Tag Archives: Family

Far away, so close: Negotiating relationships during COVID-19

By Laurie Meyers January 26, 2021

COVID-19 has taken away many of our in-person interactions. Office chitchat by the coffee maker. Happy hour with friends. Holiday celebrations. Friends, co-workers, extended family — since the pandemic began, many of us have seen them only virtually. In many ways, it’s like we’re all stuck on our own desert island — closed off from the outside world yet sometimes desperately wishing to vote our “fellow inhabitants” off.

The people we live with. We love them. We’ve treasured the extra time with them. But sometimes we just want them all to go away.

The never-ending togetherness; the uneven distribution of household responsibilities; the challenges of balancing work, child care and virtual schooling; and the career sacrifices that many people (women primarily) have had to make are all creating new stress and tension, while also exacerbating pre-existing conflicts in couples and families. In other words, couples and family counselors are very much in demand.

Seeking moments of solitude and respite

“Time and space are just different this year,” says licensed professional counselor (LPC) Christina Thaier. “We no longer divide our roles and tasks into different spaces, and that means all of who we are has to exist within less space. This is tough for kids and adults alike.”

Work, school, family, intimacy, socializing and relaxing are all wedged into the home.

Esther Benoit, an LPC with a private practice in Newport News, Virginia, points out that many parents are really struggling with roles they never expected to play — such as teacher and tutor when their children encounter difficulties with virtual schooling — while still trying to work from home. Other clients are working outside the home but spending substantial time on the phone providing “tech support” to their adolescent children who are at home alone, Benoit says.

Thaier notes that clients are floundering to find a way to balance everything in the absence of real-life connection to their communities and support networks. “It’s limiting. We miss a lot, and if we live with others, we are taking this on without any real break from our family or roommates,” says Thaier, a couples counselor who is the founder and director of Terrace House, a group practice located in St. Louis. “It’s a strange feeling to feel lonely and cut off from our usual life and, at the same time, never feel we get a break from others.”

“We [also] miss the versions of ourselves that exist in our usual spaces — our co-worker self, our happy-hour self, the version of us that shows up at the gym or the part of us that sings in the car after dropping the kids off at school — and the natural breaks and alone time that were previously built into our day,” she continues.

Thaier, an American Counseling Association member, helps clients envision alternative ways to be their different selves. “Maybe I can access the part of me that comes alive during time with friends by moving our time together to the park with masks,” she suggests. “Or I can plan a 10-minute Zoom call with my favorite co-worker at a time we would usually stop by one another’s desks.”

Thaier and her clients also seek simple ways to re-create those moments of solitude with activities such as taking a walk in the middle of the day, running errands, completing a solitary trip to the store to pick up groceries, or taking a bath or shower. “We’ve also talked about meditation apps and making the most of the early morning or late evening time when most of the house is sleeping,” she says.

Megan Dooley Hussman, a provisional licensed professional counselor and clinical supervisor at Terrace House, says many clients have found not just alone time but also a way to stay centered by engaging in daily rituals such as meditating, walking or even making and drinking tea mindfully.

Some clients also seek quasi-solitude by establishing family reading or movie-watching times, Thaier notes, adding that “quiet is almost alone.”

But with the multiple roles that parents are playing, stolen moments of solitude often aren’t enough, Thaier asserts. She helps parents map out the logistics of making sure that each partner gets their own break at some point during the week. That often involves one parent — or a family member within the household bubble — “hanging” with the kids while the other parent gets some time to themselves, she says. Thaier describes it as a “big win” for parents when everyone else leaves the house — even if only for an hour.

Sharing the struggle

The pandemic has been overwhelming for everyone — in unique but also universal (or at least common) ways. For parents and couples, the biggest contributor to distress and conflict is often unequal distribution of the “mental load,” says LPC June Williams, whose specialties include couples counseling. The mental load, she explains, is everything that needs to be done to keep the household moving. And much of it seems never-ending.

As Williams, a private practitioner in Cedar Park, Texas, points out, everyone is eating all the time when the kids are at home due to virtual schooling. Meals need to be planned and scheduled because family members aren’t necessarily eating at the same time. The dishes seem to self-replicate, requiring multiple dishwasher runs per day. It isn’t uncommon for one parent to manage this process — in addition to keeping the children engaged in online schooling and attempting to perform their “regular” job duties from home. In such cases, the parent spends the day constantly switching focus from their work laptop to their children’s screens. One of Williams’ clients is working and managing the family’s three children while their partner is in another room with the door shut.

When the distribution of household responsibility is not equal, it is often because much of the mental load is invisible, Williams says. She helps make it visible to her couples clients.

Williams will sit with the couple and task the partner carrying the uneven load to walk her through their day. Williams asks the other partner to listen without interrupting. Often, the partner who has been contributing less is shocked to learn the full mental load that their loved one has been carrying, Williams says.

It isn’t always possible to achieve a 50-50 split, Williams says, but she helps couples distribute the load more equitably. They discuss all of the tasks that make up the mental load and talk about how to handle them as a team. Williams asks the partner with the lesser load to think about what areas they would be willing to take over. She then asks the other partner to decide where they are willing to relinquish control. “What’s something you are willing to give away, knowing that it’s not going to be done your way?” she asks. If the partner offloads dish duty, they have to accept that the dishwasher may not be loaded “correctly,” Williams counsels.

Williams also has couples take responsibility for different areas of the house. Once that’s done, each partner’s domain is sacrosanct. “No micromanaging,” she says. “If the trash is your partner’s deal, you don’t say anything — it’s in their lap.”

ACA member Paul Peluso agrees that cooperation and flexibility are essential for navigating home life during the pandemic. He recommends that couples come up with a practical, workable schedule that allows each partner some time off. Unlike Williams, he recommends that couples switch off tasks such as bathing the children, taking out the trash and cooking. This cooperative effort creates a sense of fairness that allows a partner who has had a particularly bad or busy day to ask the other partner to take over a task that the tired partner feels too tapped out to do. The understanding is that the same grace will be extended to the other partner when needed, says Peluso, a professor of counselor education at Florida Atlantic University and a former president of the International Association of Marriage and Family Counselors, a division of ACA.

Peluso also recommends that couples cut themselves and each other some slack, especially during the pandemic. For instance, perhaps the routine has been to fold and put away clothes immediately after they come out of the dryer. “Give yourself a break and let it be in the basket for a few days, and use that time to watch a show together or to talk,” Peluso urges.

Sometimes, an unevenly distributed responsibility cannot be transferred from one partner to another, Williams says. The couple with one partner working and managing school for three kids is doing it out of necessity because the partner with the closed door is constantly in meetings.

In cases such as these, Williams typically encourages couples to explore possible outside resources that can be brought in: “Can we talk to family [about providing help]? Do we have a COVID-safe nanny? A COVID pod so that two days a week the kids are going to another parent’s house?”

Sharing the load becomes more difficult when one partner is working outside the home and the other works virtually or has put their career on hold. This scenario can easily lead to resentment, Benoit says. To the partner who stays home, it can seem as though the partner who works externally has experienced a return to business as (almost) normal, she explains. Meanwhile, the “inside” partner feels like their life has been completely upended because they are either trying to work from home while also providing child care or may even have felt it necessary to leave their job, Benoit says. Resentment builds because the partner at home feels trapped.

Benoit finds it helpful to externalize these conflicts for couples, emphasizing that it is the situation that is the problem, not the person who is working outside the home. Adopting this perspective, it becomes something that the couple can address as a team. The goal is to avoid recrimination and accusations, Benoit says, and to ask instead, “How do we get through this together?”

Although the essential circumstance cannot be changed, the level of resentment can be lowered dramatically, Benoit says, by something as simple as the partner working outside the home acknowledging that the other partner has the tougher end of the deal and asking, “What can I do to help?”

Benoit also emphasizes self-compassion. “I tell a lot of clients that what we’re aiming to do is get through,” she says. “We’re not aiming to thrive, but to survive.”

Couples also must learn that they are not responsible for each other’s moods, Williams says. A felt need to “fix” everything is often present in the partner who feels “overloaded,” she says.

“I work with that person who is trying to fix and [I] help them get more comfortable with everyone’s discomfort,” Williams says. This is doubly beneficial because the person who is underfunctioning may be hanging back as a result of receiving the message from their partner (directly or indirectly) that they never do anything right. Williams wants to help the partner carrying the lighter load to take on more of the burden not because they are being nagged but because it is important to the family.

Williams also asks the “overburdened” spouse about the feelings they are living with. Do they feel the need to fix, rescue, save and control? Do they feel anxious and resentful? If the client acknowledges these patterns, Williams asks whether they like feeling that way.

The usual response? “No, I am mad all the time and tired.”

Possessing a sense of responsibility does not mean that the client is responsible for everyone in the world, Williams counsels.

She gives clients a scenario: Your husband comes in and is in a terrible mood. He sighs heavily and drops his bag. As his wife with an overdeveloped sense of responsibility, you may flutter about and try to step in and take over. The end result? You haven’t fixed anything. He’s still irritated, and now you are too, Williams says.

