peace to those who followed — and the key element is they followed.

Saturn, top, and Jupiter, below, are seen after sunset from Shenandoah National Park, Sunday, Dec. 13, 2020, in Luray, Virginia. Photo credit: NASA/Bill Ingalls

Hope and mental health

As mental health clinicians, we know the importance of hope in wellness. Yet, we often forget that hope is also a verb. We create a space for hope in our sessions with our clients. We hold hope when our clients are unable.

There are three elements that accompany the experience of hope.

Having goals

Having something to work toward can provide us with structure and predictability. However, we want to craft goals that are specific, measurable, attainable, relevant, and timely (SMART). That should sound familiar to counselors. Often goals are too broad. For example, in my other life I owned an aerobic company and often provided personal training to people who attended the aerobic classes. Goal setting was an integral part of the training. At times, my clients would give me goals such as, “I want to be healthy.” “I want to be skinny.” “I want to be happy.” or “ I want to be active.” I would follow up each request with “What exactly does that mean? Paint a picture for me of what being “healthy, skinny, happy, or active” means to you? Then we would break it down into specific, manageable goals in which “being healthy” may mean running a first 5K race or being skinny may mean losing 10 pounds.

This year, one of my big goals is to celebrate my parents’ 60th wedding anniversary this summer with family face to face, even if we need to meet outdoors. I have missed my family desperately this year. However, we have family members who are vulnerable, and we have resisted gathering this year because of the risks of COVID-19. What more joyous way is there to come out of the darkness of the pandemic than by celebrating the commitment and legacy of my parents’ union together.

Feeling empowered to shape your daily life.

Envisioning the outcome of your goal is so much a part of the process. Performance psychologists have utilized imagery for decades with athletes. Imagine yourself as already attaining the goal. Feel it already accomplished.

It is also important to recognize our agency and there are times when we really do not have control over things. I like to ask myself, “What do I have control over? What don’t I have control over?” I then focus on areas under my control.

For example, I worked toward a family gathering goal with something I could control by scheduling renovations to my home during the pandemic lockdown. I now have the space to celebrate when I am able to gather with my family again.

Additionally, I have been fortunate to be included in the first rounds of the COVID-19 vaccine rollout. So, I will be fully immunized, as will be most (if not all) of my family members by summer. While I still anticipate taking precautions, there will be greater confidence in gathering.

Identifying ways to make goals happen.

Really lean into the role you play in accomplishing your goals. What steps do you need to take to achieve them? If you want an advanced degree, what is the next step? Information gathering? Taking the GRE? Applying for funding? Create a chart of the actual actions needed to be taken to achieve your goal.

As I make ready my home for celebrations and follow the CDC guidelines around my vaccine schedule and follow up protocol, I am furthering the vaccination efforts by volunteering with my local medical response corps. I am assisting in providing human resources to advance the distribution of the vaccines so that my family and community will have a better chance of achieving full immunization sooner. Check with your local agencies to see how you can promote the change you want to see. For example, senior and community centers need assistance with helplines that reach out to vulnerable populations to help them navigate the online vaccine registration process.

Hope in action requires motion. It requires feeding the flame with movement toward goals, desires, dreams. Hope is choosing to look beyond the darkness to recognize even the smallest glimmers of light and then magnifying them with our words, actions and deeds. The Wise Men saw the brightness of the star, and rather than stay in the darkness, they chose to follow the light. That is hope. Hope in action.

Let your COVID-19 recovery begin with hope in action.

 

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Cheryl Fisher

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

 

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