She tells clients that they can still be compassionate, check in with their partner and ask how their day was. But if the partner responds that their day was terrible, clients need to ask themselves whether they have the emotional energy to carry that burden with their partner, Williams advises. If not, “It’s OK to say, ‘Here’s a soda water,’ give them a hug and move on,” she says.

When clients feel that tension in the pit of their stomach that is pushing them to step in, Williams urges them to do something calming in another room, such as belly breathing, stretching or taking a quick shower. These strategies also have the advantage of physically separating the person from the partner and their bad mood.

“Offer them compassion and allow yourself to remain separate,” Williams advises.

The price women pay

Williams doesn’t generally like to make assessments along gender lines, but she says the consequences of the pandemic are clearly delineated. Women are typically the ones expected to put their careers on pause — to be the caregivers and nurturers, to be more in tune with the children and to meet the family’s needs — even if they are the family’s highest wage earner, Williams asserts. She references a pithy and pitch-perfect quote from sociologist Jessica Calarco: “Other countries have safety nets. America has women.”

Thaier agrees. “Women already tend to take on more of the emotional, social and household roles, and that has not changed despite those tasks further multiplying,” she says. “In my practice, we talk a lot about our humanness, and that no one human can do all the things. We work on asking for help, prioritizing and eliminating what we can, establishing boundaries, and making time for ourselves.”

Women have absorbed a tremendous number of losses but haven’t had time to properly acknowledge those losses, Thaier says. “It’s hard to grieve within the experience of trauma,” she continues. “If we use the definition of trauma as too much, too fast, all of 2020 has been that. The quick reorganization of our lives has required [clients] — especially women — to move into crisis management mode. In crisis management, we do, we don’t get to be. In that way, therapy itself invites a chance for being, even if, after the hour, we revert back to survival mode a good portion of the time. We begin to carve out moments, which build on each other, for something different.”

“In some ways, because everything is different, there are opportunities for everything to be different, and that means families can brainstorm and strategize together on how to take care of the home and one another,” Thaier says. “It’s not easy, and there are lots of challenges. But I see a lot of great conversations happening, and with that, a lot of change too.”

In therapy, clients get to recenter themselves and their experiences, Thaier says. “They can voice resentments, frustrations, fears and anxieties, and their fear that feeling this way makes them a bad mother, partner, employee or friend.”

Thaier encourages clients to question these assumptions and where they came from, and then begin to redefine what is important to them about the roles they play. “For example, if we are redefining being ‘good’ at a relationship from an old definition of trying to not let anyone down to a new definition of being present and authentic with the people we love, we can begin to think about what this might look like,” she explains. “We can notice when the old definition is guiding our behavior and patterns, and we can start to practice new ways of relating.”

Reimagining clients’ relationships and roles often involves rejecting parts of the past by breaking patterns driven by cultural assumptions. But the past can also inform the future. Thaier uses narrative therapy to help clients grieve their losses and find ways to preserve elements of what was lost. “I think a lot about telling the stories of the people and experiences we have loved and that have significantly influenced our lives,” she says. “For a woman who has made the sacrifice of a current work role that is a significant part of her identity, we explore that.

“How did the job bring you alive? What did it make possible? What were the best parts of your day? Where did you imagine this would take you next? How did this role fit into an imagined and cherished future?”

“We can actually strengthen that story even as we grieve the space it has left in the present,” Thaier says. “And we can begin to narrate how the client can access her relationship to her work — or [what] she found possible there — and bring that into the present. In other words, the people and experiences we love become a part of us, and we can continue to take them with us into our futures. Our relationship with them gets to continue, if we want it to.”

An existential pause

The pandemic-induced global slowdown has provided people an opportunity (even if unrequested) to examine their lives and reevaluate their priorities, Peluso says. A number of people are asking themselves if they want to get back on the treadmill of constant activity and productivity, “or do I want to start thinking about what I was saving for someday and do it now?” he says.

Regardless of whether they choose to return to the treadmill, stepping off of it even temporarily has granted many people clarity about their relationships, Peluso observes. Some have grown closer to their partners during the pandemic, whereas other couples who were gritting their teeth and staying together for the sake of the children beforehand are asking themselves whether it’s worth the price they are paying.

Some couples are reassessing how they were choosing to spend their time prepandemic, he says. “I think especially early in the pandemic, when there was a hard stop to a lot of activity, it created a window of opportunity to just build some new rituals for connection,” Peluso says. “Couples were able to do things together — tasks, projects around the house.”

This ability to slow down — rather than charge through a list of chores — allowed some couples to rediscover pieces of each other that may have been subsumed in the daily grind, Peluso says. “For a lot of them, it forced them to look at some places where they had been neglecting relationships,” he adds.

“While this year has been incredibly challenging, it has also been an invitation,” Thaier says. “An invitation to slow down, to be together more, to take stock of what we’re doing and how we spend our time. To be at home more. To rest. To see our limitless creativity and resilience and strength. To acknowledge that our lives really could look different at a moment’s notice. To learn to be together in new ways. To be outside more. To take less for granted.”

“I wouldn’t say it’s been ‘worth it,’” she continues. “That would disrespect all of the loss and tragedy and, frankly, just wouldn’t be true. But there’s good here too. And there’s invitation in every holding pattern to see something that is waiting to be acknowledged. There’s a mirror here, if we’re willing to look into it.    

“I’m thankful for the invitation, and I’m hopeful about what’s next.”

 

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Additional resources

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

Counseling Today (ct.counseling.org)

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

  • Theory and Practice of Couples and Family Counseling, third edition, by James Robert Bitter
  • Mediating Conflict in Intimate Relationships (DVD) presented by Gerald Monk and John Winslade

Continuing Professional Development (aca.digitellinc.com/aca/specialties/56/view)

  • “Creative Counseling for Couples: Using the Integrative Model” (webinar) with Mark Young
  • “Imago Relationship Therapy” (podcast) with Susan Hammonds-White

International Association of Marriage and Family Counselors (iamfconline.org)

IAMFC is a division of the American Counseling Association that embraces a multicultural approach in support of the worth, dignity, potential and uniqueness
of families.

 

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

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

How (not) to isolate during the COVID-19 pandemic

By Bethany Bray October 28, 2020

The coronavirus pandemic has steeply curtailed social gatherings, travel plans and in-person events for most of 2020. And that has raised something of a perplexing scenario for counselors and other mental health professionals: When almost everyone is isolating themselves physically to some extent — and will be for the foreseeable future — how do you identify that a client might be isolating in the “classic” sense, which is typically viewed as a red flag that someone might be struggling with their mental health?

“As I’ve gone through the last six months, my view on what isolation looks like has definitely changed,” says Sean Nixon, a licensed clinical professional counselor outside of Boise, Idaho, who works with children and families. “I used to think of isolating as a person who is off by themselves, not engaged or interacting with anyone. But now, [for] a lot of people who I’ve worked with in my practice, there’s this forced, constant isolating. Even now that they can leave the house, to walk up and give someone a hug, as you might have done six months ago, is not the norm.”

Nixon, like many clinicians, has needed to shift his thinking about what isolation looks like in clients during the COVID-19 pandemic, and respond differently as well. When screening for isolation and depression, one of the primary indicators counselors look for is a loss of interest or lack of participation in activities that a person once enjoyed. But throughout the pandemic, many clients haven’t felt safe playing group sports or participating in activities or hobbies that typically involve others. Plus, many of these activities haven’t been available anyway because of widespread cancellations and closures.

“Now, when asking those screener questions, I have to consider the person’s situation. … We have to screen more — are we seeing an increase in depression, an increase in stress because of the pandemic, or are we dealing with both here?” says Nixon, a member of the American Counseling Association who works as a pediatric mental health therapist in an outpatient setting for a medical system.

Nixon says he has also broadened his scope of thinking about isolation to look for it both in individuals and entire family units. Not only are families feeling isolated from friends and outside activities that they used to enjoy, but they are sometimes isolating themselves from each other within the household during this stressful time, he explains. This can range from physical withdrawal, such as shutting themselves in their bedrooms, to spending too much time using digital devices as an avoidance mechanism.

Signs of isolation in families with children often become apparent when youngsters express a constant desire to play with or do one-on-one activities with a caregiver, he says. At the same time, many parents are expressing that they feel overwhelmed or that they feel guilty about needing to spend time sequestered away from their children as they work from home.

“From parents, I’m hearing [in sessions] how they just need a break and are feeling like their children always want their attention. They’re trying to find balance while they still have work commitments and are trying to explain to younger children that ‘Mom and Dad aren’t just home; we’re home and we have work to do.’ It’s definitely a strain and struggle on parents,” says Nixon, who is also a licensed marriage and family counselor.

“A lot of times, the previous concept of isolation was as an individual problem,” he continues. “But [as the pandemic worsened] I was working with family units who were limited on where they could go, and I started to see stress and overwhelming emotions that came with being around each other 24 hours a day, seven days a week. As that continued to build, for some families, it helped them grow closer together. For others, it was increasing their dysfunction and tearing them apart faster.”

What to listen for

Ryan Holliman is a licensed professional counselor and supervisor (LPC-S) and a counselor educator who counsels adult clients one day per week at a free medical clinic in Dallas. Forging a strong bond with clients and getting to know what is and isn’t normal behavior for them is always important for clinicians, but that’s even more the case now, he says.

Many of Holliman’s clients have personality disorders and struggle with maintaining long-term relationships. During the COVID-19 pandemic, Holliman has found he needs to assess clients more regularly and rigorously for isolation, including asking focused questions about their relationships and the resources they rely on when experiencing stress.

“Isolation is now a lot more nuanced,” says Holliman, an ACA member and an assistant professor at Tarleton State University. “You have to listen for different things [such as] if they are being proactive about developing social networks and accessing those networks, or are they letting COVID-19 dictate the terms of their social life? … Most relationships right now are facing a lot of stress [because] we’re placing all the emotional weight on a few places.”

Holliman has increased his check-ins with clients about their relationships with friends and family, asking them to rate these relationships on a scale. He asks, “How happy are you with the relationship, and how happy do you think the other person is with the relationship?” The aim of this exercise is to ensure that clients are continuing to grow, not stall, in their relationships during this trying time, he explains.

“With COVID-19, it’s easy [for clients] to say ‘good enough is good enough’ and lapse into complacency. But I tell clients, ‘That’s not what I want for you.’ It would be easy to say, ‘It’s a crisis, it’s a pandemic, and this is as good as it’s going to get.’ But as counselors, we are called to be dealers in hope,” he emphasizes. “Help [clients] move toward hope and [see] that there can be more.”

Among the college student population, many individuals are exhibiting typical signs such as having trouble sleeping or feeling overwhelmed that suggest they are struggling and feeling isolated — but exponentially so, says Elizabeth Bambacus, a student engagement and summer studies administrator at Virginia Commonwealth University (VCU). She runs a peer mentoring program for first-generation college students, a population that is already susceptible to feeling out of place and experiencing self-doubt. Her program pairs freshmen first-generation students with upperclassmen first-generation students for support, guidance and friendship.

Bambacus says many of her students have talked about feeling like their academic programs are much harder this fall. One student recently remarked that she wouldn’t be upset if she threw her laptop across the room and it broke. In another conversation, a male student told Bambacus that he hadn’t been outdoors in four days.

“We [would] generally have students who pop in [to our office] and say hi and random drop-ins wanting to chat about everything from ‘I’m worried about an assignment’ to ‘I just had a big argument with my dad, and it’s impacting my ability to focus.’ But there isn’t much opportunity for that now,” say Bambacus, who has a doctorate in counselor education and supervision. “It’s just not the same because everyone is avoiding everyone.”

VCU’s campus in Richmond is open, but a majority of the school’s classes are being held online. While some students are staying on campus, many have chosen to live at home or by themselves in apartments off campus, Bambacus says. Most of the ways that students would typically be personally interacting with others, from staying after class to ask a professor a question to getting involved in student clubs and group events, are off the table this fall.

Another big indicator of isolation among students is avoidance behaviors, such as not engaging with peer mentors and neglecting assignments or otherwise letting their academics slide. Bambacus observes that many students, including those who have a prior history of being responsive, aren’t responding to her emails this semester. “College students in general aren’t great at this,” she says, “but I have noticed an uptick.”

Many students this year are also experiencing a resurgence of anxiety and depression that were previously under control, Bambacus adds. Students with those diagnoses are always at risk for isolating behaviors, but this year, that is acutely so. As they begin to feel disconnected, their anxiety spikes and they get behind in their classwork, leading to a vicious cycle, she notes.

“I see students get overwhelmed, get behind in classes, and that’s triggering too — that feeling of doom. ‘Oh no. It’s happening again.’ With all of the anxiety and depressive thoughts, how can anyone do their homework or study for a test? That requires so much mental energy to do that, and the shame in not being able to do that — beating yourself up for not being able to focus for more than 30 seconds at a time — it’s just a cycle.”

Adapt as needed

In addition to checking in more frequently with clients and listening for the different (and potentially new) ways that isolation is affecting them, Holliman is focusing on self-talk. These past few months have left many clients prone to a downward spiral of self-critical thinking, he says.

Many of his clients talk about being “stuck in their own thoughts,” he notes. “When you’re at home all the time, that’s a real struggle to fight that.”

That is all the more acute for clients dealing with reduced income or job loss during the recent economic shifts caused by COVID-19, he adds. Feeling trapped financially can lead to increased feelings of isolation, he says, particularly when added to the social isolation and self-doubt that have gone hand in hand with the pandemic.

“Clients may just need to hear, ‘This is not a normal situation, and you’re handling it,’” Holliman says. “Drawing from compassion-focused therapy, I ask [clients], ‘How are you talking to yourself? What’s the tone of voice you use? Do you give yourself credit for managing your mental health during all of this?’ We all need to give ourselves credit.”

Normalization is an important therapeutic tool right now, says Nellie Scanlon, an ACA member and LPC in the counseling center at Slippery Rock University (SRU) in Pennsylvania. Scanlon, a temporary faculty member at SRU, started a support group this fall for students to talk about the loss, isolation and other feelings they have experienced during the pandemic. The group meets weekly via Zoom.

Like Bambacus, Scanlon says she is seeing an uptick in symptoms of depression and anxiety among the college student population she sees. “Many clients are using the phrase ‘It’s fine’ when they really mean they are not fine. I have been encouraging clients to allow themselves to feel what they are feeling and process those feelings in session. So often, we are expected to be OK and move on without acknowledging that our feelings of loss and loneliness are normal responses in times of crisis such as the current pandemic,” says Scanlon, who successfully defended her dissertation and earned her doctorate in counselor education at Duquesne University earlier this fall.

“I also remind clients that they are more resilient than they realize,” she says. “I ask clients to remember a time in the past when they were successful at bouncing back and talk about it. It seems to be personally impactful for them to recall when they have been resilient in the past, and that increases their confidence level to adjust to current life circumstances.”

Of course, there are also some tried-and-true interventions for addressing isolation and loneliness that counselors are no longer finding helpful or appropriate to use during the pandemic. The professionals interviewed for this article agree that counselors should put exposure therapy and similar techniques on the shelf for now. They say it simply isn’t appropriate to encourage clients struggling with depression, social anxiety, obsessive-compulsive disorder or other diagnoses to interact with others in person at this time as a way to stave off isolation.

Bambacus notes that many of the go-to suggestions she would typically give to college students to boost their mental wellness, such as calling a friend to get together, going to a campus event or party, or simply getting out of the house to sit at a coffee shop for an hour, are not advisable at this time. She has been forced to consider other ways that she might help students make connections and avoid isolation. “This is definitely bringing out the creativity in us all right now — along with frustration,” Bambacus says with a chuckle.

“I think this is a real struggle given the current social restrictions in place due to the COVID-19 pandemic,” agrees Scanlon, the chair-elect of ACA’s North Atlantic Region and immediate past president of the Pennsylvania Counseling Association. “I have been encouraging clients to connect with others in a meaningful manner that is effective for them. … Needless to say, there still appears to be an overwhelming loss of personal connection with others because we are limited due to the pandemic in the how, what, when and where of connecting with others.”

Creative connections

Psychoeducation can be a helpful tool in situations in which clients assume that they can’t be social during the pandemic or even push back against that line of thinking, Holliman says. By making themselves aware of out-of-the-box options, counselors can be ready to offer suggestions. For example, Holliman notes that his local library offers book clubs that meet over Zoom.

“There are a lot of unique ways for us to connect with one another,” Holliman says. “Limited options doesn’t mean no options, and that’s something clients really need to hear. There are ways [to find connection], but you have to be creative. The counselor needs to be a creative co-creator of options.”

For many clients, especially those in recovery, the pandemic actually offers more options for attending 12-step meetings and support groups because so many of them are meeting online now, he says.

Holliman found psychoeducation to be a powerful tool recently when working with a woman with bipolar disorder who was estranged from her family and struggling with isolation. She ended up in the hospital due to dosage issues that led to toxicity from one of her medications. In a session following her hospitalization, the client confided in Holliman: “Other than you, those doctors in the hospital were the first people I’ve talked to in a long time.”

Holliman said he knew even prior to this session that relationships were a challenge for the client, but her hospitalization served as a tipping point and an indicator of how acute her isolation had become during the pandemic. During the session, Holliman spent a good deal of time normalizing the client’s experience with bipolar disorder, emphasizing that supports were available and connecting her with resources, including online support groups for individuals with bipolar disorder. Holliman told the client, “You may feel alone, but you don’t have to be alone.”

“She had no idea there were others like her out there,” Holliman says. “She made the comment, ‘I thought we all just ended up in asylums.’ She didn’t realize [there were supports]. She had just assumed, ‘This is how life goes.’”

Clients with bipolar disorder are at higher risk for isolation because of the rapid mood fluctuations of their disorder and the impact that can have on their close relationships, often causing these clients to become estranged from friends and family members, Holliman notes.

This client has engineered a significant turnaround since her hospitalization, according to Holliman, including rekindling her relationship with her parents. “Things aren’t perfect [in this client’s life], but they are better,” he says.

Bambacus also emphasizes the need for creativity to help clients find ways to avoid isolation during the pandemic. This fall, she started offering online office hours and helped organize a series of faculty talks (also held online) for her first-generation students on nonacademic topics such as impostor syndrome.

At the same time, she is encouraging her upperclassmen mentors to organize events for students in the mentoring program, with a focus on staying connected. If the event is in person, students must hold it outside and limit it to a small number of attendees. Other students are planning virtual events, such as game nights and a live “cooking show” in which students demonstrate how to make their favorite recipes over video chat. Still others are doing low-risk volunteer work, such as writing letters to older adults or doing a trash pickup outdoors.

Bambacus has also been checking in with students more frequently. For those exhibiting withdrawal or avoidance behaviors, she sometimes includes a gentle reminder that she needs to hear back from them.

“I’m watching everyone a little more carefully,” she says. “Especially students who put on a brave face, they often appreciate check-ins. … I am watching students who are more susceptible to slowing down during the semester and struggling and those who have taken breaks [withdrawn from enrollment] previously because of their mental health. Often, the first sign they are struggling is unresponsiveness. I get creative with my emails and give them a deadline, such as ‘I need to know by Friday.’ Once they respond, then I say, ‘Hey, you’re there. Let’s talk!’”

This fall, she has been emphasizing self-care and wellness among her students, including the importance of physical activity, eating and sleeping well, getting outside and turning off the news. She is also pushing the message that it is OK to ask for help when you are struggling. Even something as simple as encouraging students to call their friends and family members instead of texting, so that they actually hear one another’s voices, can foster stronger connection, she says.

“There’s so much healing in knowing that you’re not alone in your feelings of isolation, so create opportunities for clients to see that other people are in the same boat,” Bambacus says. “Maybe that means running more groups and offering those types of services. It can be held outside or virtually. [It’s] just having that space where clients can see that this is not just happening to them and that other people are surviving ‘in spite of’ and offering them some hope and options. Isolation is such a devious thing because it makes you think that you are the only one — you’re not just alone; you’re the only one who’s alone — and that’s just not true.”

Families and isolation: A group effort

For families struggling with isolation, Nixon is focusing on ways they can be intentional about prioritizing connection, both within and outside the family unit. With all the stressors families are facing during the pandemic, it is easy to lapse into bad habits, he notes. “When you get resolved to ‘this is how life is going to be,’ you kind of go through the motions,” says Nixon, a board member of the Association for Child and Adolescent Counseling, a division of ACA.

Step one of being intentional often involves creating and maintaining a daily schedule in the household, Nixon advises. He suggests setting times for family members to focus on work or school and times to focus on connecting as a family, including designated times to put away all electronic devices.

Family time should include activities that prompt family members to interact and engage with one another to minimize isolation and boost mental health, Nixon says. This could include everything from getting outside and playing in the yard to coloring or drawing together, playing board games, having an indoor dance party or engaging in a scavenger hunt. (For more ideas, see the article “Supporting families with engagement strategies during COVID-19.”)

The lack of in-person celebrations during the pandemic, especially surrounding birthdays, has been hard for young clients and families. Nixon has helped clients find new ways to connect with family and friends to mark special occasions, including blowing their celebratory candles out during video chats and organizing walk-by or drive-by “parades” of well-wishers.

Similarly, many of Nixon’s adolescent clients are missing the in-person interactions they would normally have with friends and peers through school and extracurricular activities. Here, intentionality also helps fill the void. Nixon asks adolescent clients to identify what they enjoyed most before the pandemic. The answers usually involve hanging out with friends, watching movies or playing video games together. One of the ways his clients have adapted is by setting a specific time to watch a movie simultaneously with friends (each in their own home) and then texting or video chatting with one another as they watch.

Nixon also encourages family clients to identify substitutes for things they enjoyed doing together before the pandemic. He uses a whiteboard in sessions to visualize clients’ ideas and prompt dialogue.

“I get their perspective and talk about what their preference and focus was before the pandemic. Was it being together at mealtimes? Then be intentional about that now. Or if sports were really important, organized sports may not be an option, but they can play as a family or set time aside to sit down and review tapes from past games and analyze them,” says Nixon, a past president of the Idaho Counseling Association. “Identify what was important to [clients] before, and help them realize that it’s still important and how to find a new context for it.”

Counselors can guide clients to find new rituals by identifying the core reason they enjoyed certain activities before the pandemic. Ask “why do families do what they do, and what meaning do they give to it? Then try and find something else that will give them the same meaning in a different context,” Nixon advises.

For one family on Nixon’s caseload, family meals were very important, and they found connection by going out to eat in restaurants together. This became more challenging when many restaurants closed their dining rooms throughout the spring and summer.

Nixon helped the family reframe this ritual and brainstorm ways they could re-create the aspects of eating out that they most enjoyed. After breaking it down, the family identified the core features they enjoyed as trying new restaurants and experiencing new cuisines together. The family had a self-imposed rule of never eating at the same restaurant twice in one month or having the same type of cuisine twice in one week, so they were always looking for new places to try, Nixon says.

“For them, what was meaningful was … the adventure of trying something new and ordering with the intention of sharing it with someone at the table,” he says. “The intention was to be adventurous, to try something new and to share that together.”

Once they came to this realization, Nixon suggested the family experience new foods together by learning to cook them at home. Their initial reply? “We don’t cook,” Nixon recalls.

Undeterred, Nixon suggested the family search the internet for ideas and how-to videos. The family started small, making an appetizer, and found it was easier than they had assumed it would be. From there, the activity blossomed into setting aside one night per week to replicate dishes together that they had previously enjoyed at restaurants.

“They didn’t want to mess up and fail, and they didn’t want to waste time and money [on specialty ingredients]. But they found that nothing was ever a failure, just as with going out to a restaurant that they didn’t like. It was the trying that they enjoyed,” Nixon says.

Now, even with restaurants reopening, this family continues with its at-home cooking adventures. They set aside the money they save by eating at home to splurge on an occasional restaurant meal that they previously would have considered a treat.

“The opportunity that this family has taken to take a step outside of their comfort zone has brought them closer together,” Nixon says. “They have found that family members have skills that they did not completely see before, and they have found that small changes have always impacted the family. In the past, the small changes were seen negatively, [but] now they see the opportunity and positivity that can come within the family.”

Looking ahead

Nixon says he has been contemplating the long-term effects the COVID-19 pandemic might have on mental health, especially with the increased physical and social isolation that will return for many people during the winter months. As cases of COVID-19 continue to rise in the U.S., combined with the arrival of the traditional flu season, it is possible that states or localities may reimpose some of the stringent lockdown measures, such as school and business closures, that happened back in the spring.

It is possible that counselors might witness an uptick not only of isolating behaviors but also feelings of hopelessness and suicidal ideation among clients, Nixon says. With that in mind, he is increasing his screenings of clients for safety, harm and abuse, plus making sure that he shares resources such as crisis hotline numbers.

“I have been thinking about that a lot lately: how to help families and clients with the potential for an extended stay at home and the long-term aspect with winter coming on,” Nixon says. “How can families be intentional [to avoid isolation]? What’s important to [a client’s] family, and how do you continue to keep that ember burning?”

 

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Contact the counselors interviewed for this article:

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

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

The costs of COVID-19: Parental anxiety syndrome

By Rebekah Lemmons September 8, 2020

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

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

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

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

What is parental anxiety?

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

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

Who is at risk?

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

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

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

What creates these risks?

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

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

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

How can we help parents manage these symptoms?

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

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

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

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

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

Click on the image to see it full size

Other considerations

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

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

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

 

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

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

Supporting families with engagement strategies during COVID-19

By Carson Eckard June 18, 2020

To combat the toxic stress caused by the COVID-19 pandemic, I have created a list of activities to positively engage children during this time. The following list includes a description of what each activity is, what materials are needed (with an understanding that many families are under financial hardship) and the possible psychological benefits of the activity.

These activities are designed for entire families, including adults, to reduce stress and promote healing during the pandemic. Most of these activities can be done either inside or outside and can be tailored to individual interests, ages and ability levels.

 

Obstacle course

This activity will get the whole family moving. Use objects around the house to get the family involved. This could include climbing under or over chairs, throwing a bundle of socks into a laundry basket, spinning, using paper strips in place of lasers, and so on.

Inside, a slower pace can be taken to ensure that nothing gets broken and no one gets hurt. If you have access to an outdoor space or a sidewalk in front of your home, you can create an obstacle course out of chalk. Here’s an example.

This website includes a list of materials to use.

This slideshow has ideas for children in wheelchairs.

Materials: Whatever you have in the house

Ages: Toddlers and early elementary-age children

Psychological benefit: Obstacle courses can target many aspects of a child’s brain, including sensory input, motor planning, coordination, sequencing and problem-solving. They can also reduce psychological stress and anxiety. When more people participate, the teamwork and competition can provide some of the social interaction children have been missing from environments such as school.

 

Broadway play

This activity allows children to engage in imaginary play by creating plots to their own stories. When the story is written, have the child cast the characters in the story, find props (or imagine them) and direct the scene. If there aren’t enough family members to act out the scene, consider playing multiple parts at once or having the child draw the characters instead. Children may need direction and prompting, but allow them to be in control of constructing their own narrative. Activities that could be added include constructing sets and props and making movie posters.

Materials: Whatever you have in the house — paper, markers, drawing materials, prop-making materials and so on

Ages: Toddlers through early middle school age

Psychological benefit: During the pandemic, children may be struggling with an inability to control the situation. When they are able to control a scene and story in a healthy way, it can reduce their stress and promote individuality and resilience. Furthermore, creativity reduces anxiety and depression and can help children process toxic stress.

 

Board games and card games

When everyone is stuck at home, board games and card games are a great option for helping the entire family to connect. For younger kids, games such as Go Fish, Candy Land, and Guess Who? could be hits, whereas older kids may like Monopoly, Clue, and Sorry!

If you don’t have any board games at home, use paper or cardboard to create your own. WikiHow has information on steps to take when you’d like to create your own board game. Make sure your child is part of the creative process of creating the game if you choose to make your own.

For more information on why board games are good for a child’s mental health, as well as a breakdown of age-appropriate games, check this link from Manhattan Psychology Group.

Materials: Cardboard, paper, markers, small toys, etc.

Ages: Any

Psychological benefit: Playing fun games decreases anxiety and can increase confidence in children. Some games include aspects of problem-solving and can access the cortex for children who feel safe. Board games allow for healthy cognitive and social development for children.

Mazes and finger labyrinths

Mazes and finger labyrinths are easily made at home. They are a great brain teaser for kids and can also be extremely relaxing. Finger labyrinths are just like mazes, but instead of drawing a line to the exit, a finger is used to follow the path. When paired with deep breathing exercises, this can have a meditative quality.

For help on constructing labyrinths made out of materials such as rice, play dough, paperclips and more, go to this website.

The Labyrinth Society offers an online resource for downloadable and printable finger labyrinths.

The All Kids Network has many printable mazes for kids.

Materials: Paper, printer, something to write with

Ages: Whereas mazes are most engaging for children ages 3-6, finger labyrinths are a good mindfulness activity for children of all ages

Psychological benefit: Mazes offer many benefits to a child’s development, including problem-solving and motor control. Children will need patience and persistence to complete the puzzle and, once done, may experience a boost of confidence. Finger labyrinths originated in prayer but are also used as a grounding exercise.

 

Dance party

Turn up your favorite songs and get moving. Be sure to build a playlist the entire family can move to. Only upbeat jams! Spotify is a free service you can use to build playlists if you establish an account. Spotify playlists that might make for super fun dance parties can be found here. You may need to look around to find a playlist without explicit lyrics, but Spotify does offer an explicit content filter in its settings. Other free services include Amazon Music, Pandora, iHeartRadio and YouTube, but most have ads and can incorporate explicit lyrics, so be careful.

Materials: A phone, laptop, tablet or any device that plays music

Ages: Any

Psychological benefit: Dancing is both great exercise and a form of creative expression. Dancing keeps your heart healthy and muscles strong, improves coordination and balance, and provides an outlet for emotions. Music activates the cerebellum, stimulates the release of hormones that reduce stress, and improves self-esteem.

 

Karaoke party

On a similar note to a dance party, a karaoke party could be another viable option for the family. Because you want family members to sing, I recommend using YouTube and allowing each person to pick a song of their choice, unless you have a premium subscription for a music streaming service. As a finale, try singing a few songs that everyone knows together. For an added bonus, try creating a song by making your own lyrics and finding objects around the house to use as instruments.

Materials: A phone, laptop, tablet or any device that plays music; maybe a prop to use as a “microphone”

Ages: Any

Psychological benefit: Singing releases hormones that reduce stress and make us feel happy, improves mental alertness and helps us control our breath flow, which can help us regulate. Singing also helps children’s communication skills and self-esteem. Studies show that singing stimulates the vagus nerve responsible for our senses, motor function, digestion, respiration and heart rate. When stimulated, the vagus nerve reduces stress, lowers the heart rate and blood pressure, and reduces inflammation.

 

Play teacher

Let your child become the expert and pretend to be a teacher of whatever they are passionate about. This can take a more “formal” approach by pretending to be in school, or it can be more informal, simply asking them questions about the things they are interested in. This helps children realize that adults don’t know everything and allows them to develop as individuals.

Materials: None

Ages: Elementary school age (Note: It is beneficial and important to ask children of any age what their interests are to strengthen your relationship with them)

Psychological benefit: Taking on a formal “school” scenario involves imaginative play. Imaginative play allows children to experiment with different interests and skills. Furthermore, children who engage in pretend play are understanding social relationships, expressing and understanding emotions, expressing themselves both verbally and nonverbally, and practicing problem-solving skills. If imaginative play isn’t your cup of tea, have conversations with your child about what they are passionate about or interested in. Having these kinds of conversations will help you and your child relate to each other more.

 

Yoga

Although it may be difficult to practice advanced yoga poses with younger kids, it is possible to find something appropriate for their level. One of the most important aspects of yoga is breathing. Try doing the yoga poses with your child. Model a positive attitude and a willingness to try new poses, and compliment the child when poses are attempted. Make sure the poses are not too advanced for children or they may become frustrated.

Here is a free YouTube video of yoga poses that you can do with children. If you do not have access to a video device or the child would not benefit from structured instructions found in a video, you can find printable yoga poses from Kids Yoga Stories. If you and the child are new to yoga, it is vitally important to follow a guide to ensure that you are not hurting yourself or the child.

Materials: A guide to follow (either pictures or a video)

Ages: Any

Psychological benefit: It is no secret that yoga has therapeutic qualities such as offering a sense of calmness and relaxation. Furthermore, yoga enhances children’s flexibility, strength, coordination and body awareness. Doing yoga can reduce muscle tension held in our bodies and is another activity that stimulates the vagus nerve, which reduces stress, lowers the heart rate and blood pressure, and reduces inflammation.

 

Indoor sports

This category can depend on whether there is space to move around and interact with each other, but there are options for small spaces too. Each activity is meant to allow children to have fun and can be created with multiple objects around the house.

The Fatherly website has many ideas, such as balloon tennis, for bigger spaces. Roll up some paper and make a ball or a puck to kick, throw or hit around the house. Use a balloon to play volleyball or keep-up. If you have a smaller space, perhaps finger football might suit your needs.

Materials: Anything you can find around the house

Ages: Early elementary to early middle school age

Psychological benefit: If your family doesn’t have much space to run around and play, even the simplest games such as finger football increase coordination. In addition, these sports need multiple participants, which assists in the social development of the child.

 

Video games

Many video games are not family friendly or age appropriate for children. However, many options are available for younger kids both online and offline. PBS Kids offers many educational games for young children. Older kids may benefit from playing games online with their friends. Among popular options are Fortnite, Roblox, Minecraft, League of Legends and titles usually found on consoles, such as NBA 2K and Call of Duty. Many of these games are not free (some can be very expensive), and many are not appropriate for all kids. Have a conversation with the children in your life about what their friends are playing, and then set healthy boundaries around screen time.

There are also online video games that you can play with your family and friends. Popular options include Kahoot!, Jackbox Party Pack, digital board games through apps, Mario Kart Tour and others. Many of these games require only your phone or another device with internet access.

Materials: Games to play and something to play on

Ages: Any (as long as you monitor what games they are playing)

Psychological benefit: Your child is likely missing their friends from school and other environments. Allowing children to play video games with their friends online can help them stay connected and have fun. With all ages, video games offer an outlet for motor development, the release of stress relief hormones, social interaction, problem-solving, development of leadership skills, and increased alertness.

 

Call-and-response songs

If you’ve ever been to summer camp, call-and-response songs will be familiar to you. These songs are started by one person and imitated by another person or group. For children, particularly children with special needs, transitions between activities may be challenging. Side note: I worked at a summer camp with children with autism spectrum disorder, and mealtimes were one of the most stressful parts of the day for them. Singing a simple song such as “We put our foot up on the tree, we put our foot up on the tree, we put our feet up on the tree so that we can eat” makes these times less stressful for all.

Performing a quick redirect activity such as a call-and-response song can lighten the mood and offers a fun incentive for completing an activity. Although there are already call-and-response songs that you can utilize, you can also make your own (or change the words to an existing song) to suit the child’s needs. This activity could also be paired with dance moves or even a camp-themed day.

Go to Ultimate Camp Resource for a list of call-and-response songs. Design Improvised has a great list of themed summer camp ideas to use if you’d like to host a camp-themed day at home.

Materials: None

Ages: Toddler through elementary school age

Psychological benefit: Singing has profound mental health benefits. Singing forces a person to control their breathing. If someone is anxious and having trouble regulating their breathing, singing can help. Singing also improves mental alertness and confidence.

 

Grounding activities

The purpose of a grounding activity is to refocus on reality. It is particularly effective for children who suffer from anxiety, high levels of stress, trauma, dissociation, self-harm tendencies and suicidal thoughts. When children experience these events, they are more likely to enter a state of fight, flight or freeze because they feel they are in danger. Grounding techniques help move the brain from survival mechanisms to a calm state.

Although grounding activities are used in circumstances of higher emotion, they should be practiced often (and even when children are feeling happy) to ensure that children can perform them while in a dysregulated state of mind. You should take time out of the day for all family members to practice these skills together.

Sound search: Sit calmly in a comfortable position. The person lists the sounds they hear. Focusing on other senses helps bring the child back to safety and stabilization.

Coloring break: Although this is most effective for younger kids, it can be used for any age. Even if you do not have coloring pages, encourage the child to draw or color on a piece of paper. Support whatever they need to create in the moment. Crayola has printable coloring pages both for kids and adults.

Sensory bin: A sensory bin is a container filled with materials to stimulate the senses. You must know what types of sensations the child feels are soothing and what sensations may make the child excited. When used with soothing objects such as water or sand, a child may be able to focus on the container instead of overwhelming thoughts. The good thing about sensory bins is that they are easy to make and easy to store when needed. This technique is used mainly with younger kids, but a child of any age may appreciate a sensory bin if it is filled with the appropriate objects. Go to Your Kids Table for a list of ideas on what to put inside a sensory bin.

Positive affirmations: Building a mantra, based on a child’s strengths, that the child can repeat when they are feeling overwhelmed may be beneficial. The idea of having a child repeat a positive mantra when overwhelmed is to help the brain focus not only on the words they are saying but also on the breath needed to form the words. Whenever a family member or friends see the child becoming overwhelmed, they can support the child by guiding the child through the mantra.

Breathing techniques: You can teach children to utilize many different breathing techniques. Breathing exercises calm the brain’s reactions to threats by getting more oxygen. The adult should make sure the child has no anxiety about breath retention and that the child is slow and intentional instead of hyperventilating. If the child is hyperventilating, try to get them to exhale longer than they inhale. Model the techniques for them. Repeat the technique for as long as it takes the child to calm down. Breathing techniques take many forms, such as:

  • Sniff the Flower, Blow Out the Candle: The child imagines holding a flower in one hand and a candle in the other. The child must focus on breathing in through their nose while bringing the “flower” to their face, as if sniffing it, and then exhaling out the mouth while bringing the “candle” to their face.
  • 4-7-8 breathing: The child should breathe in through the nose for 4 seconds, hold their breath for 7 seconds, and exhale out their mouth for 8 seconds.
  • One-nostril breath: The child should place their finger over one nostril and breathe in deeply. The child should then switch to the other nostril and breathe out.

 

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Carson Eckard is a rising second-year graduate student in the community and trauma counseling program at Thomas Jefferson University. He graduated with his B.S. in psychology from Thomas Jefferson University in December 2019. He is passionate about advocating for clients, particularly LGBTQ+ youth. Contact him at Carson.Eckard@jefferson.edu.

 

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

Affirming all shades of the rainbow

By Laurie Meyers May 27, 2020

Licensed professional counselor (LPC) Laura Brackett’s specialties include counseling LGBTQ+ individuals. A frequent complaint she hears from her clients is that those outside of the LGBTQ+ community — including some mental health practitioners — see it as one big, happy family that shares all of the same problems and concerns.

This is, of course, not the case. “There can be deep and painful divides between the various groups that make up this community,” says Brackett, an American Counseling Association member who practices and is the director of community engagement at Change Inc. in St. Louis.

That is especially true for marginalized communities within the LGBTQ+ population. For example, American society has made significant progress in accepting differences in sexual or “affectional” identity but remains distinctly uncomfortable with alternate gender expressions such as transgender and nonbinary, says ACA member Christian Chan, an assistant professor in the Department of Counseling and Educational Development at the University of North Carolina Greensboro. People can generally grasp (even if in some cases only reluctantly) being gay, lesbian or bisexual as being about whom one chooses to love. However, the idea of someone being assigned the wrong gender at birth or a person rejecting that they must choose the binary of either male or female undermines deeply held notions of what constitutes a person’s identity, explains Chan, whose research interests include intersectionality and issues affecting queer people of color.

Even the LGBTQ+ community tends to prioritize affectional identity over gender identity, says Chan, a member of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (ALGBTIC), a division of ACA. For too long, there has been a hierarchy of whose needs matter, he asserts, and transgender people — particularly women of color — have been at the bottom.

“Mental health providers are not really culturally responsive to the needs of [diverse] communities — particularly communities that have multiple identities,” he says. Even counselors who are affirming of LGBTQ+ clients don’t always take the time to consider clients’ intersecting identities and how those identities affect their mental health needs, Chan adds.

When transitioning is not an option

LPC Jessica Jarman Hayes says the transgender clients she counsels are often not out and almost “sneaking themselves into therapy.” Hayes, whose Columbia, South Carolina, practice specializes in LGBTQ+ issues, explains that being transgender anywhere in the surrounding area is just not accepted. If anyone in the communities where her clients live learned that these individuals are struggling with their true identity as a transgender woman or man, her clients would lose everything, she says. If married, their spouses would leave them and take their children. Their families, friends and neighbors would reject them, leaving them with no social support. The need for secrecy is so great that it can be challenging for these clients to even schedule appointments with Hayes.

Other of Hayes’ clients live out in isolated areas of South Carolina’s Low Country. They cannot easily get to her office, so their only option is teletherapy, sometimes from a car in the parking lot of a grocery store because they have no safe space available to them at home.

“It reminds me a lot of when I was working in domestic violence,” says Hayes, who is also a volunteer at the Harriet Hancock LGBT Center in Columbia. “You just have to be there to support them, sometimes for years, when they finally reach a place in which it [denying their identity] is no longer acceptable, and then come up with a plan to get out of Dodge.”

Violence is an ever-present threat for people who identify as transgender and gender nonconforming or “nonbinary.” According to the Human Rights Campaign report “Violence Against the Transgender and Gender Non-Conforming Community in 2020,” at least 26 individuals who were transgender or gender nonconforming were murdered in 2019. Most of the victims were African American women.

As the report notes, “These victims were killed by acquaintances, partners or strangers, some of whom have been arrested and charged, while others have yet to be identified. Some of these cases involve clear anti-transgender bias. In others, the victim’s transgender status may have put them at risk in other ways, such as forcing them into unemployment, poverty, homelessness and/or survival sex work.”

Hayes says the fear of violent retribution is another reason, in addition to fear of losing family and friends, that her transgender clients feel unable to express their identities in any way. One client hid underwear in a wall in the house, and their spouse gave them a severe beating when they discovered it, Hayes says.

There is no protection for the abused in these cases because the local police do not take such incidents seriously, according to Hayes. This lack of concern is present even when a juvenile is involved, she says, recounting the story of a suicide hotline call from a transgender teen that got routed her way. The teenager was actively suicidal and in danger. The father had found girls’ clothing and had severely beaten the teen. Hayes called the police and made it clear this was a domestic violence incident involving child abuse and a victim who was actively suicidal.

“The police went in there and teamed up with the dad,” Hayes says. “They said, ‘If you would just stop pretending to be a girl, your dad wouldn’t have to do this.’”

For a time, the girl was able to maintain touch with Hayes by using a self-wiping app on her cell phone to avoid being detected. Hayes called the police repeatedly, but they continued to refuse to take action. Eventually, the father discovered the girl was making calls and took her phone, her computer and his computer out of the house so that she had no means of reaching out. Hayes and other volunteers at the Hancock Center have done their best to check on the teen’s welfare since losing contact but have been unsuccessful. Her school has been ordered not to give out any information, and the local police aren’t providing any help. A Columbia-area police officer has agreed to keep his ears open for any news, but thus far the Hancock Center hasn’t heard anything.

In search of support

Closeted transgender women (i.e., people presenting as men, in accordance with their assigned gender at birth, but who secretly self-identify as women) who are discovered are at risk of violence not just from spouses but, potentially, the spouse’s family, Hayes says. “This is seen as an act of great betrayal.”

Hayes recommends that all of her transgender clients use the time after their phone sessions with her (or any other time they have 15-20 minutes of private time) to connect with virtual support groups. She wants clients to find at least one “safety buddy” to whom they can reach out if they just need to talk or if something serious is going on. She also makes sure that all clients have the transgender peer support and crisis hotline number (Trans Lifeline: 877-565-8860).

Hayes also uses radical acceptance to help her clients cope with the inability to embrace their true identities. “OK,” she tells clients, “we can radically accept that this situation really sucks and is really uncomfortable, but we have to accept that we are in danger of losing a job or family, even if we never come out but someone else finds out.”

Hayes urges her transgender clients always to have a go-bag packed, but recommending places for refuge is a challenge. A few domestic violence shelters in Georgia are trans-affirming, but they are a significant car ride away. The Columbia area has some homeless shelters that will accept transgender individuals. Still, these are not always great options because some of them are run by religious organizations that require those seeking refuge to read “applicable” Bible verses. Hayes generally encourages clients to think of relatives with whom they could stay. Clients don’t necessarily need to explain the whole story of what is happening — just that they need to get away, Hayes says.

In an environment in which wearing gender-affirming underwear or painting one’s toenails can have devastating consequences, Hayes acknowledges that it is incredibly challenging to help make her clients’ situations more livable. Even so, she has found a few small ways for her transgender and nonbinary clients to explore their identities, including gaming, an environment in which having avatars of different or no fixed gender is common.

Another outlet she suggests — but only if clients believe their phones are safe from scrutiny — is the social media platform Tumblr, which is very graphics-oriented and functions a bit like a cross between Facebook and Twitter. Users can set up an account and post or follow others who share art, graphics, GIFs and other visual content. Crucially for Hayes’ clients, it’s also possible to search content without registering. Why is this an affirming outlet? Because Tumblr is a hive for many kinds of interests, including fashion, design, décor and art. Hayes tells her clients to use the platform to explore what their “aesthetic” (personal style) would look like if they had complete freedom, encompassing not just their appearance but also their surroundings. 

Hayes began her career counseling domestic violence survivors in the Miami area, where the shelters are transgender and LGB affirming and intimate partner violence between gay men or a trans woman and cisgender man is taken seriously by the legal system. Although Hayes, who considers herself a member of the LGBTQA+ community, has been in South Carolina for several years, she is still sometimes surprised by the virulence of the hatred many in the area feel toward transgender and other queer people. She echoes Chan in saying that although different affectional orientations are now more tolerated (even if sometimes grudgingly) in some quarters, alternative gender expression is still largely viewed as unacceptable. She believes there also remains significant transphobia within the LGBTQ+ community itself, which leaves her transgender clients with very few resources for social support.   

Family struggles

When ACA member Bethany Novotny moved from Pittsburgh to Johnson City, Tennessee, to begin teaching as an assistant professor of human services at Eastern Tennessee State University (ETSU), she wasn’t sure how friendly her new surroundings would be to those identifying as LGBTQ+. Novotny, who went on to start a local lesbian dine-out group, was pleased to find that Johnson City had a robust LGBTQ+ community and that it and the university were a haven among the surrounding Appalachian towns for queer young adults.

Over time, Novotny, who is an LPC in Pennsylvania, found that students viewed her as a safe and sympathetic person to talk to. That rapport, her desire to help transgender and nonbinary students, and Novotny’s friendship with staff at the campus counseling center led to her taking over ETSU’s transgender support group, now called ASPECTS — Aligning Support, Pride, Education and Community for Transgender Students. The group originally included only students who had been referred by the campus counseling center. But Novotny opened it up to all transgender and gender-nonconforming students because she feels they have unique challenges apart from the rest of the queer community. “People are more afraid [discussing alternative gender expression] than they are when we talk about sexual orientation,” she notes.

Novotny supervises while students lead the group, which meets once a week. The students share practical information such as where they can go to receive hormone therapy and find affirmative health care providers. Obtaining these services usually requires traveling to either Knoxville, Tennessee, or Asheville, North Carolina, which is a challenge, especially for those students who don’t have cars. Novotny says the group often works together to make sure members get rides when necessary.

Not surprisingly, acceptance is a constant topic in the group, Novotny says. The students feel safe — many for the first time in their lives — at ETSU, but they still have to navigate family and community attitudes when they go home on breaks.

“We would talk about coping skills [before breaks],” Novotny says. “Sometimes they would choose to stay with a friend or another family member. I would remind them to have a crisis plan — making sure if things got bad, they knew what to do.” A crisis plan resembles a suicide safety plan, with a list of local and campus resources, shelter locations and the number for the national suicide hotline.

Once, a student who had started taking hormones decided that they should come out to their family on break. The group talked it through for several weeks beforehand, Novotny says. The student’s parents did not take the coming out announcement well, and the student was forced to seek shelter with a cousin. The cousin turned out to be very supportive and even helped the student come out to their grandmother, which they never thought possible, Novotny recounts. All too often, however, students would return to school without getting any affirmation from their families.

Although revealing oneself as transgender is particularly challenging, coming out to family and friends isn’t easy for anyone in the LGBTQ+ community. Even among families who want to support and affirm their loved ones, the coming out process can be a difficult transition, Brackett says. Some family members — often parents in particular — grieve letting go of the future they had envisioned for their loved one, she adds. “That’s not to say that they reject their family member’s future as an LGBTQ+ person, simply that they may need to adjust the specifics of what that future may be. Maybe the vision was of a son who [would have] a wife and children, and now that vision needs to be adjusted to [having] a husband instead of a wife,” Brackett says.

In other cases, families fear their loved one will become an entirely different person, she says. Brackett explains to families that although changes in expression and personality are very likely, it isn’t a foregone conclusion that in coming out, their loved one will undergo a complete transformation.

“Even when there are substantial changes, I try to remind families that the person they knew was possibly more of a mask than they want to accept,” she explains. “This person is now trying to discover who they really are, and that process will take time. It’s important to be patient, be curious, be respectful, and [for families to] find their own support.”

Novotny says many of her group members have parents who struggle because they perceive the transition of their child’s gender expression — from the one the student was assigned at birth to their true gender — as an alteration that has transformed their child into someone they don’t recognize. This comes in part from a lack of exposure to and understanding of what being transgender means.

One student’s mother couldn’t even grasp the concept, telling her child, “You have a penis, so you’re a boy,” Novotny recounts. “The student was trying to communicate to [their] mom, ‘I’m still the same person. I’ve actually been this person the whole time, and you don’t see that. I am trying to share something scary and vulnerable with you.’” At the student’s request, Novotny helped them talk to their mother.

“I always respond first with empathy,” Novotny says. “I know that what they [parents] are going through is difficult, and I don’t want to minimize or dismiss their feelings. It’s all about meeting them where they are, even though sometimes I want to shake them and scream at how horrible they are being. I also worked to affirm the love and support that it took for mom to show up in my office that day. The fact that she was there was huge. She was willing to talk even though she didn’t understand, and I wanted both mom and my student to recognize what a big step that was.”

Novotny listened to the mother’s concerns and helped correct misinformation by inserting “tidbits of information that might help mom put the puzzle pieces together. I did this very gently and only where appropriate because I did not want to come off as though I was lecturing her,” Novotny says. “As an educator, I know how important it is to plant seeds. We may not always see that come to fruition, but it is so important to plant those seeds gently. … I also try to communicate to parents that they don’t need to fully understand to provide support, love, affirmation and acceptance.”

In some cases, the family conflict isn’t rooted in a lack of understanding but something more fundamental. Brackett, like Novotny, tackles these struggles with understanding and empathy.

“I seek to understand what their resistance or hostility is connected to and move from there,” she says. “Working with a family that has deeply rooted religious beliefs that condemn sexual or gender minorities is drastically different from working with a family that is afraid of the changes that may occur within their family system. At times it can be necessary to have these discussions without the LGBTQ+ family member present in order to not only protect them from hearing this process in its most raw form, but also to allow the family space to be open about what they are feeling. Additionally, recommending outside support groups or resources can help alleviate some of the misinformation and isolation the family may carry.”

Families also fear the treatment their loved one might experience in the outside world. “Will they be bullied or ignored or even physically hurt or killed?” Brackett says about some of the common concerns families voice. “Will they suffer mental anguish and be at higher risk for addiction or suicide?” 

“It’s important for families to remember that a huge protective factor for members of the LGBTQ+ community is the presence of a supportive family,” Brackett asserts. “When working with family members in this place of fear, I try to highlight for them the power they have in creating a safe and loving environment for their loved one. While a mother can’t make the world safe for her gender-nonconforming child, she can at least work to ensure that she is safe for them.”

The process of coming out

In some cultures, such as those Hayes’ clients live in, as well as other racial and ethnic communities, coming out may be dangerous to the LGBTQ+ individual and perhaps to their family. Or an LGBTQ+ person may have some family members who would support their coming out but others who would not be affirmative or accepting. Some individuals choose to honor both their LGBTQ+ identity and their familial or cultural identity by coming out only to certain family members or friends.

“I frame coming out as an ongoing process and remind my clients that the need for a grand unveiling isn’t necessary unless it’s important to them,” Brackett says. “Often, I see my clients come out by degrees, starting with the safest people or environments first to gain support. By identifying safe people and thinking through the possible outcomes of coming out, the client can begin to amass protective factors they need as they go through the process. Deciding not to come out to people they identify as unsafe or unnecessary doesn’t have to be framed as a betrayal to their identity, though it’s an understandable reaction. It can also be framed as a means of protecting themselves. They are not required to disclose information that puts them at risk.”

With any major life change, there is grief at whatever is lost, and this is very true in people who are negotiating the ways in which they want or don’t want to be publicly out, Brackett continues. “Being rejected by a family member or important institution like a religious community or friend group can be devastating,” she says. “Gentleness, empathy and nonjudgmental discussions are important in allowing clients the freedom to connect with the impact coming out is having on them. Holding the grief is important, but so is guiding them toward creation of a new life and support system: ‘Yes, this is horrible and heartbreaking. Is there someone who has acted differently or where you’ve felt acceptance?’”

Counselors can help clients build a new support system by working with them to change their concept of family, says ACA member Leah Polk, a licensed clinical social worker and clinical director at Change Inc. in St. Louis. Clients are not limited to their families of origin; they can assemble ones of their own choosing, she emphasizes. So, even though their families of origin may have set a priority on traditional scripts or rituals, the families they choose can be inclusive and view each member as inherently valuable, says Polk, whose specialties include LGBTQ+ issues. 

“The important part here is that the client gets to spend time identifying what is most important and valuable to them as it relates to family,” she explains. “They are able to map out how they establish family and gain reliable reflections that emphasize what they like about themselves.”

Peer support for transgender youth and young adults

Laura Boyd Farmer, an LPC whose specialties include affirmative LGBTQ+ counseling, helped found a peer group for youth and teenagers 10 years ago in the Roanoke, Virginia, area. She and other area professionals saw a need among the area’s LGBTQ+ youth, who were frequently ostracized and bullied and had little family support. “Our intention was to create a safe and supportive space,” says Farmer, a member of ALGBTIC. Farmer and others sat with teens in the area and asked them what they needed and what kind of support would be helpful. The result was Youth SAGA (Sexuality & Gender Alliance) of Roanoke.

“The kids created the name,” Farmer says. “They were very passionate that they wanted this to be a group for queer-identified kids, but also for anyone who was affirming of gender and sexuality diversity.”

SAGA meets twice a month, and there are always two leaders with mental health experience (Farmer and three volunteers take turns serving as the two leads). Meeting times are posted on Facebook, and the group gathers in public spaces such as coffeehouses, libraries and bookstores so that teenagers who are not out to their families will have a ready-made excuse to drop in.

The group follows two basic rules: Respect participants’ chosen identities, names and pronouns, and give everyone time to talk. Group members are also asked not to talk about what goes on at meetings outside of SAGA. All of the participants are so invested in preserving a place where they can find and give support that there has never been an issue with breaking confidentiality, according to Farmer.

The structure of each meeting depends on the size of the group. If only a few teens are present that week, the session is relatively informal, with group members simply discussing what is going on in their lives. With larger groups, leaders pass out pieces of paper so participants can write down any topics they would like the group to cover. The group leaders put all the pieces of paper in a bowl, which is then passed around. Each person removes a piece of paper and reads out the topic for discussion.

Topics range from concerns such as “My parents don’t want me to transition and I don’t know what to do” and “I don’t know how to come out to a family member” to the practicalities of expressing gender identity. The group has covered logistical questions about the physical and hormonal aspects of transition, as well as ways that youth can present themselves in a way that affirms their gender expression when their families are not letting them transition. The teens also ask each other about how to find good chest binders and affordable makeup.

Dealing with bullies and finding allies are also common topics, Farmer says. She recounts an approach to bullying that she thought was particularly effective: “This trans youth shared that he found the best way to deal with bullies was to choose a direct statement to respond with and to use it repeatedly,” Farmer explains. “For example, when a bully would say to this youth that he was really a ‘she’ and just confused, the youth would reply, ‘That sounds like a you problem.’ This kid also had his friends use the same response when they heard anyone say anything unkind about him or toward him. I loved this approach because it puts responsibility back on the bully to educate themselves, like holding up a mirror for them to see that whatever mean things they are saying are actually about them, not the person they are trying to bully.”

Sometimes the group features outside speakers. For example, because the intersection of religion with sexual and gender identity is a common concern in southwest Virginia, Farmer had a pastor lead a discussion on how spirituality and sexuality intersect. The pastor also talked about what the Scriptures actually say (and don’t say) about the topic and gave the group recommendations for discussing the topic with family.

Farmer emphasizes that SAGA is not a therapy group but rather peer-based support. Because discussions about sexual and gender identity sometimes include topics such as trauma that can be triggering for others, she and her co-leaders have developed a signal that group members can use if they are being triggered. If someone puts a hand on their heart, it is a signal for the leaders to gently and respectfully move the discussion away from the current topic. Farmer and the other leaders are careful to check in afterward to see whether the teen who brought up the topic wants to continue the discussion privately.

“The beauty of this group is that I don’t have to know the answers,” Farmer says. “The kids are sharing their wisdom with others. It’s a beautiful thing to witness.”

Providing affirmative counseling

Even professional clinical counselors who have experience with the LGBTQ+ community may have biases and blind spots, say the practitioners Counseling Today interviewed for this article. Brackett and Polk offer some suggestions for counselors who want to make sure they are offering affirmative counseling to LGBTQ+ clients.

“The first thing I recommend is self-reflection on how you are connected to the LGBTQ+ community outside of being a clinician,” Brackett says. “Understanding your own involvement and comfort within the LGBTQ+ community will help you be present with these clients in an authentic way.”

She suggests that counselors ask themselves the following:

  • Are you a member of the LGBTQ+ community? If so, what elements do you connect to versus what elements do you find yourself separated from? Are there parts of the queer community that you (consciously or unconsciously) avoid or dislike? If so, why? Do you feel like you “belong,” and how does that impact your willingness to connect with others in the community? How do your opinions change if the race, ethnicity, income, gender or gender presentation of the person changes?
  • If you don’t consider yourself part of the LGBTQ+ community, how open and connected are you to people within it? Do you seek out or seek to avoid places or events that are heavily attended by the queer community? How comfortable do you feel when you are in those spaces? How do your opinions change if the race, ethnicity, income, gender or gender presentation of the person changes?

“Remember that there are generalized experiences, and then there are your client’s experiences,” Brackett continues. “Trust your client to tell you their reality. It may align with your own experiences or general narrative you have of the LGBTQ+ community, but it may not. Your goal is to be present with them where they are, as they are.”

Polk has some additional suggestions:

  • Allow the client to determine the pace. It is not the counselor’s job to set an agenda for coming out or transitioning.
  • Frequently reassess goals in therapy. What the client needs when they enter therapy is often not the same as what they need after eight to 10 sessions have taken place.
  • Monitor for clients’ sense of safety and agency. For example, ask them how their relationships are and how they experience safety in an environmental context (e.g., employment, social events, political environment).
  • Continue to scan and assess for co-occurring disorders such as substance abuse. Individuals who identify as LGBTQ+ tend to have a disproportionate number of stressors that could lead to comorbid emotional and mental health concerns.

“Additionally, I would suggest some form of participation in LGBTQ+-affirming communities,” Polk says. “For example, attend a support group, view LGBTQ+ art [and] film, or read literature written by queer authors. Ask to interview LGBTQ+ counselors, or seek out LGBTQ+-specific supervision and psychotherapy training. Finally, perform a self-assessment of your own attitudes and biases of LGBTQ+ people to determine your growing edges in counseling.”

Brackett offers a closing thought: “If you find that you are uncomfortable with LGBTQ+ clients or are concerned about your ability to work with this population, seek out clinical supervision, and engage in your own therapy.”

 

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Additional resources

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

Counseling Today (ct.counseling.org)

Books (counseling.org/publications/bookstore)

  • Affirmative Counseling With LGBTQI+ People edited by Misty M. Ginicola, Cheri Smith and Joel M. Filmore
  • Casebook for Counseling LGBT Persons and Their Families edited by Sari H. Dworkin and Mark Pope
  • Group Counseling With LGBTQI Persons by Kristopher M. Goodrich and Melissa Luke

Continuing Professional Development: LGBTQ (aca.digitellinc.com/aca/specialties/137/view)

  • “Transgender — Moving From Awareness to Advocacy” with Becca Smith
  • “Affirming Counseling Practice With Queer People of Color: From Margins to Center” with Adrienne N. Erby and Christian D. Chan
  • “Resiliency Factors of Trans-College Students: Implications for Professional Counselors and Higher Education Professionals” with Jane E. Rheineck and Matthew Lonski
  • “Lesbian, Gay, Bisexual, Transgender and Queer Youth: Family Acceptance and Emotional Development” with Julie Basulto
  • “The Counseling Experiences of Transgender and Gender Nonconforming Clients” by Rafe Julian McCullough, Lindy K. Parker, Cory Viehl, Catharina Chang, Thomas M. Murphy and Franco Dispenza

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

  • LGBTQ
  • Grief and loss

Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (algbtic.org)

 

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

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